Cerebral abscess complicating dental treatment. Case report and review of the literature

Brain abscesses due to odontogenic infection: Case series

Brain abscesses due to odontogenic infection are infrequent, but they deserve attention due to the high incidence of serious complications and the high mortality rate. This article aimed to report five cases of cerebral abscess due to odontogenic infection, of patients attended in the Clinical Hospital of Medical School of the University of São Paulo (HCFMUSP). In all cases, treatment consisted of draining the brain abscess, antibiotic therapy and extraction of all teeth responsible for the infection. Streptococcus sp. was the causative agent of all the cases reported in this article. The purpose of the study was to highlight the importance of the dental approach for the resolution of cases.

A case of septic arthritis of the temporomandibular joint with necrotic peri-articular infection and Lemierre's syndrome: an unusual presentation

BACKGROUND

Septic arthritis of the temporomandibular joint (TMJ) is rare. It usually causes isolated, locoregional symptoms related to the infected intra-articular space but may also cause fever and malaise.

CASE REPORT

We present a case of a 72-year-old male with septic arthritis of the TMJ complicated by extensive peri-articular necrosis, septic shock, cerebral abscess, Lemierre's syndrome, and a pathological fracture of the mandibular condyle.

CONCLUSION

Case reports describing such a severe course of the disease are few. Moreover, this is the first report of septic arthritis of the TMJ to cause Lemierre's syndrome.

MALDI-TOF vs. VITEK 2 for identification of Aggregatibacter actinomycetemcomitans chest wall abscess

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A 56-year-old male patient has a chest wall abscess with intercostal muscle involvement.

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Aggregatibacter actinomycetemcomitans was misidentified as Pasturella canis or Pasturella multocida by the automated VITEK 2 system.

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The study re-enforces the importance of an accurate and rapid diagnosis to assist patient management.

Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) is a facultative anaerobic Gram-negative coccobacillus that is associated with a variety of diseases in humans. In the present study, the isolate finally identified as A. actinomycetemcomitans by MALDI-TOF was misidentified as Pasturella canis or Pasturella multocida by the automated VITEK 2 system. The findings re-enforce the importance of an accurate and rapid diagnosis to assist patient management.

Use of FDG-PET to detect a chronic odontogenic infection as a possible source of the brain abscess

This study describes the use of (18)F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) to detect a chronic odontogenic infection as the possible origin of a brain abscess (BA). A 74-year-old man with esophageal carcinoma was referred to our department to determine the origin of a BA in his oral cavity. He had no acute odontogenic infections. The BA was drained, and bacteria of the Staphylococcus milleri group were detected. Whole body FDG-PET revealed that the only sites of definite uptake of FDG were the esophageal carcinoma and the left upper maxillary region (SUVmax: 4.5). These findings suggested that the BA may have originated from a chronic periodontal infection. Six teeth with progressive chronic periodontal disease were extracted to remove the possible source of BA. These findings excluded the possibility of direct spread of bacteria from the odontogenic infectious lesion to the intracranial cavity. After extraction, there was no relapse of BA.

Cerebral abscess potentially of odontogenic origin

Odontogenic origins are rarely implicated in the formation of brain abscesses. The relative paucity of this kind of infection and the difficulty in matching the causative microorganisms of a brain abscess to an odontogenic source can explain the late management of patients. We herein describe a case of a 46-year-old man with a cerebellar abscess that was probably due to an odontogenic infection. The diagnosis supported by imaging and microscopic identification, mini craniectomy for abscess drainage followed by eradication of all potential dental infectious foci, and an antibiotic regimen based on cephalosporins, metronidazole, and vancomycine contributed to a successful outcome.

Brain abscess potentially secondary to odontogenic infection: case report

Odontogenic infections are rarely implicated in the causes of brain abscess formation. As such, there are very few reports of brain abscesses secondary to odontogenic infections in the literature. This is due partly to the relative rarity of brain abscesses but also to the difficulty in matching the causative organisms of a brain abscess to an odontogenic source. The authors report a case of a 50-year-old woman whose brain abscess may potentially have been secondary to an odontogenic infection. The patient's early diagnosis, supported by imaging and microbiologic assessment, along with early minicraniotomy and extraction of infected dentition followed by a course of cephalosporins and metronidazole, contributed to a successful outcome.

Brain abscess of odontogenic origin

Brain abscess is a rare and threatening infection, which is in a suppuration area, caused either by trauma, neurosurgical complication, or by a secondary infection of dental origin complication. The infectious process spread from the start focus can occur in 2 ways: hematogenous or by contiguity. The treatment should ideally be based on the etiological factor excision, combined with drainage and antibiotics as adjuvant; this philosophy is not observed in the reports described in the 1960s, 1970s, and 1980s. This study's goal was to report a case of brain abscess consequent of an odontogenic outbreak, where an adequate treatment was set up, but it was already in advanced stages and had as a result the lethal outcome. Complications from the odontogenic infections have a low incidence, but should never be disregarded, because they can lead to death, as described in this manuscript.

Brain abscess associated with Aggregatibacter actinomycetemcomitans: case report and review of literature

INTRODUCTION

Aggregatibacter actinomycetemcomitans is considered a major pathogen in localized and generalized aggressive periodontitis. A. actinomycetemcomitans has been found in various extra oral infections and most frequently in endocarditis. We report a patient with multiple brain abscesses due to infection with A. actinomycetemcomitans and review the English language literature related to this subject.

CASE REPORT

A 42-year-old patient with no underlying medical conditions presented with multiple brain lesions initially thought to be metastatic lesions of a tumour of unknown origin. Findings during drainage and subsequent histopathological conclusions made infection more likely. Culture of drained material remained negative; however, 16S rDNA polymerase chain reaction and sequence analysis on direct material revealed A. actinomycetemcomitans as the causative agent of the infection. The most likely source of infection was the poor dentition of the patient. After repeated drainage of the lesions and antibiotic treatment the patient gradually improved, although cognitive impairment remained.

CONCLUSIONS

Our report illustrates that a poor dental condition, notably destructive periodontal disease, can be a risk for life-threatening extra oral disease, and thus contributes to the total inflammatory burden of the body.

Liver abscess caused by periodontal bacterial infection with Fusobacterium necrophorum

Liver abscess is recognized as a life-threatening disease. However, even in recent years, approximately 50% of liver abscess cases are considered to be cryptogenic. Here, we report a case of liver abscess associated with periodontal bacterial infection by Fusobacterium necrophorum, which is commonly found in the oropharyngeal flora. A 36-year-old man presented with fever and contrast-enhanced abdominal computed tomography revealed multiple liver abscesses. F.necrophorum was isolated from oral smears, liver aspirates and blood samples. Liver abscesses caused by periodontal bacterial infection are rare, however, the incidence is expected to increase in the future, as periodontitis is extremely common and is on the rise as one of the most common chronic infections in the world. A systemic survey including periodontitis may be required for the exact diagnosis of the source of infection.

High incidence of actinobacillus actinomycetemcomitans infection in acute coronary syndrome

Recent epidemiological studies suggest that periodontitis is an important risk factor for coronary heart disease (CHD). The aim of this study was to evaluate the association between periodontitis and CHD, particularly acute coronary syndrome (ACS), focusing on microbiological and immunological features. Twenty-eight CHD patients, 15 with ACS and 13 with chronic CHD, were included in this study. Coronary angiography, periodontal examination, and dental radiography were performed in all patients. Subgingival plaque, saliva, and blood samples were analyzed for the periodontopathogens Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia using polymerase chain reaction. Specific serum antibody titers to the 5 periodontal pathogens were determined by enzyme-linked immunosorbent assay. It was found that 33% of the ACS patients (5/15) harbored A. actinomycetemcomitans in oral samples, whereas no A. actinomycetemcomitans (0/13) was found in the chronic CHD patients (P < 0.05). Furthermore, ACS patients showed significantly higher serum IgG titers to A. actinomycetemcomitans (P < 0.05) compared with chronic CHD. More tooth loss and alveolar bone loss were noted in ACS patients than in chronic CHD patients, although the differences were not statistically significant. Periodontal pathogens, particularly A. actinomycetemcomitans, may play a role in the development of ACS.

Tooth loss, dementia and neuropathology in the Nun study

BACKGROUND

Numerous studies have linked dementia to the subsequent deterioration of oral health. Few investigators, however, have examined oral disease as a potential risk factor in the development of dementia. The authors conducted a study to investigate a potential association between a history of oral disease and the development of dementia.

METHODS

Longitudinal dental records supplemented data collected from 10 annual cognitive assessments of 144 Milwaukee participants in the Nun Study, a longitudinal study of aging and Alzheimer disease, who were 75 to 98 years old. Neuropathologic findings at autopsy were available for 118 participants who died.

RESULTS

A low number of teeth increased the risk of higher prevalence and incidence of dementia.

CONCLUSION

Participants with the fewest teeth had the highest risk of prevalence and incidence of dementia.

CLINICAL IMPLICATIONS

Edentulism or very few (one to nine) teeth may be predictors of dementia late in life.

Retrospective analysis of 49 cases of brain abscess and review of the literature

The case records of 49 patients discharged from St George's Hospital, London, between December 2000 and March 2004 with the diagnosis of brain abscess were reviewed in order to document the epidemiology, causes, treatment, and prognostic factors associated with brain abscess. Brain abscess occurred at all ages, more frequently in men than in women. Headache and altered mental status were common presenting symptoms. The frontal lobe was the most common site. Streptococcal infection was seen most commonly, but staphylococcal infection predominated in cases following neurosurgery. Computed tomography provided sufficient diagnostic information in most cases. All but five patients had early surgical drainage. Cefotaxime and metronidazole were used most often for empirical therapy. Thirty-nine patients recovered fully or had minimal incapacity. Five patients died. Patients with underlying cranial neoplasms or medical conditions had a worse outcome than those with a contiguous focus of infection or post-traumatic abscess. Changes in disease pattern were determined by comparison to a literature review. A PubMed search of the literature using the keywords "brain abscess" was undertaken, and identified papers and relevant citations were reviewed. Compared to earlier series, there was a marked decrease in the number of cases of brain abscess secondary to otitis media and congenital heart disease. There was an increase in the number of cases of brain abscess secondary to neurosurgery and trauma. Changes in the epidemiology of predisposing conditions for brain abscess are associated with changes in the patient population and causative organisms. Though still a potentially fatal infection, there have been recent improvements in diagnosis, treatment, and outcome.

Cerebral abscess of odontogenic origin

INTRODUCTION

Cerebral abscess is a rare but serious and life-threatening infection. Dental infections have occasionally been reported as the source of bacteria for such an abcess.

PATIENT AND METHODS

A 54-year-old man was admitted with a right hemiparesis and epileptic fits. After clinical, laboratory and imaging examination, the diagnosis of a cerebral abscess of the left parietal lobe was made. The intraoral clinical examination as well as a panoramic radiograph confirmed the presence of generalized periodontal disease, multiple dental caries, and periapical pathology. The treatment included: (i) Immediate administration of high-dose intravenous antibiotics and (ii) surgical procedures consisting of craniotomy and resection of the abscess cavity first, and secondly removal of the periodontal, decayed and periapically involved teeth of the patient, in an effort to eradicate all the possible septic foci, presuming the cerebral abscess to be of odontogenic infection.

RESULTS

The patient made an uneventful recovery, and 29 months postoperatively he had completely recovered from the hemiparesis.

Case report: brain and liver abscesses caused by oral infection with Streptococcus intermedius

Organ abscesses are a rare and life-threatening complication mostly of hematogenously disseminated infections. We report a case of brain and liver abscesses. Identification of the lesions was made by contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI), respectively. An oral examination comprised an oral focus of infection. Streptococcus intermedius was isolated from oral smear, liver and ventricular drainage, and blood sample. After the commencement of antibiotic therapy, drainage of abscesses and oral rehabilitation, complete recovery was noted.

The Acute Orbit: Etiology, Diagnosis, and Therapy

PURPOSE

Extension of dental abscesses to distant areas of the head and neck has been repeatedly reported in the medical literature. Subsequent involvement of the orbit still remains a rarity, resulting in protracted onset of therapy because of inaccurate diagnosis. Considering the possible lasting damage that can result from insufficient therapy, like blindness or even death, the need to extensively educate practicing physicians becomes evident.

MATERIALS AND METHODS

With the help of a comprehensive review of the medical literature underlined with a clinical case, the etiology, diagnosis, and therapy of the acute orbit are highlighted with emphasis on the new imaging modalities as well as the broad spectrum antibiotics currently available on the market.

RESULTS

Orbital infections of odontogenic origin are the rarest sequelae, with a prevalence of 1.3%. Correct diagnosis, adequate antibiotic therapy, and surgical drainage are the keys to success.

CONCLUSION

The acute orbit continues to be a medical challenge. With the proposed diagnostic and therapy guidelines, this affliction can be identified and contained with a high degree of certainty.

Detection of Actinobacillus actinomycetemcomitans but not bacteria of the red complex in aortic aneurysms by multiplex polymerase chain reaction

BACKGROUND

Aortic aneurysms affect an increasing number of elderly patients and cause considerable morbidity and mortality. The understanding of the mechanisms involved in the pathogenesis of aortic aneurysms is unclear and little is known about the role of microorganisms in the development of the condition. The aim of the present study was to examine aortic aneurysm samples for the presence of four putative periodontal pathogens: Actinobacillus actinomycetemcomitans, Treponema denticola, Tannerella forsythensis, and Porphyromonas gingivalis.

METHODS

Fifty-six samples from the aneurysm wall were obtained from patients undergoing aneurysm repair. DNA was extracted from tissue by conventional methods. Universal eubacterial primers for general detection of bacteria and species specific primers for detection of the periodontal pathogens were used to amplify part of the 16S rRNA gene by polymerase chain reaction (PCR).

RESULTS

Bacterial DNA was detected in 50 of the 56 aneurysm samples (89.2%). A. actinomycetemcomitans was found in four samples (7.1%). None of the samples was positive for T. denticola, T. forsythensis, or P. gingivalis.

CONCLUSION

Bacteria are commonly present in aortic aneurysms and may play a role in the development of the condition. Periodontal pathogens are also present.

Brain abscess due to Actinobacillus actinomycetemcomitans. Case report

Actinobacillus actinomycetemcomitans, a constituent of the oral flora, is a rare cause of brain abscesses. We report the case of a 47-year-old male who presented with multiple brain abscesses due to this organism, presumably originating from his poor dentition. Problems met in isolating and identifying A. actinomycetemcomitans suggest that its true rate of isolation from non-oral samples may have been underestimated.

Are dental infections a cause of brain abscess? Case report and review of the literature

Dental pathology and/or treatment have been linked to a small number of brain abscesses as possible sources of infection. A further case is presented, in which a dental site is implicated. A review of the evidence was undertaken. A wide range of dental procedures had been implicated. In some cases the brain isolate was not of dental origin. In many, the diagnosis was one of exclusion. In order to confirm the role of odontogenic infection in the pathogenesis of brain abscess, modern sampling techniques should be used to precisely identify the isolates. The causal organism should be identified in both oral and cranial sites.

Brain abscesses caused by oral infection

Brain abscesses are rare but can be life-threatening infections. Recent progress in microbiological classification and identification has indicated that they are sometimes caused by oral infection and dental treatment. It has been postulated that oral microorganisms may enter the cranium by several pathways: 1) by direct extension, 2) by hematogenous spread, 3) by local lymphatics, and 4) indirectly, by extraoral odontogenic infection. In the direct extension, oral infections spread along the fascial planes. Hematogenous spreading occurs along the facial, angular, ophthalmic, or other veins which lack valves, through the cavernous sinus and into the cranium. Another hematogenous pathway is through the general circulation. Oral bacteria may cause systemic infections, e.g., endocarditis, and then indirectly initiate brain abscess. Microbiota, complications, and the prevention and management of odontogenic brain abscesses are also discussed in this review.