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Bodilsen J, Nielsen H. Early switch to oral antimicrobials in brain abscess: a narrative review. Clin Microbiol Infect 2023; 29:1139-1143. [PMID: 37119987 DOI: 10.1016/j.cmi.2023.04.026] [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: 02/01/2023] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Early switch to oral antimicrobials has been suggested as a treatment strategy in patients with brain abscess, but the practice is controversial. OBJECTIVES This review aimed to summarize the background, current evidence, and future perspectives for early transition to oral antimicrobials in patients with brain abscess. SOURCES The review was based upon a previous systematic review carried out during the development of the ESCMID guidelines on diagnosis and treatment of brain abscess. The search used 'brain abscess' or 'cerebral abscess' as text or MESH terms in PubMed, EMBASE, and the Cochrane Library. Studies included in the review were required to be published in the English language within the last 25 years and to have a study population of ≥10 patients. Other studies known by the authors were also included. CONTENT In this review, the background for some experts to suggest early transition to oral antimicrobials in patients with mild and uncomplicated brain abscess was clarified. Next, results from observational studies were summarized and limitations discussed. Indirect support for early oral treatment of brain abscess was described with reference to other serious central nervous system infections and general pharmacological considerations. Finally, variations within and between countries in the use of early transition to oral antimicrobials in patients with brain abscess were highlighted. IMPLICATIONS Early transition to oral antimicrobials in patients with uncomplicated brain abscess may be of benefit for patients due to convenience of treatment and potential decreased risks associated with prolonged hospitalization and intravenous lines. The strategy may also confer a more rational allocation of healthcare resources and decrease expenses. However, the benefit/risk ratio for this strategy remains unresolved at present.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; ESCMID Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; ESCMID Study Group for Infections of the Brain (ESGIB), Basel, Switzerland
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Abstract
BACKGROUND The long-term prognosis of brain abscess is unclear. METHODS Using nationwide, population-based medical registries, we included all individuals <20 years of age hospitalized with first-time diagnosis of brain abscess in Denmark from 1982 to 2016. A comparison cohort individually matched for age, sex and residence was identified, as were siblings of all study participants. Next, cumulative incidence curves of mortality and new-onset epilepsy were constructed, and Cox regression was used for analyses of hazard rate ratios (HRRs) with 95% confidence intervals. RESULTS We identified 155 brain abscess patients and 1,550 population controls with median follow-up times of 15 years (interquartile range, 6-25) and 16 years (interquartile range, 11-26). Ear-nose-throat infections (22%) and congenital heart disease (13%) were the most common predisposing conditions for brain abscess. Overall mortality was 21/155 (14%) in brain abscess patients versus 20/1,550 (1%) in population controls. The corresponding HRRs were 150 (95% confidence interval: 19.8-1,116) after 1 year of observation, 24.6 (4.78-127) after 2-5 years and 0.66 (0.09-4.98) after 6-30 years. New-onset epilepsy occurred in 28% of 30-day brain abscess survivors versus 1% in population controls yielding a HRR of 29.6 (14.4-60.8) adjusted for previous head trauma, stroke and cancer. Analyses of sibling cohorts showed that family-related factors did not explain the observed increased risks of death or epilepsy among brain abscess patients. CONCLUSIONS Brain abscess is associated with increased risk of mortality for up to 5 years. New-onset epilepsy occurred in 28% of survivors and remained a risk for several years after infection.
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Lundy P, Kaufman C, Garcia D, Partington MD, Grabb PA. Intracranial subdural empyemas and epidural abscesses in children. J Neurosurg Pediatr 2019; 24:14-21. [PMID: 31553545 DOI: 10.3171/2019.1.peds18434] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors conducted a retrospective analysis of a consecutive series of children with intracranial subdural empyemas (SEs) and epidural abscesses (EAs) to highlight the important clinical difference between these two entities. They describe the delays and pitfalls in achieving accurate diagnoses and make treatment recommendations based on clinical and imaging findings. METHODS They reviewed their experience with children who had presented with intracranial SE and/or EA in the period from January 2013 to May 2018. They recorded presenting complaint, date of presentation, age, neurological examination findings, time from presentation to diagnosis, any errors in initial image interpretation, timing from diagnosis to surgical intervention, type of surgical intervention, neurological outcome, and microbiology data. They aimed to assess possible causes of any delay in diagnosis or surgical intervention. RESULTS Sixteen children with SE and/or EA had undergone evaluation by the authors’ neurosurgical service since 2013. Children with SE (n = 14) presented with unmistakable evidence of CNS involvement with only one exception. Children with EA alone (n = 2) had no evidence of CNS dysfunction. All children older than 1 year of age had sinusitis. The time from initial presentation to a physician to diagnosis ranged from 0 to 21 days with a mean and median of 4.5 and 6 days, respectively. The time from diagnosis to neurosurgical intervention ranged from 0 to 14 days with a mean and median of 3 and 1 day, respectively. Delay in treatment was due to misinterpretation of images, a failure to perform timely imaging, progression on imaging as an indication for surgical intervention, or the managing clinician’s preference. Among the 14 cases with SE, initial imaging studies in 6 were not interpreted as showing SE. Four SE collections were dictated as epidural even on MRI. The only fatality was associated with no surgical intervention. Endoscopic sinus surgery was not associated with reducing the need for repeat craniotomy. CONCLUSIONS Regardless of the initial imaging interpretation, any child presenting with focal neurological deficit or seizures and sinusitis should be assumed to have an SE or meningitis, and a careful review of high-resolution imaging, ideally MRI with contrast, should be performed. If an extraaxial collection is identified, surgical drainage should be performed expeditiously. Neurosurgical involvement and evaluation are imperative to achieve timely diagnoses and to guide management in these critically ill children. ABBREVIATIONS EA = epidural abscess; SE = subdural empyema.
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Affiliation(s)
| | - Christian Kaufman
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - David Garcia
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - Michael D Partington
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - Paul A Grabb
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,2Children's Mercy Hospital and.,3University of Missouri at Kansas City, Kansas City, Missouri
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van der Velden FJS, Battersby A, Pareja-Cebrian L, Ross N, Ball SL, Emonts M. Paediatric focal intracranial suppurative infection: a UK single-centre retrospective cohort study. BMC Pediatr 2019; 19:130. [PMID: 31023283 PMCID: PMC6482535 DOI: 10.1186/s12887-019-1486-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Paediatric focal intracranial suppurative infections are uncommon but cause significant mortality and morbidity. There are no uniform guidelines regarding antibiotic treatment. This study reviewed management in a tertiary healthcare centre in the United Kingdom and considers suggestions for empirical treatment. Methods A retrospective, single-centre cohort review of 95 children (< 18 years of age) with focal intracranial suppurative infection admitted between January 2001 and June 2016 in Newcastle upon Tyne, United Kingdom. Microbiological profiles and empirical antibiotic regimens were analysed for coverage, administration and duration of use. Mortality and neurological morbidity were reviewed. Data was analysed using t-tests, Mann-Whitney U tests, independent-samples median tests, and χ2-tests where appropriate. P-values < 0.05 were considered statistically significant. Results Estimated annual incidence was 8.79 per million. Age was bimodally distributed. Predisposing factors were identified in 90.5%, most commonly sinusitis (42.1%) and meningitis (23.2%). Sinusitis was associated with older children (p < 0.001) and meningitis with younger children (p < 0.001). The classic triad was present in 14.0%. 43.8% of 114 isolates were Streptococcus spp., most commonly Streptococcus milleri group organisms. Twelve patients cultured anaerobes. Thirty one empirical antibiotic regimens were used, most often a third-generation cephalosporin plus metronidazole and amoxicillin (32.2%). 90.5% would have sufficient cover with a third generation cephalosporin plus metronidazole. 66.3% converted to oral antibiotics. Median total antibiotic treatment duration was 90 days (interquartile range, 60–115.50 days). Mortality was 3.2, 38.5% had short-term and 24.2% long-term neurological sequelae. Conclusions Paediatric focal intracranial suppurative infection has a higher regional incidence than predicted from national estimates and still causes significant mortality and morbidity. We recommend a third-generation cephalosporin plus metronidazole as first-choice empirical treatment. In infants with negative anaerobic cultures metronidazole may be discontinued.
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Affiliation(s)
- Fabian J S van der Velden
- Paediatric Immunology, Infectious Diseases and Allergy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, NE1 4LP, UK.,Erasmus MC, Rotterdam, 3015, CE, The Netherlands
| | - Alexandra Battersby
- Paediatric Immunology, Infectious Diseases and Allergy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, NE1 4LP, UK
| | - Lucia Pareja-Cebrian
- Microbiology Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - Nicholas Ross
- Neurosurgery department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - Stephen L Ball
- Otorhinolaryngology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases and Allergy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, NE1 4LP, UK. .,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
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Robertson FC, Lepard JR, Mekary RA, Davis MC, Yunusa I, Gormley WB, Baticulon RE, Mahmud MR, Misra BK, Rattani A, Dewan MC, Park KB. Epidemiology of central nervous system infectious diseases: a meta-analysis and systematic review with implications for neurosurgeons worldwide. J Neurosurg 2019; 130:1107-1126. [PMID: 29905514 DOI: 10.3171/2017.10.jns17359] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Central nervous system (CNS) infections cause significant morbidity and mortality and often require neurosurgical intervention for proper diagnosis and treatment. However, neither the international burden of CNS infection, nor the current capacity of the neurosurgical workforce to treat these diseases is well characterized. The objective of this study was to elucidate the global incidence of surgically relevant CNS infection, highlighting geographic areas for targeted improvement in neurosurgical capacity. METHODS A systematic literature review and meta-analysis were performed to capture studies published between 1990 and 2016. PubMed, EMBASE, and Cochrane databases were searched using variations of terms relating to CNS infection and epidemiology (incidence, prevalence, burden, case fatality, etc.). To deliver a geographic breakdown of disease, results were pooled using the random-effects model and stratified by WHO region and national income status for the different CNS infection types. RESULTS The search yielded 10,906 studies, 154 of which were used in the final qualitative analysis. A meta-analysis was performed to compute disease incidence by using data extracted from 71 of the 154 studies. The remaining 83 studies were excluded from the quantitative analysis because they did not report incidence. A total of 508,078 cases of CNS infections across all studies were included, with a total sample size of 130,681,681 individuals. Mean patient age was 35.8 years (range: newborn to 95 years), and the male/female ratio was 1:1.74. Among the 71 studies with incidence data, 39 were based in high-income countries, 25 in middle-income countries, and 7 in low-income countries. The pooled incidence of studied CNS infections was consistently highest in low-income countries, followed by middle- and then high-income countries. Regarding WHO regions, Africa had the highest pooled incidence of bacterial meningitis (65 cases/100,000 people), neurocysticercosis (650/100,000), and tuberculous spondylodiscitis (55/100,000), whereas Southeast Asia had the highest pooled incidence of intracranial abscess (49/100,000), and Europe had the highest pooled incidence of nontuberculous vertebral spondylodiscitis (5/100,000). Overall, few articles reported data on deaths associated with infection. The limited case fatality data revealed the highest case fatality for tuberculous meningitis/spondylodiscitis (21.1%) and the lowest for neurocysticercosis (5.5%). In all five disease categories, funnel plots assessing for publication bias were asymmetrical and suggested that the results may underestimate the incidence of disease. CONCLUSIONS This systematic review and meta-analysis approximates the global incidence of neurosurgically relevant infectious diseases. These results underscore the disproportionate burden of CNS infections in the developing world, where there is a tremendous demand to provide training and resources for high-quality neurosurgical care.
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Affiliation(s)
- Faith C Robertson
- 1Harvard Medical School
- 2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts
| | - Jacob R Lepard
- 3Department of Neurosurgery, University of Alabama, Birmingham, Alabama
| | - Rania A Mekary
- 2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts
- 4MCPHS University, Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, Boston
| | - Matthew C Davis
- 3Department of Neurosurgery, University of Alabama, Birmingham, Alabama
| | - Ismaeel Yunusa
- 2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts
- 4MCPHS University, Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, Boston
| | - William B Gormley
- 1Harvard Medical School
- 2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Department of Neurosurgery, Boston, Massachusetts
- 5Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ronnie E Baticulon
- 6University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
| | - Muhammad Raji Mahmud
- 7Department of Surgery, National Hospital Abuja, PMB 425, Federal Capital Territory, Nigeria
| | - Basant K Misra
- 8Department of Neurosurgery & Gamma Knife Radiosurgery, P. D. Hinduja National Hospital, Mahim, Mumbai, India
| | - Abbas Rattani
- 9Meharry Medical College, School of Medicine, Nashville, Tennessee
- 10Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; and
| | - Michael C Dewan
- 10Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; and
- 11Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 10Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; and
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Bahubali VKH, Vijayan P, Bhandari V, Siddaiah N, Srinivas D. Methicillin-resistant Staphylococcus aureus intracranial abscess: An analytical series and review on molecular, surgical and medical aspects. Indian J Med Microbiol 2018; 36:97-103. [PMID: 29735835 DOI: 10.4103/ijmm.ijmm_17_41] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose Intracranial abscess caused by methicillin-resistant Staphylococcus aureus (MRSA) is rare and unexplored. The aim of the present study is to examine the prevalence, clinical and molecular characteristics, treatment options and outcome of MRSA intracranial abscess over a period of 6 years. Patientsand Methods A total of 21 patients were included in this retrospective study. The demographic and clinical details of all the patients were collected. Molecular typing including staphylococcal cassette chromosome mec typing, spa typing and polymerase chain reaction of Panton-Valentine leucocidin toxin (PVL) gene for the latter 6 isolates was performed. Results The paediatric population was the most affected group (33.3%). The primary route of infection was post-operative/trauma in 7 (33.3%) cases. All the patients were treated surgically either by aspiration or excision. Fifteen (71%) patients received anti-MRSA treatment with vancomycin or linezolid, where linezolid-treated patients showed better prognosis. Of the 11 patients who were on follow-up, unfavourable outcome was observed in 3 (27.3%) cases and 8 (72.7%) cases improved. The molecular typing of six isolates revealed four community-associated (CA) MRSA, one each of livestock-associated (LA) and healthcare-associated MRSA with PVL gene noted in all. Conclusion We propose that timely diagnosis, surgical intervention and appropriate anti-MRSA treatment would contribute to better outcome. The occurrence of CA-MRSA and LA-MRSA infection in the central nervous system signifies the threat from the community and livestock reservoir, thus drawing attention towards surveillance and tracking to understand the epidemiology and implement infection control measures.
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Affiliation(s)
| | - Priya Vijayan
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vasundhra Bhandari
- Department of Infectious Diseases, National Institute of Animal Biotechnology, Hyderabad, Telangana, India
| | - Nagarathna Siddaiah
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Boy With Upper Neck Pain and Generalized Weakness. Ann Emerg Med 2016; 68:519-28. [DOI: 10.1016/j.annemergmed.2016.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Indexed: 11/18/2022]
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McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, Clark JE, Cooper CM, Curtis N, Goeman E, Hazelton B, Haeusler GM, Khatami A, Newcombe JP, Osowicki J, Palasanthiran P, Starr M, Lai T, Nourse C, Francis JR, Isaacs D, Bryant PA. Antibiotic duration and timing of the switch from intravenous to oral route for bacterial infections in children: systematic review and guidelines. THE LANCET. INFECTIOUS DISEASES 2016; 16:e139-52. [PMID: 27321363 DOI: 10.1016/s1473-3099(16)30024-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 03/04/2016] [Accepted: 03/29/2016] [Indexed: 12/22/2022]
Abstract
Few studies are available to inform duration of intravenous antibiotics for children and when it is safe and appropriate to switch to oral antibiotics. We have systematically reviewed antibiotic duration and timing of intravenous to oral switch for 36 paediatric infectious diseases and developed evidence-graded recommendations on the basis of the review, guidelines, and expert consensus. We searched databases and obtained information from references identified and relevant guidelines. All eligible studies were assessed for quality. 4090 articles were identified and 170 studies were included. Evidence relating antibiotic duration to outcomes in children for some infections was supported by meta-analyses or randomised controlled trials; in other infections data were from retrospective series only. Criteria for intravenous to oral switch commonly included defervescence and clinical improvement with or without improvement in laboratory markers. Evidence suggests that intravenous to oral switch can occur earlier than previously recommended for some infections. We have synthesised recommendations for antibiotic duration and intravenous to oral switch to support clinical decision making and prospective research.
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Affiliation(s)
- Brendan J McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - David Andresen
- Department of Infectious Diseases, Immunology, and HIV Medicine, St Vincent's Hospital, Darlinghurst, NSW, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; PathWest Laboratory Medicine, WA, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Minyon L Avent
- The University of Queensland, UQ Centre for Clinical Research and School of Public Health, Herston, QLD, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia; School of Paediatrics and Child Health, University of Western Australia, WA, Australia; Menzies School of Health Research, Darwin, NT, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, WA, Australia
| | - Philip N Britton
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Julia E Clark
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Celia M Cooper
- Department of Microbiology and Infectious Diseases, SA Pathology, Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Emma Goeman
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Briony Hazelton
- Sydney Medical School, University of Sydney, NSW, Australia; Department of Infectious Diseases, Princess Margaret Hospital for Children, Subiaco, WA, Australia
| | - Gabrielle M Haeusler
- Department of Infectious Diseases and Infection Control, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Infection and Immunity, Monash Children's Hospital, Clayton, VIC, Australia
| | - Ameneh Khatami
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - James P Newcombe
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Joshua Osowicki
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Pamela Palasanthiran
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia; School of Women's and Children's Health, University of New South Wales, NSW, Australia
| | - Mike Starr
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Tony Lai
- Department of Pharmacy, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Clare Nourse
- Infection Management and Prevention Service, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - David Isaacs
- Department of Infectious Diseases & Microbiology, Children's Hospital at Westmead, Westmead, NSW, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Penelope A Bryant
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
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Köksal V, Özgür A, Terzi S. Which should be appropriate surgical treatment for subtentorial epidural empyema? Burr-hole evacuation versus decompressive craniectomy: Review of the literature with a case report. Asian J Neurosurg 2016; 11:81-6. [PMID: 27057210 PMCID: PMC4802958 DOI: 10.4103/1793-5482.175630] [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] [Indexed: 11/09/2022] Open
Abstract
Subtentorial empyema is a rare intracranial complication of chronic otitis media. Moreover, if not correctly treated, it is a life-threatening infection. Epidural and subdural empyemas on subtentorial space have different effects. This difference is not mentioned in literature. If the distinction can be made, surgical treatment method will be different, and the desired surgical treatment may be less minimal invasive. A 26-year-old male patient was found to have developed epidural empyema in the subtentorial space. We performed a burr-hole evacuation in this case because there was low cerebellar edema, Also, the general condition of the patient was good, the empyema was a convex image on the lower surface of tentorium on magnetic resonance images, and when the dura mater base is reached during mastoidectomy for chronic otitis media, we were observed to drain a purulent material through the epidural space. After 10 days from surgery increased posterior fossa edema caused hydrocephalus. Therefore, ventriculoperitoneal shunt insertion was performed. The patient fully recovered and was discharged after 6 weeks. Complete correction in the posterior fossa was observed by postoperative magnetic resonance imaging. Burr-hole evacuation from inside of the mastoidectomy cavity for subtentorial epidural empyema is an effective and minimal invasive surgical treatment.
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Affiliation(s)
- Vaner Köksal
- Department of Neurosurgery, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Abdulkadir Özgür
- Department of Otorhinolaryngology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Suat Terzi
- Department of Otorhinolaryngology, School of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
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Kogilavaani J, Shatriah I, Regunath K, Helmy AKA. Bilateral orbital abscesses with subdural empyema and cavernous sinus thrombosis due to melioidosis in a child. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60744-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Brain abscess as a cause of macrocephaly in a newborn. Pediatr Neurol 2014; 50:121-2. [PMID: 24188912 DOI: 10.1016/j.pediatrneurol.2013.08.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 08/21/2013] [Accepted: 08/27/2013] [Indexed: 11/24/2022]
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Choudhury N, Khan A, Tzvetanov I, Garcia-Roca R, Oberholzer J, Benedetti E, Jeon H. Cerebellar abscess caused byListeria monocytogenesin a liver transplant patient. Transpl Infect Dis 2013; 15:E224-8. [DOI: 10.1111/tid.12145] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 05/31/2013] [Accepted: 07/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- N. Choudhury
- Division of Transplantation; Department of Surgery; University of Illinois Hospital and Health Sciences System; Chicago Illinois USA
| | - A.B. Khan
- Division of Transplantation; Department of Surgery; University of Illinois Hospital and Health Sciences System; Chicago Illinois USA
| | - I. Tzvetanov
- Division of Transplantation; Department of Surgery; University of Illinois Hospital and Health Sciences System; Chicago Illinois USA
| | - R. Garcia-Roca
- Division of Transplantation; Department of Surgery; University of Illinois Hospital and Health Sciences System; Chicago Illinois USA
| | - J. Oberholzer
- Division of Transplantation; Department of Surgery; University of Illinois Hospital and Health Sciences System; Chicago Illinois USA
| | - E. Benedetti
- Division of Transplantation; Department of Surgery; University of Illinois Hospital and Health Sciences System; Chicago Illinois USA
| | - H. Jeon
- Division of Transplantation; Department of Surgery; University of Illinois Hospital and Health Sciences System; Chicago Illinois USA
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