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Eichorn FC, Kameda-Smith M, Fong C, Graham AK, Main C, Lu JQ. Polymicrobial brain abscesses: A complex condition with diagnostic and therapeutic challenges. J Neuropathol Exp Neurol 2024:nlae058. [PMID: 38874452 DOI: 10.1093/jnen/nlae058] [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: 06/15/2024] Open
Abstract
Brain abscesses (BA) are focal parenchymal infections that remain life-threatening conditions. Polymicrobial BAs (PBAs) are complex coinfections of bacteria or bacterial and nonbacterial pathogens such as fungi or parasites, with diagnostic and therapeutic challenges. In this article, we comprehensively review the prevalence, pathogenesis, clinical manifestations, and microbiological, histopathological, and radiological features of PBAs, as well as treatment and prognosis. While PBAs and monomicrobial BAs have some similarities such as nonspecific clinical presentations, PBAs are more complex in their pathogenesis, pathological, and imaging presentations. The diagnostic challenges of PBAs include nonspecific imaging features at early stages and difficulties in identification of some pathogens by routine techniques without the use of molecular analysis. Imaging of late-stage PBAs demonstrates increased heterogeneity within lesions, which corresponds to variable histopathological features depending on the dominant pathogen-induced changes in different areas. This heterogeneity is particularly marked in cases of coinfections with nonbacterial pathogens such as Toxoplasma gondii. Therapeutic challenges in the management of PBAs include initial medical therapy for possibly underrecognized coinfections prior to identification of multiple pathogens and subsequent broad-spectrum antimicrobial therapy to eradicate identified pathogens. PBAs deserve more awareness to facilitate prompt and appropriate treatment.
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Affiliation(s)
- Frances-Claire Eichorn
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
| | | | - Crystal Fong
- Department of Radiology/Neuroradiology, McMaster University, Hamilton, Canada
| | - Alice K Graham
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
| | - Cheryl Main
- Department of Pathology and Molecular Medicine/Microbiology, McMaster University, Hamilton, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
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2
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Reynolds AS. Neuroinfectious Emergencies. Continuum (Minneap Minn) 2024; 30:757-780. [PMID: 38830070 DOI: 10.1212/con.0000000000001425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE This article describes nervous system infections and complications that lead to neurologic emergencies. LATEST DEVELOPMENTS New research on the use of dexamethasone in viral and fungal infections is reviewed. The use of advanced MRI techniques to evaluate nervous system infections is discussed. ESSENTIAL POINTS Neurologic infections become emergencies when they lead to a rapid decline in a patient's function. Emergent complications may result from neurologic infections that, if not identified promptly, can lead to permanent deficits or death. These complications include cerebral edema and herniation, spinal cord compression, hydrocephalus, vasculopathy resulting in ischemic stroke, venous thrombosis, intracerebral hemorrhage, status epilepticus, and neuromuscular respiratory weakness.
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Sharma B, Sreenivasan P, Singh A, Mondal PS, Ray P, Angrup A. Otogenic Cerebellar Abscess with Polymicrobial Anaerobic Infection in a Young Female- A Rare Presentation. Indian J Otolaryngol Head Neck Surg 2024; 76:1195-1198. [PMID: 38440584 PMCID: PMC10908990 DOI: 10.1007/s12070-023-04218-x] [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: 07/02/2023] [Accepted: 09/04/2023] [Indexed: 03/06/2024] Open
Abstract
Brain abscess is a serious clinical condition caused by a localized collection of pus within the brain tissue. This typically occurs as a result of an infection that originates from a nearby area, such as an ear, sinus, or dental infection, or an infection in the bloodstream. Streptococcus and Staphylococcus species are the most common organisms implicated in brain abscesses. Apart from aerobic growth, cases of mixed infections of both aerobic and anaerobic organisms are also commonly reported in the literature. Herein we report a 23-year-old immunocompetent female with chronic otitis media who presented with cerebellar abscess where the aerobic growth was sterile and anaerobic culture revealed pure growth of dual anaerobes viz… Peptostreptococcus and Bacteroides thetaiotaomicron. This case highlights the importance of prompt diagnosis and management of polymicrobial anaerobic infection in cases of brain abscess.
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Affiliation(s)
- Bhawna Sharma
- Department of Medical Microbiology, AIIMS, Bathinda, India
| | - Priya Sreenivasan
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Huff HV, Wilson-Murphy M. Neuroinfectious Diseases in Children: Pathophysiology, Outcomes, and Global Challenges. Pediatr Neurol 2024; 151:53-64. [PMID: 38103523 DOI: 10.1016/j.pediatrneurol.2023.09.020] [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: 03/23/2023] [Revised: 08/22/2023] [Accepted: 09/24/2023] [Indexed: 12/19/2023]
Abstract
Pathogens with affinity for the central nervous system (CNS) in children are diverse in their mechanisms of infecting and attacking the brain. Infections can reach the CNS via hematogenous routes, transneurally thereby avoiding the blood-brain barrier, and across mucosal or skin surfaces. Once transmission occurs, pathogens can wreak havoc both by direct action on host cells and via an intricate interplay between the protective and pathologic actions of the host's immune system. Pathogen prevalence varies depending on region, and susceptibility differs based on epidemiologic factors such as age, immune status, and genetics. In addition, some infectious diseases are monophasic, whereas others may lie dormant for years, thereby causing a dynamic effect on outcomes. Outcomes in survivors are highly variable for each particular pathogen and depend on the vaccination and immune status of the patient as well as the speed by which the patient receives evidence-based treatments. Given pathogens cause communicable diseases that can cause morbidity and mortality on a population level when spread, the burden is often the greatest and the outcomes the worst in low-resource settings. Here we will focus on the most common infections with a propensity to affect a child's brain, the pathologic mechanisms by which they do so, and what is known about the developmental outcomes in children who are affected by these infections.
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Affiliation(s)
- Hanalise V Huff
- Department of Neurology, National Institutes of Health, Bethesda, Maryland
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Kyyriäinen J, Andrade P, Ekolle Ndode-Ekane X, Manninen E, Hämäläinen E, Rauramaa T, Heiskanen M, Puhakka N, Immonen R, Pitkänen A. Brain abscess - A rare confounding factor for diagnosis of post-traumatic epilepsy after lateral fluid-percussion injury. Epilepsy Res 2024; 200:107301. [PMID: 38244466 DOI: 10.1016/j.eplepsyres.2024.107301] [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: 09/13/2023] [Revised: 12/28/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To assess the prevalence of brain abscesses as a confounding factor for the diagnosis of post-traumatic epilepsy (PTE) in a rat model of lateral fluid-percussion-induced (FPI) traumatic brain injury (TBI). METHODS This retrospective study included 583 rats from 3 study cohorts collected over 2009-2022 in a single laboratory. The rats had undergone sham-operation or TBI using lateral FPI. Rats were implanted with epidural and/or intracerebral electrodes for electroencephalogram recordings. Brains were processed for histology to screen for abscess(es). In abscess cases, (a) unfolded cortical maps were constructed to assess the cortical location and area of the abscess, (b) the abscess tissue was Gram stained to determine the presence of gram-positive and gram-negative bacteria, and (c) immunostaining was performed to detect infiltrating neutrophils, T-lymphocytes, and glial cells as tissue biomarkers of inflammation. In vivo and/or ex vivo magnetic resonance images available from a subcohort of animals were reviewed to evaluate the presence of abscesses. Plasma samples available from a subcohort of rats were used for enzyme-linked immunosorbent assays to determine the levels of lipopolysaccharide (LPS) as a circulating biomarker for gram-negative bacteria. RESULTS Brain abscesses were detected in 2.6% (15/583) of the rats (6 sham, 9 TBI). In histology, brain abscesses were characterized as vascularized encapsulated lesions filled with neutrophils and surrounded by microglia/macrophages and astrocytes. The abscesses were mainly located under the screw electrodes, support screws, or craniectomy. Epilepsy was diagnosed in 60% (9/15) of rats with an abscess (4 sham, 5 TBI). Of these, 67% (6/9) had seizure clusters. The average seizure frequency in abscess cases was 0.436 ± 0.281 seizures/d. Plasma LPS levels were comparable between rats with and without abscesses (p > 0.05). SIGNIFICANCE Although rare, a brain abscess is a potential confounding factor for epilepsy diagnosis in animal models of structural epilepsies following brain surgery and electrode implantation, particularly if seizures occur in sham-operated experimental controls and/or in clusters.
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Affiliation(s)
- Jenni Kyyriäinen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Pedro Andrade
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Xavier Ekolle Ndode-Ekane
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Eppu Manninen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Elina Hämäläinen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Tuomas Rauramaa
- Department of Pathology, Kuopio University Hospital, University of Kuopio, Kuopio, Finland; Unit of Pathology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mette Heiskanen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Noora Puhakka
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Riikka Immonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland
| | - Asla Pitkänen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland.
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Mantova MC, Moya BT. A thalamic brain abscess in an immunocompetent patient. Br J Hosp Med (Lond) 2023; 84:1-3. [PMID: 38153023 DOI: 10.12968/hmed.2023.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Maria C Mantova
- Department of Acute Medicine, King's College Hospital, London, UK
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Son H, Moon J, Ha EJ, Kim N, Kim EY, Lee HS, Koh EJ, Phi JH, Park CK, Kim JE, Kim SK, Lee ST, Jung KH, Lee SK, Cho WS, Chu K. Identification of bacterial pathogens in brain abscesses by metagenomic approach using nanopore 16S amplicon sequencing. Diagn Microbiol Infect Dis 2023; 107:116041. [PMID: 37741170 DOI: 10.1016/j.diagmicrobio.2023.116041] [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: 03/09/2023] [Revised: 06/30/2023] [Accepted: 07/22/2023] [Indexed: 09/25/2023]
Abstract
Brain abscess is medically challenging. In this study, we applied nanopore sequencing for 16S rRNA analysis and investigated its efficacy and diagnostic value for patients with brain abscesses. Genomic DNA was extracted from the pus samples (n = 27) of brain abscess, and 16S rRNA genes were amplified by PCR. Sequencing libraries were generated using a rapid barcoding kit, and the generated reads were analyzed using the EPI2ME16S workflow. A conventional culture study was performed. More sensitive identification of pathogens was made by 16S sequencing, faster than the culture study. The proportion of anaerobic bacteria identified by 16S sequencing was higher (75%) than that obtained by culturing (32%). Polymicrobial infections were identified in 10 cases (40%) by 16S sequencing, while the culture study identified multiple bacteria in only 2 cases (8%). 16S sequencing was useful for identifying the composition of polymicrobial infections, including rare pathogens, and for the initial diagnosis of space-occupying lesions.
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Affiliation(s)
- Hyoshin Son
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, College of Medicine Seoul National University, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, College of Medicine Seoul National University, Seoul National University Hospital, Seoul, South Korea; Department of Genomic Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Eun Jin Ha
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Narae Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, College of Medicine Seoul National University, Seoul National University Hospital, Seoul, South Korea
| | - Eun-Young Kim
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, College of Medicine Seoul National University, Seoul National University Hospital, Seoul, South Korea; Department of Neurology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Han Sang Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, College of Medicine Seoul National University, Seoul National University Hospital, Seoul, South Korea; Center of Hospital Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Eun Jung Koh
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea; Center of Hospital Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ji Hoon Phi
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, College of Medicine Seoul National University, Seoul National University Hospital, Seoul, South Korea
| | - Keun-Hwa Jung
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, College of Medicine Seoul National University, Seoul National University Hospital, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, College of Medicine Seoul National University, Seoul National University Hospital, Seoul, South Korea
| | - Won-Sang Cho
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Laboratory for Neurotherapeutics, Biomedical Research Institute, College of Medicine Seoul National University, Seoul National University Hospital, Seoul, South Korea.
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Abed K, Paciorek M, Bursa D. Potential infection foci in the oral cavity and their impact on the formation of central nervous system abscesses: A literature review. Medicine (Baltimore) 2023; 102:e35898. [PMID: 37986318 PMCID: PMC10659677 DOI: 10.1097/md.0000000000035898] [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: 06/14/2023] [Revised: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 11/22/2023] Open
Abstract
Despite advancements in preventive, diagnostic, and therapeutic activities in medicine, inflammatory processes of the central nervous system remain a significant problem, posing a serious threat to life and health. Purulent central nervous system infections are unique, including abscesses of the brain and spine, which are severe infections occurring in 0.4% to 0.9% of 1000 patients worldwide. Central nervous system abscesses have varying etiology. For example, organized, encapsulated abscesses of the brain are a unique group of inflammatory processes in the central nervous system caused by inflammation around the teeth in 3% to 10% of cases. Sometimes, the condition of patients with brain abscesses is severe and life-threatening. Therefore, detecting and eliminating all causes early, including those potentially resulting from odontogenic infections, is important; accurate and early diagnosis enables appropriate treatment. This paper presents a review of the information available in the literature on brain abscesses and their relationship with odontogenic foci of infection in the oral cavity.
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Affiliation(s)
- Kamil Abed
- Department of Cranio-Maxillofacial and Oral Surgery and Implantology, Infant Jesus Clinical Hospital-University Clinical Center of the Medical University of Warsaw, Warsaw, Poland
| | - Marcin Paciorek
- Department of Adult Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Dominik Bursa
- Department of Adult Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
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Bengio M, Goodwin G, Roka A, Marin M. Pediatric headache patient with cerebral abscesses: a brief review of the literature and case report. J Int Med Res 2023; 51:3000605231213751. [PMID: 38006608 PMCID: PMC10683565 DOI: 10.1177/03000605231213751] [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: 07/05/2023] [Accepted: 10/26/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Pediatric headache is a common cause of pediatric emergency department (ED) visits, and 8.8% of cases require imaging. Alarmingly, 12.5% of imaged cases have a pathologic cause. A pediatric patient with a complicated medical history presented to the pediatric ED with multiple cerebral abscesses. The possible causes and contributors to this rare cause of pediatric headache and a review of pediatric headache emergency management are presented.Case Presentation: A 12-year-old male patient with a complex medical and surgical history, including post-repair pulmonary valve stenosis, visited the pediatric ED for intractable and worsening left frontoparietal headache, refractory to ibuprofen, for 6 days. A physical examination revealed severe photophobia and restlessness secondary to severe head pain. Non-contrast brain computed tomography demonstrated two round, bilateral, parietal hypodense lesions with surrounding vasogenic edema. The lesions were consistent with abscesses on magnetic resonance imaging. Eventually, the patient underwent successful surgical abscess drainage and made a full recovery. The patient was lost to follow-up; therefore, no causative bacterial species was determined. CONCLUSION Managing pediatric headache in emergency settings requires a robust history and physical examination. Cerebral abscesses are an infrequent but fatal cause of pediatric headache and therefore should be considered among the differential diagnoses.
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Affiliation(s)
- Moshe Bengio
- Emergency Department, HCA Aventura Hospital and Medical Center, Aventura, USA
| | - Glenn Goodwin
- Emergency Department, HCA Aventura Hospital and Medical Center, Aventura, USA
| | - Abhishek Roka
- Emergency Department, HCA Aventura Hospital and Medical Center, Aventura, USA
| | - Michelle Marin
- Emergency Department, HCA Palms West Children's Hospital, Loxahatchee, USA
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Chaganti SS, Sidhom G, Chaganti J. Multiparametric imaging in the evaluation of intracerebral abscesses. Pract Neurol 2023; 23:376-385. [PMID: 37248041 DOI: 10.1136/pn-2023-003694] [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] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
Cerebral abscesses are uncommon space occupying lesions; they are associated with high morbidity and mortality, though are potentially treatable. Patients often present with non-specific symptoms and may have few clinical signs. Routine clinical imaging may not give a definite diagnosis, as the findings can be indistinguishable from those of other intracranial mass lesions. We review the role of advanced MR techniques to characterise brain abscesses and discuss the role of imaging in monitoring their response to the treatment.
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Affiliation(s)
- Sai Sivananda Chaganti
- Fellow, Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - George Sidhom
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Joga Chaganti
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
- Department of Radiology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
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Kavya S, Arvinda HR, Veenakumari HB, PrabuRaj AR, Smitha NR, Jyothi D, Dwarakanath S, Nagarathna S. Pertinence of Streptococcus anginosus group in intracerebral abscesses in the era of extended antibiotic resistance. Indian J Med Microbiol 2023; 45:100395. [PMID: 37573041 DOI: 10.1016/j.ijmmb.2023.100395] [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: 09/13/2022] [Revised: 03/30/2023] [Accepted: 05/26/2023] [Indexed: 08/14/2023]
Abstract
AIMS • To study the incidence of Streptococcus anginosus group (SAG) in pyogenic or community acquired intra cerebral abscess. • To understand the risk factors for the same. • To analyze the specific radiological features and clinical outcome after surgery and antibiotic therapy. METHODS This is a retrospective observational study of case series over a period of one year. Patients diagnosed with intracerebral abscess were included in the study. Pus collected from were received in the laboratory and processed according to the standard protocols. Data regarding the clinical findings and demographics were collected from medical records. FINDINGS A total of 202 samples were studied. 103 were found to be pyogenic. SAG were isolated from 21 samples (20.38%) and all the isolates were sensitive to Penicillin. Age of the patients ranged from 18months to 68years. Male preponderance was noted with male to female ratio of 4:1. Otogenic infections were the most common predisposing factors and focus of infection could not be ascertained in 5 patients. All patients were treated with surgical intervention and antibiotics (Vancomycin, Amikacin and Metronidazole) for 6 weeks and recovery was remarkable. One patient succumbed to the illness. CONCLUSION SAG can be an aggressive pathogen with propensity for abscess formation. Chronic Suppurative Otitis Media (CSOM) is still a major cause of intracerebral abscess in developing country like India which is a benign and curable disease and should not be neglected. Injudicious use of antibiotics and negligence regarding the dose and duration of therapy from both patients and health care providers is the major cause for common infections to become more difficult to treat and succumbing to complications.
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Affiliation(s)
- S Kavya
- Department of Neuromicrobiology, NIMHANS, India
| | - H R Arvinda
- Department of Neuro Imaging and Interventional Radiology, NIMHANS, India
| | | | | | - N R Smitha
- Department of Neuromicrobiology, NIMHANS, India
| | | | | | - S Nagarathna
- Department of Neuromicrobiology, NIMHANS, India.
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Teferi N, Chowdhury A, Lee S, Challa M, Weiner L, Auerbach S, Rao M, Dlouhy BJ. Pediatric brainstem abscess successfully treated with stereotactic aspiration: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23262. [PMID: 37581585 PMCID: PMC10555595 DOI: 10.3171/case23262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/28/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Pediatric brainstem abscesses are rare entities that account for 1% of all brain abscesses and, when diagnosed, constitute a neurosurgical emergency. OBSERVATIONS A previously healthy 11-year-old male presented with several days of worsening headache, confusion, and ataxia. Brain magnetic resonance imaging (MRI) revealed a midbrain and pons lesion. The patient subsequently had a rapid neurological decline with loss of consciousness and brainstem function. Follow-up MRI revealed significant enlargement of the brainstem lesion with extension into the pons, midbrain, and thalamus, with greater concerns for an abscess rather than a tumor or an inflammatory process. He was taken for an emergent stereotactic aspiration of the abscess, and broad-spectrum antibiotics were initiated. He had neurological improvement, which subsequently declined 5 days later with brain MRI revealing an increase in the brainstem abscess, which required a second stereotactic aspiration. After rehabilitation, he made a significant neurological recovery. LESSONS Pediatric brainstem abscesses are rare pathologies, and a high index of suspicion is needed in patients presenting with a brainstem lesion mimicking tumor but with rapid neurological decline despite no other evidence of infection or infectious/inflammatory markers. Stereotactic aspiration is required for large lesions to target the antibiotic treatment and as an adjunct to broad-spectrum antibiotics.
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Affiliation(s)
- Nahom Teferi
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | | | - Sarah Lee
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
| | - Meron Challa
- University of Iowa, Carver College of Medicine, Iowa City, Iowa
| | - Lukasz Weiner
- Department of Pediatrics, Division of Infectious Disease, University of Iowa, Iowa City, Iowa; and
| | - Sarah Auerbach
- Department of Pediatrics, Division of Infectious Disease, University of Iowa, Iowa City, Iowa; and
| | - Mahil Rao
- Department of Pediatrics, Division of Critical Care Medicine, University of Iowa, Iowa City, Iowa; and
| | - Brian J. Dlouhy
- Department of Neurosurgery, University of Iowa, Iowa City, Iowa
- University of Iowa, Carver College of Medicine, Iowa City, Iowa
- Iowa Neuroscience Institute, Iowa City, Iowa
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Álvarez C, Almuzara M, Tosello C, Stecher D, Vay C, Barberis C. [Actinomyces europaeus (Gleimia europaea) associated with brain abscess: A report of three cases]. Rev Argent Microbiol 2023; 55:235-239. [PMID: 36642684 DOI: 10.1016/j.ram.2022.07.003] [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: 01/29/2022] [Revised: 05/16/2022] [Accepted: 07/04/2022] [Indexed: 01/15/2023] Open
Abstract
A brain abscess is a focal infection characterized by a collection of pus in the brain parenchyma. It is a life-threatening condition that should be diagnosed and treated as soon as possible. We report here three cases of patients with otogenic brain abscesses of polymicrobial origin that had in common the isolation of Actinomyces europaeus, which has not been previously described in this location. A. europaeus was identified by the conventional methodology, matrix-associated laser deionization-time of flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing. Antibiotic susceptibility was evaluated by the epsilometric method, and all isolates showed sensitivity to penicillin, vancomycin and linezolid, whereas susceptibility to clindamycin and erythromycin was variable. MALDI-TOF MS identification allowed a quick and reliable species level identification in order to provide a rapid and effective response to avoid treatment delay that could lead to increased morbidity and even mortality.
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Affiliation(s)
- Carla Álvarez
- Cátedra de Microbiología Clínica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina; Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina.
| | - Marisa Almuzara
- Cátedra de Microbiología Clínica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina; Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Claudia Tosello
- División Infectología, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Stecher
- División Infectología, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carlos Vay
- Cátedra de Microbiología Clínica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina; Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Claudia Barberis
- Cátedra de Microbiología Clínica, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina; Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina
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14
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Ngo TM, Okabe A, Nguyen KB, Tong A, Chang J, Lui F. Cryptogenic Pontine Abscess Treated With Stereotactic Aspiration: A Case Report. Cureus 2023; 15:e41463. [PMID: 37546074 PMCID: PMC10404128 DOI: 10.7759/cureus.41463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Brainstem abscesses are localized collections of pus or infected material within the brainstem, which can cause inflammation, tissue damage, and compression of adjacent structures. This can lead to a variety of symptoms, including headache, fever, and focal neurological deficits, among many others. Brainstem abscesses are potentially life-threatening and considered to be rare, and pontine abscesses are even rarer. Both are often caused by the spread of infection from nearby structures like the middle ear, sinuses, and mastoid air cells, but they can also result from distant infectious sites that have spread to the bloodstream. Ambiguous clinical presentation can delay appropriate care and lead to poorer outcomes. We present a rare case of pontine abscess in a 54-year-old male with both undetermined causal origins and unclear infectious signs, namely, the lack of fever, fatigue, and chills. We will discuss the etiologies, diagnosis, and treatment of cryptogenic brainstem lesions in this case report.
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Affiliation(s)
- Taylor M Ngo
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Anna Okabe
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Kailey B Nguyen
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Anhtho Tong
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Jason Chang
- Neurology, Kaiser Permanente South Sacramento Medical Center, Sacramento, USA
| | - Forshing Lui
- Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA
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15
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Wager SG, Bourdeau NK, Collins JD. Streptococcus constellatus Brain Abscess in a Middle-Aged Man With an Undiagnosed Patent Foramen Ovale. Cureus 2023; 15:e34626. [PMID: 36891022 PMCID: PMC9987340 DOI: 10.7759/cureus.34626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/07/2023] Open
Abstract
Brain abscess is a rare diagnosis. Common sources of infection include direct spread from otic sources, sinuses, or oral cavities, and hematogenous spread from distant sources, including the heart and lungs. Brain abscess with cultures growing oral flora species, in rare cases, may develop from bacteria in the oral cavity entering the bloodstream and then traveling to the brain via a patent foramen ovale. This report highlights a case of brain abscess caused by Streptococcus constellatus in a middle-aged man with an undiagnosed patent foramen ovale.
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Affiliation(s)
- Susan G Wager
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Nina K Bourdeau
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
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16
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Duong MT, Rudie JD, Mohan S. Neuroimaging Patterns of Intracranial Infections: Meningitis, Cerebritis, and Their Complications. Neuroimaging Clin N Am 2023; 33:11-41. [PMID: 36404039 PMCID: PMC10904173 DOI: 10.1016/j.nic.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neuroimaging provides rapid, noninvasive visualization of central nervous system infections for optimal diagnosis and management. Generalizable and characteristic imaging patterns help radiologists distinguish different types of intracranial infections including meningitis and cerebritis from a variety of bacterial, viral, fungal, and/or parasitic causes. Here, we describe key radiologic patterns of meningeal enhancement and diffusion restriction through profiles of meningitis, cerebritis, abscess, and ventriculitis. We discuss various imaging modalities and recent diagnostic advances such as deep learning through a survey of intracranial pathogens and their radiographic findings. Moreover, we explore critical complications and differential diagnoses of intracranial infections.
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Affiliation(s)
- Michael Tran Duong
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jeffrey D Rudie
- Department of Radiology, Scripps Clinic and University of California San Diego, 10666 Torrey Pines Road, La Jolla, CA 92037, USA
| | - Suyash Mohan
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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17
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Evans TJ, Jawad S, Kalyal N, Nadarajah A, Amarouche M, Stapleton S, Ward C, Breathnach A. Retrospective review of the epidemiology, microbiology, management and outcomes of intra-cranial abscesses at a neurosurgical tertiary referral centre, 2018-2020. Ann Clin Microbiol Antimicrob 2022; 21:58. [PMID: 36575518 PMCID: PMC9795649 DOI: 10.1186/s12941-022-00550-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Intracranial abscesses are rare but serious, and are associated with significant morbidity and mortality. Due to both the rarity and severity of these infections, well-controlled trials have not been reported in the literature, and optimal management is a matter for expert opinion. Advances in surgical management have improved outcomes and increased rates of microbiological diagnosis. However, the approach to antimicrobial chemotherapy varies considerably, including the choice of antibiotic, the duration of treatment, and the timing of oral switch. METHODS We conducted a retrospective review of 43 cases of intracranial abscesses from a large, tertiary neurosurgical centre in London, UK, between 2018 and 2020, including 29 primary intra-parenchymal abscesses, 11 subdural abscesses and 3 extradural abscesses. RESULTS The majority of cases had surgical intervention; 6/43 (14%) required repeat intervention (all intra-parenchymal abscesses). A microbiological diagnosis was made in 83% of cases. Intravenous antibiotics were given for a median of 33 days (IQR 23-44 days), with a variable duration of oral follow-on antibiotics. Total duration of antibiotic treatment ranged from 0 to 467 days. Only three patients from our cohort are known to have died. CONCLUSION Shorter courses of intravenous antibiotics for brain abscesses were not associated with increased mortality. In the absence of well-controlled trials, a national registry of intracranial abscesses would provide invaluable data to inform optimal treatment.
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Affiliation(s)
- Terry John Evans
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Jawad
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Nida Kalyal
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Angelina Nadarajah
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Meriem Amarouche
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Simon Stapleton
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Christopher Ward
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
| | - Aodhan Breathnach
- grid.451349.eSt George’s University Hospitals NHS Foundation Trust, London, UK
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18
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Leavitt L, Baohan A, Heller H, Kozanno L, Frosch MP, Dunn G. Surgical management of an abscess of the insula. Surg Neurol Int 2022; 13:591. [PMID: 36600730 PMCID: PMC9805647 DOI: 10.25259/sni_871_2022] [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: 09/20/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background Mass lesions within the insular are diagnostically and surgically challenging due to the numerous critical cortical, subcortical, and vascular structures surrounding the region. Two main surgical techniques - the transsylvian approach and the transcortical approach - provide access to the insular cortex. Of the range of pathologies encountered, abscesses in the insula are surprisingly rare. Case Description A 34-year-old patient was admitted for surgical resection of a suspected high-grade glioma in the insula of the dominant hemisphere. A rapid clinical decline prompted emergent neurosurgical intervention using a transsylvian approach. Surprisingly, abundant purulent material was encountered on entering the insular fossa. Pathological analysis confirmed an insular abscess, although a source of infection could not be identified. The patient required a second evacuation for reaccumulation of the abscess and adjuvant corticosteroids for extensive cerebral edema. Conclusion An abscess located in the insular cortex is an incredibly rare occurrence. Surgical management using the transsylvian approach is one option to approach this region. Familiarity with this approach is thus extremely beneficial in situations requiring emergent access to the dominant insula when awake mapping is not feasible. In addition, treatment of abscesses with adjuvant corticosteroids is indicated when extensive, life-threatening cerebral edema is present.
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Affiliation(s)
- Lydia Leavitt
- Department of Neurosurgery, University of Illinois College of Medicine, Rockford, Illinois
| | - Amy Baohan
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Howard Heller
- Infectious Diseases Division, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Liana Kozanno
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Matthew P. Frosch
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Gavin Dunn
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States.,Corresponding author: Gavin Dunn, Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States.
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19
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Pereira RS, Guerra RC, Hochuli-Vieira E, Alves FRF. Cavernous sinus thrombosis followed by brain ischaemia in a type-1 diabetic patient: a persistent endodontic infection report. AUST ENDOD J 2022; 48:510-514. [PMID: 34637565 DOI: 10.1111/aej.12579] [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: 03/17/2021] [Revised: 08/12/2021] [Accepted: 09/26/2021] [Indexed: 12/14/2022]
Abstract
Central nervous system infections and cavernous sinus thrombosis are associated with high mortality rates and may be a consequence of oral infection propagation. A 24-year-old woman has attended a private dental office with a pain complaint in the upper right central incisor and had the endodontic treatment completed. However, the patient returned to the dental office reporting pain in the same tooth and the presence of swelling. Then, the root canal was retreated. After one week, the patient presented to a Basic Health Unit with a history of vomiting and convulsion crisis followed by loss of consciousness. A computed tomography exam showed cavernous sinus thrombosis and brain ischaemic areas. The present report describes a rare case of cavernous sinus thrombosis followed by brain ischaemia in a type-1 diabetic patient, associated with persistent endodontic infection, with subsequent patient's death.
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Affiliation(s)
- Rodrigo S Pereira
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
| | - Raphael C Guerra
- LeFort Hospital, São Paulo, Brazil.,Metodista University, São Bernardo do Campo, São Paulo, Brazil
| | | | - Flávio R F Alves
- Postgraduate Program in Dentistry, University of Grande Rio (UNIGRANRIO), Rio de Janeiro, Brazil
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20
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Zahed M, Vedula SV, Keyes DC, Grider DJ. Complicated chronic rhinosinusitis: A fatal case in a patient with thalassemia and Crouzon syndrome. OTOLARYNGOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.xocr.2022.100491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Zou J, Shang W, Yang L, Liu T, Wang L, Li X, Zhao J, Rao X, Gao J, Fan X. Microglia activation in the mPFC mediates anxiety-like behaviors caused by Staphylococcus aureus strain USA300. Brain Behav 2022; 12:e2715. [PMID: 35977050 PMCID: PMC9480961 DOI: 10.1002/brb3.2715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/19/2022] [Accepted: 07/07/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Staphylococcus aureus (S. aureus) is considered as one of the major causative agents of serious hospital- and community-acquired infections. Recent studies have reported that S. aureus infection induced neuroinflammation and was linked with some mental disorders. To evaluate the effects of S. aureus infection on abnormal behaviors, we conducted the present study. METHODS A S. aureus USA300-infected mouse model was established using bacterial suspension injection into tail vein. A series of behavioral tests were performed after USA300 infection. The expression of cytokines was detected in serum and mPFC. The number and some morphological parameters of microglia were also evaluated by immunofluorescence staining. RESULTS Anxiety-like behaviors, instead of locomotor activity impairment or depression-like behaviors, were observed in mice infected with S. aureus USA300 compared with control. S. aureus USA300 infection caused overexpression of IL-6, TNF-α, and IL-1β in serum, resulted in microglial over-activation and excessive release of proinflammatory cytokines in the mPFC. In addition, overexpression of TLR2 accompanied by increased GLS1 and p-STAT3 was observed in the mPFC of mice infected with S. aureus USA300. CONCLUSION This study provides evidence that S. aureus USA300 infection can lead to neuroinflammation in the mPFC of mice, which may contribute to the development of anxiety.
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Affiliation(s)
- Jiao Zou
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Weilong Shang
- Department of Microbiology, College of Basic Medical Sciences, Third Military Medical University (Army Medical University), Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Ling Yang
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Tianyao Liu
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lian Wang
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xin Li
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jinghui Zhao
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiancai Rao
- Department of Microbiology, College of Basic Medical Sciences, Third Military Medical University (Army Medical University), Key Laboratory of Microbial Engineering under the Educational Committee in Chongqing, Chongqing, China
| | - Junwei Gao
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaotang Fan
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, China
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22
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Kameda-Smith MM, Duda T, Duncan DB, Ragulojan M, Jung Y, Farrokhyar F, Main C, Reddy K. Retrospective Review of the Clinical Outcomes of Surgically Managed Patients with Intracranial Abscesses: A Single-Center Review. World Neurosurg 2022; 165:e697-e711. [PMID: 35798293 DOI: 10.1016/j.wneu.2022.06.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study analyzed patient, radiologic, and clinical factors associated with operative brain abscesses and patients' functional outcomes. METHODS A retrospective analysis was conducted of neurosurgical cases of brain abscesses from 2009 to 2019 at a Canadian center. Functional outcome was recorded as Modified Rankin Scale score and Extended Glasgow Outcome Scale score. Multivariate analysis was conducted to identify relevant prognostic factors. RESULTS We identified 139 patients managed surgically for brain abscesses. Resection alone was performed in 64% of patients, whereas 26.6% underwent aspiration alone. Most were adults (93.2%) and male (68.3%). Immunocompromise risk factors included diabetes (24.5%), cancer (23.7%), and immunosuppressive therapy (11.5%). Likely sources were postoperative (17.3%), systemic spread (16.5%), and poor dentition (12.9%). Microorganisms cultured from abscess samples were mixed growth (28%), Streptococcus anginosus (24.5%), and Staphylococcus aureus (7.9%). Disposition was home (42.4%) or repatriation to a home hospital (50.4%). By Extended Glasgow Outcome Scale, 25.2% had an unfavorable outcome including a mortality of 11.5%. Factors on multivariate analysis associated with poor outcome included diabetes (odds ratio, 2.8; 95% confidence interval [CI], 1.2-5.0) and ventricular rupture (odds ratio, 5.0; 95% CI, 1.7-13.5; hazard ratio, 12; 95% CI, 3.9-37.0). Supratentorial superficial eloquently located abscess was also associated with poor outcome (hazard ratio, 5.5; 95% CI, 1.8-16.7). Outcomes were similar with surgical excision and aspiration. CONCLUSIONS Ventricular rupture and diabetes are significant risk factors for poor outcomes in intraparenchymal brain abscesses. No clear difference in outcomes was found between surgical excision or aspiration in our retrospective cohort.
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Affiliation(s)
| | - Taylor Duda
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Donald B Duncan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malavan Ragulojan
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Yongkyung Jung
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Main
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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23
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Srichawla BS. Plasma Microbial Cell-Free DNA (CF-DNA) Next-Generation Sequencing in Diagnosing Intracranial Abscesses: Pathophysiology and a Scoping Review of the Literature. Cureus 2022; 14:e28172. [PMID: 36148190 PMCID: PMC9482791 DOI: 10.7759/cureus.28172] [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: 08/19/2022] [Indexed: 11/26/2022] Open
Abstract
Plasma microbial cell-free DNA (cf-DNA) from next-generation sequencing (NGS) provides improved sensitivity and specificity compared to standard microbial blood cultures. cf-DNA sequencing also has an improved turnaround time (TAT) and allows quicker commencement of antibiotics in life-threatening infections such as a brain abscess. Brain abscesses carry significant morbidity and mortality. Empiric treatment and management are critical in improving functional neurological outcomes. Reported here is the case of a severe central nervous system (CNS) infection with multiple ring-enhancing lesions seen throughout the cerebrum on magnetic resonance imaging (MRI). Standard microbial blood cultures were inconclusive and definitive identification of the pathogen was achieved through microbial cf-DNA NGS. Brain abscesses develop in four distinct phases: early cerebritis, late cerebritis, early capsule formation, and late capsule formation. The pathogenesis of cerebral abscess involves direct parenchymal inflammation of the pathogen, the recruitment of inflammatory CNS cell types (microglia, inflammatory astrocytes, etc), and the chemotaxis of immune cells. cf-DNA is released into the bloodstream in response to pathogen opsonization and immune-mediated cell death. A scoping literature review includes cases of intracranial abscesses diagnosed via cf-DNA NGS.
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24
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Amorim RP, Henriques VM, Junior FT, Reis VG, Bulhões SO. Hydrocephalus and Intracranial Hypertension by an Odontogenic Brain Abscess. Cureus 2022; 14:e26945. [PMID: 35989854 PMCID: PMC9380847 DOI: 10.7759/cureus.26945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2022] [Indexed: 11/08/2022] Open
Abstract
Brain abscesses are rare and severe infections with high mortality, corresponding to neurosurgical emergencies. 12% of all abscesses are caused by odontogenic etiologies, either an infectious process or a dental procedure. This paper describes a case of a patient who underwent tooth extraction, presenting days later with hydrocephalus and intracranial hypertension due to a brain abscess, whose isolated pathogen is the same identified in the oral cavity.
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25
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Verghese RJ, Balamurugesan K, Hamide A, Kumar A. A Common Neurological Presentation With an Unusual Etiology: Dense Hemiplegia Due to Pneumococcal Meningitis. Cureus 2022; 14:e26624. [PMID: 35949735 PMCID: PMC9356653 DOI: 10.7759/cureus.26624] [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: 07/07/2022] [Indexed: 12/02/2022] Open
Abstract
Acute hemiplegia is a common neurological presentation that usually occurs due to a cerebrovascular accident. A similar presentation may also be seen in several other conditions such as postictal (Todd’s) paralysis, hemiplegic migraine, brain abscess, and extradural or subdural hemorrhage. We present the case of a 32-year-old South Indian female who was brought to the emergency department with acute hemiplegia and decreased responsiveness for one day. She was provisionally diagnosed with an ischemic stroke at presentation; however, contrast-enhanced computed tomography (CECT) of the brain with CT angiography and venography revealed no focal lesions or filling defects. CSF examination showed gram-positive cocci in pairs, concerning brain abscess. Magnetic resonance imaging (MRI) of the brain was suggestive of multiple evolving abscesses in the right frontal and parietal lobes. Her hemiplegia was attributed to the abscess, and she was given six weeks of intravenous (IV) antibiotics, after which she recovered completely. Maintaining a high index of clinical suspicion enabled the correct diagnosis in a patient who did not have any typical features of acute meningitis.
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26
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Gil RK, Yu J, Izquierdo-Pretel G. Asymptomatic Cryptogenic Brain Abscess: A Case Report. Cureus 2022; 14:e26644. [PMID: 35949748 PMCID: PMC9356766 DOI: 10.7759/cureus.26644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/05/2022] Open
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27
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Chetty M, Rakhi B, Rachana K, Sujatha S, Srinivasan GM. An Eight Year Clinico-Microbiological Retrospective Study on Brain Abscesses in India. Microbiol Insights 2022; 15:11786361221106111. [PMID: 35784588 PMCID: PMC9247994 DOI: 10.1177/11786361221106111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Intracranial abscesses have been a diagnostic and therapeutic challenge since
time immemorial for both the microbiologists and the neurosurgeons. There is
paucity of detailed studies documenting the infecting organism causing brain
abscesses in South India. Aims: The study aimed at identifying and assessing the prevalence of aerobic,
anaerobic bacteria and fungi associated with brain abscesses at a tertiary
care hospital in South India. Methods and Material: Eight years data was collected from the records of culture reports from 2007
to 2010 and 2013 to 2018. The corresponding clinical case records were
retrieved for the assessment of risk factors. Risk factors of brain abscess
development were assessed based on clinical cases records. Results: Data from 140 brain abscess cases obtained over a period of 8 years were
analyzed. Out of the 140 samples, 66 (47.14%) were culture positive in which
33 (50%) had single aerobic/facultative anaerobic bacteria, 20 (30.3%) had
mixture of more than one aerobic/facultative anaerobic bacteria, 12 (18.18%)
had single obligate anaerobic bacteria and 1(1.5%) sample had
Mycobacterium tuberculosis isolated. Among the total 92
isolates, Pseudomonas aeruginosa (21/92, 23%) and
Staphylococcus aureus (20/92, 22%) predominated.
Bacteroides fragilis group was the most common obligate
anaerobe isolated. There were no fungal isolates. As there were various
isolates isolated, hence there is heterogeneity of isolates detected
Neuroanatomically, parietal lobe (45/140, 32%) was the most common location.
Otogenic infection was the major risk factor for parietal and temporal lobe
abscess (P value < .05). Conclusions: It has become essential for the microbiologists to be aware of unusual
isolates from brain abscess and its complex nature. Obscurity and difficulty
in their microbiological diagnosis calls for more such detailed studies.
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Affiliation(s)
- Meghna Chetty
- Department of Microbiology, PIMS, Kalapet, Puducherry, India
| | - Biswas Rakhi
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Kannambath Rachana
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sistla Sujatha
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Gopalkrishnan Muthu Srinivasan
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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28
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Opara NU. Cortical Blindness Due to Neurocysticercosis in an Adolescent Patient. Trop Med Infect Dis 2022; 7:tropicalmed7060096. [PMID: 35736975 PMCID: PMC9230689 DOI: 10.3390/tropicalmed7060096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 11/16/2022] Open
Abstract
Neurocysticercosis (NCC) is a common cause of recent-onset seizures in both adults and children in tropical areas, especially when there is no other suggestion of another underlying neurological disorder. In addition, there have been reports of very rare cases of bilateral cortical blindness caused by this helminth in children. It is still unclear whether healthy adolescents with no pre-existing health problems could be vulnerable to developing such sequelae due to NCC. We report a case of a 14-year-old African boy from Nigeria with bilateral cortical blindness caused by NCC due to Taenia solium. According to the boy’s mother, symptoms began with headaches, vomiting, fatigue, visual loss, and fever (40.0 °C). Clinical investigations led to a diagnosis of cortical blindness and encephalitis due to NCC. Appropriate treatment was administered, and it resulted in the resolution of most symptoms, though the patient remained permanently blind.
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Affiliation(s)
- Nnennaya U Opara
- Department of Emergency Medicine, Charleston Area Medical Center, Institute for Academic Medicine, Charleston, WV 25304, USA
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Carloni A, Bernardini M, Mattei C, De Magistris AV, Llabres-Diaz F, Williams J, Gutierrez-Quintana R, Oevermann A, Schweizer-Gorgas D, Finck C, Masseau I, Lorenzo V, Sabatini A, Contiero B, Specchi S. Can MRI differentiate between ring-enhancing gliomas and intra-axial abscesses? Vet Radiol Ultrasound 2022; 63:563-572. [PMID: 35509117 DOI: 10.1111/vru.13098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022] Open
Abstract
Gliomas of the brain may appear as expansile ring-enhancing masses in MRI studies, mimicking the appearance of intra-axial abscesses. The aims of this study were to compare the MRI features of ring-enhancing gliomas and intra-axial brain abscesses in dogs and cats and to identify the characteristics that might help differentiate them. For this multicenter, retrospective, and observational study, the inclusion criteria were as follows: (a) a definitive diagnosis of glioma or abscess based on cytological or histopathological examination following CSF collection or surgical biopsy/necropsy, respectively; (b) MRI study performed with a high- or low-field MRI scanner, including a same plane T1W pre- and postcontrast, a T2W and a T2 FLAIR sequence in at least one plane. If available, delayed T1W postcontrast, T2*W GE, DWI/ADC, and SWI sequences were also evaluated. Sixteen patients were diagnosed with ring-enhancing gliomas, and 15 were diagnosed with intra-axial abscesses. A homogenous signal on T1W (P = 0.049) and T2W (P = 0.042) sequences, a T2W (P = 0.005) or T2*W GE (P = 0.046) peripheral hypointense halo, and an even enhancing capsule (P = 0.002) were significantly associated with brain abscesses. A progressive central enhancement on delayed T1W postcontrast sequences was correlated with ring-enhancing gliomas (P = 0.009). The combination of the following features was suggestive of brain abscess: homogeneous T1W or T2W signal intensity, a T2W or T2*W GE peripheral hypointense halo and an evenly enhancing capsule. Central progression of enhancement on delayed T1W postcontrast sequences was suggestive of glioma.
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Affiliation(s)
- Andrea Carloni
- Diagnostic Imaging Department, Veterinary Hospital "I Portoni Rossi" Anicura Italy, Zola Predosa, Bologna, Italy
| | - Marco Bernardini
- Diagnostic Imaging Department, Veterinary Hospital "I Portoni Rossi" Anicura Italy, Zola Predosa, Bologna, Italy.,Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Padua, Legnaro, Italy
| | - Chiara Mattei
- Diagnostic Imaging Department, Veterinary Hospital "I Portoni Rossi" Anicura Italy, Zola Predosa, Bologna, Italy
| | - Angela Vittoria De Magistris
- Diagnostic Imaging Department, Veterinary Hospital "I Portoni Rossi" Anicura Italy, Zola Predosa, Bologna, Italy
| | | | - Jonathan Williams
- Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
| | - Rodrigo Gutierrez-Quintana
- School of Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, UK
| | - Anna Oevermann
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | - Cyrielle Finck
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Isabelle Masseau
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | | | | | - Barbara Contiero
- Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Padua, Legnaro, Italy
| | - Swan Specchi
- Diagnostic Imaging Department, Veterinary Hospital "I Portoni Rossi" Anicura Italy, Zola Predosa, Bologna, Italy
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Borni M, Znazen M, Kolsi F, Zaher Boudawara M. Clinico-radiological assessment and therapeutic management of intracranial suppurations: Bicentric series of 43 cases with literature review. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mabaso SH, Bhana-Nathoo D, Lucas S. An audit of CT brain findings in adults with new-onset seizures in a resource restricted setting in South Africa. SA J Radiol 2022; 26:2294. [PMID: 35169503 PMCID: PMC8831926 DOI: 10.4102/sajr.v26i1.2294] [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] [Received: 09/05/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background Globally, adults presenting with seizures account for 1% – 2% of visits to emergency departments (EDs), of which 25% are new-onset seizures. Neuroimaging is essential as part of the initial workup. Multiple studies have demonstrated abnormal CT brain (CTB) findings in these patients. Objectives To review the CTB findings in adults presenting with new-onset seizures in a resource restricted setting. Method A retrospective review of 531 CTBs was conducted at a tertiary hospital in Gauteng on adults presenting to the ED with new-onset seizures. Results The mean age of the patients was 45.6 ± 17.1 years, and the male to female ratio was 1.2:1. Generalised and focal seizure types were almost equally represented. Of the total 531 patients, 168 (31.6%) were HIV positive. The CTB findings were abnormal in 257 (48.4%) patients, albeit vascular pathology accounted for 21.9%. Infective pathology accounted for 14.1% with a statistically significant association with HIV (p = 0.003). Trauma related pathology was 2.4%, whilst neoplastic pathology was seen in 3.0%. Other causes included congenital pathology, calcifications, atrophy and gliosis. Clinical factors associated with abnormal CTB findings were age ≥ 40 years, HIV infection, hypertension, focal seizures, low Glasgow Coma Scale (GCS), raised cerebrospinal fluid (CSF) protein and presence of lymphocytes. Conclusion A high yield of abnormal CTB findings was noted in adult patients who presented with new-onset seizures, supporting the use of urgent CTB in patients with certain clinical risk factors. Patients without these risk factors can be scanned within 24–48 h in a resource restricted setting.
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Affiliation(s)
- Sabelo H Mabaso
- Department of Radiology, Faculty of Health Sciences, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Deepa Bhana-Nathoo
- Department of Radiology, Faculty of Health Sciences, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Susan Lucas
- Department of Radiology, Faculty of Health Sciences, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Phuna ZX, Madhavan P. A CLOSER LOOK AT THE MYCOBIOME IN ALZHEIMER'S DISEASE: FUNGAL SPECIES, PATHOGENESIS AND TRANSMISSION. Eur J Neurosci 2022; 55:1291-1321. [DOI: 10.1111/ejn.15599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Zhi Xin Phuna
- School of Medicine, Faculty of Health & Medical Sciences, Taylor’s University Malaysia Subang Jaya Selangor
| | - Priya Madhavan
- School of Medicine, Faculty of Health & Medical Sciences, Taylor’s University Malaysia Subang Jaya Selangor
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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
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Holla VV, Prasad S, Pal PK. Neurological effects of respiratory dysfunction. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:309-329. [PMID: 36031312 DOI: 10.1016/b978-0-323-91532-8.00001-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The respiratory and the nervous systems are closely interconnected and are maintained in a fine balance. Central mechanisms maintain strict control of ventilation due to the high metabolic demands of brain which depends on a continuous supply of oxygenated blood along with glucose. Moreover, brain perfusion is highly sensitive to changes in the partial pressures of carbon dioxide and oxygen in blood, which in turn depend on respiratory function. Ventilatory control is strictly monitored and regulated by the central nervous system through central and peripheral chemoreceptors, baroreceptors, the cardiovascular system, and the autonomic nervous system. Disruption in this delicate control of respiratory function can have subtle to devastating neurological effects as a result of ensuing hypoxia or hypercapnia. In addition, pulmonary circulation receives entire cardiac output and this may act as a conduit to transmit infections and also for metastasis of malignancies to brain resulting in neurological dysfunction. Furthermore, many neurological paraneoplastic syndromes can have underlying lung malignancies resulting in respiratory dysfunction. It is essential to understand the underlying mechanisms and the resulting manifestations in order to prevent and effectively manage the many neurological effects of respiratory dysfunction. This chapter explores the various neurological effects of respiratory dysfunction with focus on their pathophysiology, etiologies, clinical features and long-term neurological sequelae.
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Affiliation(s)
- Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India; Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India.
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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]
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Zhao Y, Lian B, Liu X, Wang Q, Zhang D, Sheng Q, Cao L. Case report: Cryptogenic giant brain abscess caused by Providencia rettgeri mimicking stroke and tumor in a patient with impaired immunity. Front Neurol 2022; 13:1007435. [PMID: 36212658 PMCID: PMC9538924 DOI: 10.3389/fneur.2022.1007435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
The highly lethal cryptogenic brain abscess can be easily misdiagnosed. However, cryptogenic brain abscess caused by Providencia rettgeri is rarely reported. We present the case of a cryptogenic Providencia rettgeri brain abscess and analyze the clinical manifestations, imaging findings, treatment, and outcome to improve the level of awareness, aid in accurate diagnosis, and highlight effective clinical management. A 39-year-old man was admitted to the hospital after experiencing acute speech and consciousness disorder for 1 day. The patient had a medical history of nephrotic syndrome and membranous nephropathy requiring immunosuppressant therapy. Magnetic resonance imaging revealed giant, space-occupying lesions involving the brain stem, basal ganglia, and temporal-parietal lobes without typical ring enhancement, mimicking a tumor. Initial antibiotic treatment was ineffective. Afterward, pathogen detection in cerebrospinal fluid using metagenomic next-generation sequencing revealed Providencia rettgeri. Intravenous maximum-dose ampicillin was administered for 5 weeks, and the patient's symptoms resolved. Cryptogenic Providencia rettgeri brain abscess typically occurs in patients with impaired immunity. Our patient exhibited a sudden onset with non-typical neuroimaging findings, requiring differentiation of the lesion from stroke and brain tumor. Metagenomic next-generation sequencing was important in identifying the pathogen. Rapid diagnosis and appropriate use of antibiotics were key to obtaining a favorable outcome.
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Affiliation(s)
- Yu Zhao
- Department of Neurology, Shenzhen Third People's Hospital, Shenzhen, China
- Department of Neurology, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Baorong Lian
- Shantou University Medical College, Shantou University, Shantou, China
| | - Xudong Liu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Qizheng Wang
- Department of Neurology, Shenzhen Third People's Hospital, Shenzhen, China
- Department of Neurology, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Daxue Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Qi Sheng
- Department of Neurology, Shenzhen Third People's Hospital, Shenzhen, China
- Department of Neurology, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Liming Cao
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- *Correspondence: Liming Cao
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Ryu B, Khatri D, Zlochower A, Maslak S, D'Amico RS. Erosion of the sella turcica and pituitary expansion secondary to polymicrobial brain abscesses: a case report. Access Microbiol 2021; 3:000270. [PMID: 34816090 PMCID: PMC8604177 DOI: 10.1099/acmi.0.000270] [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: 03/26/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Brain abscesses can lead to a diverse array of complications, especially when they are polymicrobial in nature. Multiple underlying pathogens may present with a unique set of clinical symptoms which require an early identification and treatment. Skull base osteomyelitis with sellar floor erosion and pituitary involvement with SIADH are such rare complications of brain abscesses which have never been reported previously in the literature. Case Presentation We report the case of an immunocompetent 38-year-old male with altered mental sensorium and left hemiparesis due to polymicrobial brain abscess which required surgical evacuation. The post-operative recovery was complicated by severe hyponatremia secondary to SIADH which was treated uneventfully. Radiological imaging demonstrated pituitary enlargement with herniation through an eroded sella turcica without active CSF leak. Patient responded well to the antibiotic therapy based on microbiological susceptibility testing with a complete resolution of the pituitary enlargement on radiological follow-up. Conclusion Conservative treatment with targeted antibiotics can lead to the resolution of pituitary enlargement secondary to a brain abscess. However, a close clinical follow-up is required to look for a CSF leak considering the sellar floor erosion due to osteomyelitis.
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Affiliation(s)
- Brendan Ryu
- Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Deepak Khatri
- Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Avraham Zlochower
- Department of Radiology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Stephen Maslak
- Department of Internal Medicine, Division of Infectious Diseases, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Randy S D'Amico
- Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
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Dhar S, Pal B. Analysis of 93 Brain Abscess Cases to Review the Effect of Intervention to Determine the Feasibility of the Management Protocol: A Tertiary Care Perspective. Asian J Neurosurg 2021; 16:483-487. [PMID: 34660357 PMCID: PMC8477837 DOI: 10.4103/ajns.ajns_467_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/23/2020] [Accepted: 04/10/2021] [Indexed: 11/04/2022] Open
Abstract
Context Brain abscess is a suppurative process within the brain parenchyma, which remains a challenge for clinicians. Surgical excision or aspiration combined with prolonged antibiotics (usually 4-8 weeks) or only conservative management remains the treatment of choice. Aims The purpose of this study is to analyze the epidemiology of brain abscess and to determine the potential factors leading to better outcomes. Settings and Design This was a retrospective analysis of 93 patients undergoing various treatment options for brain abscess in a tertiary care center. Materials and Methods Their preoperative status, etiology, and microbiological and clinical outcomes were analyzed. Statistical Analysis Used Statistical analysis was done by Chi-square, one-way analysis of variance, and post hoc Newman-Keuls multiple comparison test wherever applicable using SPSS software. Results Among 93 brain abscess cases, only 21 cases had a diameter <2.5 cm. Among them, conservative treatment was done for 38% of patients (8/21), aspiration for 47.6% (10/21) of patients, and excision for only 3 (14.2%) of cases. About 37.5% (3/8) persons among these conservatively managed patients had recurrence. None of the patients of <2.5 cm abscess having surgical management had recurrence or any new neurological deficits postsurgery during the 6-month follow-up. Conclusions There was a significantly high recurrence among the nonsurgically treated patients with lesions <2.5 cm and there was no recurrence or neurological deficit after aspiration among these patients. Probably, aspiration has better results among these patients contrary to previous recommendations of antibiotic therapy alone.
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Affiliation(s)
- Sambuddha Dhar
- Department of Neurosurgery, Institute of Medical Sciences-Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Barnava Pal
- Department of Anesthesiology, Institute of Medical Sciences-Banaras Hindu University, Varanasi, Uttar Pradesh, India.,Department of Anesthesiology, JIMSH, Kolkata, West Bengal, India
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Liotta EM. Management of Cerebral Edema, Brain Compression, and Intracranial Pressure. Continuum (Minneap Minn) 2021; 27:1172-1200. [PMID: 34618757 DOI: 10.1212/con.0000000000000988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article reviews the pathophysiology and management of cerebral edema, brain compression, and elevated intracranial pressure (ICP). It also provides a brief introduction to the concept of the glymphatic system and select cellular contributors to cerebral edema. RECENT FINDINGS Cerebral edema and brain compression should be treated in a tiered approach after the patient demonstrates a symptomatic indication to start treatment. All patients with acute brain injury should be treated with standard measures to optimize intracranial compliance and minimize risk of ICP elevation. When ICP monitors are used, therapies should target maintaining ICP at 22 mm Hg or less. Evidence exists that serial clinical examination and neuroimaging may be a reasonable alternative to ICP monitoring; however, clinical trials in progress may demonstrate advantages to advanced monitoring techniques. Early decompressive craniectomy and hypothermia are not neuroprotective in traumatic brain injury and should be reserved for situations refractory to initial medical interventions. Medical therapies that acutely lower plasma osmolality may lead to neurologic deterioration from osmotic cerebral edema, and patients with acute brain injury and renal or liver failure are at elevated risk. SUMMARY A tiered approach to the management of cerebral edema and brain compression can reduce secondary brain injury when implemented according to core physiologic principles. However, our knowledge of the pathophysiology of acute brain injury is incomplete, and the conceptual framework underlying decades of clinical management may need to be revised in response to currently evolving discoveries regarding the pathophysiology of acute brain injury.
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Murali S, Shenoy SV, Prabhu RA, Nagaraju SP. Hypertensive emergency and seizures during haemodialysis. BMJ Case Rep 2021; 14:e242471. [PMID: 34548293 PMCID: PMC8458320 DOI: 10.1136/bcr-2021-242471] [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] [Accepted: 08/26/2021] [Indexed: 11/04/2022] Open
Abstract
Intracranial abscesses are uncommon, serious and life-threatening infections. A brain abscess is caused by inflammation and collection of infected material, coming from local or remote infectious sources. Patients with chronic kidney disease on dialysis are prone to invasive bacterial infections like methicillin-resistant Staphylococcus aureus (MRSA) especially in the presence of central venous catheters or arteriovenous grafts. However, intracranial abscess formation due to MRSA is rare. Here, we present a case of MRSA brain abscess with an atypical clinical presentation in the absence of traditional risk factors.Intracranial abscesses are uncommon, serious, and life-threatening infections. A Brain abscess is caused by inflammation and collection of infected material, coming from local or remote infectious sources. Patients with chronic kidney disease on dialysis are prone to invasive bacterial infections like methicillin-resistant staphylococcus aureus (MRSA) especially in the presence of central venous catheters or arterio-venous grafts. However intracranial abscess formation due to MRSA is rare. Here we present a case of MRSA brain abscess with an atypical clinical presentation in the absence of traditional risk factors. A 46-year-old male with chronic kidney disease (CKD) secondary to chronic glomerulonephritis, on haemodialysis for 4 years through a left brachio-cephalic AVF developed an episode of generalised tonic-clonic seizures lasting 2 min during his scheduled dialysis session. He reported no complaints before entry to the dialysis. On clinical examination, he was drowsy with the absence of any focal motor deficits. His blood pressure was recorded to be 200/120 mm Hg. He was managed in the intensive care unit with mechanical ventilation, intravenous nitroglycerine for blood pressure control, levetiracetam for seizures and empirical vancomycin. Radiological evaluation showed a brain abscess in the midline involving bosth basi-frontal lobes. After medical optimization, the abscess was drained surgically, and the pus cultured. As culture grew Methicillin Resistant Staphylococcus aureus, he was treated with intravenous vancomycin for 6 weeks. On follow up, the abscess had resolved and the patient recovered without any neurological deficits.
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Affiliation(s)
| | | | - Ravindra Attur Prabhu
- Department of Nephrology, Kasturba Medical College Manipal, Manipal, Karnataka, India
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Anand P. Neurologic Infections in Patients on Immunomodulatory and Immunosuppressive Therapies. ACTA ACUST UNITED AC 2021; 27:1066-1104. [PMID: 34623105 DOI: 10.1212/con.0000000000000985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Both broadly immunosuppressive medications and selective immunomodulatory agents that act on particular components of the immune system are increasingly used in the treatment of neurologic and non-neurologic diseases. These therapies predispose patients to particular infections, some of which may affect the nervous system. Therefore, familiarity with the clinical and radiologic features of neurologic infections associated with specific immunomodulatory therapies is of importance for the practicing neurologist. This article reviews these neuroinfectious conditions, as well as other neurologic complications unique to transplant recipients and other patients who are immunocompromised. RECENT FINDINGS Diagnosis of infectious pathogens in patients who are immunocompromised may be particularly challenging because a decreased immune response can lead to atypical imaging or laboratory findings. Next-generation sequencing and other novel diagnostic modalities may improve the rate of early identification of neurologic infections in patients who are immunocompromised and ultimately ameliorate outcomes in this vulnerable population. SUMMARY A broad range of bacterial, viral, fungal, and parasitic infections of the nervous system can complicate solid organ and hematopoietic cell transplantation as well as other forms of immunocompromise. In addition to neurologic infections, such patients are at risk of neurotoxic and neuroinflammatory complications related to immunomodulatory and immunosuppressive therapies. Early recognition of infectious and noninfectious complications of immunocompromise is essential to guide appropriate treatment, which can include antimicrobial therapy and, in some cases, withdrawal of the predisposing medication with a transition to an alternative regimen.
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Lakhdar F, Benzagmout M, Chakour K, Chaoui M. Bulbo-medullary abscess’s management. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Darmawan AB, Azkia ES. Right hemiparesis caused by massive otogenic brain abscess in children: Unusual case report and review of the literature. Int J Surg Case Rep 2021; 83:105987. [PMID: 34029843 PMCID: PMC8166752 DOI: 10.1016/j.ijscr.2021.105987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/30/2021] [Accepted: 05/08/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Hemiparesis caused by otogenic brain abscess in children is an unusual complication of Chronic Suppurative Otitis Media. Complications can occur when the disease is not treated properly so that the infection in the middle ear spreads intracranially. Case presentation We report a case of Chronic Suppurative Otitis Media with cholesteatoma in a 14-year-old boy with complications of right hemiparesis caused by an otogenic brain abscess. His management included open craniotomy, drainage of the abscess, radical mastoidectomy and intravenous antibiotics according to the result of the culture and sensitivity. Clinical discussion Commonly, the location of the abscess is closely related to the source of infection. Affected brain lobes usually depend on predisposing factors that cause the development of brain abscesses. In this case, clinical manifestations appear in the form of contralateral hemiparesis even though the source of infection comes from the ear. This can occur due to massive abscesses and the presence of extensive perifocal edema which results in pressure in the subcortex area. The patient underwent radical mastoidectomy in conjunction with an abscess excision craniotomy. Conclusion Hemiparesis caused by an otogenic brain abscess is unusual. Rapid and precise diagnosis and treatment can minimize patient mortality and morbidity. In the antibiotic era, right hemiparesis caused by otogenic brain abscess in children is uncommon. It is life-threatening if not treated properly. Hemiparesis occurs because of the massive abscess in the frontal and parietal lobe area. A collaboration between a neurosurgeon and an otologist to manage the disease was performed on the same occasion, showing good results.
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Affiliation(s)
- Anton Budhi Darmawan
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Universitas Jenderal Soedirman-Margono Soekarjo Hospital, Purwokerto, Indonesia.
| | - Ema Shofiana Azkia
- Department of Neurosurgery, Faculty of Medicine, Universitas Jenderal Soedirman-Margono Soekarjo Hospital, Purwokerto, Indonesia
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Dey R, Bishayi B. Ciprofloxacin and dexamethasone in combination attenuate S. aureus induced brain abscess via neuroendocrine-immune interaction of TLR-2 and glucocorticoid receptor leading to behavioral improvement. Int Immunopharmacol 2021; 97:107695. [PMID: 33962227 DOI: 10.1016/j.intimp.2021.107695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/06/2021] [Accepted: 04/18/2021] [Indexed: 12/14/2022]
Abstract
Staphylococcus aureus induced brain abscess is a critical health concern throughout the developing world. The conventional surgical intervention could not regulate the abscess-induced brain inflammation. Thus further study over the alternative therapeutic strategy for treating a brain abscess is of high priority. The resident glial cells recognize the invading S. aureus by their cell surface Toll-like receptor-2 (TLR-2). Glucocorticoid receptor (GR) was known for its immunosuppressive effects. In this study, an attempt had been taken to utilize the functional relationship or cross-talking between TLR-2 and GR during the pathogenesis of brain abscesses. Here, the combination of an antibiotic (i.e. ciprofloxacin) and dexamethasone was used to regulate the brain inflammation either in TLR-2 or GR blocking condition. We were also interested to figure out the possible impact of alternative therapy on behavioral impairments. The results indicated that combination treatment during TLR-2 blockade significantly reduced the bacterial burden and abscess area score in the infected brain. However, marked improvements were observed in anxiety, depression-like behavior, and motor co-ordination. The combination treatment after TLR-2 blocking effectively scavenged free radicals (H2O2, superoxide anion, and NO) through modulating antioxidant enzyme activities that ultimately control S. aureus induced glial reactivity possibly via up-regulating GR expression. The exogenous dexamethasone might regulate the GR expression in the brain by increasing the corticosterone concentration and the GC-GR mediated signaling. Therefore, this in-vivo study demonstrates the possible regulatory mechanism of bacterial brain abscess that involved TLR-2 and GR as a part of neuroendocrine-immune interaction.
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Affiliation(s)
- Rajen Dey
- Department of Physiology, Immunology Laboratory, University of Calcutta, University Colleges of Science and Technology, Calcutta, West Bengal, India
| | - Biswadev Bishayi
- Department of Physiology, Immunology Laboratory, University of Calcutta, University Colleges of Science and Technology, Calcutta, West Bengal, India.
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Rens J, Van Thielen T, Derweduwen A, Goedseels K, Hes R, de Jong L. Screening in cryptogenic brain abscess: Do not forget pulmonary arteriovenous malformations. Surg Neurol Int 2021; 12:188. [PMID: 34084616 PMCID: PMC8168651 DOI: 10.25259/sni_51_2021] [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: 01/19/2021] [Accepted: 04/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Brain abscess usually occurs secondary to trauma, through contiguous spread (e.g.; dental infections, [paranasal] sinusitis, otitis, and mastoiditis), after intracranial neurosurgical procedures, or through hematogenous spread in case of an arteriovenous (AV) shunt, for example; atrial septum defect. Although uncommon, another possible cause of AV shunt which can facilitate brain abscess is a pulmonary arteriovenous malformation (PAVM). We report a case of brain abscess secondary to a solitary PAVM and review the literature. Case Description: A 74-year-old male patient presented with headaches, fatigue, low-grade fever, and homonymous hemianopsia. He was diagnosed with a brain abscess in the left occipital lobe. A chest computed tomography (CT) with intravenous (IV) contrast was performed because of fever and respiratory insufficiency in a period where screening for COVID-19 in suspected patients was important. A solitary PAVM of the left lung was diagnosed. Initial stereotactic burr hole drainage of the abscess was insufficient and resection of the abscess was deemed necessary. Routine workup did not reveal any additional pathology apart from the PAVM. After treatment of the cerebral abscess, the PAVM was treated with embolization using an endovascular plug. Conclusion: It is recommended to screen for PAVM by chest CT with IV contrast in patients with brain abscess when no obvious source of infection can be identified.
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Affiliation(s)
- Jasmien Rens
- Department of Neurosurgery, AZ Klina, Brasschaat, Belgium
| | | | | | - Koen Goedseels
- Department of Neurosurgery, AZ Klina, Brasschaat, Belgium
| | - Robert Hes
- Department of Neurosurgery, AZ Klina, Brasschaat, Belgium
| | - Lars de Jong
- Department of Neurosurgery, AZ Klina, Brasschaat, Belgium
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Abdulghani YS, Elzain MA, Ahmed ADS, Abdelhalim SA. Brain abscess burr hole aspiration in children with congenital heart disease in low facility centers: case series. Sudan J Paediatr 2021; 21:61-66. [PMID: 33879945 DOI: 10.24911/sjp.106-1589487269] [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: 11/11/2022]
Abstract
This is a prospective cross-sectional study on brain abscess burr hole aspiration in children with congenital heart disease (CHD) performed from January 2018 to March 2019. All patients were operated on through a burr hole, and then received intravenous antibiotics for 6 weeks and orally for 2 weeks either empirically or according to the results of abscess culture, if positive. The follow-up of cranial computed tomography or brain magnetic resonance image with contrast was obtained after 2 months (post-operatively) to assess the effectiveness of the procedure and to look for any residual or recurrent abscesses. Data were collected in a designed data collection sheet and analysed using Statistical Package for the Social Sciences-20. Thirteen patients were found to satisfy inclusion criteria. The most common presenting symptoms were fever (n = 11/13, 84.6%), vomiting (n = 7/13, 53.8%), headache (n = 6/13, 46.2%), convulsions (n = 6/13, 46.2%), focal weakness (n = 3/13, 23.1%), and impaired level of consciousness (n = 1/13, 7.7%). No bacterial growth was detected in two-thirds of the cases (69.2%), while the culture was positive in the remaining one-third (30.8%). The follow-up images showed complete resolution of the abscesses except in one case (n = 1/13, 7.7%), which required a second session of aspiration. One patient died (n = 1/13, 7.7%) on the 19th post-operative day due to severe pneumonia. Aspiration of brain abscess in children with CHD through a burr hole is a safe and effective procedure in terms of operative time, duration of anaesthesia and postoperative complications.
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Lallani SB, Hyte M, Trieu E, Reyes-Sacin C, Doan N. Use of an Intracranial Drain as a Conduit for Treatment of an Intracranial Streptococcus intermedius Abscess. Cureus 2021; 13:e14613. [PMID: 34040913 PMCID: PMC8139600 DOI: 10.7759/cureus.14613] [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: 11/25/2022] Open
Abstract
Brain abscesses are difficult to manage clinically and often result in a poor outcome. Although surgical and medical therapeutics have progressed, there are still challenges that make treating intracranial abscesses problematic. One of these treatment barriers is the poor penetration of intravenous antibiotics to the infection source through the blood-brain barrier. In this case report, we will discuss the use of a surgical drain as a conduit for direct antibiotic administration for a rare, recurrent Streptococcus intermedius infection. This technique allows us to bypass the blood-brain barrier while also reducing the systemic effects of antibiotics. When used in conjunction with craniotomy and resection, direct antibiotic administration via a surgical drain proved to be effective at treating our patient’s abscess and preventing recurrence.
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Affiliation(s)
- Shoeb B Lallani
- Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Melanie Hyte
- Pharmacology, Baptist Medical Center South, Montgomery, USA
| | - Emily Trieu
- Neurosurgery, Pleasant Grove High School, Elk Grove, USA
| | | | - Ninh Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, USA
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Neuroimaging of CNS infection in haematological malignancy: important signs and common diagnostic pitfalls. Clin Radiol 2021; 76:470.e1-470.e12. [PMID: 33610289 DOI: 10.1016/j.crad.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 01/14/2021] [Indexed: 01/15/2023]
Abstract
Patients with haematological malignancy are at increased risk of developing central nervous system (CNS) infections, which are associated with significant morbidity and mortality. Neuroimaging plays a pivotal role in the diagnostic pathway of these patients; however, layers of complexity are added to image interpretation by the heterogeneity in imaging manifestations of haematological malignancies in the CNS, overlapping imaging features of CNS infection, treatment-related parenchymal changes and the presence of intracranial comorbidity. In this article, we review important intracranial findings of CNS infection cases accrued in 1,855 studies over more than a decade at a specialist tertiary centre. We offer schema to identify common and important neuroimaging features, discuss key differential diagnoses and frequent diagnostic pitfalls.
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Elmallawany M, Ashry A, Alsawy MF. Endoscopic treatment of brain abscess. Surg Neurol Int 2021; 12:36. [PMID: 33598352 PMCID: PMC7881504 DOI: 10.25259/sni_800_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Treatment of brain abscess is still a subject of controversy. The main treatment is surgical, although medical therapy alone can be used for selected cases. The treatment of choice is aspiration, which may be performed with the aid of an endoscope or by freehand technique, with or without stereotactic or intraoperative ultrasound guidance. Excision is valuable in some cases. We are reporting our results of endoscopic approach in 12 patients. Methods: This study included 12 patients of brain abscesses treated between January 2015 and January 2018. All the cases except those with small abscesses (<3.0 cm in diameter) were included in the study. Rigid endoscope was used. Follow-up CT scan was done in all cases within 7 and 30 days after surgery. Follow-up periods ranged between 3 and 6 months. Results: There were 11 patients with a history of chronic otitis media and one patient who suffered from congenital cyanotic heart disease. Glasgow Coma Score (GCS) was 5 in one patient, 13 in two cases, and 14–15 in 9 cases. There were one cerebellar, six temporal, and five frontal abscesses. All the patients recovered completely except one who died (GCS 5). There was no procedure-related complication. Hospital stay ranged from 14 to 45 days with an average of 28 days. The endoscopy aided visualization of multiloculations and septation in eight patients which allowed the opening of the septations and complete evacuation. Conclusion: Endoscopic aspiration is safe, easy, and represents an effective way of treatment of brain abscess through proper visualization. It can be used for ensuring the complete aspiration of contents, control of any bleeding point, and also for multiloculated abscess to identify and open the septations which may not be possible in stereotactic or any other guided aspirations.
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Affiliation(s)
- Mohamed Elmallawany
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Ashry
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed F Alsawy
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Minciunescu A, Ekanem E, Nitta B, Castro F, Dhanani H. Intraparenchymal Brain Abscess in an Adult Male With Underlying Ebstein Anomaly and Cor Triatriatum Dexter. JACC Case Rep 2021; 3:194-197. [PMID: 34317501 PMCID: PMC8310961 DOI: 10.1016/j.jaccas.2020.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 12/01/2022]
Abstract
A 21-year-old man presented with new-onset seizures and brain abscess. Echocardiography and cardiac magnetic resonance imaging revealed underlying Ebstein anomaly, secundum atrial septal defect, and cor triatriatum dexter. The elevated right heart pressures shunting through the septal defect and transient bacteremia were the likely mechanisms for his presentation. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Andrei Minciunescu
- Department of General Internal Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Address for correspondence: Dr. Andrei Minciunescu, Inova Fairfax Medical Campus, Department of Medicine, 3300 Gallows Road, Falls Church, Virginia 22042, USA.
| | - Emmanuel Ekanem
- Department of Cardiovascular Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Bradley Nitta
- Department of General Internal Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Felix Castro
- Department of Cardiovascular Disease, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Hussain Dhanani
- Department of Critical Care Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
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