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Attouchi I, Dammak N, Zouaghi H, Ben Khelifa M. Intracranial Infections Arising From an Odontogenic Infection: A Report of 2 Cases. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241261883. [PMID: 38895741 PMCID: PMC11184996 DOI: 10.1177/11795476241261883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024]
Abstract
Introduction Intracranial empyema is a rare but serious and life-threatening infection. It is an accumulation of purulent material in the subdural or extradural space leading to development of subdural empyema or intracranial epidural abscess, respectively. The incidence of morbidity and mortality is high because the diagnosis is often unsuspected. Infections of dental origin could be responsible for such condition. Case reports A 22-year-old female and 30-year-old male patients, both with no significant medical history, presented with subdural empyema and intracranial epidural abscess, respectively, both complicating pan-sinusitis of dental origin. Successful outcomes were achieved with surgical drainage of the lesions, antibiotic therapy, and extraction of affected teeth. Female patient underwent further management for neurological sequelae, while male patient was discharged without neurological complications. Discussion Intracranial suppuration of odontogenic origin is an uncommon but extremely serious complication. The most common dental origins are caries with periapical involvement and periodontitis. Wisdom tooth extraction is the most common preceding dental procedure for this infection. A multidisciplinary approach is essential for the identification and treatment of suspected oral sources. Antibiotic therapy with surgical approach is the gold standard treatment. Conclusion This sequel to odontogenic infection is quite rare, but it can be prevented by a good oral hygiene and removal of abscessed teeth.
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Affiliation(s)
- Ikram Attouchi
- Department of Oral Medicine and Oral Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Nouha Dammak
- Department of Oral Medicine and Oral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Hela Zouaghi
- Department of Oral Medicine and Oral Surgery, Taher Sfar Hospital, Mahdia, Tunisia
| | - Mohamed Ben Khelifa
- Department of Oral Medicine and Oral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
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Lou Y, Sun Z, Ma H, Cao D, Sun M, Wang Q, Wang J, Zhuo Q, Tao R, Ying B, Liu Y, Yu M, Wang H. Odontogenic infections in the antibiotic era: approach to diagnosis, management, and prevention. Infection 2024; 52:301-311. [PMID: 37926767 DOI: 10.1007/s15010-023-02117-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE The prevalence of odontogenic infections remains one of the highest in the world. If untreated, odontogenic infections can break through the limitation, disseminate to other organs or spaces, and cause high mortality rates. However, it is still difficult to rapidly target limited or disseminated infections in clinical practice. The type of disseminated odontogenic infections and the responsible bacteria have not been described in detail. METHODS Search databases (e.g., PubMed, MEDLINE, Web of Science, Embase) for reports published from 2018.1 to 2022.9. Use search strategies: ("odontogenic infections" OR "pulpitis" OR "periapical lesions" OR "periodontal diseases") AND ("disseminated infections" OR "complication"). RESULTS Fourteen different types of disseminated odontogenic infections, most of which are polymicrobial infections, can spread through the body either direct or through hematogenous diffusion. Multiple microbial infections can be more invasive in the transmission of infection. Secondary infections are commonly associated with bacteria like Fusobacterium spp., Streptococcus spp., Peptostreptococcus spp., Prevotella spp., and Staphylococcus spp. Antibiotics with broad-spectrum activity are fundamental as first-line antimicrobial agents based on the microorganisms isolated from disseminated infections. CONCLUSION This review elaborates on the epidemiology, microorganisms, risk factors, and dissemination routes, and provides evidence-based opinions on the diagnosis, multidisciplinary management, and prevention of odontogenic infections for dentists and clinicians.
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Affiliation(s)
- Yiting Lou
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
| | - Zheyuan Sun
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
| | - Haiying Ma
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
| | - Danna Cao
- Department of Stomatology, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, Zhejiang, China
| | - Mouyuan Sun
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
| | - Qianting Wang
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
| | - Jingyu Wang
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
| | - Qunhao Zhuo
- Department of Stomatology, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, Zhejiang, China
| | - Ran Tao
- Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX, USA
| | - Binbin Ying
- Department of Stomatology, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, Zhejiang, China.
| | - Yu Liu
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China.
| | - Mengfei Yu
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China.
| | - Huiming Wang
- School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
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Fernández Vecilla D, Roche Matheus MP, Urrutikoetxea Gutiérrez M, Iglesias Hidalgo G, Aspichueta Vivanco C, Díaz de Tuesta Del Arco JL. Brain abscess caused by Porphyromonas gingivalis and Eubacterium nodatum mimicking acute stroke. Anaerobe 2023; 84:102801. [PMID: 38007215 DOI: 10.1016/j.anaerobe.2023.102801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/27/2023]
Abstract
We described a case of a 65-year-old man with a brain abscess caused by Porphyromonas gingivalis and Eubacterium nodatum. The patient presented right central facial nerve palsy, mutism and right hemiparesis at the examination. The patient underwent a left frontal craniotomy with evacuation of the brain abscess. Specimens were collected for microbiological analysis and intravenous treatment was started with levetiracetam, dexamethasone, meropenem (1 g/8 h) and linezolid (600 mg/12 h). After identification of anaerobic bacteria the antibiotic treatment was changed to piperacillin/tazobactam (4 g/0,5 g/8 h), fulfilling 8 weeks of antibiotic with good clinical and radiological evolution.
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Affiliation(s)
- Domingo Fernández Vecilla
- Clinical Microbiology Service, Laredo Regional Hospital, Av. Derechos Humanos, 40, 39770, Laredo, Cantabria, Spain.
| | - Mary Paz Roche Matheus
- Clinical Microbiology Service, Basurto University Hospital, 18 Avenida Montevideo, 48013, Bilbao, Biscay, Spain; Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Biscay, Spain
| | - Mikel Urrutikoetxea Gutiérrez
- Clinical Microbiology Service, Basurto University Hospital, 18 Avenida Montevideo, 48013, Bilbao, Biscay, Spain; Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Biscay, Spain
| | | | - Cristina Aspichueta Vivanco
- Clinical Microbiology Service, Basurto University Hospital, 18 Avenida Montevideo, 48013, Bilbao, Biscay, Spain; Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Biscay, Spain
| | - José Luis Díaz de Tuesta Del Arco
- Clinical Microbiology Service, Basurto University Hospital, 18 Avenida Montevideo, 48013, Bilbao, Biscay, Spain; Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Biscay, Spain
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Chen KC, Sun JM, Hsieh CT. Brain abscess caused by Parvimonas micra: A rare case report and literature review. Anaerobe 2023; 80:102711. [PMID: 36736989 DOI: 10.1016/j.anaerobe.2023.102711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
Brain abscesses mostly develop due to direct infection caused by a nearby infectious lesion or hematogenous spread and are rarely caused by an odontogenic infection. We report a 47-year-old woman who presented with high fever, disturbed consciousness, headache, and neck pain. Imaging studies revealed a ring-shaped enhanced mass in the left frontal lobe causing a mass effect and midline shift. Magnetic resonance spectroscopy revealed a peak alanine concentration of 1.5 ppm. Supraorbital keyhole surgery with abscess removal was performed, and a bacterial culture confirmed a diagnosis of Parvimonas micra infection. After undergoing 6-week antibiotic treatment, the patient's symptoms resolved completely. No recurrence of abscess was observed during the follow-up period. Although brain abscess caused by P. micra has rarely been reported, an odontogenic origin should be investigated, especially when a patient has a history of periodontal infection or tooth extraction.
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Affiliation(s)
- Kuan-Chi Chen
- Department of Surgery, Cathay General Hospital, Taipei City, 106, Taiwan.
| | - Jui-Ming Sun
- Section of Neurosurgery, Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi City, 600, Taiwan; Department of Biotechnology, Asia University, Taichung City, 41354, Taiwan.
| | - Cheng-Ta Hsieh
- Division of Neurosurgery, Department of Surgery, Sijhih Cathay General Hospital, New Taipei City, 22174, Taiwan; School of Medicine, National Tsing Hua University, Hsinchu, 300044, Taiwan; Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, 24205, Taiwan.
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Neal TW, Schlieve T. Complications of Severe Odontogenic Infections: A Review. BIOLOGY 2022; 11:biology11121784. [PMID: 36552293 PMCID: PMC9775288 DOI: 10.3390/biology11121784] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
Severe odontogenic infections are routinely treated with little associated morbidity and mortality. Improvements in surgical techniques, antibiotic treatments, and imaging modalities have made associated complications exceedingly rare. A number of complications have been described in the literature including airway obstruction, descending necrotizing mediastinitis, orbital abscess, septic cavernous sinus thrombosis, cerebral abscess, sepsis, necrotizing fasciitis, and Lemierre's syndrome. The purpose of this article is to discuss the pathophysiology of severe odontogenic infections and the risk factors associated with the development of complications. Given the morbidity and mortality of these conditions, it is important to review the clinical features of each and the diagnostic tools that aid in early recognition.
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Amorim RP, Henriques VM, Junior FT, Reis VG, Bulhões SO. Hydrocephalus and Intracranial Hypertension by an Odontogenic Brain Abscess. Cureus 2022; 14:e26945. [PMID: 35989854 PMCID: PMC9380847 DOI: 10.7759/cureus.26945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 11/08/2022] Open
Abstract
Brain abscesses are rare and severe infections with high mortality, corresponding to neurosurgical emergencies. 12% of all abscesses are caused by odontogenic etiologies, either an infectious process or a dental procedure. This paper describes a case of a patient who underwent tooth extraction, presenting days later with hydrocephalus and intracranial hypertension due to a brain abscess, whose isolated pathogen is the same identified in the oral cavity.
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