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Jilani M, Renteria M, Brockman MJ, Guvvala S. Homeless Patient With Community-Acquired Methicillin-Resistant Staphylococcus aureus Brain Abscesses. Cureus 2023; 15:e39667. [PMID: 37398838 PMCID: PMC10307930 DOI: 10.7759/cureus.39667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Brain abscess secondary to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection is a rare, yet highly fatal disease. This article presents the case of a 45-year-old homeless female with a medical history of bipolar disorder, seizure disorder, and substance use disorder who was admitted with altered mental status. Laboratory tests on admission revealed neutrophil-predominant leukocytosis, elevated inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and lactic acid. MRI brain demonstrated multiple cerebral abscesses with surrounding edema and sagittal vein thrombosis. The patient was initiated on broad-spectrum antibiotics and underwent a right-sided minimally invasive needle biopsy of the abscess and left frontal craniotomy for abscess evacuation, the culture of which confirmed the diagnosis of MRSA infection. As the patient did not have any hospitalization or procedure in the recent past, a diagnosis of CA-MRSA was made. The patient's clinical status improved following the procedure and antibiotic administration, but she left against medical advice before completing treatment. This case highlights the importance of early recognition and aggressive management of CA-MRSA infections, especially in vulnerable populations such as the homeless.
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Affiliation(s)
- Misbah Jilani
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Mellisa Renteria
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Michael J Brockman
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Suvarna Guvvala
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
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Kameda-Smith MM, Duda T, Duncan DB, Ragulojan M, Jung Y, Farrokhyar F, Main C, Reddy K. Retrospective Review of the Clinical Outcomes of Surgically Managed Patients with Intracranial Abscesses: A Single-Center Review. World Neurosurg 2022; 165:e697-e711. [PMID: 35798293 DOI: 10.1016/j.wneu.2022.06.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study analyzed patient, radiologic, and clinical factors associated with operative brain abscesses and patients' functional outcomes. METHODS A retrospective analysis was conducted of neurosurgical cases of brain abscesses from 2009 to 2019 at a Canadian center. Functional outcome was recorded as Modified Rankin Scale score and Extended Glasgow Outcome Scale score. Multivariate analysis was conducted to identify relevant prognostic factors. RESULTS We identified 139 patients managed surgically for brain abscesses. Resection alone was performed in 64% of patients, whereas 26.6% underwent aspiration alone. Most were adults (93.2%) and male (68.3%). Immunocompromise risk factors included diabetes (24.5%), cancer (23.7%), and immunosuppressive therapy (11.5%). Likely sources were postoperative (17.3%), systemic spread (16.5%), and poor dentition (12.9%). Microorganisms cultured from abscess samples were mixed growth (28%), Streptococcus anginosus (24.5%), and Staphylococcus aureus (7.9%). Disposition was home (42.4%) or repatriation to a home hospital (50.4%). By Extended Glasgow Outcome Scale, 25.2% had an unfavorable outcome including a mortality of 11.5%. Factors on multivariate analysis associated with poor outcome included diabetes (odds ratio, 2.8; 95% confidence interval [CI], 1.2-5.0) and ventricular rupture (odds ratio, 5.0; 95% CI, 1.7-13.5; hazard ratio, 12; 95% CI, 3.9-37.0). Supratentorial superficial eloquently located abscess was also associated with poor outcome (hazard ratio, 5.5; 95% CI, 1.8-16.7). Outcomes were similar with surgical excision and aspiration. CONCLUSIONS Ventricular rupture and diabetes are significant risk factors for poor outcomes in intraparenchymal brain abscesses. No clear difference in outcomes was found between surgical excision or aspiration in our retrospective cohort.
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Affiliation(s)
| | - Taylor Duda
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Donald B Duncan
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malavan Ragulojan
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Yongkyung Jung
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Main
- Department of Biochemistry, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Shaabi A, Moshref RH. Epidural Abscess Following Epidural Evacuation in a Patient With Ventriculoperitoneal Shunt: A Case Report. Cureus 2021; 13:e19134. [PMID: 34868772 PMCID: PMC8627705 DOI: 10.7759/cureus.19134] [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] [Accepted: 10/29/2021] [Indexed: 11/30/2022] Open
Abstract
Epidural abscess is considered one of the most common intracranial infections. We report a pediatric patient with chronic hematopoiesis and thick double periosteal layers who developed an epidural pus collection after epidural hematoma evacuation. This article highlights the importance of detecting complications from epidural hematoma evacuation, including intracranial abscess and pus formation. Therefore, it is crucial to treat such cases meticulously.
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Affiliation(s)
- Afaf Shaabi
- Neurological Surgery, King Fahad General Hospital, Jeddah, SAU
| | - Rana H Moshref
- Neurological Surgery, King Fahad General Hospital, Jeddah, SAU
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Murali S, Shenoy SV, Prabhu RA, Nagaraju SP. Hypertensive emergency and seizures during haemodialysis. BMJ Case Rep 2021; 14:e242471. [PMID: 34548293 PMCID: PMC8458320 DOI: 10.1136/bcr-2021-242471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2021] [Indexed: 11/04/2022] Open
Abstract
Intracranial abscesses are uncommon, serious and life-threatening infections. A brain abscess is caused by inflammation and collection of infected material, coming from local or remote infectious sources. Patients with chronic kidney disease on dialysis are prone to invasive bacterial infections like methicillin-resistant Staphylococcus aureus (MRSA) especially in the presence of central venous catheters or arteriovenous grafts. However, intracranial abscess formation due to MRSA is rare. Here, we present a case of MRSA brain abscess with an atypical clinical presentation in the absence of traditional risk factors.Intracranial abscesses are uncommon, serious, and life-threatening infections. A Brain abscess is caused by inflammation and collection of infected material, coming from local or remote infectious sources. Patients with chronic kidney disease on dialysis are prone to invasive bacterial infections like methicillin-resistant staphylococcus aureus (MRSA) especially in the presence of central venous catheters or arterio-venous grafts. However intracranial abscess formation due to MRSA is rare. Here we present a case of MRSA brain abscess with an atypical clinical presentation in the absence of traditional risk factors. A 46-year-old male with chronic kidney disease (CKD) secondary to chronic glomerulonephritis, on haemodialysis for 4 years through a left brachio-cephalic AVF developed an episode of generalised tonic-clonic seizures lasting 2 min during his scheduled dialysis session. He reported no complaints before entry to the dialysis. On clinical examination, he was drowsy with the absence of any focal motor deficits. His blood pressure was recorded to be 200/120 mm Hg. He was managed in the intensive care unit with mechanical ventilation, intravenous nitroglycerine for blood pressure control, levetiracetam for seizures and empirical vancomycin. Radiological evaluation showed a brain abscess in the midline involving bosth basi-frontal lobes. After medical optimization, the abscess was drained surgically, and the pus cultured. As culture grew Methicillin Resistant Staphylococcus aureus, he was treated with intravenous vancomycin for 6 weeks. On follow up, the abscess had resolved and the patient recovered without any neurological deficits.
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Affiliation(s)
| | | | - Ravindra Attur Prabhu
- Department of Nephrology, Kasturba Medical College Manipal, Manipal, Karnataka, India
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Ravikumar R, John DV. Brain Abscess in the Current Decade (2010–2019) in India—A Review. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1725230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractBrain abscess outcomes have improved in recent years due to advancements in cranial imaging, microbiological techniques, minimally invasive neurosurgical procedures, and effective antibiotic treatments. However, the incidence of brain abscess remains unchanged in developing countries. We searched PubMed and Google Scholar for references using the key words “brain abscess” and “India” and reviewed both retrospective and prospective studies published in peer-reviewed journals in the current decade to understand the present status. The review shows that the patients’ ages, the predominance of male patients, the symptoms and locations of brain abscesses, and the types of bacteria associated with them have remained unchanged over the past decade. The most common predisposing condition in recent years has been chronic suppurative otitis media with a mortality rate of 7 to 10%. Middle ear infection is often neglected and not treated aggressively in Asian countries. It requires multidisciplinary treatment strategies to address the primary source of infection and better health awareness to prevent the development of brain abscess.
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Affiliation(s)
- R. Ravikumar
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Daisy Vanitha John
- Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Lallani SB, Hyte M, Trieu E, Reyes-Sacin C, Doan N. Use of an Intracranial Drain as a Conduit for Treatment of an Intracranial Streptococcus intermedius Abscess. Cureus 2021; 13:e14613. [PMID: 34040913 PMCID: PMC8139600 DOI: 10.7759/cureus.14613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Brain abscesses are difficult to manage clinically and often result in a poor outcome. Although surgical and medical therapeutics have progressed, there are still challenges that make treating intracranial abscesses problematic. One of these treatment barriers is the poor penetration of intravenous antibiotics to the infection source through the blood-brain barrier. In this case report, we will discuss the use of a surgical drain as a conduit for direct antibiotic administration for a rare, recurrent Streptococcus intermedius infection. This technique allows us to bypass the blood-brain barrier while also reducing the systemic effects of antibiotics. When used in conjunction with craniotomy and resection, direct antibiotic administration via a surgical drain proved to be effective at treating our patient’s abscess and preventing recurrence.
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Affiliation(s)
- Shoeb B Lallani
- Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Melanie Hyte
- Pharmacology, Baptist Medical Center South, Montgomery, USA
| | - Emily Trieu
- Neurosurgery, Pleasant Grove High School, Elk Grove, USA
| | | | - Ninh Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, USA
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Gu L, Yang XL, Yin HK, Lu ZH, Geng CJ. Application value analysis of magnetic resonance imaging and computed tomography in the diagnosis of intracranial infection after craniocerebral surgery. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.5891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Gu L, Yang XL, Yin HK, Lu ZH, Geng CJ. Application value analysis of magnetic resonance imaging and computed tomography in the diagnosis of intracranial infection after craniocerebral surgery. World J Clin Cases 2020; 8:5894-5901. [PMID: 33344588 PMCID: PMC7723704 DOI: 10.12998/wjcc.v8.i23.5894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/11/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intracranial infection is a common clinical disease. Computed tomography (CT) and magnetic resonance imaging (MRI) have certain sensitivity and have good diagnostic efficacy.
AIM To study the application value of MRI and CT in the diagnosis of intracranial infection after craniocerebral surgery.
METHODS We selected 82 patients who underwent craniocerebral surgery (including 40 patients with intracranial infection and 42 patients without infection) during the period from April 2016 to June 2019 in our hospital. All 82 patients received CT and MRI examinations, and their clinical data were reviewed. A retrospective analysis was performed, and the coincidence rate of positive diagnosis and the overall diagnosis coincidence rate of different pathogenic infection types were measured with the two examination methods. The diagnostic sensitivity and specificity as well as the positive and negative predictive values of the two examination methods were compared.
RESULTS For all types of pathogenic infections (Staphylococcus aureus, Staphylococcus hemolyticus, Staphylococcus epidermidis, and others), MRI scans had higher positive diagnostic coincidence rates than CT scans; the overall diagnostic coincidence rate, sensitivity, specificity, positive predictive value, and negative predictive values were significantly higher with MRI examinations than with CT examinations, and the differences were statistically significant (P < 0.05).
CONCLUSION MRI examination can accurately diagnose intracranial infection after clinical craniocerebral surgery. Compared with CT, MRI had higher diagnostic efficiency. The diagnostic sensitivity and specificity, the diagnostic coincidence rate, and the positive and negative predictive values were significantly higher with MRI than with conventional CT, which can be actively promoted.
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Affiliation(s)
- Lan Gu
- Department of Radiology, Wuxi Fifth People’s Hospital, Wuxi 214000, Jiangsu Province, China
| | - Xiao-Liang Yang
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi 214044, Jiangsu Province, China
| | - Hui-Kang Yin
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi 214044, Jiangsu Province, China
| | - Ze-Hua Lu
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi 214044, Jiangsu Province, China
| | - Cheng-Jun Geng
- Department of Medical Imaging, Wuxi Medical College of Anhui Medical University, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi 214044, Jiangsu Province, China
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Ghia CJ, Waghela S, Rambhad G. A Systemic Literature Review and Meta-Analysis Reporting the Prevalence and Impact of Methicillin-Resistant Staphylococcus aureus Infection in India. Infect Dis (Lond) 2020; 13:1178633720970569. [PMID: 33223835 PMCID: PMC7656882 DOI: 10.1177/1178633720970569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022] Open
Abstract
Aim and objective This systematic review and meta-analysis was conducted to assess the prevalence, burden and epidemiology of methicillin-resistant S. aureus (MRSA). This systemic review was also aimed to highlight the challenges in the diagnosis and management of methicillin-resistant S. aureus (MRSA) in India (for all age groups). We also examined the published literature on the available treatment options and the role of prevention in the management of MRSA in India. By summarizing the currently available data, our objectives were to highlight the need for the prevention of MRSA infections and also emphasize the role of vaccination in the prevention of MRSA infections in India. Methodology Electronic databases such as PubMed and databases of the National Institute of Science Communication and Information Resources and Indian Council of Medical Research Embase were searched for relevant literature published from 2005/01/01 to 2020/05/13 in English language, according to the predefined inclusion and exclusion criteria. A manual search was also conducted using the key term "MRSA 'or' Methicillin Resistant Staphylococcus aureus 'and' India." An independent reviewer extracted data from the studies using a structured Microsoft Excel spreadsheet, and a meta-analysis of proportion for MRSA prevalence with a corresponding 95% confidence interval (CI) for all included individual studies were performed. Result A total of 34 studies involving 16 237 patients were included in the final meta-analysis. The pooled proportion of patients with MRSA infection was 26.8% (95% CI: 23.2%-30.7%). The MRSA infection was more prevalent among male patients (60.4%; 95% CI: 53.9%-66.5%) as compared to female patients (39.6%; 95% CI: 33.5%-46.1%), while the prevalence of MRSA was higher among adults (18 years and above; 32%; 95% CI: 5%-80%) in comparison to pediatric patients (0-18 years; 68%; 95% CI: 20%-94.8%). The degree of heterogeneity was found to be significant. Conclusion The prevalence of MRSA in India was relatively high at 27% with a higher proportion observed among men aged >18 years. The high prevalence of MRSA infections in India necessitates the implementation of surveillance and preventive measures to combat the spread of MRSA in both hospital and community settings.
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Affiliation(s)
| | - Shaumil Waghela
- Medical and Scientific Affairs, Pfizer Limited, Mumbai, India
| | - Gautam Rambhad
- Medical and Scientific Affairs, Pfizer Limited, Mumbai, India
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Rebai L, Fitouhi N, Daghmouri MA, Bahri K. Linezolid for the treatment of postneurosurgical infection caused by methicillin-resistant Staphylococcus. Surg Neurol Int 2019; 10:215. [PMID: 31819809 PMCID: PMC6884953 DOI: 10.25259/sni_455_2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/19/2019] [Indexed: 12/15/2022] Open
Abstract
Background Postneurosurgical infection (PNSI) is a major problem. Linezolid is a bacteriostatic oxazolidinone antibiotic with a highly activity against Gram-positive cocci resistant to methicillin and a good cerebrospinal fluid penetration. The purpose of this study is to evaluate the efficacy of linezolid in the treatment of PNSI caused by methicillin-resistant Staphylococcus (MRS). Methods We conducted an observational study for all patients over 14 years old and diagnosed with MRS PNSI. Demographic, clinical, and laboratory information were collected prospectively. Results A total of 10 patients with PNSI (6 meningitis, 2 ventriculitis, and 2 subdural empyema) received linezolid. MRS isolated was Staphylococcus aureus in seven cases and Staphylococcus epidermidis in three cases. All isolated microorganisms were susceptible to vancomycin (minimum inhibitory concentration (MIC) = 2 mg/L) and linezolid (MIC = 1). The rate of microbiologic efficacy was 100% for patients with meningitis or ventriculitis. In the case of subdural empyema, focal infection had improved between 14 and 18 days. No adverse effects occurred during this study. Conclusion Our results suggest that linezolid as an alternative to vancomycin for the treatment of PNSI caused by MRS with a high rate of efficacy.
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Affiliation(s)
- Lotfi Rebai
- Departments of Anesthesiology and Critical Care Medicine, Uninversity of Tunis El Manar, Tunisia
| | - Nizar Fitouhi
- Departments of Anesthesiology and Critical Care Medicine, Uninversity of Tunis El Manar, Tunisia
| | - Mohamed Aziz Daghmouri
- Departments of Anesthesiology and Critical Care Medicine, Uninversity of Tunis El Manar, Tunisia
| | - Kamel Bahri
- Departments of Neurosurgery, Traumatology and Severe Burns Center, Faculty of Medicine of Tunis, Uninversity of Tunis El Manar, Tunisia
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