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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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Camacho-Gomez SM, Monagas J, Noel RA, Castagnini L. Brain Abscess due to Streptococcus intermedius after Spontaneous Esophageal Perforation in an Adolescent. Case Rep Pediatr 2024; 2024:5593403. [PMID: 38756504 PMCID: PMC11098600 DOI: 10.1155/2024/5593403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/22/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
Streptococcus intermedius is an inhabitant of the oral cavity and gastrointestinal tract, known to cause deep-seated abscesses. Thereby, we present a previously healthy adolescent with esophageal perforation (EP) and secondary mediastinal and brain abscesses due to Streptococcus intermedius. EP is a potentially life-threatening condition that requires a prompt diagnosis.
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Affiliation(s)
- Sandra Mabel Camacho-Gomez
- Department of Pediatrics, The University of Texas at Austin, Section of Gastroenterology, Hepatology and Nutrition, Dell Children's Medical Center, Austin, Texas, USA
| | - Javier Monagas
- Department of Pediatrics, Baylor College of Medicine, Section of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of San Antonio, San Antonio, Texas, USA
| | - Robert Adam Noel
- Department of Pediatrics, Baylor College of Medicine, Section of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of San Antonio, San Antonio, Texas, USA
| | - Luis Castagnini
- Vaccine Clinical Research, Merck Research Laboratories, North Wales, Pennsylvania, USA
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3
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Spencer EE, Nostrand SV, Arya S. Group B Streptococcus Brain Abscess in a Neonate with Bilateral Otorrhea. AJP Rep 2024; 14:e106-e110. [PMID: 38586436 PMCID: PMC10994689 DOI: 10.1055/a-2275-9482] [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: 01/07/2024] [Accepted: 02/19/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Group B streptococcus (GBS) is the leading cause of bacterial sepsis and meningitis in neonates worldwide, but brain abscess secondary to GBS is extremely rare. While temporal brain abscesses have been described as a sequelae of otogenic infections in children and adults, such a presentation has not been described in neonates. Case Description An 8-day-old female infant presented with a fever and irritability along with bilateral purulent otorrhea. Maternal GBS screening was negative, but the delivery was complicated by chorioamnionitis. Workup revealed neutrophilic pleocytosis in the cerebrospinal fluid and culture of the ear drainage was positive for GBS. Magnetic resonance imaging showed a circular lesion with rim enhancement within the left temporal lobe concerning for an abscess. The infant was treated with 14 days of intravenous vancomycin, cefepime, and metronidazole followed by 10 weeks of intravenous ampicillin. The hospital course was complicated by seizures and obstructive hydrocephalus requiring multiple neurosurgical interventions. Conclusion Brain abscess can occur as a sequela of GBS meningitis in neonates, but they are rare. Otogenic infections require prompt evaluation and treatment as they can progress to serious central nervous infections in neonates.
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Affiliation(s)
- Emily E. Spencer
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Fairborn, Ohio
| | - Sarah Van Nostrand
- Department of Neonatal-Perinatal Medicine, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital and Pediatrix Neonatology of Ohio, Dayton, Ohio
| | - Shreyas Arya
- Department of Neonatal-Perinatal Medicine, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital and Pediatrix Neonatology of Ohio, Dayton, Ohio
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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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Bodilsen J, D'Alessandris QG, Humphreys H, Iro MA, Klein M, Last K, Montesinos IL, Pagliano P, Sipahi OR, San-Juan R, Tattevin P, Thurnher M, de J Treviño-Rangel R, Brouwer MC. European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect 2024; 30:66-89. [PMID: 37648062 DOI: 10.1016/j.cmi.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
SCOPE These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. METHODS Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I2 tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low). QUESTIONS ADDRESSED BY THE GUIDELINES AND RECOMMENDATIONS Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). No recommendation is offered for early transition to oral antimicrobials because of a lack of data, and oral consolidation treatment after ≥6 weeks of intravenous antimicrobials is not routinely recommended (conditional and very low). Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low). Research needs are addressed.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Mildred A Iro
- Department of Paediatric Infectious diseases and Immunology, The Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Matthias Klein
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Hospital of the Ludwig-Maximilians University, Munich, Germany; Emergency Department, Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Katharina Last
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Inmaculada López Montesinos
- Infectious Disease Service, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Pasquale Pagliano
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Unit of Infectious Diseases, University of Salerno, Baronissi, Italy; UOC Clinica Infettivologica AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Oğuz Reşat Sipahi
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey; Infectious Diseases Department, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
| | - Rafael San-Juan
- CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, 12 de Octubre University Hospital, Madrid, Spain; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections in Compromised Hosts (ESGICH), Basel, Switzerland
| | - Pierre Tattevin
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Majda Thurnher
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rogelio de J Treviño-Rangel
- Faculty of Medicine, Department of Microbiology, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; European Society of Clinical Microbiology and Infectious Diseases, Fungal Infection Study Group (EFISG), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Antimicrobial Stewardship (ESGAP), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Genomic and Molecular Diagnostics (ESGMD), Basel, Switzerland
| | - Matthijs C Brouwer
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Mohammad R, Maoldomhnaigh CÓ, Crimmins D. Clinical characteristics and outcomes of children with non-sinogenic Brain infections. Br J Neurosurg 2023:1-9. [PMID: 38149672 DOI: 10.1080/02688697.2023.2297877] [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: 05/15/2023] [Accepted: 12/16/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Central Nervous System (CNS) suppurative infections are serious but rare conditions in the paediatric population. Data on long-term neurocognitive and quality of life outcomes in children recovering from these infections are lacking. METHODS A retrospective cohort review of children <16 years with non-sinogenic infections undergoing neurosurgery was conducted. Data for patients admitted to Children's Health Ireland at Temple St between 2008-2021 were analysed for clinical and microbiological profiles. Follow-up reviews evaluating neurological and academic sequelae and quality of life were performed. Categorical variables were analysed for unfavourable outcome with a p < 0.05 significance value. RESULTS Forty patients were included with a mean age of 4.5 years and equal gender distribution. Fever (68%) and vomiting (58%) were the most common presenting complaints. Only fourteen (35%) patients presented with the classic triad of fever, headache, and focal neurological deficit. Meningitis/Encephalitis was the most common cause of suppurative infection (40%). Predisposing factors included congenital heart disease (18%), prematurity (15%) and immunocompromised status (10%). More patients received an initial Burr hole aspiration (73%) than Craniotomy (27%). The re-operation rate was higher in the craniotomy group (45%) compared to the burr hole group (34%), but this was not statistically significant (p = 0.522). Four patients died (10%) including two intra-hospital deaths (5%). Male gender (p = 0.047) and multiple abscesses (p = 0.041) were associated with unfavourable outcome at discharge. Mobility impairment was the most affected determinant of quality of life. CONCLUSION CNS suppurative infections are associated with long-term neurocognitive sequelae in children. Multiple abscesses and male gender are associated with unfavourable GOS on discharge. Children are still left with mobility impairment (25%), personality changes (23%) and intellectual disability (18%) at an average of 5 years. Long-term follow up with multidisciplinary input is required. Further research should focus on evaluating long-term HRQoL in children.
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Affiliation(s)
- Retaj Mohammad
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
- Department of Neurosurgery, Temple St Children's University Hospital, Ireland
| | - Cilian Ó Maoldomhnaigh
- Department of Paediatric Infectious Diseases, Temple St Children's University Hospital, Ireland
| | - Darach Crimmins
- Department of Neurosurgery, Temple St Children's University Hospital, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Kameda-Smith MM, Mendoza M, Brown LA, Hartley J, Aquilina K, James G, Jeelani NO, Silva AHD, Thompson D, Tisdall M, Tahir MZ, Hatcher J. Comparison of endoscopic sinus sampling versus intracranial sampling for microbiological diagnosis of intracranial infection in children: a case series and literature review. Childs Nerv Syst 2023; 39:3561-3570. [PMID: 37368066 DOI: 10.1007/s00381-023-06038-4] [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: 05/23/2023] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Intracranial infection is often associated with contiguous sinus infection, with Streptococcus intermedius being the most common pathogen. Microbiological assessment is possible via sinus or intracranial sampling. While a sinus approach is minimally invasive, it is not clear whether this yields definitive microbiological diagnosis leading to optimized antimicrobial therapy and avoidance of intracranial surgery. METHODS A retrospective review of a prospectively collected electronic departmental database identified patients between 2019 and 2022. Further demographic and microbiological information was obtained from electronic patient records and laboratory management systems. RESULTS Thirty-one patients were identified with intracranial subdural and/or epidural empyema and concurrent sinus involvement during the 3-year study period. The median age of onset was 10 years with a slight male predominance (55%). All patients had intracranial sampling with 15 patients undergoing sinus sampling in addition. Only 1 patient (7%) demonstrated identical organism(s) grown from both samples. Streptococcus intermedius was the most common pathogen in intracranial samples. Thirteen patients (42%) had mixed organisms from their intracranial cultures and 57% of samples undergoing bacterial PCR identified additional organisms, predominantly anaerobes. Sinus samples had a significant addition of nasal flora and Staphylococcus aureus which was rarely grown from intracranial samples. Of concern, 7/14 (50%) of sinus samples did not identify the main intracranial pathogen diagnosed on intracranial culture and additional PCR. Literature review identified 21 studies where sinus drainage was used to treat intracranial empyemas, with only 6 authors reporting concurrent microbiology results. This confirmed our cohort to be the largest comparative study in the current literature. No center has observed a greater than 50% concordance in microbiological diagnoses. CONCLUSION Endoscopic sinus surgery may have therapeutic benefit, but it is not an appropriate approach for microbiological diagnosis in pediatric subdural empyemas. High rates of contaminating nasal flora can lead to misdiagnosis and inappropriate treatment. Routine addition of 16S rRNA PCR to intracranial samples is recommended.
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Affiliation(s)
- Michelle Masayo Kameda-Smith
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
| | - Maya Mendoza
- Medical School, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Li-An Brown
- Department of Microbiology, Great Ormond Street Hospital for Children, London, UK
| | - John Hartley
- Department of Microbiology, Great Ormond Street Hospital for Children, London, UK
| | - Kristian Aquilina
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Greg James
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Noor Owase Jeelani
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | | | - Dominic Thompson
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Martin Tisdall
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - M Zubair Tahir
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - James Hatcher
- Department of Microbiology, Great Ormond Street Hospital for Children, London, UK.
- Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
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Chen XB, Zhou YX, Feng Y. Citrobacter freundii induces sepsis with new-onset status seizure in an adult: A case report and literature review. Medicine (Baltimore) 2023; 102:e32549. [PMID: 36607873 PMCID: PMC9829297 DOI: 10.1097/md.0000000000032549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
RATIONALE Sepsis with brain abscess induced by Citrobacter freundii in adults has rarely been reported and is extremely pathogenic with a high mortality rate. Early diagnosis of the infection still remains challenging. PATIENT CONCERNS A 27-year-old woman was transferred to our emergency department for fever, status seizure and refractory hypotension. Administration of midazolam, propofol and sodium valproate could not attenuate the seizure except for the addition of vecuronium. The blood white blood cell count was 42.91 (109/L) with 80% neutrophils, and procalcitonin was 22.46ng/mL. DIAGNOSES Both deoxyribonucleic acid and ribonucleic acid of C freundii were detected in blood by metagenomic next-generation sequencing of pathogens,the diagnosis of septic shock and brain abscess caused by C freundii was highly suspected. INTERVENTIONS On day 1, antibiotics of cefoperazone sodium and sulbactam sodium 6g/day, immunoglobulin, and hydrocortisone were used with suspected septic shock. Continuous renal replacement therapy was used to eliminate excessive lactate, ammonia, myohemoglobin and creatinine. On day 2, a brain computed tomography scan revealed multiple patchy slightly low densities in the brain, antibiotics were adjusted to meropenem intravenously 3g/day. OUTCOMES On day 2, a brain computed tomography scan revealed multiple patchy slightly low densities in the brain, she died on day 3. LESSONS Clinicians should consider the possibility of brain abscess when evaluating a patient with new-onset dizziness, fever, seizure, or other neurologic symptoms or signs, especially for patients whose mental status changes. metagenomic next generation sequencing and resistance genes could be considered when cerebrospinal fluid or blood results are negative and clinical manifestations are highly suspected of infection or when the treatment time is limited.
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Affiliation(s)
- Xiao-bo Chen
- Department of General Surgery, Shuangliu District First People’s Hospital, Chengdu, Sichuan, China
| | - Ya-xiong Zhou
- Emergency Department, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Yan Feng
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU12), Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
- * Correspondence: Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU12), Chinese Academy of Medical Sciences, Chengdu, Sichuan 610041, China (e-mail:)
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Intracranial empyema complicating sinusitis in childhood: Epidemiology, imaging findings and outcome. Int J Pediatr Otorhinolaryngol 2022; 162:111299. [PMID: 36137474 DOI: 10.1016/j.ijporl.2022.111299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 08/02/2022] [Accepted: 08/27/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND To describe clinical presentations of intracranial sinusitis complications in childhood, their pitfalls and imaging findings. MATERIEL AND METHODS This retrospective IRB-approved single-center study included infants diagnosed with sinusitis and empyema and/or other intracranial complications who underwent imaging between September 2008 and September 2019. Three radiologists individually reviewed clinical charts and imaging findings, including sinusitis complications and at-risk anatomical variations. RESULTS 21 children (76% males and 24% females, mean age 13±3.1 years) with imaging pansinusitis were included. Headache (95%) and fever (90%) were the main clinical nonspecific signs. Ten (48%) children presented an extradural empyema, nine (43%) children had a subdural empyema and two (10%) children had both. Frontal location sinusitis was the most common (76%). In MRI, all empyema presented as a hypo intensity on pre-contrast T1-WI, a hyperintensity on T2-WI, a reduced apparent diffusion coefficient (ADC) on diffusion weighted imaging (DWI) and a peripheral contrast enhancement on post-contrast T1-WI. CT or MRI revealed intracranial complications such as a collection size increase (52%), a midline shift (62%), intraparenchymal abscesses (24%), a cerebral venous thrombosis (29%), an intracranial pressure increase (29%), cerebral ischemia (43%) and Pott's Puffy Tumor (10%). Imaging highlighted sinus anatomical abnormalities in 52% of cases. All children were treated with sinus drainage and/or neurosurgery. Long-term follow-up was favorable in 14 cases (67%). CONCLUSION Complications of sinusitis are life threatening in the studied population. Empyema and cerebral complications may be misleading. Brain contrast-enhanced CT covering sinuses and orbits, is mainly the first examination done but MRI is mandatory.
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Sarvestani HK, Ansari S, Parvaneh N, Yaghmaie B, Ahmadi B. Fatal invasive aspergillosis in a child with chronic granulomatous disease. J Wound Care 2022; 31:427-431. [PMID: 35579316 DOI: 10.12968/jowc.2022.31.5.427] [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] [Indexed: 01/14/2023]
Abstract
Patients with chronic granulomatous disease, a primary immunodeficiency, experience granulomatous complications and recurrent life-threatening opportunistic bacterial and fungal infections. In this article, we report on a case of invasive aspergillosis in an eight-year-old boy with chronic granulomatous disease, who presented with pleural effusion and pneumonia, cerebral venous sinus thrombosis, and unusual skin lesions caused by Aspergillus fumigatus. Antifungal treatment with itraconazole and other antifungal agents, along with interferon-γ, was ineffective and the patient eventually died from cerebral venous sinus thrombosis, and intracerebral haemorrhage following increased intracranial pressure after one month. The diagnosis of invasive aspergillosis should be considered early in children presenting with invasive fungal infections, particularly those involving the central nervous system.
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Affiliation(s)
- Hasti Kamali Sarvestani
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saham Ansari
- Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Parvaneh
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yaghmaie
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Ahmadi
- Department of Medical Laboratory Sciences, School of Para-Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
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Sexton GP, Nae A, Cleere EF, O'Riordan I, O'Neill JP, Lacy PD, Amin M, Colreavy M, Caird J, Crimmins D. Concurrent management of suppurative intracranial complications of sinusitis and acute otitis media in children. Int J Pediatr Otorhinolaryngol 2022; 156:111093. [PMID: 35272257 DOI: 10.1016/j.ijporl.2022.111093] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/02/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Intracranial complications of sinusitis and acute otitis media (AOM) are rare but life-threatening events. In children with suppurative intracranial complications, concurrent neurosurgical and otolaryngological (ORL) intervention has been recommended to optimize outcomes. The aim of this study was to investigate outcomes following concurrent neurosurgical and ORL intervention. METHODS A retrospective cohort study of children undergoing neurosurgical intervention for intracranial complications of sinusitis or AOM in two neurosurgical centres in Ireland was conducted. RESULTS 65 children were identified. Mean age was 11.9 years. The most prevalent symptoms were headache, pyrexia, altered level of consciousness, facial swelling, and vomiting. Subdural empyema (n = 24, 36.9%) and extradural abscess (n = 17, 26.2%) were the most common complications. 54 underwent same admission ORL intervention; 47 (87%) were performed concurrently or earlier. For rhinogenic infections, 35 (64.8%) underwent endoscopic sinus surgery (ESS), 13 (24.1%) underwent frontal sinus trephine, and 5 (9.3%) underwent maxillary sinus washout alone. For otogenic infections, 10 (90.9%) underwent mastoidectomy and 7 (63.6%) underwent tympanostomy tube placement. 19 (29.2%) had post-operative neurological deficits, of which 2 (3.1%) were permanent. Streptococcus intermedius was the most common pathogen (n = 30, 46.2%). Concurrent intervention reduced the prevalence of residual collection (p = 0.018) and the need for revision neurosurgical intervention (p = 0.039) for sinogenic complications. The same trends did not achieve statistical significance for the otogenic group. Mortality was 0%. CONCLUSION Intracranial complications of sinusitis and AOM are best managed in a specialist centre with multidisciplinary input. Concurrent ORL and neurosurgical intervention reduces abscess recurrence and requirement for revision neurosurgery in sinogenic complications and should represent the standard of care. ESS is the ORL modality of choice in experienced hands.
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Affiliation(s)
- G P Sexton
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland.
| | - A Nae
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland
| | - E F Cleere
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland
| | - I O'Riordan
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland
| | - J P O'Neill
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland
| | - P D Lacy
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Ireland
| | - M Amin
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland
| | - M Colreavy
- Department of Otolaryngology, Children's Health Ireland at Temple Street Hospital, Ireland; University College Dublin School of Medicine, Ireland
| | - J Caird
- University College Dublin School of Medicine, Ireland; Department of Neurosurgery, Beaumont Hospital, Ireland
| | - D Crimmins
- University College Dublin School of Medicine, Ireland; Department of Neurosurgery, Beaumont Hospital, Ireland
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Khan A, Azadian M, Richter D, Young TP, Kuntz HM. Clinical Presentation of Toddlers With New Intracranial Space-Occupying Lesions: A Case Series. Pediatr Emerg Care 2022; 38:e618-e621. [PMID: 33760576 DOI: 10.1097/pec.0000000000002388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Intracranial space occupying lesions (ICSOLs) like tumors and abscesses can be life-threatening conditions. It can be especially difficult to diagnose these conditions in toddlers. We aimed to describe symptoms and signs present in a sample of toddlers with ICSOLs. METHODS We performed a retrospective chart review of 15 toddlers with intracranial tumors, abscesses, or infected cysts. We collected data on the presence of various signs and symptoms on presentation to the emergency department. RESULTS Eight toddlers (53%) presented with vomiting. A change in behavior was the second most common symptom (6, 40%). Seven children (47%) had motor weakness, and 5 (33%) had ataxia. Eleven of the 12 children with tumors (92%) had documented abnormal neurologic signs on initial physical examination. CONCLUSIONS Vomiting, a change in behavior, and an abnormal neurologic examination were common signs and symptoms in our sample of toddlers with ICSOLs. An accurate history and appropriate neurologic examination can help physicians make this challenging diagnosis in this age group.
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Affiliation(s)
- Abdullah Khan
- From the Department of Emergency Medicine, Pediatric Emergency Medicine, Loma Linda University Hospital, Loma Linda, CA
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13
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Guo F, Yan J, Ling G, Chen H, Huang Q, Mu J, Mo L. Screening and Identification of Key Biomarkers in Lower Grade Glioma via Bioinformatical Analysis. Appl Bionics Biomech 2022; 2022:6959237. [PMID: 35035531 PMCID: PMC8759910 DOI: 10.1155/2022/6959237] [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: 11/09/2021] [Accepted: 12/06/2021] [Indexed: 02/07/2023] Open
Abstract
Lower-grade glioma (LGG) is a common type of central nervous system tumor. Due to its complicated pathogenesis, the choice and timing of adjuvant therapy after tumor treatment are controversial. This study explored and identified potential therapeutic targets for lower-grade. The bioinformatics method was employed to identify potential biomarkers and LGG molecular mechanisms. Firstly, we selected and downloaded GSE15824, GSE50161, and GSE86574 from the GEO database, which included 40 LGG tissue and 28 normal brain tissue samples. GEO and VENN software identified of 206 codifference expressed genes (DEGs). Secondly, we applied the DAVID online software to investigate the DEG biological function and KEGG pathway enrichment, as well as to build the protein interaction visualization network through Cytoscape and STRING website. Then, the MCODE plug is used in the analysis of 22 core genes. Thirdly, the 22 core genes were analyzed with UNCLA software, of which 18 genes were associated with a worse prognosis. Fourthly, GEPIA was used to analyze the 18 selected genes, and 14 genes were found to be a significantly different expression between LGGs and normal brain tumor samples. Fifthly, hierarchical gene clustering was used to examine the 14 important gene expression differences in different histologies, as well as analysis of the KEGG pathway. Five of these genes were shown to be abundant in the natural killer cell-mediated cytokines (NKCC) and phagosome pathways. The five key genes that may be affected by the immune microenvironment play a crucial role in LGG development.
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Affiliation(s)
- Fangzhou Guo
- Department of Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jun Yan
- Department of Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Guoyuan Ling
- Department of Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hainan Chen
- Department of Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qianrong Huang
- Department of Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Junbo Mu
- Department of Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Ligen Mo
- Department of Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China
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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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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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Hasan MT, Lewis D, Siddiqui M. Brain abscess – A rare complication of endovascular treatment for acute ischemic stroke. Surg Neurol Int 2020; 11:319. [PMID: 33093996 PMCID: PMC7568088 DOI: 10.25259/sni_481_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Brain abscess is a neurosurgical emergency, which can arise through direct bacterial seeding or hematogenous spread. Rarely, brain abscess formation has been reported following ischemic stroke. An increasingly utilized therapy for stroke is mechanical thrombectomy, and within this report, we present a case of brain abscess formation following this procedure. Case Description: A 78-year-old female presented to our center with a right total anterior circulation stroke (TACS) secondary to terminal internal carotid artery occlusion. An emergent mechanical thrombectomy was performed and the patient’s initial postoperative recovery was good. In the 3rd week after the procedure, however, the patient became more confused and following the onset of fever, an MRI brain was performed, which demonstrated an extensive multiloculated right-sided brain abscess. Burr hole drainage of the abscess was subsequently undertaken and pus samples obtained grew Proteus mirabilis, presumed secondary to a urinary tract infection, and the patient was started on prolonged antibiotic therapy. To date, the infection has been eradicated and the patient survives albeit with persistent neurological deficits. Conclusion: To the best of our knowledge, this is the first reported UK case of brain abscess following mechanical thrombectomy for stroke. Endovascular interventions can lead to increased incidence of ischemia-reperfusion injury in stroke with increased blood–brain barrier damage and risk of microbial seeding. This case highlights the need for rigorous asepsis and proactive treatment of systemic infections in the acute phase following endovascular treatment and consideration of brain abscess in all patients who present with new-onset confusion and unexplained fever following stroke.
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Affiliation(s)
- Md Tanvir Hasan
- Departments of Neurosurgery Salford Royal NHS Foundation Trust, Salford, Manchester, United Kingdom
| | - Daniel Lewis
- Departments of Neurosurgery Salford Royal NHS Foundation Trust, Salford, Manchester, United Kingdom
| | - Mohammed Siddiqui
- Departments of Stroke Medicine, Salford Royal NHS Foundation Trust, Salford, Manchester, United Kingdom
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Rahwan M, Lekoubou A, Bishu KG, Ovbiagele B. Frequency and predictors of 30-day readmission after an index hospitalization for generalized convulsive status epilepticus: A nationwide study. Epilepsy Behav 2020; 111:107252. [PMID: 32698108 DOI: 10.1016/j.yebeh.2020.107252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/31/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the study was to assess the frequency and factors associated with all-cause 30-day readmission among patients hospitalized with generalized convulsive status epilepticus (GCSE) in a nationwide sample in the United States. METHODS We used The 2014 Nationwide Readmission Database (NRD) as the data source. We included adults (age ≥18 years) with a primary discharge diagnosis of GCSE, identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 345.3. We excluded patients who died during hospitalization and those who had missing information on the length of stay (LOS). We also excluded those discharged in December 2014. We computed the overall 30-day readmission rate and compared prespecified groups by their 30-day readmission status. We applied a multiple logistic regression analysis to identify independent predictors of all-cause 30-day readmission adjusting for potential confounders. RESULTS Among 14,562 (weighted 31,062) adults discharged with a diagnosis of GCSE, 2520 (17.3%) were readmitted within 30 days. In multivariate analysis, patients with comorbid conditions (odds ratio (OR) for Charlson Comorbidities Index (CCI) = 1 and ≥2 was 1.12, 95% confidence interval (CI): 1.0-1.36 and 1.32, 95% CI: 1.17-1.48, respectively), LOS >6 days (OR: 1.42; 95% CI: 1.05-192), discharged against medical advice (OR: 1.45; 95% CI: 1.09-1.92), or discharged to a short-term hospital (OR: 1.39; 95% CI: 1.0-1.88), had higher odds of 30-day readmission, while there was an inverse association for those aged ≥45 years or with high income. Seizures were the most common cause associated with readmission, followed by sepsis and cerebrovascular diseases, respectively. SIGNIFICANCE Little is known about the frequency and predictors of early readmission after GCSE. This study showed that more than one in six patients with GCSE was readmitted within 30 days after discharge. More considerable attention to high-risk subgroups may identify opportunities to ameliorate the clinical outcome and lessen the economic burden of early readmission after GCSE.
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Affiliation(s)
- Mohamad Rahwan
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Alain Lekoubou
- Department of Neurology, Penn State University, Hershey, PA, USA.
| | - Kinfe G Bishu
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA; Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
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Shah PV, Wathen J, Keyes J, Osborne C, Messacar K, Stence N, Kothari K. Foreign Body Esophageal Perforation Leading to Multifocal Brain Abscesses: A Case Report. J Emerg Med 2020; 59:e131-e135. [DOI: 10.1016/j.jemermed.2020.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/23/2020] [Accepted: 06/01/2020] [Indexed: 01/12/2023]
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Abstract
BACKGROUND The long-term prognosis of brain abscess is unclear. METHODS Using nationwide, population-based medical registries, we included all individuals <20 years of age hospitalized with first-time diagnosis of brain abscess in Denmark from 1982 to 2016. A comparison cohort individually matched for age, sex and residence was identified, as were siblings of all study participants. Next, cumulative incidence curves of mortality and new-onset epilepsy were constructed, and Cox regression was used for analyses of hazard rate ratios (HRRs) with 95% confidence intervals. RESULTS We identified 155 brain abscess patients and 1,550 population controls with median follow-up times of 15 years (interquartile range, 6-25) and 16 years (interquartile range, 11-26). Ear-nose-throat infections (22%) and congenital heart disease (13%) were the most common predisposing conditions for brain abscess. Overall mortality was 21/155 (14%) in brain abscess patients versus 20/1,550 (1%) in population controls. The corresponding HRRs were 150 (95% confidence interval: 19.8-1,116) after 1 year of observation, 24.6 (4.78-127) after 2-5 years and 0.66 (0.09-4.98) after 6-30 years. New-onset epilepsy occurred in 28% of 30-day brain abscess survivors versus 1% in population controls yielding a HRR of 29.6 (14.4-60.8) adjusted for previous head trauma, stroke and cancer. Analyses of sibling cohorts showed that family-related factors did not explain the observed increased risks of death or epilepsy among brain abscess patients. CONCLUSIONS Brain abscess is associated with increased risk of mortality for up to 5 years. New-onset epilepsy occurred in 28% of survivors and remained a risk for several years after infection.
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Kudo-Kubo A, Shimakawa S, Odanaka Y, Ikeda N, Kitahara H, Toshikawa H, Ashida A, Fukui M, Ozaki N, Kishi K, Wanibuchi M, Ashida A. Multiple brain abscesses with good prognosis in an infant with cyanotic congenital heart disease: a case report. J Med Case Rep 2020; 14:111. [PMID: 32690062 PMCID: PMC7372864 DOI: 10.1186/s13256-020-02436-3] [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: 04/22/2020] [Accepted: 06/08/2020] [Indexed: 11/19/2022] Open
Abstract
Background Brain abscesses are relatively rare, but they are a potentially life-threatening condition. Predictive factors for poor outcome are a young age and the presence of multiple abscesses. We report a case of a 15-month-old girl with cyanotic congenital heart disease who developed multiple brain abscesses caused by Streptococcus intermedius. The patient was treated with a combination of surgical aspiration and antimicrobial therapy without apparent neurological sequelae. To the best of our knowledge, this is the youngest such patient to have been reported in the literature. We explore the possible causes of her good outcome. Case presentation At the age of 15 months, the Japanese patient initially was presented to our hospital with transient eye deviation to the left and vomiting. In a blood examination, her white blood cell count (12,720 per mm3 with a left shift) and C-reactive protein level (1.23 mg/ml) were slightly elevated. Magnetic resonance imaging of the brain showed three mass lesions. These were 1.5-cm, 1.9-cm, and 1.2-cm rim-enhancing lesions with extensive surrounding edema. Brain abscesses were diagnosed, and vancomycin (50 mg every 12 hours) and meropenem (40 mg every 8 hours) were started empirically. However, because each brain abscess was enlarged at 8 days after admission, surgical aspiration was performed at 10 days after admission, and cultures of the aspirated pus grew S. intermedius. Penicillin G (0.7 million units every 4 hours) and ceftriaxone (280 mg every 12 hours), to which this isolate is susceptible, were then administered, and the brain abscesses reduced in size. After 1 month of ceftriaxone and 3 months of penicillin G treatment, all of the brain abscesses disappeared. Apparent neurological sequelae were not observed at 6 months after onset. Conclusions A good outcome can be obtained if multiple brain abscesses develop in infancy or early childhood in cases without unconsciousness at admission, meningitis, or sepsis. Appropriate antimicrobial therapy should be started immediately after diagnosis, with surgical aspiration performed to identify the causative pathogen and avoid intraventricular rupture of the brain abscesses.
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Affiliation(s)
- Atsuko Kudo-Kubo
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Takatsuki, Osaka, 569-8686, Japan
| | - Shuichi Shimakawa
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Takatsuki, Osaka, 569-8686, Japan.
| | - Yutaka Odanaka
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Takatsuki, Osaka, 569-8686, Japan
| | - Naokado Ikeda
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Hikaru Kitahara
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Takatsuki, Osaka, 569-8686, Japan
| | - Hiromitsu Toshikawa
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Takatsuki, Osaka, 569-8686, Japan
| | - Atsuko Ashida
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Takatsuki, Osaka, 569-8686, Japan
| | - Miho Fukui
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Takatsuki, Osaka, 569-8686, Japan
| | - Noriyasu Ozaki
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Takatsuki, Osaka, 569-8686, Japan
| | - Kanta Kishi
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Takatsuki, Osaka, 569-8686, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Takatsuki, Osaka, 569-8686, Japan
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Rotter J, Graffeo CS, Perry A, Gilder HE, Wilson JW, Link MJ. Polymicrobial Intracerebral Abscess Growing Mycobacterium avium Complex and Achromobacter xylosoxidans: Case Report and Literature Review. World Neurosurg 2020; 141:441-447.e1. [PMID: 32525087 DOI: 10.1016/j.wneu.2020.05.283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mycobacterium avium complex (MAC) and Achromobacter xylosoxidans (AX) are uncommon sources of neurosurgical infections, particularly in immunocompetent hosts. We report the first published case of intracranial AX abscess and polymicrobial AX-MAC abscess, as well as the fourth MAC abscess in a non-immunocompromised patient. METHODS This case report was conducted via retrospective chart review. A literature review was completed in compliance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS Ten years following mucocele resection, a 60-year-old man presented with sinus congestion and headache. Head imaging revealed a left frontal lesion abutting the cribriform plate and ethmoid roof. The patient had a left frontal craniotomy for abscess drainage. Intraoperative cultures demonstrated polymicrobial growth of AX and MAC, managed with antimicrobial therapy and staged skull base reconstruction. Three cases of MAC abscess and 16 cases of AX ventriculitis or meningitis have been reported in immunocompetent patients. All MAC cerebral abscesses occurred in adults, one of whom succumbed to the infection. Of the 9 AX meningitis cases, 4 occurred in neonates and 2 in pediatric patients. Six of the 7 AX ventriculitis cases occurred after neurosurgical operations at the same hospital from contaminated chlorhexidine basins. Except for the neonates, AX ventriculitis or meningitis patients had undergone neurosurgery or had a history of cranial trauma. There were no reports of polymicrobial AX-MAC intracranial abscess. CONCLUSIONS AX and MAC are rare causes of intracranial infection. Patients with these pathogens identified in the central nervous system require a multidisciplinary approach for successful management.
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Affiliation(s)
- Juliana Rotter
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Avital Perry
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hannah E Gilder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - John W Wilson
- Division of Infectious Disease, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Link
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Brain Abscess Secondary to a Dental Infection. Case Rep Emerg Med 2020; 2020:3248174. [PMID: 32089904 PMCID: PMC7026700 DOI: 10.1155/2020/3248174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/15/2019] [Indexed: 11/18/2022] Open
Abstract
The risk of a brain abscess is a complication of odontogenic infection that is rarely considered by physicians and little spoken of, yet treating dental infections may avoid a potentially life-threatening condition. We report a case of 7-year-old boy with a brain abscess secondary to a dental infection. He was immediately taken to the operating theatre for drainage and cleaning of the abscess. A dental examination revealed root abscesses on temporary molars, which were extracted under general anaesthetic. Two months after his admission, the child was switched to oral antibiotherapy and could return home. A brain abscess represents a life-threatening disease. Childhood brain abscess is uncommon but may be encountered by all physicians and students as a clinical emergency. It is indispensable that physicians finding symptoms similar to those in this case study refer the patient for emergency care and that possible dental foci of infection be assessed, whether or not the patient is being followed for dental care.
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Lekoubou A, Bishu KG, Ovbiagele B. Association of Prevalent Stroke with Hospitalization for Seizure: Patterns and Prognoses. J Stroke Cerebrovasc Dis 2019; 28:104344. [PMID: 31488375 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104344] [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: 01/17/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite the close relationship between stroke and seizures, little is known about stroke trends and inpatient mortality among patients with seizures. MATERIALS AND METHODS The National Inpatient Sample was used to analyze the prevalence and trends of stroke among patients discharged with a primary diagnosis of seizures between 2006 and 2014. International Classification of Diseases, Ninth Revision, Clinical Modification was used to identify patients discharged with a primary diagnosis of seizures and those with a secondary diagnosis of stroke. Multivariable logistic regression was used to examine the association between inpatient hospital mortality and stroke. Adjusted prediction of mortality post estimates of logistic regression was used to analyze mortality by stroke status overtime. FINDINGS A total of 400,391 (weighted 1,980,707) patients with seizures were identified between 2006 and 2014, including 61,039 weighted (3%) with a secondary diagnosis of stroke patients. Among patients with a primary diagnosis of seizures, having a secondary diagnosis of stroke doubled the odds of in-hospital death (odds ratio = 2.02; 95% confidence interval: 1.74-2.34; P < .001). Overall, between 2006 and 2014, the prevalence of stroke among patients discharged with a primary diagnosis of seizures remained stable at 3% amid fluctuations across years. Among patients with a primary discharge diagnosis of seizures who had stroke, in-hospital mortality increased from 2.3% in 2006 to 3.6% in 2014 but decreased from .8% in 2006 to .7% in 2014 in those without stroke. CONCLUSIONS Stroke is prevalent and is associated with increased mortality among patients who are discharged with a primary diagnosis of seizure, with a stable prevalence but suggested increased mortality across time.
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Affiliation(s)
- Alain Lekoubou
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.
| | - Kinfe G Bishu
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Section of Health Systems Research and Policy, Medical University of South Carolina, Charleston, South Carolina
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, California
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Mameli C, Genoni T, Madia C, Doneda C, Penagini F, Zuccotti G. Brain abscess in pediatric age: a review. Childs Nerv Syst 2019; 35:1117-1128. [PMID: 31062139 DOI: 10.1007/s00381-019-04182-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/28/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The purpose of the paper is to examine the current state of the art about epidemiology, diagnosis, and treatment of this infection. METHODS A review of the literature was performed through a PubMed search of original articles, case reports, and reviews using the key words "brain abscess," "cerebral abscess," "brain infection," "intracranial suppuration," "otogenic brain abscess," "otitis complications," and "sinusitis complications." RESULTS Pediatric brain abscess is a rare but serious infection, often involving patients with specific risk factors and burdened by a high risk of morbidity and mortality. Brain abscess incidence and mortality decreased over the years, thanks to improved antibiotic therapy, new neurosurgical techniques, and the wide spread of vaccinations. There are no guidelines for the adequate diagnostic-therapeutic pathway in the management of brain abscesses; therefore, conflicting data emerge from the literature. In the future, multicentric prospective studies should be performed in order to obtain stronger evidences about brain abscesses management. Over the next few years, changes in epidemiology could be observed because of risk factors changes.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy.
| | - Teresa Genoni
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy
| | - Cristina Madia
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy
| | - Chiara Doneda
- Pediatric Radiology and Neuroradiology Unit, Children Hospital V. Buzzi, Milan, Italy
| | - Francesca Penagini
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Childrens' Hospital, University of Milan, Milan, Italy
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Hall S, Yadu S, Gaastra B, Mathad N, Sparrow O, Waters R, Chakraborty A, Tsitouras V. Paediatric brain abscesses: a single centre experience. Br J Neurosurg 2019; 33:550-554. [DOI: 10.1080/02688697.2019.1587381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Samuel Hall
- Department of Neurosurgery, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Shirley Yadu
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Benjamin Gaastra
- Department of Neurosurgery, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Nijaguna Mathad
- Department of Neurosurgery, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Owen Sparrow
- Department of Neurosurgery, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Ryan Waters
- Department of Neurosurgery, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Aabir Chakraborty
- Department of Neurosurgery, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Vassilios Tsitouras
- Department of Neurosurgery, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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van der Velden FJS, Battersby A, Pareja-Cebrian L, Ross N, Ball SL, Emonts M. Paediatric focal intracranial suppurative infection: a UK single-centre retrospective cohort study. BMC Pediatr 2019; 19:130. [PMID: 31023283 PMCID: PMC6482535 DOI: 10.1186/s12887-019-1486-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 04/03/2019] [Indexed: 11/10/2022] Open
Abstract
Background Paediatric focal intracranial suppurative infections are uncommon but cause significant mortality and morbidity. There are no uniform guidelines regarding antibiotic treatment. This study reviewed management in a tertiary healthcare centre in the United Kingdom and considers suggestions for empirical treatment. Methods A retrospective, single-centre cohort review of 95 children (< 18 years of age) with focal intracranial suppurative infection admitted between January 2001 and June 2016 in Newcastle upon Tyne, United Kingdom. Microbiological profiles and empirical antibiotic regimens were analysed for coverage, administration and duration of use. Mortality and neurological morbidity were reviewed. Data was analysed using t-tests, Mann-Whitney U tests, independent-samples median tests, and χ2-tests where appropriate. P-values < 0.05 were considered statistically significant. Results Estimated annual incidence was 8.79 per million. Age was bimodally distributed. Predisposing factors were identified in 90.5%, most commonly sinusitis (42.1%) and meningitis (23.2%). Sinusitis was associated with older children (p < 0.001) and meningitis with younger children (p < 0.001). The classic triad was present in 14.0%. 43.8% of 114 isolates were Streptococcus spp., most commonly Streptococcus milleri group organisms. Twelve patients cultured anaerobes. Thirty one empirical antibiotic regimens were used, most often a third-generation cephalosporin plus metronidazole and amoxicillin (32.2%). 90.5% would have sufficient cover with a third generation cephalosporin plus metronidazole. 66.3% converted to oral antibiotics. Median total antibiotic treatment duration was 90 days (interquartile range, 60–115.50 days). Mortality was 3.2, 38.5% had short-term and 24.2% long-term neurological sequelae. Conclusions Paediatric focal intracranial suppurative infection has a higher regional incidence than predicted from national estimates and still causes significant mortality and morbidity. We recommend a third-generation cephalosporin plus metronidazole as first-choice empirical treatment. In infants with negative anaerobic cultures metronidazole may be discontinued.
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Affiliation(s)
- Fabian J S van der Velden
- Paediatric Immunology, Infectious Diseases and Allergy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, NE1 4LP, UK.,Erasmus MC, Rotterdam, 3015, CE, The Netherlands
| | - Alexandra Battersby
- Paediatric Immunology, Infectious Diseases and Allergy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, NE1 4LP, UK
| | - Lucia Pareja-Cebrian
- Microbiology Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - Nicholas Ross
- Neurosurgery department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - Stephen L Ball
- Otorhinolaryngology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
| | - Marieke Emonts
- Paediatric Immunology, Infectious Diseases and Allergy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, NE1 4LP, UK. .,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
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Chen M, Low DCY, Low SYY, Muzumdar D, Seow WT. Management of brain abscesses: where are we now? Childs Nerv Syst 2018; 34:1871-1880. [PMID: 29968000 DOI: 10.1007/s00381-018-3886-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/25/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Brain abscesses affect all age groups and are not peculiar to a particular country, race, or geographical location. It is a disease that, in the past, carried a high morbidity and mortality. With improvements in medical technology and expertise, outcomes have improved tremendously. The causative organisms vary vastly and have evolved with time. Treatment of brain abscesses is primarily with antimicrobial therapy but surgery plays a vital role in achieving better outcomes. CONTENT In this article, we review the literature to find out how the epidemiology of this disease has changed through the years and re-visit the basic pathological process of abscess evolution and highlight the new research in the biochemical pathways that initiate and regulate this process. We also highlight how magnetic resonance imaging and its various modalities have improved diagnostic accuracy. Finally, we discuss the pros and cons of traditional open surgery versus newer minimally invasive methods.
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Affiliation(s)
- Minwei Chen
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - David C Y Low
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.,Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore.,Singhealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, Singapore
| | - Sharon Y Y Low
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.,Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore.,Singhealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, Singapore
| | - Dattatraya Muzumdar
- Department of Neurosurgery, King Edward VII Memorial hospital, Mumbai, India
| | - Wan Tew Seow
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore. .,Neurosurgical Service, KK Women's and Children's Hospital, Singapore, Singapore. .,Singhealth Duke-NUS Neuroscience Academic Clinical Program, Singapore, Singapore.
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Sahbudak Bal Z, Eraslan C, Bolat E, Avcu G, Kultursay N, Ozkinay F, Kurugol Z, Vardar F. Brain Abscess in Children: A Rare but Serious Infection. Clin Pediatr (Phila) 2018; 57:574-579. [PMID: 28969451 DOI: 10.1177/0009922817733301] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Brain abscess is a rare disease in childhood requiring prompt medical and/or surgical treatment. The objective was to review presentation, management, and outcome of brain abscess in children. We reviewed the clinical and radiological features and outcomes of 18 children (10 females, 8 males), with a median age of 48 months (range 1-182), that presented with brain abscesses and admitted to a tertiary pediatric infectious department between December 2010 and January 2017. One (5.5%) patient underwent craniotomy and 14 (77.7%) had burr hole aspirations. The most common localization was the frontal lobe (33.3%). The survival rate was 94.4%, and long-term neurological sequelae affected 27.7% of the patients. Empiric treatment choices require knowledge of common pathogens and local resistance. The most predominant infections were still upper respiratory infections. Clinicians may treat the children with appropriate choice and duration of antibiotic treatment for upper respiratory tract infections.
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Affiliation(s)
| | - Cenk Eraslan
- 1 Medical School of Ege University, Bornova, Izmir, Turkey
| | - Elif Bolat
- 1 Medical School of Ege University, Bornova, Izmir, Turkey
| | - Gulhadiye Avcu
- 1 Medical School of Ege University, Bornova, Izmir, Turkey
| | | | - Ferda Ozkinay
- 1 Medical School of Ege University, Bornova, Izmir, Turkey
| | - Zafer Kurugol
- 1 Medical School of Ege University, Bornova, Izmir, Turkey
| | - Fadil Vardar
- 1 Medical School of Ege University, Bornova, Izmir, Turkey
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Kim JH, Park SP, Moon BG, Kim DR. Brain Abscess Showing a Lack of Restricted Diffusion and Successfully Treated with Linezolid. Brain Tumor Res Treat 2018; 6:92-96. [PMID: 30381924 PMCID: PMC6212685 DOI: 10.14791/btrt.2018.6.e16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 01/23/2023] Open
Abstract
A 59-year-old patient with a history of hepatocellular carcinoma presented with decreased consciousness and left hemiparesis. A rim-enhanced mass lesion without diffusion restriction was observed in contrast-enhanced MRI including diffusion-weighted imaging. Based on these findings, metastatic brain tumor was suspected. However, brain abscess (BA) was diagnosed after multiple bacterial colonies were observed in aspiration biopsy. Initial conventional antibiotic treatment including vancomycin had failed, so linezolid was used as second-line therapy. As a result, infection signs and clinical symptoms were resolved. We report a case with atypical imaging features and antibiotic susceptibility of a BA in an immunocompromised patient undergoing chemotherapy.
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Affiliation(s)
- Joo Hyun Kim
- Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center, Seoul, Korea
| | - Sang Phil Park
- Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center, Seoul, Korea
| | - Byung Gwan Moon
- Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center, Seoul, Korea
| | - Deok Ryeong Kim
- Department of Neurosurgery, Eulji University, Nowon Eulji Medical Center, Seoul, Korea.
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Eggart MD, Greene C, Fannin ES, Roberts OA. A 14-Year Review of Socioeconomics and Sociodemographics Relating to Intracerebral Abscess, Subdural Empyema, and Epidural Abscess in Southeastern Louisiana. Neurosurgery 2017; 79:265-9. [PMID: 26909804 DOI: 10.1227/neu.0000000000001225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Secondary intracranial infections are a persistent health concern despite advancements in medicine and improvements in surgical care. Previous studies have reported on the incidence of infection and outcomes in the immunocompromised patient, yet few studies have investigated demographic elements linked to contracting a secondary intracranial infection, a preventable disease. OBJECTIVE The aim of this study was to uniquely describe immunocompetent pediatric patients with secondary intracranial infections and further examine the socioeconomic and sociodemographic factors that may put them at higher risk of acquiring an infection. METHODS A retrospective review was conducted for patients presenting with intracranial infections to the regional Children's Hospital between 2001 and 2014. Patients with a previous history of neurosurgical disease or procedure were excluded. A Z test for proportions was performed to detect significant variations between demographic groups. RESULTS A total of 41 patients were included in the study sample. From 2001 to 2014, 63.4% of patients diagnosed with intracranial infections were white, and 36.5% were other/nonwhite. This incidence of infection varied significantly between white and nonwhite (P = .015). At Children's Hospital, 19.5% of patients were privately insured and 80.5% had public health insurance. The most notable variation of a secondary intracranial infection was health insurance; 51% of Louisiana children carry public insurance, yet they represent more than 80% of disease incidence (P < .001). CONCLUSION Improving access to care and treatment for underinsured populations may contribute to a decrease in secondary intracranial infection cases. ABBREVIATIONS CHD, congenital heart diseaseED, emergency departmentICD-9, International Classification of Diseases, Ninth RevisionRR, relative risk.
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Affiliation(s)
- M Daniel Eggart
- *Department of Neurosurgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, Louisiana; ‡Department of Neurosurgery, Children's Hospital New Orleans, New Orleans, Louisiana
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Abstract
Brain abscess is uncommon in paediatric population, but of clinical importance because of significant long-term morbidity and mortality. In this multicentre study, promoted by the Italian Society for Paediatric Infectious Diseases, we retrospectively collected patients aged 0-18 years, with a diagnosis of 'brain abscess'. Seventy-nine children were included; the median age was 8·75 years. As predisposing factor, 44 children had preceding infections. The Gram-positive cocci were mostly isolated (27 cases). Sixty (76%) children underwent a surgical intervention. Intravenous antibiotic therapy was administered in all patients, then switched to oral treatment. Clinical sequelae were recorded in 31 (39·2%) children. Twenty-one of them had a single sequela, of which, the most represented, was epilepsy in nine of them. This study focus the attention on the need to have standardized national guidelines or adequate recommendations on type and duration of antibiotic treatment.
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Ndubuisi CA, Ohaegbulam SC, Mezue WC, Chikani MC, Nkwerem SP, Ozor II. Management of Brain Abscess: Changing Trend and Experience in Enugu, Nigeria. Niger J Surg 2017; 23:106-110. [PMID: 29089734 PMCID: PMC5649424 DOI: 10.4103/njs.njs_46_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Intracranial abscess remains a significant health-care problem. Its causes, diagnosis, treatment, and outcome are changing. Aim: This paper reviewed the demography, examined new trends, and compared outcomes with different treatment options. Methodology: Retrospective analysis of intracranial abscesses managed at Memfys Hospital, Enugu (2004–2014) and University of Nigeria Teaching Hospital (2009–2014). Patients were followed up for at least 6 months. All patients had neuroimaging before intervention. Microscopy and culture were performed for the specimens. Intravenous antibiotics were given for 2 weeks before conversion to oral. Results: Seventy-nine parenchymal abscesses (eight cases per year) were managed. Peak age was the second decade of life. Previous head injury (21.5%) and meningitis (16.5%) were the most common predisposing factors. The frontal lobe was most common anatomical location (32%). Only 24% had positive culture result. Three cases were fungal infections. Seventy percent of patients managed with burr hole drainage and 37.5% of craniotomy made complete recovery. Overall, 58% of patients made complete recovery, whereas 19.0% died. Nine percent of cases died before definitive intervention. Among the 24% of patients that presented in coma, 47% died within 6 months. Most important factor influencing mortality was admission level of consciousness. Abscess recurred in 6% of cases. Conclusion: Intraparenchymal abscesses in Enugu were mostly solitary lesions resulting from poorly managed head injury and meningitis. Predisposition from otitis media and systemic diseases has reduced. The proportion of fungal organisms is increasing. A significant proportion of the patients present in coma. Burr hole and aspiration of abscess is less invasive and has very good outcome.
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Affiliation(s)
| | - Samuel C Ohaegbulam
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Wilfred C Mezue
- Neurosurgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Mark C Chikani
- Neurosurgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Sunday P Nkwerem
- Department of Neurosurgery, Memfys Hospital for Neurosurgery, Enugu, Nigeria
| | - Ignatius I Ozor
- Neurosurgery Unit, Department of Surgery, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Glickstein JS, Chandra RK, Thompson JW. Intracranial Complications of Pediatric Sinusitis. Otolaryngol Head Neck Surg 2016; 134:733-6. [PMID: 16647525 DOI: 10.1016/j.otohns.2005.12.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 12/01/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE: To study intracranial extension of pediatric sinusitis, an infrequent but potentially fatal complication. STUDY DESIGN AND SETTING: Ten-year retrospective review at a tertiary children's hospital identified 21 cases of intracranial complications of sinusitis. RESULTS: Thirteen males and eight females with mean age of 13.3 years were identified. Overall 18 of 21 (81%) exhibited abscess formation, most commonly epidural. Only 3 of 21 (14%) had meningitis alone. All but 4 patients were managed surgically, requiring craniotomy in 13 of 21 (61.9%) and endoscopic sinus surgery (ESS) in 10 of 21 (48%). Seven patients (33%) required multiple operations during admission. Nineteen patients (90%) had a total of 30 organisms cultured. Oral flora was observed in 12 of 21 (57%). Polymicrobial infections, seen in 9 of 21 (43%), were significantly associated with the need for craniotomy ( P = 0.02). Mean hospital stay was 15 days, and mean length of IV antibiotic was 5 weeks. CONCLUSIONS: Intracranial complications of pediatric sinusitis often require craniotomy. Oral flora and polymicrobial infections were prominent in this series. EBM rating: C-4
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Affiliation(s)
- Jonathan S Glickstein
- University of Tennessee Health Science Center, Department of Otolaryngology-Head and Neck Surgery, 956 Court Ave Suite B224, Memphis, TN 38163, USA.
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Adebayo BE, Ogunkunle OO, Ayun FO. Meningitis and brain abscess: First but fatal presentation in a child with tetralogy of fallot. J Cardiol Cases 2016; 13:72-74. [PMID: 30546609 PMCID: PMC6280679 DOI: 10.1016/j.jccase.2015.10.004] [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: 05/02/2015] [Revised: 10/01/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022] Open
Abstract
Brain abscess is a known complication of cyanotic congenital heart diseases. We report the case of a four-year-old girl whose first presentation in the hospital was because of symptoms referable to the neurological system. These symptoms are similar to those seen in cerebral malaria as well as other infections of the central nervous system, e.g. meningitis and encephalitis. Detailed history, painstaking examination, and investigations will however help in differentiating these conditions. In the index case however, the illness was fatal due to the late presentation, which is not uncommon in this environment. In a resource-poor environment such as Nigeria, this is a reminder that proper history taking, clinical examination, and subsequent investigations will aid in early diagnosis and subsequent management of such cases to reduce childhood mortality. It also underscores the need for increased awareness among primary health care providers. .
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Moussa WMM, Mohamed MAA. Efficacy of postoperative antibiotic injection in and around ventriculoperitoneal shunt in reduction of shunt infection: A randomized controlled trial. Clin Neurol Neurosurg 2016; 143:144-9. [PMID: 26945767 DOI: 10.1016/j.clineuro.2016.02.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Infection is a common complication of ventriculoperitoneal (VP) shunt surgery. The incidence of shunt infection is still high despite routine administration of perioperative antibiotics. A lower incidence of shunt infection was observed when antibiotic-impregnated shunts (AIS) were used to treat hydrocephalus and a rapid cure was reported in cases of ventriculitis when antibiotics were injected into external ventricular drain (EVD). That is why we theorized that postoperative prophylactic injection of antibiotics in and around the shunt hardware would reduce the incidence of shunt infection. PATIENTS AND METHODS A randomized controlled clinical trial where 60 patients up to one year old, diagnosed with congenital hydrocephalus and submitted to VP shunt insertion, were randomly assigned to one of 3 groups. The treatment groups received the conventional perioperative antibiotics in addition to vancomycin and gentamicin injection in the reservoir and around the peritoneal catheter either once (group A) or twice (group B), while the control group (C) received only the conventional perioperative antibiotics. Cases were followed-up for up to 1 year. RESULTS The majority of patients were less than 1 month old. The follow-up period ranged from 2 to 12 months with a mean of 8.9 months. The mean duration of onset of infection after surgery was 30 days. Prematurity (p=0.00236), age less than one month (p<0.0001) and duration of surgery of 90 min or more (p<0.00001) were significant risk factors for postoperative shunt infection. Significantly more cases of shunt infection occurred within one month after surgery (p=0.021). The control group had significantly more cases of postoperative shunt infection than the treatment groups (p=0.0042). CONCLUSIONS In congenital hydrocephalus patients submitted to VP shunt insertion, injection of prophylactic vancomycin and gentamicin in and around the shunt hardware significantly reduced the incidence of postoperative shunt infection.
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Udoh DO, Ibadin E, Udoh MO. Intracranial abscesses: Retrospective analysis of 32 patients and review of literature. Asian J Neurosurg 2016; 11:384-391. [PMID: 27695542 PMCID: PMC4974963 DOI: 10.4103/1793-5482.150007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Intracranial abscess collections, though uncommon, are dreaded complications of head trauma, neurosurgical operations, meningitis, and otogenic, mastoid, and paranasal air sinus infections. Combining surgical evacuation with the appropriate antibiotic therapy is the effective treatment for intracranial abscesses. However, literature on surgical treatment is replete with several procedures which, on their own, may not Objectives: To determine the epidemiology and outcomes (of various treatment modalities) of intracranial abscesses in our institution, a major referral center for neurosurgical conditions in the midwestern region of Nigeria. Materials and Methods: This is a retrospective analysis of demographic data as well as indications, treatment modalities, and outcomes of various surgical procedures for evacuation of intracranial abscesses between September 2006 and December 2011. Results: We carried out 40 procedures in 32 (23 male and 9 female) patients with various intracranial abscesses. These represented approximately 5.6% of all operative neurosurgical procedures in our unit since inception. Most abscesses [16, i.e. 50%] occurred in the second decade. In the first decade, there were 7 (22%), and after the age of 30 years, there were 4 (12.5%). The most susceptible single year of life was infancy with 4 (12.5%) cases of intracranial abscesses. None of the infants had features of congenital heart disease. The predisposing factors were mostly otolaryngologic (9) or posttraumatic (6). Most abscesses (41%) were located in the frontal region, and intraparenchymal (i.e. intracerebral or intracerebellar) (50%) lesions were commoner than extradural, subdural, or intraventricular lesions. The commonest procedure performed (50%) was burr hole evacuation. Four patients (12.5% of cases) died. Prognosis appears to worsen with meningitis as the predisposing infection, ventriculitis, multiple abscesses especially in infants, and immunosuppression. Conclusion: The relative rarity of intracranial abscesses and the frequent delays in making the diagnosis render the condition a significant challenge to the clinician. A high index of suspicion, close interaction between the neurosurgeon and infectious disease specialist, with early treatment by adequate abscess drainage and appropriate antimicrobial treatment are important in their management.
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Affiliation(s)
- David O Udoh
- Division of Neurological Surgery, Department of Surgery and Pathology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Emmanuel Ibadin
- Division of Neurological Surgery, Department of Surgery and Pathology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Mojisola O Udoh
- Division of Neurological Surgery, Department of Surgery and Pathology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
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Yakut N, Kadayifci EK, Karaaslan A, Atici S, Akkoc G, Ocal Demir S, Dagcinar A, Akbulut F, Soysal A, Bakır M. Braın abscess due to Streptococcus intermedius secondary to mastoiditis in a child. SPRINGERPLUS 2015; 4:809. [PMID: 26722629 PMCID: PMC4689728 DOI: 10.1186/s40064-015-1608-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/13/2015] [Indexed: 11/13/2022]
Abstract
Background Brain abscess is a rare but serious, life-threatening infection in children. It may arise from parameningeal infections such as otitis media, sinusitis and mastoiditis. Case description A ten-year-old boy with the diagnosis of glycogen-storage disease and obesity was admitted to the emergency room with complaints of vomiting, decreased level of consciousness, imbalance on walking. On neurological examination, the patient was ataxic. His cranial magnetic resonance imaging (MRI) examination showed mastoiditis on the right side and 39 × 34 mm abscess formation with surrounding edema on the right cerebellar hemisphere. The patient underwent surgery to drain the abscess, microbiological samples were obtained and empirical antibiotic treatment with vancomycin and piperacillin–tazobactam were started. Postoperative cranial MRI examination showed that the lesion regressed 10 × 10 mm with a reduction in the edema. On the second week of the treatment, the antibiotics were switched to vancomycin and meropenem because of the relapsing fever. The therapy was continued for 6 weeks. A final MRI (after completing antibiotherapy) showed resolution of the cerebellar abscess. The child’s clinical condition improved and he was discharged without any sequelae. Discussion and evaluation Children with congenital heart disease and an immonocompromised state are particularly at risk. Streptococcus intermedius is usually a commensal microorganism in the normal flora of the mouth which can cause brain abscess rarely in children. Brain abscess induced mortality rates are still relatively high, even with the advancement of imaging technologies, the combination of surgical drainage and antimicrobial therapy. Conclusion This case is one of the few reported cases of cerebellar abscess caused by S. intermedius in an immunocompetent child, due to its low virulence, a rare occurence and timely management resulting in fully healed.
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Affiliation(s)
- Nurhayat Yakut
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Eda Kepenekli Kadayifci
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayse Karaaslan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Serkan Atici
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Gulsen Akkoc
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Sevliya Ocal Demir
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
| | - Adnan Dagcinar
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Fatih Akbulut
- Department of Neurosurgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Ahmet Soysal
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey ; No 41, Fevzi Cakmak mahallesi, Ustkaynarca, Pendik, Istanbul, Turkey
| | - Mustafa Bakır
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Marmara University School of Medicine, Istanbul, Turkey
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Pediatric brainstem abscess with hemorrhage mimicking diffuse intrinsic pontine glioma: a case report. Childs Nerv Syst 2015; 31:2359-62. [PMID: 26139548 DOI: 10.1007/s00381-015-2801-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We report a rare case of brainstem abscess with hemorrhage mimicking diffuse intrinsic pontine glioma (DIPG). METHODS A 7-month-old baby girl presented with lethargy and poor oral feeding. She had the mild fever for 1 month. Brain computed tomography revealed the hypodense lesion in the pons. Brain magnetic resonance images (MRI) showed around 1.4-cm-sized rim-enhanced mass with perilesional edema and internal hemorrhage in the pons. The cerebral blood volume was increased in the rim-enhanced area. The provisional diagnosis was DIPG, but the mass did not show the expansile mass with encasement of the basilar artery on the ventral pons. RESULTS The biopsy was done via the floor of the fourth ventricle, and the pathologic findings showed the many inflammatory cells and CD68-immunopositive macrophage which were compatible with abscess. The antibiotics with ceftriaxone and metronidazole were administrated for 11 weeks, and the follow-up MRI showed the slightly small enhanced lesion without central necrotic area. Three years later, follow-up MRI revealed the encephalomalacic change and atrophy of the pons. She had the stable neurologic deficit of left facial palsy and right hemiparesis. CONCLUSION The biopsy could be necessary for pontine lesions without typical radiologic findings of DIPG.
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Laulajainen-Hongisto A, Lempinen L, Färkkilä E, Saat R, Markkola A, Leskinen K, Blomstedt G, Aarnisalo AA, Jero J. Intracranial abscesses over the last four decades; changes in aetiology, diagnostics, treatment and outcome. Infect Dis (Lond) 2015; 48:310-316. [PMID: 26592421 DOI: 10.3109/23744235.2015.1113557] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The development of modern medicine has resulted in changes in the predisposing conditions, clinical picture, treatment and results of treatment of intracranial abscesses. This study sought to evaluate these changes in a hospital district. Methods A retrospective analysis of the clinical data of all patients treated due to intracranial abscesses at a tertiary referral centre, between 1970-2012. Results The total number of intracranial abscesses was 166. The incidence of intracranial abscesses was 0.33/100 000/year (2000-2012). The most common predisposing conditions were infection of the ear-, nose- and throat region (22%), odontogenic infection (15%) and cardiac anomaly (13%). Lately (2000-2012), infections of the ear-, nose- and throat region (15%) and cardiac anomalies (5%) have become less common, whereas odontogenic infections (32%) have become more common. The most common pathogens belong to Streptococcus spp (42%), Fusobacteriae (14%), Actinomycetales (8%) and Staphylococcus spp (8%). Most patients (66%) experienced a favourable recovery; the proportion of patients with favourable outcome enabling return to prior occupation rose over time, from 12% in 1970-1989 to 24% in 1990-2012. Conclusions The predisposing conditions for intracranial abscesses have changed markedly within the study period. Odontogenic infections have become a common predisposing condition, whereas infections of the ear-, nose- and throat region and cardiac malformations are nowadays less common as predisposing conditions compared to at the beginning of the study period. The proportion of patients with favourable outcome enabling return to prior occupation seems to have increased with time.
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Affiliation(s)
- Anu Laulajainen-Hongisto
- a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,b Department of Allergy , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Laura Lempinen
- a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Esa Färkkilä
- c Department of Oral and Maxillofacial Diseases , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Riste Saat
- d Department of Radiology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Antti Markkola
- d Department of Radiology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kimmo Leskinen
- a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland.,e Pikkujätti Medical Centre for Children and Youth , Helsinki , Finland
| | - Göran Blomstedt
- f Department of Neurosurgery , University of Helsinki and Helsinki University Hospital, Töölö Hospital , Helsinki , Finland
| | - Antti A Aarnisalo
- a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Jussi Jero
- a Department of Otorhinolaryngology , HUS Medical Imaging Centre, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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Walden JH, Hess B, Rigby M. Streptococcal pharyngitis: an uncommon cause of subdural empyema. BMJ Case Rep 2015; 2015:bcr-2015-211312. [PMID: 26385939 DOI: 10.1136/bcr-2015-211312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 7-year-old girl with an unremarkable medical history presented to a local paediatric emergency department with a 7-day history of fever, sore throat and vomiting, and a 1-day history of rash. She was admitted to the hospital, with presumed Kawasaki disease. A few hours after admission, the patient had sudden onset of two witnessed tonic-clonic seizures and subsequent decreased mental status. She was transferred to the paediatric intensive care unit and started on broad-spectrum antibiotics. On hospital day 2, cerebral spinal fluid cultures and blood cultures grew Streptococcus pyogenes, and repeat physical examination was consistent with acute streptococcal pharyngitis. On hospital day 3, the patient developed left-sided hemiparesis and had another witnessed seizure. A CT scan was obtained and revealed a subdural abscess. She was transferred to a tertiary care centre and underwent craniotomy with evacuation of her subdural abscess. Surgical cultures eventually grew S. pyogenes.
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Affiliation(s)
- Jeffrey Howard Walden
- Department of Family Medicine, University of North Carolina Chapel Hill, Greensboro, North Carolina, USA
| | - Bryan Hess
- Cone Health Family Medicine Residency, Greensboro, North Carolina, USA
| | - Michael Rigby
- Cone Health Family Medicine Residency, Greensboro, North Carolina, USA
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Abstract
Intracranial infections in children are a relatively rare, but potentially severe condition. Because of the potential for rapid deterioration, timely diagnosis and treatment are necessary. These infections are categorized based on their intracranial location: epidural abscess, subdural empyema, and brain abscess. They largely arise from direct extension of adjacent infection, hematogenous seeding, or trauma. Clinical presentations of intracranial infections also vary. However, common signs and symptoms include headache, fever, nausea and vomiting, altered mental status, focal neurologic deficits, and seizures. In general, MRI demonstrates a peripherally enhancing lesion with high signal on diffusion weighted imaging (DWI). Bacterial isolates vary, but most commonly are a single pathogen. Successful treatment requires a multidisciplinary team approach including such modalities as antibiotic therapy and surgical drainage. When possible, open surgical evacuation of the abscess is preferred, however, in cases of deep-seated lesions, or in unstable patients, aspiration has also been performed with good results.
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Affiliation(s)
- Christopher M Bonfield
- Division of Neurosurgery, Department of Surgery, BC Children's Hospital, Vancouver, Canada.
| | - Julia Sharma
- Division of Neurosurgery, Department of Surgery, BC Children's Hospital, Vancouver, Canada.
| | - Simon Dobson
- Division of Infectious Diseases, Department of Pediatrics, BC Children's Hospital, Vancouver, Canada.
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Staphylococcal α-hemolysin is neurotoxic and causes lysis of brain cells in vivo and in vitro. Neurotoxicology 2015; 48:61-7. [PMID: 25757835 DOI: 10.1016/j.neuro.2015.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/25/2015] [Accepted: 03/02/2015] [Indexed: 01/11/2023]
Abstract
Formation of a bacterial brain abscess entails loss of brain cells and formation of pus. The mechanisms behind the cell loss are not fully understood. Staphylococcus aureus, a common cause of brain abscesses, produces various exotoxins, including α-hemolysin, which is an important factor in brain abscess formation. α-Hemolysin may cause cytolysis by forming pores in the plasma membrane of various eukaryotic cells. However, whether α-hemolysin causes lysis of brain cells is not known. Nor is it known whether α-hemolysin in the brain causes cell death through pore formation or by acting as a chemoattractant, recruiting leukocytes and causing inflammation. Here we show that α-hemolysin injected into rat brain causes cell damage and edema formation within 30 min. Cell damage was accompanied by an increase in extracellular concentrations of zinc, GABA, glutamate, and other amino acids, indicating plasma membrane damage, but leukocytic infiltration was not seen 0.5-12h after α-hemolysin injection. This was in contrast to injection of S. aureus, which triggered extensive infiltration with neutrophils within 8h. In vitro, α-hemolysin caused concentration-dependent lysis of isolated nerve endings and cultured astrocytes. We conclude that α-hemolysin contributes to the cell death inherent in staphylococcal brain abscess formation as a pore-forming neurotoxin.
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Canpolat M, Ceylan O, Per H, Koc G, Tumturk A, Kumandas S, Patiroglu T, Doganay S, Gumus H, Unal E, Kose M, Gorkem SB, Kurtsoy A, Ozturk MK. Brain abscesses in children: results of 24 children from a reference center in Central Anatolia, Turkey. J Child Neurol 2015; 30:458-67. [PMID: 25223695 DOI: 10.1177/0883073814549247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/02/2014] [Indexed: 11/16/2022]
Abstract
Childhood brain abscesses are a rare and potentially life-threatening condition requiring urgent diagnosis and treatment. This retrospective study analyzed the clinical and radiologic findings of 24 (7 girl, 17 boys) cases with brain abscess. Mean age was 92.98 ± 68.04 months. The most common presenting symptoms were nausea-vomiting (45.8%) and headache (41.7%). Brain abscess was most commonly located in the frontal region. Diffusion restriction was determined in 78.4% of lesions. The mean apparent diffusion coefficient value in these lesions was 0.511 ± 0.23 × 10(-3) mm(2)/s. Cultures were sterile in 40% of cases. Antimicrobial therapy was given to only 16.7% of cases. Predisposing factors were identified in 91.6% of cases (congenital heart disease in 20.8% and immunosuppression in 20.8%). Mortality level was 12.5%. In conclusion, immunocompromised states, and congenital heart disease have become an important predisposing factor for brain abscesses. Effective and prompt management should ensure better outcome in childhood.
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Affiliation(s)
- Mehmet Canpolat
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ozgur Ceylan
- Division of Pediatric Infectious diseases, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Huseyin Per
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gonca Koc
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Abdulfettah Tumturk
- Department of Neurosurgery, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Sefer Kumandas
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Turkan Patiroglu
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Selim Doganay
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Hakan Gumus
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ekrem Unal
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Kose
- Division of Pediatric Pulmonology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Sureyya Burcu Gorkem
- Department of Pediatric Radiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ali Kurtsoy
- Department of Neurosurgery, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Mustafa Kursat Ozturk
- Division of Pediatric Infectious diseases, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Yoganathan S, Chakrabarty B, Gulati S, Kumar A, Kumar A, Singh M, Xess I. Candida tropicalis brain abscess in a neonate: An emerging nosocomial menace. Ann Indian Acad Neurol 2014; 17:448-50. [PMID: 25506171 PMCID: PMC4251023 DOI: 10.4103/0972-2327.144036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/05/2014] [Accepted: 04/29/2014] [Indexed: 11/18/2022] Open
Abstract
Fungi are a relatively uncommon cause of brain abscess in neonates and early infancy. They are usually associated with predisposing factors like prematurity, low birth weight, use of broad-spectrum antibiotics, and prolonged stay in the intensive care unit. Candida tropicalis (C. tropicalis) is rapidly emerging as a nosocomial threat in the neonatal intensive care settings. This case report describes a neonate with C. tropicalis brain abscess who was diagnosed early and managed aggressively with a favorable outcome. Inadvertent use of intravenous antibiotics can have serious complications such as invasive fungal infection. Correct microbiological diagnosis is the key to successful treatment of deep-seated pyogenic infection. Fungal etiology should always be studied in relevant clinical settings.
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Affiliation(s)
- Sangeetha Yoganathan
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sheffali Gulati
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Sadahiro H, Nomura S, Inamura A, Yamane A, Sugimoto K, Fujiyama Y, Suzuki M. Brain abscess associated with patent foramen ovale. Acta Neurochir (Wien) 2014; 156:1971-6; discussion 1976. [PMID: 24975278 DOI: 10.1007/s00701-014-2170-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Brain abscesses can develop with Tetralogy of Fallot and pulmonary anterior venous fistula with large right-to-left shunt. However, some patients exhibit cryptogenic brain abscess (CBA) in the absence of any such congenital disease or other infections. Patent foramen ovale (PFO) is a very common disease that exhibits right-to-left shunt. This study reports the potential for concern between CBA and PFO. METHODS We enrolled patients with CBA in our hospital between January 2003 and January 2013. Patients underwent transesophageal echocardiography (TEE) with contrast medium to investigate the presence of PFO. RESULTS Seven patients were included. Four were females, and the mean age was 67.7 ± 9.2 years. In all patients, TEE failed to reveal any new findings, however, six patients had PFO, and another patient had pulmonary arteriovenous shunt. Four patients had odontopathy. CONCLUSION In this study, all CBA patients exhibited right-to-left shunt. CBA might be caused by paradoxical embolization of a bacterial mass via PFO. Thus, more patients with CBA need to undergo TEE to detect PFO.
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Giannitti F, Schapira A, Anderson M, Clothier K. Suppurative otitis and ascending meningoencephalitis associated with Bacteroides tectus and Porphyromonas gulae in a captive Parma wallaby (Macropus parma) with toxoplasmosis. J Vet Diagn Invest 2014; 26:683-8. [PMID: 25057163 DOI: 10.1177/1040638714543676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 6-year-old female Parma wallaby (Macropus parma) at a zoo in California developed acute ataxia and left-sided circling. Despite intensive care, clinical signs progressed to incoordination and prostration, and the animal was euthanized. At necropsy, the left tympanic cavity was filled with homogeneous suppurative exudate that extended into the cranium expanding the meninges and neuroparenchyma in the lateral and ventral aspect of the caudal ipsilateral brainstem and medulla oblongata. Microscopically, the brainstem showed regional severe suppurative meningoencephalitis with large numbers of neutrophils, fewer macrophages, and lymphocytes admixed with fibrin, necrotic cellular debris, hemorrhage, and mineralization, with numerous intralesional Gram-negative bacilli. Bacteroides spp. and Porphyromonas spp. were isolated on anaerobic culture from the meninges, and the bacteria were further characterized by partial 16S ribosomal RNA gene sequencing as Bacteroides tectus and Porphyromonas gulae. Bacterial aerobic culture from the meninges yielded very low numbers of mixed flora and Proteus spp., which were considered contaminants. Culture of Mycoplasma spp. from middle ear and meninges was negative. Additionally, Toxoplasma gondii cysts were detected by immunohistochemistry in the heart and brain, and anti-Toxoplasma antibodies were detected in serum. The genera Bacteroides and Porphyromonas have been associated with oral disease in marsupials; but not with otitis and meningoencephalitis. The results of the present work highlight the importance of performing anaerobic cultures in the diagnostic investigation of cases of suppurative otitis and meningoencephalitis in macropods.
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Affiliation(s)
- Federico Giannitti
- California Animal Health and Food Safety Laboratory System, University of California, Davis, CA (Giannitti, Anderson, Clothier)School of Veterinary Sciences, University of Buenos Aires, Buenos Aires, Argentina (Schapira)
| | - Andrea Schapira
- California Animal Health and Food Safety Laboratory System, University of California, Davis, CA (Giannitti, Anderson, Clothier)School of Veterinary Sciences, University of Buenos Aires, Buenos Aires, Argentina (Schapira)
| | - Mark Anderson
- California Animal Health and Food Safety Laboratory System, University of California, Davis, CA (Giannitti, Anderson, Clothier)School of Veterinary Sciences, University of Buenos Aires, Buenos Aires, Argentina (Schapira)
| | - Kristin Clothier
- California Animal Health and Food Safety Laboratory System, University of California, Davis, CA (Giannitti, Anderson, Clothier)School of Veterinary Sciences, University of Buenos Aires, Buenos Aires, Argentina (Schapira)
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Hassel B, Dahlberg D, Mariussen E, Goverud IL, Antal EA, Tønjum T, Maehlen J. Brain infection with Staphylococcus aureus leads to high extracellular levels of glutamate, aspartate, γ-aminobutyric acid, and zinc. J Neurosci Res 2014; 92:1792-800. [PMID: 25043715 DOI: 10.1002/jnr.23444] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/06/2014] [Accepted: 06/01/2014] [Indexed: 11/08/2022]
Abstract
Staphylococcal brain infections may cause mental deterioration and epileptic seizures, suggesting interference with normal neurotransmission in the brain. We injected Staphylococcus aureus into rat striatum and found an initial 76% reduction in the extracellular level of glutamate as detected by microdialysis at 2 hr after staphylococcal infection. At 8 hr after staphylococcal infection, however, the extracellular level of glutamate had increased 12-fold, and at 20 hr it had increased >30-fold. The extracellular level of aspartate and γ-aminobutyric acid (GABA) also increased greatly. Extracellular Zn(2+) , which was estimated at ∼2.6 µmol/liter in the control situation, was increased by 330% 1-2.5 hr after staphylococcal infection and by 100% at 8 and 20 hr. The increase in extracellular glutamate, aspartate, and GABA appeared to reflect the degree of tissue damage. The area of tissue damage greatly exceeded the area of staphylococcal infiltration, pointing to soluble factors being responsible for cell death. However, the N-methyl-D-aspartate receptor antagonist MK-801 ameliorated neither tissue damage nor the increase in extracellular neuroactive amino acids, suggesting the presence of neurotoxic factors other than glutamate and aspartate. In vitro staphylococci incubated with glutamine and glucose formed glutamate, so bacteria could be an additional source of infection-related glutamate. We conclude that the dramatic increase in the extracellular concentration of neuroactive amino acids and zinc could interfere with neurotransmission in the surrounding brain tissue, contributing to mental deterioration and a predisposition to epileptic seizures, which are often seen in brain abscess patients.
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Affiliation(s)
- Bjørnar Hassel
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Norwegian Defense Research Establishment, Kjeller, Norway
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Mishra AK, Dufour H, Roche PH, Lonjon M, Raoult D, Fournier PE. Molecular revolution in the diagnosis of microbial brain abscesses. Eur J Clin Microbiol Infect Dis 2014; 33:2083-93. [DOI: 10.1007/s10096-014-2166-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/15/2014] [Indexed: 12/30/2022]
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Abstract
Brain abscess is a serious and life-threatening disease among children despite advances in diagnosis and management. Changes in the epidemiology of predisposing conditions for brain abscess are associated with changes in the patient population and causative organisms. Though still a potentially fatal infection, there have been recent improvements in diagnosis, treatment, and outcome. Although mortality appears to be decreasing, a significant percentage of children continue to have residual neurological deficits, including epilepsy, permanent motor or sensory dysfunction, visual field defects, and personality change. Some children also require placement of a ventriculoperitoneal shunt. The most common origin of microbial infection in children remains direct or indirect cranial infection arising from the middle ear, paranasal sinuses, or teeth. No prospective clinical trials have compared the various surgical and medical treatment strategies available to guide the management of cerebral abscesses in children. Most surgical and medical treatment guidelines are based on populations consisting primarily of adult patients. The use of corticosteroids for treatment of brain abscess is controversial. Anticonvulsants are recommended in children who have developed seizures potentially to prevent further episodes. Duration of anticonvulsant therapy should be individualized and guided by electroencephalographic (EEG) study in the follow-up phase of disease.
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