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Kameda-Smith MM, Ragulojan M, Hart S, Duda TR, MacLean MA, Chainey J, Aminnejad M, Rizzuto M, Bergeron D, Eagles M, Chalil A, Langlois AM, Gariepy C, Persad A, Hasen M, Wang A, Elkaim L, Christie S, Farrokhyar F, Reddy K. A Canadian National Survey of the Neurosurgical Management of Intracranial Abscesses. Can J Neurol Sci 2023; 50:679-686. [PMID: 36184886 DOI: 10.1017/cjn.2022.299] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Intracerebral abscess is a life-threatening condition for which there are no current, widely accepted neurosurgical management guidelines. The purpose of this study was to investigate Canadian practice patterns for the medical and surgical management of primary, recurrent, and multiple intracerebral abscesses. METHODS A self-administered, cross-sectional, electronic survey was distributed to active staff and resident members of the Canadian Neurosurgical Society and Canadian Neurosurgery Research Collaborative. Responses between subgroups were analyzed using the Chi-square test. RESULTS In total, 101 respondents (57.7%) completed the survey. The majority (60.0%) were staff neurosurgeons working in an academic, adult care setting (80%). We identified a consensus that abscesses >2.5 cm in diameter should be considered for surgical intervention. The majority of respondents were in favor of excising an intracerebral abscess over performing aspiration if located superficially in non-eloquent cortex (60.4%), located in the posterior fossa (65.4%), or causing mass effect leading to herniation (75.3%). The majority of respondents were in favor of reoperation for recurrent abscesses if measuring greater than 2.5 cm, associated with progressive neurological deterioration, the index operation was an aspiration and did not include resection of the abscess capsule, and if the recurrence occurred despite prior surgery combined with maximal antibiotic therapy. There was no consensus on the use of topical intraoperative antibiotics. CONCLUSION This survey demonstrated heterogeneity in the medical and surgical management of primary, recurrent, and multiple brain abscesses among Canadian neurosurgery attending staff and residents.
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Affiliation(s)
- Michelle M Kameda-Smith
- McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Neurosurgery, London, UK
| | | | - Shannon Hart
- McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Neurosurgery, London, UK
| | - Taylor R Duda
- McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Neurosurgery, London, UK
| | - Mark A MacLean
- Dalhousie University, Department of Surgery, Neurosurgery, QEII Health Sciences Center, Halifax Infirmary, Halifax, Nova Scotia, Canada
| | - Jonathan Chainey
- University of Alberta, Department of Surgery, Neurosurgery, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Minoo Aminnejad
- McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Michael Rizzuto
- University of British Columbia, Department of Surgery, Neurosurgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - David Bergeron
- Université de Montreal, Department of Surgery, Neurosurgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Québec, Canada
| | - Mathew Eagles
- University of Calgary, Department of Surgery, Neurosurgery, Foothills Medical Center, Calgary, Alberta, Canada
| | - Alan Chalil
- University of Western Ontario, Department of Surgery, Neurosurgery, University Hospital, London, Ontario, Canada
| | - Anne-Mare Langlois
- Université de Sherbrooke, Department of Surgery, Neurosurgery, Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Charles Gariepy
- Université de Laval, Department of Surgery, Neurosurgery, Hôpital de l'Enfant-Jésus Quebec City, Québec, Canada
| | - Amit Persad
- University of Saskatchewan, Department of Surgery, Neurosurgery, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Mohammed Hasen
- University of Manitoba, Department of Surgery, Neurosurgery, Health Science Center (HSC), Winnipeg, Manitoba, Canada
| | - Alick Wang
- University of Ottawa, Department of Surgery, Neurosurgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lior Elkaim
- University of McGill, Department of Surgery, Neurosurgery, Montreal Neurological Institute (MNI) Hospital, Montreal, Quebec, Canada
| | - Sean Christie
- Dalhousie University, Department of Surgery, Neurosurgery, QEII Health Sciences Center, Halifax Infirmary, Halifax, Nova Scotia, Canada
| | - Forough Farrokhyar
- McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Kesava Reddy
- McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Neurosurgery, London, UK
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Su J, Hu B, Zhang Y, Li Y. Clinical and radiological characteristics of brain abscess due to different organisms in hospitalized patients: A 6-year retrospective study from China. Heliyon 2023; 9:e16003. [PMID: 37215846 PMCID: PMC10192766 DOI: 10.1016/j.heliyon.2023.e16003] [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: 09/27/2022] [Revised: 04/22/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023] Open
Abstract
Background Brain abscess (BA) is a rare but life-threatening infection. Early identification of the pathogen is helpful to improve the outcomes. This study aimed to describe the clinical and radiological features of patients with BA caused by different organisms. Methods A retrospective, observational study of patients with known etiologic diagnosis of BA in Huashan Hospital Affiliated to Fudan University in China between January 2015 and December 2020 was conducted. Data on patient demographics, clinical and radiological presenting features, microbiological results, surgical treatment, and outcomes were collected. Results Sixty-five patients (49 male, 16 female) with primary BAs were included. Frequent clinical presentations included headache (64.6%), fever (49.2%) and confusion (27.3%). Streptococcus viridans was associated with thicker wall of abscesses (6.94 ± 8.43 mm for S. viridans versus 3.66 ± 1.74 mm for other organisms, P = 0.031) and larger oedema (89.40 ± 15.70 mm for S. viridans versus 74.72 ± 19.70 mm for other organisms, P = 0.023). The independent factor associated with poor outcome identified by multivariate analysis was confusion (Odds ratio 6.215, 95% confidence interval 1.406-27.466; P = 0.016). Conclusions Patients with BAs caused by Streptococcus species had nonspecific clinical signs, but specific radiological features, which might be helpful for early diagnosis.
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Affiliation(s)
- Jiachun Su
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Hu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yixin Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
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Iro MA, Goldacre MJ, Goldacre R. Central nervous system abscesses and empyemas in England: epidemiological trends over five decades. J Infect 2023; 86:309-315. [PMID: 36764391 DOI: 10.1016/j.jinf.2023.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To report on population-based epidemiological trends in central nervous system (CNS) abscesses and empyemas in England over five decades. METHODS Trend analyses of age-sex-specific hospital admission and death rates using routinely collected English national hospital discharge records, mortality records, and annual population denominators from 1968 to 2019. RESULTS Hospital admission rates for CNS abscesses and empyemas were stable in England until the late 1980s. In the last two decades of the study period (1999-2019), first-time admissions increased from 1.24 per 100,000 population in 1999 (95% confidence interval [CI] 1.14-1.35) to 2.86 in 2019 (95% CI 2.72-3.01). Admission rates were highest among infants and older adults, and were higher for males than females. There were small but significant increases in annual mortality rates for CNS abscesses and empyemas over the last two decades of the study period after accounting for population ageing, but mortality remained low at around 0.1-0.2 per 100,000 population. Mortality increased with advancing age; deaths in childhood were extremely rare. Case fatality rates where a relevant diagnosis was recorded as either the underlying or contributing cause were 4.3% and 9.7% respectively. CONCLUSIONS The increase in CNS abscesses and empyemas in England might reflect improved case ascertainment, but the likelihood of a true rise in incidence should be considered.
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Affiliation(s)
- M A Iro
- Faculty of Medicine and Institute of Life Sciences, University of Southampton, UK; Department of Paediatric Infectious Diseases, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK.
| | - M J Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Corsini Campioli C, O’Horo JC, Lahr BD, Wilson WR, DeSimone DC, Baddour LM, Van Gompel JJ, Sohail MR. Predictors of Treatment Failure in Patients With Pyogenic Brain Abscess. World Neurosurg X 2022; 16:100134. [PMID: 36061125 PMCID: PMC9437902 DOI: 10.1016/j.wnsx.2022.100134] [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: 05/11/2022] [Accepted: 07/28/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Cristina Corsini Campioli
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- To whom correspondence should be addressed: Cristina Corsini Campioli, M.D.
| | - John C. O’Horo
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Division of Pulmonary and Critical Care, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Brian D. Lahr
- Division of Clinical Trials and Biostatistics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Walter R. Wilson
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Daniel C. DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Larry M. Baddour
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jamie J. Van Gompel
- Departments of Otolaryngology-Head and Neck Surgery and Neurologic Surgery, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - M. Rizwan Sohail
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
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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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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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7
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Huang J, Wu H, Huang H, Wu W, Wu B, Wang L. Clinical characteristics and outcome of primary brain abscess: a retrospective analysis. BMC Infect Dis 2021; 21:1245. [PMID: 34903183 PMCID: PMC8667431 DOI: 10.1186/s12879-021-06947-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/06/2021] [Indexed: 01/04/2023] Open
Abstract
Background Patients with primary brain abscess often present with atypical symptoms, and the outcome varies. We investigated the demographic, laboratory, and neuroimaging features of patients with brain abscess at our hospital and identified factors associated with their outcomes. Methods We retrospectively collected the data of patients diagnosed with primary brain abscess at our hospital between January 2011 and December 2020. Their clinical characteristics, predisposing factors, laboratory and neuroimaging findings, treatment, and outcome were analyzed. Results Of the 57 patients diagnosed with primary abscess, 51 (89.47%) were older than 40 years, and 42 (73.68%) were male. Only eight patients (14.04%) showed the classical triad of headache, fever, and focal neurological deficit. Fifteen patients (26.31%) had comorbidities, of which diabetes mellitus was the most common. Positive intracranial purulent material cultures were obtained in 46.15% of the patients, and gram-negative enteric bacteria were found in 33.33% of them, with Klebsiella pneumoniae being the most frequently observed. Surgical treatment, most commonly in the form of stereotactic drainage, was received by 54.39% of the patients. Good outcomes were achieved in 75.44% of the patients. Multivariate logistic regression analysis showed that patients with headaches were more likely to have a poor outcome (odds ratio 6.010, 95% confidence interval 1.114–32.407, p = 0.037). Conclusions Male patients and those older than 40 years were more susceptible to brain abscess than female patients and those younger than 40 years, respectively. Only a few patients showed the classical triad of clinical symptoms. Diabetes mellitus was the most common comorbidity. Positive intracranial specimens’ culture results were uncommon, with gram-negative enteric bacteria, especially Klebsiella pneumoniae, being the main organisms found. Most patients had a good outcome, and the presence of headache may influence the outcome.
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Affiliation(s)
- Junying Huang
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Haining Wu
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Honghong Huang
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Weiqi Wu
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Bowen Wu
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Lingxing Wang
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China.
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8
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Kanu OO, Ojo O, Esezobor C, Bankole O, Olatosi J, Ogunleye E, Asoegwu C, Eghosa M, Adebayo B, Oladele R, Nwawolo C. Pediatric brain abscess – etiology, management challenges and outcome in Lagos Nigeria. Surg Neurol Int 2021; 12:592. [PMID: 34992909 PMCID: PMC8720435 DOI: 10.25259/sni_605_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Brain abscess in children is a neurosurgical emergency with potentially catastrophic outcome despite the advances made in neuroimaging techniques and antibiotic therapy. Symptoms are nonspecific and may vary with the child’s age, location, size, numbers and stage of abscess, and the primary source of infection. Treatment is usually with broad-spectrum antibiotics in combination and surgical evacuation in most cases or antibiotics alone in selected cases with clear-cut indications. This study was to document clinical characteristics, etiological factors, and spectrum of bacteriologic agents responsible for pediatric brain abscess in an African city, the challenges and management outcome over the study period. Methods: This was a retrospective study over an 11-year period involving 89 children who presented with brain abscess. Information of interest was extracted from the medical records of each participant. The results from data analysis were presented in charts and tables. Results: Eighty-nine children aged 0.85–15.7 years (median age of 6.4 years) met the inclusion criteria. The male-to-female ratio was 1.8:1. Headache (80%), fever (78%), and hemiparesis (78%) were the most common symptoms. Brain imaging deployed was CT scan in 56 (63%), MRI in 9 (10%), and transfontanel ultrasound scan in 24 (27%) children. Seventy-one (80%) children had antibiotics with surgical evacuation while 18 (20%) children received only antibiotics. In 19 (27%) children, the culture of the abscess was negative. In 53 (75%) children, Gram-positive aerobic organisms were isolated. A total of 75 patients (84%) had a favorable outcome. Conclusion: Pediatric brain abscess still poses significant public health challenge, especially in resource-limited regions. Successful management of brain abscess requires high index of suspicion for early diagnosis, referral, and intervention.
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Affiliation(s)
- Okezie Obasi Kanu
- Department of Surgery, Division of Neurosurgery, Cardiothoracic Surgical Unit, Lagos State, Nigeria
| | - Omotayo Ojo
- Department of Surgery, Division of Neurosurgery, Cardiothoracic Surgical Unit, Lagos State, Nigeria
| | | | - Olufemi Bankole
- Department of Surgery, Division of Neurosurgery, Cardiothoracic Surgical Unit, Lagos State, Nigeria
| | - John Olatosi
- Department of Anesthesiology, Cardiothoracic Surgical Unit, Lagos State, Nigeria
| | - Ezekiel Ogunleye
- Department of Surgery, Cardiothoracic Surgical Unit, Lagos State, Nigeria
| | - Chinyere Asoegwu
- Department of Surgery, Division of Otorhinolaryngology, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - Morgan Eghosa
- Department of Surgery, Neurosurgery Unit, Lagos University Teaching Hospital, Lagos State, Nigeria
| | - Bamidele Adebayo
- Department of Surgery, Neurosurgery Unit, Lagos University Teaching Hospital, Lagos State, Nigeria
| | - Rita Oladele
- Department of Microbiology, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria
| | - Clement Nwawolo
- Department of Surgery, Division of Otorhinolaryngology, College of Medicine, University of Lagos, Lagos State, Nigeria
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Risk factors for unfavorable clinical outcomes in patients with brain abscess in South Korea. PLoS One 2021; 16:e0257541. [PMID: 34543311 PMCID: PMC8451987 DOI: 10.1371/journal.pone.0257541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/06/2021] [Indexed: 01/04/2023] Open
Abstract
Background Brain abscess can be life-threatening and manifest various neurological findings, although the mortality rate has decreased recently. We investigated the risk factors for unfavorable outcomes of patients with brain abscess. Methods A retrospective cohort study examined patients with brain abscess seen from May 2005 to December 2018 in a tertiary care hospital in Seoul, South Korea. We reviewed the medical records for clinical findings, therapeutic modalities, and prognostic factors of brain abscess. Unfavorable clinical outcomes were defined as death, moderate to severe disability with neurological deficits, or vegetative state at 1 year or at the time of discharge from outpatient follow-up. Results The study enrolled 135 patients: 65.2% were males; the mean age was 56 years. 35.6% had unfavorable outcomes. In multivariate analysis, higher Sequential Organ Failure Assessment (SOFA) (p < 0.001), pre-existing hemiplegia (p = 0.049), and higher Charlson comorbidity index (CCI) (p = 0.028) were independently associated with unfavorable outcomes. Conclusions Higher SOFA, pre-existing hemiplegia and higher Charlson comorbidity index were significant risk factors for unfavorable clinical outcomes in patients with brain abscess.
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10
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Ravikumar R, John DV. Brain Abscess in the Current Decade (2010–2019) in India—A Review. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1725230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractBrain abscess outcomes have improved in recent years due to advancements in cranial imaging, microbiological techniques, minimally invasive neurosurgical procedures, and effective antibiotic treatments. However, the incidence of brain abscess remains unchanged in developing countries. We searched PubMed and Google Scholar for references using the key words “brain abscess” and “India” and reviewed both retrospective and prospective studies published in peer-reviewed journals in the current decade to understand the present status. The review shows that the patients’ ages, the predominance of male patients, the symptoms and locations of brain abscesses, and the types of bacteria associated with them have remained unchanged over the past decade. The most common predisposing condition in recent years has been chronic suppurative otitis media with a mortality rate of 7 to 10%. Middle ear infection is often neglected and not treated aggressively in Asian countries. It requires multidisciplinary treatment strategies to address the primary source of infection and better health awareness to prevent the development of brain abscess.
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Affiliation(s)
- R. Ravikumar
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Daisy Vanitha John
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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11
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P K, Raj P, Jabeen S, Bn N, Hb V, Kvl NR, M S, Maher G, B B, Chandrashekar N. Clinicomycological overview of brain abscess in a tertiary care center: A 38 year retrospection: Fungal brain abscess. J Mycol Med 2021; 31:101156. [PMID: 34280711 DOI: 10.1016/j.mycmed.2021.101156] [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: 07/16/2019] [Revised: 03/05/2021] [Accepted: 05/10/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Brain abscesses (BA) form approximately 8% of intracranial masses in developing and 1-2% in western countries. Fungal BA (FBA) are aggressive and represent a catastrophic manifestation compared to protozoan and bacterial BA. Diagnosis of FBA is rare and usually done postmortem. OBJECTIVES The present retrospective study analyses the clinico-mycological aspects of FBA presented to our neurosurgical services over a period of 38 years, from January 1979 to April 2017. MATERIALS AND METHODS Patients diagnosed as definitive cases of FBA were included in the study. Clinico- demographic and microbiological data were collected from medical records. BA pus was examined for fungal etiology using standard microbiological procedures. RESULTS During the period of 38 years out of total 2,916 brain abscesses, 29 cases of FBA were diagnosed with an overall incidence rate of 0.99% per year. Cladophialophora bantiana (44%) was the most predominant isolate followed by Aspergillus spp and others. Male preponderance was seen with a male:female ratio of 4.8:1. There was no predilection for any age group. Headache, limb weakness and fever were the most common presentations. Amphotericin B was given in 44.8% of cases. Craniotomy with excision (48.2%) was the predominant surgical management. Outcome was fatal in 62% of the cases. CONCLUSION Neurotropic C. bantiana is the predominant isolate causing fungal brain abscess. The incidence and trends of fungi causing brain abscess do not show significant change. Young immunocompetent outdoor working males were predominantly susceptible to fungal infection. Advance in the diagnostic modalities show promising in diagnosis of FBA. High index of suspicion with early diagnosis, prompt antifungal therapy and aggressive surgical management is required as FBA are associated with high mortality rate.
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Affiliation(s)
- Kruthika P
- Department of Neuromicrobiology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Prabhu Raj
- Department of Neurosurgery, NIMHANS, Bangalore 560029, Karnataka, India
| | - Shumyla Jabeen
- Department of Neuroimaging and interventional radiology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Nandeesh Bn
- Department of Neuropathology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Veenakumari Hb
- Department of Neuromicrobiology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Narasinga Rao Kvl
- Department of Neurosurgery, NIMHANS, Bangalore 560029, Karnataka, India
| | - Sandhya M
- Department of Neuroimaging and interventional radiology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Ganesh Maher
- Department of Neuromicrobiology, NIMHANS, Bangalore 560029, Karnataka, India
| | - Binukumar B
- Department of Biostatistics, NIMHANS, Bangalore 560029, Karnataka, India
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12
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Corsini Campioli C, Castillo Almeida NE, O'Horo JC, Challener D, Go JR, DeSimone DC, Sohail MR. Clinical Presentation, Management, and Outcomes of Patients With Brain Abscess due to Nocardia Species. Open Forum Infect Dis 2021; 8:ofab067. [PMID: 33855101 PMCID: PMC8026153 DOI: 10.1093/ofid/ofab067] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Background Nocardial brain abscesses are rare, and published literature describing brain abscesses due to Nocardia species is limited to individual case reports or small series. We report one of the largest contemporary retrospective studies describing risk factors, diagnostic evaluation, management, and outcomes of nocardial brain abscess. Methods Retrospective review of all adults with brain abscess due to culture-confirmed Nocardia species at our institution between January 1, 2009, and June 30, 2020. Results Overall, 24 patients had nocardial brain abscesses during the study period. The median age at presentation was 64 years, and 62.5% were immunocompromised. Pulmonary and cutaneous infections were the most common primary sites of nocardial infection. All 24 patients had magnetic resonance imaging performed, and the frontal lobe was the most commonly involved. The most common organism isolated was Nocardia farcinica, followed by Nocardia wallacei and Nocardia cyriacigeorgica. Thirteen patients were managed with antimicrobial therapy alone, while 11 had both medical and surgical management. In all patients, dual therapy was recommended for the initial 6 weeks of treatment, and 22 patients received at least 1 oral agent as part of their final antibiotic regimen, predominantly trimethoprim-sulfamethoxazole and linezolid. Fourteen patients achieved complete clinical and radiographic resolution of infection. Conclusions Nocardia is an important cause of brain abscess in the immunocompromised host. Early diagnostic and therapeutic aspiration may help health care providers confirm the diagnosis, choose an appropriate antimicrobial regimen, and achieve source control.
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Affiliation(s)
| | | | - John C O'Horo
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas Challener
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John Raymond Go
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel C DeSimone
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - M Rizwan Sohail
- Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
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Hu MB, Kesha K, Glenn C, Stables S, Tse R. Hemorrhagic Pseudocyst: A Rare Cerebral Mass Lesion Causing Death. A Case Report and Brief Review of Literature. Am J Forensic Med Pathol 2021; 42:77-80. [PMID: 33555675 DOI: 10.1097/paf.0000000000000605] [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: 11/27/2022]
Abstract
ABSTRACT Mass lesions in the brain encompass a wide range neoplastic and nonneoplastic entities. These can present as a diagnostic pitfall, with nonspecific, overlapping symptoms and similar appearances on radiology. They may cause death through varied mechanisms, either specific to the underlying pathophysiology or due to the space-occupying effect of the lesion. We report a case of fatal hemorrhagic cerebral pseudocyst, a rare mass lesion, associated with a cerebral varix, causing death in a morbidly obese individual. To the best of our knowledge, there is no previous documentation in the postmortem literature of this entity as a cause of death. This case aims to document this rare entity in the differential diagnosis of a tumor-like lesion in the brain, highlight the clinical difficulty in its assessment, and demonstrate an uncommon mechanism of death, of a mass lesion acting as a focus causing seizures, with resulting hypoxia due to effects of morbid obesity and heart failure.
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Affiliation(s)
- Mindy Bizhe Hu
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
| | - Kilak Kesha
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
| | - Charley Glenn
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
| | - Simon Stables
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
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14
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Clinical Characteristics and Outcome Analysis of 94 Children With Brain Abscess in Beijing: A Single-center Retrospective Study. Pediatr Infect Dis J 2021; 40:109-115. [PMID: 33044433 DOI: 10.1097/inf.0000000000002933] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND There are limit studies about pediatric brain abscess in China. The aim of this study was to analyze clinical characteristics and outcomes of pediatric brain abscess in recent years in China. METHODS The clinical information of children with brain abscess hospitalized in Beijing Children's Hospital between January 1, 2007 and December 31, 2016 were retrospectively reviewed. RESULTS Ninety-four children were enrolled in this study. A Streptococcus milleri group (13.8%) was identified as the most common causative organisms, followed by Staphylococcus aureus (6.4%). The overall mortality was 21.6%, with 50.0% of deaths happening in the first week after diagnosis. Long-term outcomes of 74 patients were assessed with Glasgow Outcome Scale-Extended Pediatric Reversion: 50 patients with a score of 1-2 (favorable outcome) and 24 patients with a score of 3-8 (unfavorable outcome). Patients with multiple abscesses (P = 0.029) and intraventricular rupture of brain abscess/hydrocephalus (P = 0.024) had higher risk of unfavorable outcomes. CONCLUSIONS Brain abscess is a serious disease with high mortality in children; more aggressive treatments should be considered in the first week of diagnosis because of high risk of death, and for patients with multiple brain abscesses and intraventricular rupture of brain abscess/hydrocephalus because of their higher risk of unfavorable.
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15
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Tseng YY, Kao CW, Liu KS, Tang YL, Liu YW, Liu SJ. Treating Intracranial Abscesses in Rats with Stereotactic Injection of Biodegradable Vancomycin-Embedded Microparticles. Pharmaceutics 2020; 12:pharmaceutics12020091. [PMID: 31979198 PMCID: PMC7076644 DOI: 10.3390/pharmaceutics12020091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 11/16/2022] Open
Abstract
Brain abscesses are emergent and life-threating despite advances in modern neurosurgical techniques and antibiotics. The present study explores the efficacy of vancomycin embedded to 50:50 poly(lactic-co-glycolide acid) (PLGA) microparticles in the treatment of brain abscess. The vancomycin embedded microparticles (VMPs) were stereotactically introduced into the cerebral parenchyma in Staphylococcus aureus bacteria- induced brain abscess-bearing rats. Experimental rats were divided into three groups: group A (n = 13; no treatment), group B (n = 14; daily vancomycin injection (5 mg intraperitoneally), and group C (n = 12; stereotactic introduction of VMPs into the abscess cavity). Group C exhibited no inflammatory response and significantly increased survival and reduced mean abscess volumes (p <0.001) at the eighth week, compared with other groups. Vancomycin delivery via a biodegradable PLGA vehicle can easily attain Area Under the Curve (AUC)/minimum inhibitory concentration (MIC) ratios of ≥400, and strengthens the therapeutic efficacy of antibiotics without provoking any potential toxicity. Biodegradable VMPs are a safe and sustainable drug delivery vehicle for the treatment of brain abscess.
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Affiliation(s)
- Yuan-Yun Tseng
- Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan;
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Ching-Wei Kao
- Department of Anesthesiology, Chiayi Chang Gung Memorial Hospital, Chiayi 61363, Taiwan;
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan;
| | - Kuo-Sheng Liu
- Department of Thoracic and Cardiovascular Surgery, Linkou Chang Gung Memorial. Hospital, Taoyuan 33302, Taiwan; (K.-S.L.); (Y.-W.L.)
| | - Ya-Ling Tang
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan;
| | - Yen-Wei Liu
- Department of Thoracic and Cardiovascular Surgery, Linkou Chang Gung Memorial. Hospital, Taoyuan 33302, Taiwan; (K.-S.L.); (Y.-W.L.)
| | - Shih-Jung Liu
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan 33302, Taiwan;
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital-Linkuo, Tao-Yuan 33305, Taiwan
- Correspondence: ; Tel.: +886-3-2118166; Fax: +886-3-2118558
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16
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Wu S, Wei Y, Yu X, Peng Y, He P, Xu H, Qian C, Chen G. Retrospective analysis of brain abscess in 183 patients: A 10-year survey. Medicine (Baltimore) 2019; 98:e17670. [PMID: 31725609 PMCID: PMC6867766 DOI: 10.1097/md.0000000000017670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aims to identify predictive factors related to clinical outcome, reoperation, and complications in patients with brain abscess.Patients with a diagnosis of brain abscess at discharge at the Second Affiliated Hospital of Zhejiang University School of Medicine between 2008 and 2018 were reviewed. Logistic regression was used to identify predictive factors associated with Glasgow Outcome Scale (GOS) at discharge, GOS at 1 year after discharge, reoperation and complications.Among 183 patients enrolled into the study, 142 patients had a good outcome at discharge (GOS ≥ 4) and 41 had a poor outcome (GOS ≤ 3). During the follow-up period, 20 additional patients had a good outcome. A total of 156 patients were treated by open craniotomy excision (n = 72) and aspiration (n = 84), 10 of whom underwent reoperation. Complications in surgical patients for brain abscess occurred in 54 patients. Poor outcome was related to Glasgow coma scale (P = .007) and ventricular proximity (P = .001). Surgical method was associated with reoperation (P = .04) and complications (P < .001). Seizure at admission was related to epilepsy (P < .001). Surgical method was related to postoperative intracranial hemorrhage (P = .02).Glasgow coma scale (GCS) and ventricular proximity were associated with poor outcome. Further, patients who underwent aspiration were more likely to experience reoperation, while open craniotomy excision (OCE) was related to complications. Patients presenting seizure at admission were more likely to develop epilepsy. Patients who underwent OCE tended to experience postoperative intracranial hemorrhage.
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Affiliation(s)
- Shenglian Wu
- Department of Neurological Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Yiting Wei
- Department of Neurological Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
- Department of Neurological Surgery, Zhenhai Longsai Hospital, Ningbo, Zhejiang Province, China
| | - Xiaobo Yu
- Department of Neurological Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Yucong Peng
- Department of Neurological Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Pingyou He
- Department of Neurological Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Hangzhe Xu
- Department of Neurological Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Cong Qian
- Department of Neurological Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
| | - Gao Chen
- Department of Neurological Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou
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Simlett-Moss AB, Freeman A, McConnell FJ, Coe R, Sanchez-Masian D. Successful surgical management of an Escherichia coli epidural-subdural abscess secondary to sino-rhinotomy. J Vet Emerg Crit Care (San Antonio) 2019; 29:696-701. [PMID: 31642173 DOI: 10.1111/vec.12904] [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: 08/10/2017] [Revised: 01/30/2018] [Accepted: 02/08/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe a case of successful management of epidural-subdural abscess and severe meningitis with secondary brain herniation in a dog. CASE SUMMARY A rhino-sinusotomy was performed in a 3-year-old mixed-breed dog for management of refractory sinonasal aspergillosis. Initial recovery was good, but the dog became acutely stuporous 36 hours after surgery. Evidence of increased intracranial pressure with brain herniation and midline shift secondary to an epidural abscess was observed on magnetic resonance imaging. Decompressive craniectomy and drainage of the abscess was performed. Intensive nursing care and physiologic support was performed with consciousness returning 7 days after initial stupor. The dog was discharged 14 days after craniectomy and was ambulatory with support. NEW/UNIQUE INFORMATION PROVIDED Intracranial abscesses are rarely described in dogs and few had a successful outcome reported. All previous reports have been of brain abscesses or empyema, rather than a combination of epidural and subdural abscessation. Additionally, the process of sino-rhinotomy for management of aspergillosis has not been previously linked to intracranial abscess formation. To the authors' knowledge, this is the first report of successful management of an epidural-subdural abscess and suggests that even with cases with low modified Glasgow Coma Scale scores outcome may be positive.
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Affiliation(s)
| | - Alistair Freeman
- Small Animal Teaching Hospital, University of Liverpool, Neston, UK
| | | | - Richard Coe
- Small Animal Teaching Hospital, University of Liverpool, Neston, UK
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Anaerobic bacteriological profile of brain abscess in a tertiary care center in southern India. Anaerobe 2019; 59:68-71. [PMID: 31132411 DOI: 10.1016/j.anaerobe.2019.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/22/2019] [Accepted: 05/23/2019] [Indexed: 12/14/2022]
Abstract
Brain abscess accounts for 8% of all intracranial insults in developing countries. Anaerobic infections are missed in most cases due to difficult isolation techniques. This study was done to determine the anaerobic bacteriological profile of brain abscess, their distribution according to sociodemographic variables, anatomical location, management and the outcome during the subjects' stay in a neurosciences' speciality hospital. We included 190 cases of confirmed anaerobic brain abscess from the year 1998-2017. The median age was 22 years with more males (73% of 190 cases) than females. The Bacteroides spp. were the most common (64%) anaerobic organisms isolated followed by Gram positive anaerobic cocci (51%). While 67% of the samples showed purely anaerobic bacteria on culture, remaining were mixed. Chronic suppurative otitis media (CSOM) was the most common predisposing factor.
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Zhou W, Shao X, Jiang X. A Clinical Report of Two Cases of Cryptogenic Brain Abscess and a Relevant Literature Review. Front Neurosci 2019; 12:1054. [PMID: 30692909 PMCID: PMC6339901 DOI: 10.3389/fnins.2018.01054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 12/27/2018] [Indexed: 12/11/2022] Open
Abstract
Brain abscess, a severe intracranial infectious disease, refers to the parenchyma abscess caused by local infection or remote spread. Recently, advancements in modern medicine, especially the wide application of antimicrobial drugs, have contributed to the gradual decrease in the prevalence of this disease. However, cases of cryptogenic brain abscess that feature an unknown origin and atypical symptoms are rising. In this retrospective study, we report and analyze two cases of cryptogenic brain abscess. The first patient was a 30-year-old healthy man who was admitted to our hospital due to 1 week of headache and 3 days of headache aggravation, accompanied by nausea and vomiting. Head MRI shows a circular space-occupying as well as apparently enhanced DWI signals were observed in the right parietal lobe, and the ring wall manifested an apparent increase in signal intensity after enhancement. The patient was diagnosed as a brain abscess before operation and given craniotomy. The postoperative pathology confirmed brain abscess and recovered well after surgery. The second patient was a 45-year-old healthy woman who was hospitalized in a local hospital due to symptoms of headache and right limb weakness for 1 week. Head MRI shows a circular space-occupying lesion in the left basal ganglia, and the ring wall manifested an apparent increase in signal intensity after enhancement. The patient was suspected of glioma at the local hospital and was transferred to our hospital. Twelve hours after hospitalization, the patient was suspected of developing cerebral palsy and thus underwent emergency surgery including lesion resection in the left basal ganglia, resection of the polus temporalis, and a decompressive craniotomy. Postoperative pathology confirmed brain abscess. The patient was eventually conscious, but left the right limb hemiplegia. Hence, when a patient develops the classical triad of fever, headache, and focal neurologic deficits, the possibility of brain abscess should be investigated. Early diagnosis and treatment are crucial to minimize various complications and the number of deaths.
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Affiliation(s)
- Wei Zhou
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xuefei Shao
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xiaochun Jiang
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, China
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20
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Lange N, Berndt M, Jörger AK, Wagner A, Wantia N, Lummel N, Ryang YM, Meyer B, Gempt J. Clinical characteristics and course of primary brain abscess. Acta Neurochir (Wien) 2018; 160:2055-2062. [PMID: 30069602 DOI: 10.1007/s00701-018-3633-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/19/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Due to improved diagnostic methods, the incidence of brain abscess is still rising. Therefore, clear and evidence-based therapy for the patients who suffer from brain abscesses is necessary. Brain abscesses are potentially life-threatening conditions that possibly lead to permanent injuries even after sufficient healing has taken place. The aims of this study were to analyze the clinical aspects of patients with brain abscesses and thereby to reveal the relevant aspects for the future treatment of the brain lesions. METHODS We retrospectively identified 47 patients (24 male, 23 female) who had received surgery or undergone the frameless stereotactic drainage of brain abscesses in our center from March 2009 to May 2017. We analyzed the clinical characteristics of the patients, as well as comorbidities and outcomes. RESULTS The mean age was 58 (range 7 to 86). Focus identification was successful in 28 patients (60%), with the most frequent causes of brain abscesses including the following: sinusitis (25%), dental infections (25%), and mastoiditis (21%). The mean Charlson Comorbidity Index was 1.57. Among the patients, 34% showed immunosuppressive conditions. We performed 1.5 surgeries per patient (53% via craniotomy, 28% biopsies or stereotactic drainage, 19% both procedures), followed by antibiotic treatment for 6.5 weeks (mean). In 30% of patients, no bacteria could be isolated. During the follow-up period (a median of 12 months), 23.4% of the patients died. The mortality rate during the initial hospital stay was 4.3%. CONCLUSION One third of the patients with brain abscesses showed immunosuppressive conditions, whereas brain abscesses also often occur in patients with good medical conditions. The isolation of the focus of infection is often possible. Surgical procedures showed very good outcomes. Patients over 60 years showed significantly worse clinical outcomes.
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Affiliation(s)
- Nicole Lange
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
- Neurochirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Maria Berndt
- Neuroradiological Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Ann-Kathrin Jörger
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Arthur Wagner
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nina Wantia
- Microbiological Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Nina Lummel
- Neuroradiological Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Yu-Mi Ryang
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Bernhard Meyer
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jens Gempt
- Neurosurgical Department, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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Miniar T, Amel BA, Khalil S, Ben Helal BHK, Gueddiche GMN, Tilouche TS, Saida H, Abroug AS. Pyogenic brain abscess in children: a Tunisian multi-center experience. Afr Health Sci 2018; 18:560-568. [PMID: 30602988 PMCID: PMC6307026 DOI: 10.4314/ahs.v18i3.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Brain abscess (BA) is an uncommon intracranial suppurative infectious disease, especially in children. Treatment involves surgery and prolonged courses of antibiotics. Objectives Our study aimed to describe clinical characteristics of children with BA treated in middle Tunisian health centers. Methods A retrospective study lasting 19 years (1995–2014) was conducted in Tunisia middle region. Forty one children having radiologic abnormalities suggestive of BA and confirmed per operative lesions were included. Mycobacterial, parasitic or fungal abscesses were excluded. Medical records were analyzed for age, gender, presenting symptoms, predisposing factors, imaging, microbiology results, treatment and outcome. Results The mean age was 4.9 years. The most common clinical presentations were intracranial hypertension symptoms (87%). BA was diagnosed in 95.1% on the basis of cranial imaging. The majority of abscesses was supra-tentorial (92.6%). The most frequent etiology was loco-regional infections (63.4%). No predisposing factor was found in 17%. Intravenous antibiotics were given in all cases with surgical drainage in 63.4%,. Causative organisms were identified in 53.7%. The mortality rate was 24.3%. Age less than 2 years was the only statistically significant prognostic factor identified. Conclusion Our study confirmed the severity of this pathology and underlined the importance of early diagnosis and management.
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Affiliation(s)
- Tfifha Miniar
- Pediatric Department, Sahloul Hospital, Sousse Tunisia, Sousse 4051 Tunisia
| | | | | | | | | | | | - Hassayoun Saida
- Pediatric Department, Sahloul Hospital, Sousse Tunisia, Sousse 4051 Tunisia
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Pyogenic Brain Abscess in Children: A Tunisian Multi-Centric Experience. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2018. [DOI: 10.5812/pedinfect.55012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hernandez Jimenez JM, Vahdat K, Serrano Santiago IA, Morales Hernandez MDM, Isache CL, Sands M. Thalamic bacterial abscess presenting with hemiparesis and expressive aphasia. IDCases 2018; 13:e00417. [PMID: 30101064 PMCID: PMC6076220 DOI: 10.1016/j.idcr.2018.e00417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/25/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022] Open
Abstract
Brain abscesses are relative rare in the developing world, with an incidence of 2% of all space occupying lesions. Deep-seated abscesses such as thalamic and basal ganglia abscesses are much rarer than abscesses in other locations of the brain, comprising 1.3-6% of all brain abscesses. These abscesses may present with hemiparesis, and subcortical aphasia has only been reported in a few cases throughout the literature. Here we present and discuss a case of thalamic brain abscess caused by S. anginosus that presented with subcortical aphasia.
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Affiliation(s)
- Jarelys M Hernandez Jimenez
- Department of Internal Medicine, General Internal Medicine Division, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Kelia Vahdat
- Department of Internal Medicine, Infectious Diseases Division, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ivan A Serrano Santiago
- Department of Internal Medicine, General Internal Medicine Division, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Maria Del Mar Morales Hernandez
- Department of Internal Medicine, General Internal Medicine Division, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Carmen L Isache
- Department of Internal Medicine, General Internal Medicine Division, University of Florida College of Medicine, Jacksonville, FL, USA.,Department of Internal Medicine, Infectious Diseases Division, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Michael Sands
- Department of Internal Medicine, Infectious Diseases Division, University of Florida College of Medicine, Jacksonville, FL, USA
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Abstract
Objective To determine the clinical outcome of burr-hole aspiration of brain abscess. Methods We analyzed 100 cases of intracranial abscess, treated surgically from January 2015 and October 2016 at Jinnah Postgraduate Medical Centre (JPMC). All patients were treated with burr hole aspiration. Medical records were analyzed for demographics, clinical presentation, predisposing factors, abscess location on imaging and clinical outcomes were charted. Results The study included 100 patients with 73 (73%) males and 27 (27%) females with a mean age of 36.69±10.96 years. Mean duration of signs and symptoms was 8.50±4.2 days. The most common presenting complaint was altered sensorium in 70 (70%) patients and commonest source of infection was otitis media seen in 27 patients (27%). The GCS on presentation was 13 in 57 (57%) cases. The parietal region was the most common site in 43 patients (43%), followed by frontal region in 33 patients (33%). Complete resolution of abscess with recovery of preoperative neuro-deficit was seen in 77 (77%) patients and recovery with major neuro-deficit was observed in 10 (10%) cases while 13 (13%) patients expired. Conclusion Early diagnosis, optimum follow-up and timely burr-hole aspiration are the keys in the proper management of brain abscess.
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Affiliation(s)
- Shakeel Ahmad
- Dr. Shakeel Ahmed, MBBS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Lal Rehman
- Dr. Lal Rehman, FCPS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Ali Afzal
- Dr. Ali Afzal, MBBS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Raza Rizvi
- Dr. Raza Rizvi, MS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
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Ong CT, Tsai CF, Wong YS, Chen SCC. Epidemiology of brain abscess in Taiwan: A 14-year population-based cohort study. PLoS One 2017; 12:e0176705. [PMID: 28486477 PMCID: PMC5423610 DOI: 10.1371/journal.pone.0176705] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 04/16/2017] [Indexed: 11/18/2022] Open
Abstract
Brain abscess (BA) is a severe neurological emergency, which remains a challenge for physicians despite medical advancements. The purpose of this study is to describe the epidemiology of BA in Taiwan and to investigate potential factors affecting the survival of patients with BA. By using the Taiwan National Health Insurance Research Database, we identified hospitalized patients with a discharge diagnosis of pyogenic BA (324.X) between 2000 and 2013. The incidence and in-hospital mortality of BA were calculated based on both age and sex. A total of 6027 BA cases were identified. The overall incidence of BA was 1.88 (95% CI: 1.83-1.93) per 100,000 person-years and increased with age, from 0.58 per 100,000 person-years in individuals aged 0-14 years to 4.67 per 100,000 person-years in those over 60 years of age. The male-to-female incidence ratio was 2.37 (95% CI: 2.24-2.50), with a mountain-shaped distribution across ages peaking at 40-44 years. The in-hospital mortality also increased with age, from 4.22% (95% CI: 2.54-6.97) at 0-14 years to 17.34% (95% CI: 15.79-19.02) in individuals over 60 years of age, without a gender difference (11.9% for males, 12.5% for females). Age, stroke, septicemia, pneumonia, meningitis, and hepatitis were associated with increased risk of in-hospital mortality. There was a male predominance for BA, and both the incidence and in-hospital mortality rates increased with age. Infection-related disease such as septicemia, pneumonia and meningitis were important factors associated with in-hospital mortality. In addition to the original treatment of BA, we suggest paying close attention to potential infections to improve the outcome of BA patients.
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Affiliation(s)
- Cheung-Ter Ong
- Department of Neurology, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
- Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chiayi City, Taiwan
- * E-mail:
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Yi-Sin Wong
- Department of Family Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
| | - Solomon Chih-Cheng Chen
- Department of Medical Research, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi City, Taiwan
- Department of Pediatrics, School of Medicine, Taipei Medical University, Taipei, Taiwan
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Anaerobic brain abscess. IRANIAN JOURNAL OF MICROBIOLOGY 2016; 8:120-4. [PMID: 27307977 PMCID: PMC4906718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Brain abscess remains a potentially fatal central nervous system (CNS) disease, especially in developing countries. Anaerobic abscess is difficult to diagnose because of cumbersome procedures associated with the isolation of anaerobes. MATERIALS AND METHODS This is a hospital-based retrospective microbiological analysis of 430 brain abscess materials (purulent aspirates and/or tissue), for anaerobic organisms, that were received between 1987-2014, by the Microbiology Laboratory in our Institute. RESULTS Culture showed growth of bacteria 116/430 (27%) of the cases of which anaerobes were isolated in 48/116 (41.1%) of the cases. Peptostreptococcus (51.4 %), was the predominant organism isolated in four cases followed by Bacteroides and Peptococcus species. CONCLUSION Early diagnosis and detection of these organisms would help in the appropriate management of these patients.
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Zhang Z, Cai X, Li J, Kang X, Wang H, Zhang L, Yan R, Gao N, Liu S, Yue S, Zhang J, Yang S, Yang X. Retrospective analysis of 620 cases of brain abscess in Chinese patients in a single center over a 62-year period. Acta Neurochir (Wien) 2016; 158:733-739. [PMID: 26883550 DOI: 10.1007/s00701-016-2741-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/08/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite advances in laboratory diagnostics, antibiotic regimens, and neurosurgical techniques, brain abscess (BA) remains a potentially fatal infectious disease. This study analyzed clinical and epidemiological aspects of BA in Chinese patients treated at a single center during a 62-year period. METHOD We retrospectively analyzed 620 BA patients treated at Tianjin Medical University General Hospital, Tianjin, PR China from 1952 to 2014. Because of the initiation of imaging technology use in 1992, and other specific changes, we analyzed data over three study periods: 1952-1972, 1980-1991, and 2002-2014. Information including incidence, sex, age, community distribution, BA size and location, therapeutic method, prognosis and outcome of BA patients was collected and evaluated. RESULTS Our study included 620 BA patients. The percentage mortality significantly decreased from 22.8 % in 1952 to 6.3 % in 2014 (p < 0.001). Although the incidence of BA was higher in males than females, there was no significant change in the male/female incidence ratio over time: 2.5 in 1952-1972, 2.6 in 1980-1991, and 2.2 in 2002-2014. The cryptogenic infection incidence significantly increased over time (p < 0.001). The number of positive bacterial cultures significantly decreased over the three study periods (p < 0.01). CONCLUSIONS The prognosis of patients with BA has gradually improved over the past 62 years in Tianjin, China. This may be because improvements in neurosurgical techniques, cranial imaging, and antimicrobial regimens have facilitated less invasive and more precise neurosurgical procedures.
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Affiliation(s)
- Zhen Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Xinwang Cai
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Jia Li
- Department of Neurosurgery, Baoding No.1 Hospital, Baoding, 071000, People's Republic of China
| | - Xiaokui Kang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Haining Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Lin Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Rong Yan
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Nannan Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Shengjie Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Shuyuan Yue
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Shuyuan Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China
| | - Xinyu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
- Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, Tianjin Neurological Institute, 154 Anshan Road, Heping District, Tianjin, 300052, People's Republic of China.
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