Thickening of the walls of deep brain abscesses is associated with macrophage infiltration

Clinical and radiological characteristics of brain abscess due to different organisms in hospitalized patients: A 6-year retrospective study from China

Background

Brain abscess (BA) is a rare but life-threatening infection. Early identification of the pathogen is helpful to improve the outcomes. This study aimed to describe the clinical and radiological features of patients with BA caused by different organisms.

Methods

A retrospective, observational study of patients with known etiologic diagnosis of BA in Huashan Hospital Affiliated to Fudan University in China between January 2015 and December 2020 was conducted. Data on patient demographics, clinical and radiological presenting features, microbiological results, surgical treatment, and outcomes were collected.

Results

Sixty-five patients (49 male, 16 female) with primary BAs were included. Frequent clinical presentations included headache (64.6%), fever (49.2%) and confusion (27.3%). Streptococcus viridans was associated with thicker wall of abscesses (6.94 ± 8.43 mm for S. viridans versus 3.66 ± 1.74 mm for other organisms, P = 0.031) and larger oedema (89.40 ± 15.70 mm for S. viridans versus 74.72 ± 19.70 mm for other organisms, P = 0.023). The independent factor associated with poor outcome identified by multivariate analysis was confusion (Odds ratio 6.215, 95% confidence interval 1.406-27.466; P = 0.016).

Conclusions

Patients with BAs caused by Streptococcus species had nonspecific clinical signs, but specific radiological features, which might be helpful for early diagnosis.

Inhalable GSH-Triggered Nanoparticles to Treat Commensal Bacterial Infection in In Situ Lung Tumors

Bacterial infection has been considered one of the primary reasons for low survival rate of lung cancer patients. Herein, we demonstrated that a kind of mesoporous silica nanoparticles loaded with anticancer drug doxorubicin (DOX) and antimicrobial peptide HHC36 (AMP) (MSN@DOX-AMP) can kill both commensal bacteria and tumor cells under GSH-triggering, modulating the immunosuppressive tumor microenvironment, significantly treating commensal bacterial infection, and eliminating in situ lung tumors in a commensal model. Meanwhile, MSN@DOX-AMP encapsulated DOX and AMP highly efficiently via a combined strategy of physical adsorption and click chemistry and exhibited excellent hemocompatibility and biocompatibility. Importantly, MSN@DOX-AMP could be inhaled and accumulate in lung by a needle-free nebulization, achieving a better therapeutic effect. This system is expected to serve as a straightforward platform to treat commensal bacterial infections in tumors and promote the translation of such inhaled GSH-triggered MSN@DOX-AMP to clinical treatments of lung cancer.

Brain abscess in immunocompetent patients: recent findings

PURPOSE OF REVIEW

We conducted a systematic review of the literature to update findings on the epidemiology and the management of cerebral abscesses in immunocompetent patients.

RECENT FINDINGS

Observational studies suggest that the overall prognosis has improved over the last decades but mortality rates remain high. Several parameters may contribute to a better prognosis, including the identification of common risk factors for brain abscess, the systematic use of brain MRI at diagnosis, the implementation of appropriate neurosurgical and microbiological techniques for diagnosis, the optimization of the antibacterial treatment based on epidemiology and pharmacokinetic/pharmacodynamic studies, and a long-term follow-up for detection of secondary complications. Outcome research on brain abscess is mainly based on observational studies. Randomized controlled trials have yet to be performed to identify clinically relevant interventions associated with improved patient-centered outcomes.

SUMMARY

Our review highlights the importance of a multidisciplinary approach to optimize brain abscess management both at the acute phase and in the long-term. Randomized controlled studies are urgently needed to identify interventions associated with improved outcomes.