1
|
Wu X, Qin N, Peng X, Wang L. Exploring odontogenic brain abscesses: a comprehensive review. Acta Neurol Belg 2024; 124:1155-1165. [PMID: 38722527 DOI: 10.1007/s13760-024-02569-y] [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: 02/04/2024] [Accepted: 04/29/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Whether in neurology or dentistry, odontogenic brain abscess stands as an ailment demanding undivided attention. The onset of this disease is insidious, with a relatively low incidence rate but a markedly high fatality rate. Moreover, its symptoms lack specificity, easily leading to misdiagnosis, oversight, and treatment delays. Hence, clinicians should maintain heightened vigilance when faced with pathogenic bacteria of dental origin in patients. AREAS COVERED This paper encapsulates the latest research findings on the clinical manifestations and essential treatment points of odontogenic brain abscess. It may offer a crucial reference for prompt diagnosis and improved therapeutic approaches. EXPERT OPINIONS Odontogenic brain abscess, an infection of the cerebral parenchyma, usually appears in immunocompromised patients with dental ailments or postdental surgeries. The main pathogenic microorganisms include Streptococcus intermedius, Fusobacterium nucleatum, Streptococcus anginosus, and Millerella. Given the undetectable and nonspecific symptoms in patients, the diagnostic process relies on microbiological methods. Therefore, clinicians should actively investigate and identify the pathogenic microorganisms of odontogenic brain abscess for early detection and selection of appropriate treatment regimens to avoid disease management delays.
Collapse
Affiliation(s)
- Xingguo Wu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ningxiang Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xi Peng
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Liang Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| |
Collapse
|
2
|
Olivier M, Kraus LM, Brandenburg LS, Andereggen L, Fung C, Beck J, Schnell O, Cipriani D. Undetected permanent dental inflammation as a possible trigger for brain abscesses? A retrospective analysis over the last 2 decades. Acta Neurochir (Wien) 2024; 166:313. [PMID: 39085702 PMCID: PMC11291604 DOI: 10.1007/s00701-024-06208-6] [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: 05/17/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Recently, there is increasing evidence that the proportion of odontogenic brain abscesses is greater than previously known. In this study, we aim to differentiate the oral infections as triggers more precisely and to classify them in the clinical setting. METHODS For analysis, we conducted a retrospective single center study. We reviewed patients with brain abscesses who have undergone treatment in the University Hospital of Freiburg, Germany in the period between 2000-2021. Inclusion required two main criteria: 1. The brain abscess must not have an other focus than odontogenic. 2. The microbial spectrum identified in the brain abscess must be consistent with an odontogenic origin. RESULTS Of 217 brain abscess patients, 26 met the inclusion criteria. 42% (11 patients) suffered from immunosuppressive conditions. Odontogenic foci were diagnosed in 18 cases (69%). Neurologic deficits included vigilance reduction and hemiparesis. Pathogens of the Streptococcus anginosus group were the most frequent causative agent (21 cases, 81%). Metronidazole (54%) and ceftriaxone (42%) were part of the targeted antibiotic therapy. All brain abscesses were surgically treated. Teeth were extracted in 14 of 17 cases for focus control. 18 cases (72%) showed complete or partial resolution of neurologic symptoms and 3 cases were fatal. CONCLUSION Apparently silent or chronic oral infections are sufficient to cause bacterial colonization of the brain, especially in immunocompromised patients. Therefore, special care should be taken to maintain good oral health. An interdisciplinary management should become a standard to prevent and treat the occurrence of brain abscesses.
Collapse
Affiliation(s)
- Maximilian Olivier
- Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany.
| | - Luisa Mona Kraus
- Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany
| | - Leonard Simon Brandenburg
- Department of Oral and Maxillofacial Surgery, Medical Center-University of Freiburg, Freiburg, Germany
| | - Lukas Andereggen
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - Christian Fung
- Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany
- Department of Neurosurgery, Medical Center-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Debora Cipriani
- Department of Neurosurgery, Medical Center-University of Freiburg, Freiburg, Germany
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Bodilsen J, D'Alessandris QG, Humphreys H, Iro MA, Klein M, Last K, Montesinos IL, Pagliano P, Sipahi OR, San-Juan R, Tattevin P, Thurnher M, de J Treviño-Rangel R, Brouwer MC. European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect 2024; 30:66-89. [PMID: 37648062 DOI: 10.1016/j.cmi.2023.08.016] [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: 05/23/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
SCOPE These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. METHODS Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I2 tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low). QUESTIONS ADDRESSED BY THE GUIDELINES AND RECOMMENDATIONS Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). No recommendation is offered for early transition to oral antimicrobials because of a lack of data, and oral consolidation treatment after ≥6 weeks of intravenous antimicrobials is not routinely recommended (conditional and very low). Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low). Research needs are addressed.
Collapse
Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Mildred A Iro
- Department of Paediatric Infectious diseases and Immunology, The Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Matthias Klein
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Hospital of the Ludwig-Maximilians University, Munich, Germany; Emergency Department, Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Katharina Last
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Inmaculada López Montesinos
- Infectious Disease Service, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Pasquale Pagliano
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Unit of Infectious Diseases, University of Salerno, Baronissi, Italy; UOC Clinica Infettivologica AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Oğuz Reşat Sipahi
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey; Infectious Diseases Department, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
| | - Rafael San-Juan
- CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, 12 de Octubre University Hospital, Madrid, Spain; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections in Compromised Hosts (ESGICH), Basel, Switzerland
| | - Pierre Tattevin
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Majda Thurnher
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rogelio de J Treviño-Rangel
- Faculty of Medicine, Department of Microbiology, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; European Society of Clinical Microbiology and Infectious Diseases, Fungal Infection Study Group (EFISG), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Antimicrobial Stewardship (ESGAP), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Genomic and Molecular Diagnostics (ESGMD), Basel, Switzerland
| | - Matthijs C Brouwer
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Wei J, Zhong F, Sun L, Huang CY. Brain abscess of odontogenic origin: A case report and literature review. Medicine (Baltimore) 2023; 102:e36248. [PMID: 38050225 PMCID: PMC10695514 DOI: 10.1097/md.0000000000036248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/01/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The objective of this study is to investigate and understand the characteristics of odontogenic brain abscess. METHODS A case of brain abscess suspected to be caused by odontogenic infection was documented, and a comprehensive analysis and summary of odontogenic brain abscess cases reported in various countries over the past 20 years was conducted. RESULTS Based on the analysis and synthesis of both the present and previous reports, we have examined and consolidated the distinctive features of odontogenic brain abscess, the potential transmission pathway of pathogenic bacteria, diagnostic assertions, verification techniques, and crucial considerations during treatment. CONCLUSION This investigation contributes to an enhanced comprehension and improved clinical identification of odontogenic brain abscess.
Collapse
Affiliation(s)
- Jingyi Wei
- Center of Orthodontics, Department of Dentistry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Feiyang Zhong
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lei Sun
- Center of Orthodontics, Department of Dentistry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Cheng-Yi Huang
- Center of Orthodontics, Department of Dentistry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Jespersen FVB, Hansen SUB, Jensen SS, Omland LH, Helweg-Larsen J, Bjarnsholt T, Nielsen CH, Ziebell M, Bodilsen J, Markvart M. Cerebral abscesses with odontogenic origin: a population-based cohort study. Clin Oral Investig 2023:10.1007/s00784-023-04976-6. [DOI: 10.1007/s00784-023-04976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Abstract
Abstract
Objectives
Recent studies have indicated that cerebral abscess (CA) patients with odontogenic origin are on the rise. However, CA patients are often poorly characterized and with an unknown etiologic background. The purpose of this study is to identify and characterize CA patients that may have an odontogenic origin based on microbiologic, radiographic, and/or clinical findings.
Materials and methods
This is a population-based cohort study analyzing retrospective and prospective data from CA patients. Radiographic examinations of panoramic radiographs (PRs) or computed tomography (CT) scans were conducted. CA patients characterized with odontogenic origin required the fulfilment of the following criteria on admission: (1) Oral pathologic conditions were the only bacterial infections present, (2) oral microorganisms were isolated in the purulent exudate from the brain, and (3) radiographically and/or clinical recordings of oral pathologic conditions.
Results
A total of 44 patients could be included in this study of which 25 (57%) were characterized as having CA with a likely odontogenic origin. Type two diabetes (T2D) (p = 0.014) and microorganisms of the Streptococcus anginosus group (SAG) (p < 0.01) were overrepresented in patients with CAs of odontogenic origin.
Conclusions
Odontogenic infections may cause CAs to a greater extent than previously assumed. T2D was overrepresented among patients with odontogenic CA. When microorganisms of the SAG were isolated from the brain pus, CA patients had a predisposing odontogenic or sinus infection.
Clinical relevance
The identification of patients with a likely odontogenic CA will contribute to understanding the etiology of the infectious disease and highlighting the importance of preserving oral health.
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Lannon M, Trivedi A, Martyniuk A, Farrokhyar F, Sharma S. Surgical aspiration versus excision for intraparenchymal abscess: a systematic review and Meta-analysis. Br J Neurosurg 2022; 36:743-749. [PMID: 36062586 DOI: 10.1080/02688697.2022.2118231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Brain abscesses are associated with considerable morbidity and mortality, requiring timely intervention to achieve favourable outcomes. With the advent of high-resolution computed tomography (CT) imaging, mortality following both aspiration and excision of brain abscesses has improved markedly. As a result, there has been a marked shift in neurosurgical practice with aspiration eclipsing excision as the favoured first-line modality for most abscesses. However, this trend lacks sufficient supporting evidence, and this systematic review and meta-analysis seeks to compare aspiration and excision in the treatment of brain abscess. Twenty-seven studies were included in the systematic review, and seven comparative papers in meta-analysis. Aspiration was the chosen technique for 67.5% of patients. Baseline characteristics from the studies included only in the systematic review demonstrated that abscesses treated by aspiration were typically larger and in a deeper location than those excised. In the meta-analysis, we initially found no significant difference in mortality, re-operation rate, or functional outcome between the two treatment modalities. However, sensitivity analysis revealed that excision results in lower re-operation rate. On average, the included studies were of poor quality with average Methodological Index for Non-Randomized Studies (MINORS) scores of 10.3/16 and 14.43/24 for non-comparative and comparative papers respectively. Our study demonstrates that excision may offer improved re-operation rate as compared to aspiration for those abscesses where there is no prior clinical indication for either modality. However, no differences were found with respect to mortality or functional outcome. Evidence from the literature was deemed low quality, emphasizing the need for further investigation in this field, specifically in the form of large, well-controlled, comparative trials.
Collapse
Affiliation(s)
- Melissa Lannon
- Division of Neurosurgery, McMaster University, Hamilton, Canada
| | - Arunchala Trivedi
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | | | - Forough Farrokhyar
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Sunjay Sharma
- Division of Neurosurgery, McMaster University, Hamilton, Canada
| |
Collapse
|
10
|
Burgos-Larraín LF, Vázquez-Portela Á, Cobo-Vázquez CM, Sáez-Alcaide LM, Sánchez-Labrador L, Meniz-García C. Brain complications from odontogenic infections: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e794-e800. [PMID: 35908649 DOI: 10.1016/j.jormas.2022.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Odontogenic infections can spread through different routes to more remote anatomical areas, such as the brain. Brain abscesses have an incidence of 0.3-1.3 / 100,000 population and only 2-5% are of dental origin. The main objective is to research brain complications derived from odontogenic infections. Secondary objectives were to identify the most common symptoms in brain abscess, to describe the microbiology involved in these infectious processes, report which parts of the brain complex are most commonly affected and report the sequelae of this patients. METHODS A systematic review following the PRISMA Guide and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports was carried out in PubMed, Scopus and Web of Science. The search terms were: Brain infection, brain abscess, oral health oral origin, odont* infect*. RESULTS The database search identified a total of 1000 articles. A total of 18 publications were identified after applying inclusion and exclusion criteria. A total of 38 patients were analyzed. Mean age was 49.64±18.80 years. CONCLUSION The most common symptoms of patients with brain abscess are neurological affectations first and then fever and headache second, without necessarily presenting as a symptomatological triad. Microbiological diagnosis is key to determining the origin of the infection. Anaerobic pathogens such as Streptococcus (F. Milleri), Fusobacterium Nucleatum and Porfiromonas Gingivalis families are common bacterial agents. The frontal lobe is the most frequently affected, followed by the parietal and temporal lobe. The most frequent brain complications are neurological disorders. However, most patients with brain abscesses recover without sequelae.
Collapse
Affiliation(s)
- Luis Felipe Burgos-Larraín
- Department of Clinical Specialities, Faculty of Dentistry, Complutense University of Madrid, Spain; Concepción University, Chil
| | - Álvaro Vázquez-Portela
- Department of Clinical Specialities, Faculty of Dentistry, Complutense University of Madrid, Spain; San Pablo-CEU University, Madrid, Spain
| | - Carlos M Cobo-Vázquez
- Department of Clinical Specialities, Faculty of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal, 3, Madrid 28040, Spain; Department of Dentistry and Stomatology, Gregorio Marañón University General Hospital, Madrid, Spain.
| | - Luis Miguel Sáez-Alcaide
- Department of Dentistry and Stomatology, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Luis Sánchez-Labrador
- Department of Dentistry and Stomatology, Gregorio Marañón University General Hospital, Madrid, Spain
| | - Cristina Meniz-García
- Department of Clinical Specialities, Faculty of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal, 3, Madrid 28040, Spain
| |
Collapse
|
11
|
Sasmanto S, Wasito EB. Odontogenic brain abscess due to Anaerococcus prevotii infections: A case report and review article. Int J Surg Case Rep 2022; 97:107450. [PMID: 35905679 PMCID: PMC9403287 DOI: 10.1016/j.ijscr.2022.107450] [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: 06/05/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Odontogenic brain abscess is a rare case primarily caused by normal flora such as Anaerococcus prevotii. CASE PRESENTATION A 60-years-old Indonesian female complained of severe left side headaches, hearing loss, a decrease of consciousness, several episodes of nausea and vomiting, and hemiparesis dextra for 5 days. Three months previously, she performed dental operative procedures on the left side of the first and second lower molar and debridement of phlegmon on the left side of the mouth. Head CT scan suggests multiple brain abscesses or high-grade glioma, non-communicating hydrocephalus and suggestive mastoiditis. The patient underwent excision surgery and abscess culture, which resulted in Anaerococcus prevotii. The patient received a metronidazole antibiotic, and on the seventh day, his condition improved. DISCUSSION Identifying bacterial infection in the brain abscess is crucial for effective treatment. Abscess removal in the brain and antibiotics are treatments for brain abscesses. CONCLUSION Odontogenic brain abscess caused by Anaerococcus prevotii infection effectiveness with surgical excision and antibiotics.
Collapse
Affiliation(s)
- Suharyadi Sasmanto
- Study Program of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Eddy Bagus Wasito
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Surabaya, Indonesia,Correspondence to: E.B. Wasito, Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Academic Hospital, Jl. Mayjend Prof. Dr. Moestopo No. 6-8, Airlangga, Gubeng, Surabaya, East Java 60286, Indonesia.
| |
Collapse
|
12
|
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.
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW We conducted a systematic review of the literature to update findings on the epidemiology and the management of cerebral abscesses in immunocompetent patients. RECENT FINDINGS Observational studies suggest that the overall prognosis has improved over the last decades but mortality rates remain high. Several parameters may contribute to a better prognosis, including the identification of common risk factors for brain abscess, the systematic use of brain MRI at diagnosis, the implementation of appropriate neurosurgical and microbiological techniques for diagnosis, the optimization of the antibacterial treatment based on epidemiology and pharmacokinetic/pharmacodynamic studies, and a long-term follow-up for detection of secondary complications. Outcome research on brain abscess is mainly based on observational studies. Randomized controlled trials have yet to be performed to identify clinically relevant interventions associated with improved patient-centered outcomes. SUMMARY Our review highlights the importance of a multidisciplinary approach to optimize brain abscess management both at the acute phase and in the long-term. Randomized controlled studies are urgently needed to identify interventions associated with improved outcomes.
Collapse
|
14
|
Educational case: Brain abscess. Acad Pathol 2022; 9:100017. [PMID: 35770199 PMCID: PMC9234233 DOI: 10.1016/j.acpath.2022.100017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/28/2021] [Accepted: 01/02/2022] [Indexed: 12/02/2022] Open
|
15
|
Lisboa EDCC, Silva WO, Rodrigues RCV, Brum SC, Alves FRF. The connection between brain abscess and odontogenic infections: a systematic review. Arch Oral Biol 2022; 135:105360. [DOI: 10.1016/j.archoralbio.2022.105360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 12/29/2022]
|
16
|
Yuen J, Muquit S. A woman with headache, hemiplegia, and recent toothache. BMJ 2021; 372:n10. [PMID: 33504559 DOI: 10.1136/bmj.n10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jason Yuen
- South West Neurosurgery Centre, Derriford Hospital, Plymouth, UK
| | - Samiul Muquit
- South West Neurosurgery Centre, Derriford Hospital, Plymouth, UK
| |
Collapse
|
17
|
Zhang F, Hsu G, Das S, Chen Y, August M. Independent risk factors associated with higher mortality rates and recurrence of brain abscesses from head and neck sources. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:173-179. [PMID: 33187946 DOI: 10.1016/j.oooo.2020.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/07/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to identify the features and independent risk factors associated with recurrence and mortality in patients with brain abscesses of head and neck origin. STUDY DESIGN We designed a retrospective study of patients diagnosed with a brain abscess at the Massachusetts General Hospital between 1980 and 2017. Inclusion criteria were complete medical records, including medical and surgical history; and radiographic and microbiologic data. Multinomial logistic regression and Gray's test were used to evaluate the independent variables associated with recurrence and mortality. RESULTS Eighty-eight cases met the inclusion criteria. Of these, 48 patients (54.5%) were men (mean age 50.5 ± 18.8 years). Significant association between etiology and cultured organisms was found only in cases of neurosurgical intervention with staphylococcal or streptococcal isolates (P < .05). Seizure activity was the only significant predictor of recurrence. Predictors of mortality included advanced age (P = .005); staphylococcal infection (P = .029); low monocyte count (P = .004); hyponatremia (P = .002); elevated blood urea nitrogen (P = .000); elevated creatinine (P = .002); hyperglycemia (P = .023); and status at discharge (P = .000). CONCLUSIONS Independent risk factors, such as low monocyte count, hyponatremia, renal dysfunction, and hyperglycemia, were found to be associated with higher mortality rates in patients with brain abscesses of head and neck origin. These abnormalities should be promptly recognized and aggressively treated.
Collapse
Affiliation(s)
- Fugui Zhang
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital of Chongqing Medical University, Chongqing, P. R. China; Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA.
| | - Grace Hsu
- Harvard School of Dental Medicine, Boston, MA, USA
| | - Somdipto Das
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Youbai Chen
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA; Department of Plastic and Reconstructive Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Meredith August
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard School of Dental Medicine, Boston, MA, USA
| |
Collapse
|