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Chin SJ, Horton D. Double whammy: Delayed cerebral ischemia of a 19-year-old secondary to sinogenic complications from an uncommon bacterial sinusitis, Arcanobacterium haemolyticum. Radiol Case Rep 2024; 19:2689-2697. [PMID: 38645946 PMCID: PMC11033105 DOI: 10.1016/j.radcr.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/11/2024] [Indexed: 04/23/2024] Open
Abstract
Arcanobacterium haemolyticum, found as normal flora in healthy individuals, is an unusual culprit for pharyngitis and sinusitis in young adults, rarely leading to severe infections. Here, we present a singular case involving a 19-year-old immunocompetent male who experienced complications arising from A haemolyticum sinusitis, leading to orbital and intracranial sinogenic complications. The patient developed severe cerebral vasospasm with delayed cerebral ischemia, necessitating aggressive management encompassing daily catheter-directed intra-arterial infusions, surgical source control, and maximal medical therapy. This case explores the challenging diagnostic and management aspects associated with cerebral artery vasospasm secondary to bacterial meningoencephalitis. The abrupt neurological decline in such patients presents a dilemma in recognizing the occurrence of cerebral vasospasm versus the progression of meningoencephalitis. By utilizing computed tomography brain perfusion scans, we were able to identify delayed cerebral ischemia due to cerebral vasospasm, acknowledging that this modality was not used to identify classical territorial stroke infarcts. This decision was made based on the understanding of the potential for bacterial-induced cerebral vasospasm to involve both hemispheres.
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Affiliation(s)
- Soon Jie Chin
- Department of Radiology, Western Sydney NSW Health, Westmead Hospital, Australia
| | - Damien Horton
- Department of Radiology, Sydney NSW Health, Royal Prince Alfred Hospital, Australia
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Chang N, Lennard K, Rao A, Elliott M, Dharan N, Wong J. Polymicrobial arcanobacterium haemolyticum intra cerebral abscess: A case report and review of the literature. IDCases 2024; 36:e01960. [PMID: 38690576 PMCID: PMC11059456 DOI: 10.1016/j.idcr.2024.e01960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/30/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024] Open
Abstract
Objective This article describes a case of polymicrobial Arcanobacterium haemolyticum pharyngitis and sinusitis complicated by intracranial complications and reviews similar cases in the literature. Case summary A 21-year-old immunocompetent male presented with symptoms of sore throat, rhinorrhoea, lethargy, headache, and rash. Imaging demonstrated sinusitis, pre-septal sinusitis, peritonsillar abscess formation, subdural empyema and cerebritis. He was managed with endoscopic sinus surgery, craniotomy for evacuation of subdural empyema and antibiotics. Microbiological samples demonstrated growth of A. haemolyticum, strep. anginosus, and fusobacterium necrophorum. He subsequently developed a cerebral abscess requiring stereotactic needle drainage. After a prolonged course of antibiotics, the patient was discharge and made a good recovery. Discussion A. haemolyticum is an uncommon cause of non-streptococcal pharyngitis that may occur alongside other microorganisms and is rarely associated with severe intracranial complications. This organism and its antibiotic susceptibility patterns should be considered in complicated upper respiratory tract infections in immunocompetent hosts. Penicillins and macrolide antibiotics form the mainstay of therapy for A. haemolyticum.
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Affiliation(s)
- Nicholas Chang
- Royal Prince Alfred Hospital, Department of Neurosurgery, Sydney, Australia
| | - Kate Lennard
- Royal Prince Alfred Hospital, Department of Infectious Diseases, Sydney, Australia
| | - Amshuman Rao
- Royal Prince Alfred Hospital, Department of Neurosurgery, Sydney, Australia
- Royal Prince Alfred Hospital, Department of Infectious Diseases, Sydney, Australia
- Royal Prince Alfred Hospital, Department of Otolaryngology, Sydney, Australia
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
- University of New South Wales, Faculty of Medicine and Health, Sydney, Australia
| | - Michael Elliott
- Royal Prince Alfred Hospital, Department of Otolaryngology, Sydney, Australia
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - Nila Dharan
- Royal Prince Alfred Hospital, Department of Infectious Diseases, Sydney, Australia
- University of New South Wales, Faculty of Medicine and Health, Sydney, Australia
| | - Johnny Wong
- Royal Prince Alfred Hospital, Department of Neurosurgery, Sydney, Australia
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Corredoira Sánchez J, Ayuso García B, Romay Lema EM, García-Pais MJ, Rodríguez-Macias AI, Capón González P, Otero López R, Rabuñal Rey R, Alonso García P. Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:4-12. [PMID: 37076331 DOI: 10.1016/j.eimce.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/22/2022] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections. METHODS Four cases of S. bovis CNS infections from our institution are presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted. RESULTS 52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001). CONCLUSIONS CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.
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Affiliation(s)
| | | | | | | | | | | | - Rocio Otero López
- Neurosurgery Department, Universitary Hospital Lucus Augusti, Lugo, Spain
| | - Ramón Rabuñal Rey
- Infectious Disease Unit, Universitary Hospital Lucus Augusti, Lugo, Spain
| | - Pilar Alonso García
- Clinical Microbiology Department, Universitary Hospital Lucus Augusti, Lugo, Spain
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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" Author's reply. Clin Microbiol Infect 2024; 30:149-150. [PMID: 37865338 DOI: 10.1016/j.cmi.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark; ESCMID 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
- ESCMID 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
- ESCMID 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
- ESCMID 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
- ESCMID Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Ege University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Bornova, Izmir, Turkey; Bahrain Oncology Center, King Hamad University Hospital, Infectious Diseases Department, 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 Universitary Hospital, Madrid, Spain; ESCMID Study Group for Infections in Compromised Hosts (ESGICH), Basel, Switzerland
| | - Pierre Tattevin
- ESCMID 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
- Universidad Autónoma de Nuevo León, Faculty of Medicine, Department of Microbiology, Monterrey, Nuevo León, Mexico; ESCMID Fungal Infection Study Group (EFISG), Basel, Switzerland; ESCMID Study Group for Antimicrobial Stewardship (ESGAP), Basel, Switzerland; ESCMID Study Group for Genomic and Molecular Diagnostics (ESGMD), Basel, Switzerland
| | - Matthijs C Brouwer
- ESCMID 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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Boufrikha W, Rakez R, Bizid I, Hadhri M, Njima M, Boukhris S, Laatiri M. A rare association of a high grade glioblastoma, cerebral abscess and acute lymphoblastic leukemia in a child with Noonan syndrome. Leuk Res Rep 2023; 21:100404. [PMID: 38148892 PMCID: PMC10750179 DOI: 10.1016/j.lrr.2023.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 09/16/2023] [Accepted: 11/25/2023] [Indexed: 12/28/2023] Open
Abstract
Noonan syndrome is a genetic disorder frequently caused by PTPN11 mutations. Patients with Noonan syndrome are characterized by facial dysmorphism, short stature and congenital heart defects and they have a reported predisposition to malignancies such as leukemia, and solid and central nervous system tumors. Here, we report a case of a 14-year-old boy with Noonan syndrome treated for T-cell acute lymphoblastic leukemia who presented with 2 concomitant abnormalities: cerebral abscess and high grade glioblastoma. This exceptional association exhibits to a poorer prognosis and may sometimes delay the diagnosis and therefore the therapeutic intervention.
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Affiliation(s)
- Wiem Boufrikha
- Department of Hematology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Rim Rakez
- Department of Hematology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Inaam Bizid
- Department of Hematology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - M.Maher Hadhri
- Department of Neurosurgery, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Manel Njima
- Department of Histopathology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Sarra Boukhris
- Department of Hematology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - M.Adnene Laatiri
- Department of Hematology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
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Bengio M, Goodwin G, Roka A, Marin M. Pediatric headache patient with cerebral abscesses: a brief review of the literature and case report. J Int Med Res 2023; 51:3000605231213751. [PMID: 38006608 PMCID: PMC10683565 DOI: 10.1177/03000605231213751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/26/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Pediatric headache is a common cause of pediatric emergency department (ED) visits, and 8.8% of cases require imaging. Alarmingly, 12.5% of imaged cases have a pathologic cause. A pediatric patient with a complicated medical history presented to the pediatric ED with multiple cerebral abscesses. The possible causes and contributors to this rare cause of pediatric headache and a review of pediatric headache emergency management are presented.Case Presentation: A 12-year-old male patient with a complex medical and surgical history, including post-repair pulmonary valve stenosis, visited the pediatric ED for intractable and worsening left frontoparietal headache, refractory to ibuprofen, for 6 days. A physical examination revealed severe photophobia and restlessness secondary to severe head pain. Non-contrast brain computed tomography demonstrated two round, bilateral, parietal hypodense lesions with surrounding vasogenic edema. The lesions were consistent with abscesses on magnetic resonance imaging. Eventually, the patient underwent successful surgical abscess drainage and made a full recovery. The patient was lost to follow-up; therefore, no causative bacterial species was determined. CONCLUSION Managing pediatric headache in emergency settings requires a robust history and physical examination. Cerebral abscesses are an infrequent but fatal cause of pediatric headache and therefore should be considered among the differential diagnoses.
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Affiliation(s)
- Moshe Bengio
- Emergency Department, HCA Aventura Hospital and Medical Center, Aventura, USA
| | - Glenn Goodwin
- Emergency Department, HCA Aventura Hospital and Medical Center, Aventura, USA
| | - Abhishek Roka
- Emergency Department, HCA Aventura Hospital and Medical Center, Aventura, USA
| | - Michelle Marin
- Emergency Department, HCA Palms West Children's Hospital, Loxahatchee, USA
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Bodilsen J, Nielsen H. Early switch to oral antimicrobials in brain abscess: a narrative review. Clin Microbiol Infect 2023; 29:1139-1143. [PMID: 37119987 DOI: 10.1016/j.cmi.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Early switch to oral antimicrobials has been suggested as a treatment strategy in patients with brain abscess, but the practice is controversial. OBJECTIVES This review aimed to summarize the background, current evidence, and future perspectives for early transition to oral antimicrobials in patients with brain abscess. SOURCES The review was based upon a previous systematic review carried out during the development of the ESCMID guidelines on diagnosis and treatment of brain abscess. The search used 'brain abscess' or 'cerebral abscess' as text or MESH terms in PubMed, EMBASE, and the Cochrane Library. Studies included in the review were required to be published in the English language within the last 25 years and to have a study population of ≥10 patients. Other studies known by the authors were also included. CONTENT In this review, the background for some experts to suggest early transition to oral antimicrobials in patients with mild and uncomplicated brain abscess was clarified. Next, results from observational studies were summarized and limitations discussed. Indirect support for early oral treatment of brain abscess was described with reference to other serious central nervous system infections and general pharmacological considerations. Finally, variations within and between countries in the use of early transition to oral antimicrobials in patients with brain abscess were highlighted. IMPLICATIONS Early transition to oral antimicrobials in patients with uncomplicated brain abscess may be of benefit for patients due to convenience of treatment and potential decreased risks associated with prolonged hospitalization and intravenous lines. The strategy may also confer a more rational allocation of healthcare resources and decrease expenses. However, the benefit/risk ratio for this strategy remains unresolved at present.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; ESCMID Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; ESCMID Study Group for Infections of the Brain (ESGIB), Basel, Switzerland
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Rahimi MT, Akbari AR, Amanat AW, Rahman H, Khaliqi S, Hares R. Minimal access awake craniotomy for drainage of cerebral abscess in a patient with severe complex cardiac defects in resource-limited country: A case report. Int J Surg Case Rep 2023; 109:108514. [PMID: 37487351 PMCID: PMC10369459 DOI: 10.1016/j.ijscr.2023.108514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Brain abscess is an uncommon but potentially fatal infection of the brain parenchyma that can affect 5 % to 18.7 % of people with uncorrected complex congenital heart defects. In management of patients with complex cardiac defects, the main concern is that they are prone to develop perioperative complications. Hence such cases are a real challenge for surgeons and anesthesiologists. In this study we have reported a well-managed awake craniotomy (Awake-Asleep-Awake) for drainage of cerebral abscess in a patient with complex cardiac defect. CASE PRESENTATION We present a case of a 13-year-old male patient with untreated cyanotic CHD-TOF with complete AV canal defect, who complained of right-side paralysis since 2 weeks; and has been suffering from headache, fever and vomiting for 25 days. Brain CT scan showed a large abscess in the left fronto-temporal lobes. Minimal access awake craniotomy with regional scalp nerve block and sedation was done and about 100-120 cc thick pus was drained. The patient's paralysis improved significantly and neurological deficit ceased on 3rd postoperative day. CLINICAL DISCUSSION Pediatric population itself is a challenge for anesthesiologists and this manifolds when associated with complex cardiac defects and neurosurgery cases. CONCLUSION Brain abscess is expected to be more common in patients following uncorrected complex congenital heart disease in developing countries. Physicians must hold a high index of suspicion for early diagnosis and well-management of these patients with multidisciplinary approach. Minimal access awake craniotomy with or without sedation for patients with large brain abscess is a safe surgical approach.
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Affiliation(s)
- Mohammad Tareq Rahimi
- Department of Paediatric Surgery, French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Ahmad Rashad Akbari
- Department of Anaesthesia and Renimation, French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Abdul Wahab Amanat
- Department of Paediatric Surgery, French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Haseeb Rahman
- Department of Paediatric Surgery, French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Soghra Khaliqi
- Department of Paediatric Surgery, French Medical Institute for Mothers and Children, Kabul, Afghanistan
| | - Roohullah Hares
- Department of Paediatric Surgery, French Medical Institute for Mothers and Children, Kabul, Afghanistan.
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Iro MA, Goldacre MJ, Goldacre R. Central nervous system abscesses and empyemas in England: epidemiological trends over five decades. J Infect 2023; 86:309-315. [PMID: 36764391 DOI: 10.1016/j.jinf.2023.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To report on population-based epidemiological trends in central nervous system (CNS) abscesses and empyemas in England over five decades. METHODS Trend analyses of age-sex-specific hospital admission and death rates using routinely collected English national hospital discharge records, mortality records, and annual population denominators from 1968 to 2019. RESULTS Hospital admission rates for CNS abscesses and empyemas were stable in England until the late 1980s. In the last two decades of the study period (1999-2019), first-time admissions increased from 1.24 per 100,000 population in 1999 (95% confidence interval [CI] 1.14-1.35) to 2.86 in 2019 (95% CI 2.72-3.01). Admission rates were highest among infants and older adults, and were higher for males than females. There were small but significant increases in annual mortality rates for CNS abscesses and empyemas over the last two decades of the study period after accounting for population ageing, but mortality remained low at around 0.1-0.2 per 100,000 population. Mortality increased with advancing age; deaths in childhood were extremely rare. Case fatality rates where a relevant diagnosis was recorded as either the underlying or contributing cause were 4.3% and 9.7% respectively. CONCLUSIONS The increase in CNS abscesses and empyemas in England might reflect improved case ascertainment, but the likelihood of a true rise in incidence should be considered.
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Affiliation(s)
- M A Iro
- Faculty of Medicine and Institute of Life Sciences, University of Southampton, UK; Department of Paediatric Infectious Diseases, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK.
| | - M J Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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11
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Sekimori K, Sato S, Higashizono K, Nagai E, Taki Y, Nishida M, Watanabe M, Miyakoshi A, Oba N. Esophageal cancer presenting with brain abscess. Int Cancer Conf J 2023; 12:87-91. [PMID: 36605845 PMCID: PMC9807726 DOI: 10.1007/s13691-022-00584-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/31/2022] [Indexed: 11/08/2022] Open
Abstract
A 76-year-old man experienced fatigue and progressive dysphagia. He underwent endoscopy at another hospital and was diagnosed with thoracic esophageal cancer. Three days after the endoscopy, the patient was rushed to our hospital with sudden seizures of the right upper and lower extremities. Contrast-enhanced computed tomography scan revealed a ring-shaped contrast-enhanced mass formation in the left parietal lobe with edema in the surrounding brain parenchyma. Contrast-enhanced magnetic resonance imaging showed a ring-shaped lesion with a high intensity on diffusion-weighted images. He was diagnosed with a brain abscess in the left parietal lobe. For abscess drainage, a quasi-emergent small craniotomy was performed. Culture of the drainage fluid revealed Streptococcus species and Haemophilus parainfluenzae. After 6 weeks of antibiotic therapy, the patient underwent a thoracoscopic esophagectomy. After the esophagectomy, there was no recurrence of the brain abscess for more than 2 years and only symptomatic epilepsy remained. Conclusively, although brain abscesses caused by esophageal cancer are rare, the possibility of brain abscess and metastasis should be considered when patients present with convulsions or higher brain disorders.
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Affiliation(s)
- Kenichi Sekimori
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-Ku, Shizuoka, 420-8527 Japan
| | - Shinsuke Sato
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-Ku, Shizuoka, 420-8527 Japan
| | - Kazuya Higashizono
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-Ku, Shizuoka, 420-8527 Japan
| | - Erina Nagai
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-Ku, Shizuoka, 420-8527 Japan
| | - Yusuke Taki
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-Ku, Shizuoka, 420-8527 Japan
| | - Masato Nishida
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-Ku, Shizuoka, 420-8527 Japan
| | - Masaya Watanabe
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-Ku, Shizuoka, 420-8527 Japan
| | - Akinori Miyakoshi
- Department of Neurosurgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Noriyuki Oba
- Department of Gastroenterological Surgery, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-Ku, Shizuoka, 420-8527 Japan
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12
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Sharma M, Dhagat P, Kumar A. Delayed Cerebral abscess following a retained shrapnel. Med J Armed Forces India 2023; 79:117-120. [PMID: 36605354 PMCID: PMC9807653 DOI: 10.1016/j.mjafi.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/26/2020] [Indexed: 02/01/2023] Open
Abstract
Retained foreign bodies following penetrating brain injuries continue to pose therapeutic dilemmas. Previously used aggressive approach involving extensive wound debridement and removal of foreign bodies caused additional neurological deficit with higher mortality. Less aggressive approach used more recently involving decompressive craniectomy has lead to higher incidence of retained foreign bodies with potential of infective sequelae. We describe one such case where, in presence of a retained foreign body, an intracranial abscess formed after a gap of 17 yrs. The case has peculiar radiological and morphological findings.
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Affiliation(s)
- Manish Sharma
- Senior Adviser (Surgery & Neurosurgery), Army Hospital (R&R), Delhi Cantt, India
| | - P.K. Dhagat
- Brig/i/c Adm, Command Hospital (Northern Command), Udhampur, India
| | - Anil Kumar
- Senior Adviser (Surgery & Neurosurgery), Command Hospital (Northern Command), Udhampur, India
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13
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Sharath Kumar GG, Adiga CP, Iyer PP, Goolahally LN. Role of imaging in CNS infections. INDIAN J PATHOL MICR 2022; 65:S153-S163. [PMID: 35562146 DOI: 10.4103/ijpm.ijpm_1162_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Neuroinfections are seen in both adults and children. These can result in serious morbidity and if left untreated and/or associated with comorbidities can be life threatening. Cross-sectional imaging like computed tomography (CT) and magnetic resonance imaging (MRI) are advised by the clinicians for the diagnosing, confirmation of the diagnosis, assess any complications of the infection, and also for follow up. Though CT is the initial imaging investigation commonly asked by the clinician, due to its lesser soft tissue resolution, early brain changes may not be seen on CT. MRI has better soft tissue resolution with no ionizing radiation to the patient and helps in detecting the early signs of infection. Appropriate MRI, not only helps the radiologist to reduce the number of possibilities of the causative organism but also differentiates tumors from infection. However, CT is useful to assess the bony changes and also easily available and affordable cross-sectional imaging modality worldwide. The review summarizes the approach of the radiologist to central nervous system (CNS) infections and their typical imaging characteristic features.
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Affiliation(s)
- G G Sharath Kumar
- Department of Radiology, Apollo Hospitals, Sheshadripuram, Bangaluru, Karnataka, India
| | | | - Prakash P Iyer
- Department of Radiology, Apollo Hospitals, Sheshadripuram, Bangaluru, Karnataka, India
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14
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Gupta S, Kasule SN, Seville MT. Cerebral abscess with Streptococcus intermedius as a complication of pelvic inflammatory disease in the setting of intrauterine device use. IDCases 2022; 27:e01454. [PMID: 35242560 PMCID: PMC8861415 DOI: 10.1016/j.idcr.2022.e01454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 10/25/2022] Open
Abstract
A 43-year-old healthy female with no significant medical problems except for recently diagnosed pelvic inflammatory disease presented to our hospital with acute onset, severe head and neck pain. Brain imaging revealed a rim-enhancing lesion consistent with an abscess. The patient underwent successful surgical removal of the abscess and its capsule. Intraoperative cultures grew Streptococcus intermedius and she was discharged with a plan for four weeks of intravenous ceftriaxone.
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Affiliation(s)
- Simran Gupta
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
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15
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Bodilsen J, Brouwer MC, van de Beek D, Tattevin P, Tong S, Naucler P, Nielsen H. Partial oral antibiotic treatment for bacterial brain abscess: an open-label randomized non-inferiority trial (ORAL). Trials 2021; 22:796. [PMID: 34772441 PMCID: PMC8588941 DOI: 10.1186/s13063-021-05783-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background The advised standard treatment for bacterial brain abscess following surgery is 6 to 8 weeks of intravenous (IV) antibiotic treatment, but an early switch to oral antibiotic treatment has been suggested to be equally effective. Methods This investigator-initiated, international, multi-center, parallel group, open-label, randomized (1:1 allocation) controlled trial will examine if oral treatment after 2 weeks of IV antibiotic therapy is non-inferior to standard 6–8 weeks of IV antibiotics for bacterial brain abscess in adults (≥ 18 years of age). The study will be conducted at hospitals across Denmark, the Netherlands, France, Australia, and Sweden. Exclusion criteria are severe immunocompromise or impaired gastro-intestinal absorption, pregnancy, device-related brain abscesses, and brain abscess caused by nocardia, tuberculosis, or Pseudomonas spp. The primary objective is a composite endpoint at 6 months after randomization consisting of all-cause mortality, intraventricular rupture of brain abscess, unplanned re-aspiration or excision of brain abscess, relapse, or recurrence. The primary endpoint will be adjudicated by an independent blinded endpoint committee. Secondary outcomes include extended Glasgow Outcome Scale scores and all-cause mortality at end of treatment as well as 3, 6, and 12 months since randomization, completion of assigned treatment, IV catheter associated complications, durations of admission and antibiotic treatment, severe adverse events, quality of life scores, and cognitive evaluations. The planned sample size is 450 patients for a one-sided alpha of 0.025 and a power of 90% to exclude a difference in favor of standard treatment of more than 10%. Date of initiation of first study center was November 3, 2020, with active recruitment for 3 years and follow-up for 1 year of all patients. Discussion The results of this study may guide future recommendations for treatment of bacterial brain abscess. If early transition to oral antibiotics proves non-inferior to standard IV treatment, this will provide considerable health and costs benefits. Trial registration ClinicalTrials.gov NCT04140903, first registered 28.10.2019. EudraCT number: 2019-002845-39, first registered 03.07.2019
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark. .,European Society for Clinical Microbiology and Infectious Diseases Study Group of Infections in the Brain (ESCMID), Basel, Switzerland.
| | - Matthijs C Brouwer
- European Society for Clinical Microbiology and Infectious Diseases Study Group of Infections in the Brain (ESCMID), Basel, Switzerland.,Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Diederik van de Beek
- European Society for Clinical Microbiology and Infectious Diseases Study Group of Infections in the Brain (ESCMID), Basel, Switzerland.,Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pierre Tattevin
- European Society for Clinical Microbiology and Infectious Diseases Study Group of Infections in the Brain (ESCMID), Basel, Switzerland.,Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France.,Réseau National de Recherche Clinique en Infectiologie (RENARCI), Paris, France
| | - Steven Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Australia.,Department of Infectious Diseases University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Pontus Naucler
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Nielsen
- European Society for Clinical Microbiology and Infectious Diseases Study Group of Infections in the Brain (ESCMID), Basel, Switzerland.,Department of Infectious Diseases and Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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16
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Fogg DN, Mallela AN, Abou-Al-Shaar H, González-Martínez J. Robotic-assisted stereotactic drainage of cerebral abscess and placement of ventriculostomy. Br J Neurosurg 2021:1-4. [PMID: 34463595 DOI: 10.1080/02688697.2021.1969006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Robotic surgery has found increasing use in multiple subfields of neurosurgery. While the initial applications of stereotactic robotic surgery were for the placement of electrodes for extra-operative seizure monitoring, this technique has become increasingly relevant in other areas of neurosurgery. To the best of our knowledge, we report the first case of successful robotic surgery utilization to drain a cerebral abscess and place an external ventricular drain. CASE REPORT The authors demonstrate a novel use for stereotactic robotic assistance to drain a cerebral abscess and place ventriculostomy in a 74-year-old female patient who presented with a left basal ganglia Streptococcus intermedius abscess and concomitant ventriculitis. Drainage of a deep-seated abscess and placement of ventriculostomy was successfully performed in this patient without intraoperative difficulties or complications. The total operative time, including registration was 64 minutes and the estimated blood loss was 25 mL. The patient recovered well and was discharged to inpatient rehabilitation on postoperative day 19. CONCLUSIONS The use of robotic surgery to drain cerebral abscesses and place ventriculostomies is technically feasible and may potentially decrease operative time and increase accuracy and safety.
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Affiliation(s)
- David N Fogg
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arka N Mallela
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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17
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Hernandez C, Lawal F. Cerebral and pulmonary phaeohyphomycosis due Cladophialophora bantiana in an immunocompromised patient. IDCases 2021; 25:e01240. [PMID: 34381691 PMCID: PMC8335626 DOI: 10.1016/j.idcr.2021.e01240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022] Open
Abstract
We report a case of disseminated Cladophialophora bantiana phaeohyphomycosis with cerebral and pulmonary disease in a 69-year-old renal transplant recipient. The patient presented with confusion, low-grade fever and progressed quickly to a comatose state. Imaging revealed multiple small brain abscesses and a right pulmonary nodule. Cultures of bronchial washings and biopsy of the right pulmonary nodule grew C. bantiana, a highly neurotropic fungus with a high mortality rate. He was treated with Isavuconazonium sulfate (Isavuconazole) and Liposomal Amphotericin B along with reduction immunosuppressive therapy. His neurologic status remained unimproved despite treatment with dual antifungal therapy for two months. The patient eventually died from respiratory failure 79 days after his initial presentation, C. bantiana has been reported in both immunocompetent and immunocompromised patients. Its neurotropism has been reported and described in the literature with C. bantiana responsible for 50 % of the reported cases of fungal brain abscess. However, reports of pulmonary and cerebral involvement are exceedingly rare. Our patient was immunocompromised and succumbed to cerebral involvement.
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Affiliation(s)
| | - Folake Lawal
- Corresponding author at: 1120 15th St, AE- 3024, Augusta, GA, 30912, United States. http://berkeley.edu
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18
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Catroux M, Garcia M, Lévêque N, Page P, Moal GL, Boutolleau D, Roblot F, Burrel S. Post-herpetic encephalitis cerebral abscess: Viral reactivation or latency site within central nervous system? Curr Res Transl Med 2021; 69:103297. [PMID: 34139602 DOI: 10.1016/j.retram.2021.103297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 04/22/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Abstract
Herpetic encephalitis results from central nervous system invasion by herpes simplex virus. We report the case of a man who developed a cerebral abscess fifteen months after initial Herpetic encephalitis. Retrospectively, antiviral should not have been associated with antibiotics during abscess episode, as transcriptomic analysis reported no viral reactivation.
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Affiliation(s)
- Mélanie Catroux
- Tropical Infectious Diseases Department, Poitiers University Hospital, Poitiers, France.
| | - Magali Garcia
- Virology and Mycobacteriology Department, Poitiers University Hospital, Poitiers, France; EA 4331, LITEC, University of Poitiers, Poitiers, France.
| | - Nicolas Lévêque
- Virology and Mycobacteriology Department, Poitiers University Hospital, Poitiers, France; EA 4331, LITEC, University of Poitiers, Poitiers, France.
| | - Philippe Page
- Department of Neurosurgery, Poitiers University Hospital, Poitiers, France.
| | - Gwenael Le Moal
- Tropical Infectious Diseases Department, Poitiers University Hospital, Poitiers, France.
| | - David Boutolleau
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), and AP-HP, University Hospital Pitié-Salpêtrière - Charles-Foix, National Reference Center for Herpesviruses, Virology Department, Paris, France.
| | - France Roblot
- Tropical Infectious Diseases Department, Poitiers University Hospital, Poitiers, France.
| | - Sonia Burrel
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), and AP-HP, University Hospital Pitié-Salpêtrière - Charles-Foix, National Reference Center for Herpesviruses, Virology Department, Paris, France.
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19
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Beucler N, Farah K, Choucha A, Meyer M, Fuentes S, Seng P, Dufour H. Nocardia farcinica cerebral abscess: A systematic review of treatment strategies. Neurochirurgie 2021; 68:94-101. [PMID: 33989644 DOI: 10.1016/j.neuchi.2021.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Nocardia farcinica is an opportunistic pathogen causing mainly pneumonia in immunocompromised patients, complicated in almost one-third of the cases by a thick-walled multiloculated cerebral abscess which induces significant morbidity and mortality. This review aims to assess the optimal treatment strategy for N. farcinica cerebral abscess. METHODS Report of a case. Medline database was used to conduct a systematic review from inception to January 2020 looking for English-language articles focused on N. farcinica cerebral abscess, in accordance with the PRISMA guidelines. RESULTS The research yielded 54 articles for a total of 58 patients. N. farcinica cerebral abscess displayed three different neuroimaging patterns: a single multiloculated abscess in half of the cases, multiple cerebral abscesses, or a small paraventricular abscess with meningitis. The patients who benefited from surgical excision of the abscess showed a trend towards a lower risk of surgical revision (8% versus 31%, P=0.06) and a lower mortality rate (8% versus 23%, P=0.18) than patients who benefited from needle aspiration. Twenty-two percent of the patients benefited from microbiological documentation from another site with a mortality rate of 23%. CONCLUSION Urgent multimodal MRI is necessary in face with clinical suspicion of cerebral nocardiosis. In case of single or multiple small cerebral abscesses, microbiological documentation can be obtained with puncture of pseudotumoral visceral lesions. In case of large or symptomatic cerebral abscess, an aggressive surgical excision seems a reliable option and can be preferred over needle aspiration. Long-term antibiotic therapy with cotrimoxazole is necessary thereafter.
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Affiliation(s)
- N Beucler
- Neurosurgery department, Sainte-Anne Military teaching Hospital, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France; École du Val-de-Grâce, French Military Health Service Academy, 1, place Alphonse-Laveran, 75230 Paris cedex 5, France.
| | - K Farah
- Neurosurgery department, Timone University Hospital, APHM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - A Choucha
- Neurosurgery department, Timone University Hospital, APHM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - M Meyer
- Neurosurgery department, Timone University Hospital, APHM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - S Fuentes
- Neurosurgery department, Timone University Hospital, APHM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - P Seng
- Unité microbes, évolution, phylogenie et infection (MEPHI), IHU - méditerranée infection, Service de maladies infectieuses tropicales et infections chroniques (MITIC), Aix-Marseille Université, APHM, 19-21, boulevard Jean-Moulin, 13005 Marseille, France
| | - H Dufour
- Neurosurgery department, Timone University Hospital, APHM, 264, rue Saint-Pierre, 13005 Marseille, France; Inserm, MMG, Aix-Marseille Université, Marseille, France
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20
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Meena DS, Kumar D, Bohra GK, Kumar G. Clinical manifestations, diagnosis, and treatment outcome of CNS aspergillosis: A systematic review of 235 cases. Infect Dis Now 2021; 51:654-660. [PMID: 33964485 DOI: 10.1016/j.idnow.2021.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
Aspergillus is a ubiquitous ascomycete that can cause a variety of clinical presentations depending on immune status. Central nervous system aspergillosis is a fatal disease with non-specific clinical features. The aim of this systematic review was to evaluate the epidemiology, clinical features, diagnosis and therapeutic interventions in CNS aspergillosis patients. We also aimed to examine the possible predictors of mortality in neuroaspergillosis. Literature search was performed in Medline, PubMed, and Google scholar and all patients≥18 years with proven CNS aspergillosis were included. A total of 175 articles (235 patients) were included in the final analysis. Their mean age was 51 years and the majority were male (57.4%). Overall case-fatality was 45.1%. Aspergillus fumigatus was the most common species (70.8%) followed by A. flavus (18.6%). Corticosteroids (22.6%), malignancy (19.1%) and diabetes mellitus (14%) were the most common risk factors. Neuroimaging findings included cerebral abscess (70.2%), meningitis (14%), infarction (13.2%) and mycotic aneurysm (8.9%). Disseminated disease (29.2% vs 17.8%, p 0.03), CSF hypoglycorrhachia (48.1% vs 22.2%, P: 0.001) and heightened CSF galactomannan (3.62 vs 2.0ng/ml, p 0.05), were the factors associated with poor outcome in neuroaspergillosis. Persons infected with Aspergillus flavus (13.1% vs 3.1%, P: 0.01), and having been treated with Voriconazole (51.9% vs 29.2%, P: 0.004) were more likely to survive. Our review will provide insight into the different spectrums of CNS aspergillosis. Notwithstanding the promising role of Voriconazole, future work is required to ascertain the role of combination antifungal therapy.
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Affiliation(s)
- Durga Shankar Meena
- Department of Internal Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, Rajasthan, India.
| | - Deepak Kumar
- Department of Internal Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, Rajasthan, India.
| | - Gopal Krishana Bohra
- Department of Internal Medicine, All India Institute of Medical Sciences, 342005 Jodhpur, Rajasthan, India.
| | - Gaurav Kumar
- Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
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21
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Demerath T, Erny D, Schnell O, Urbach H, Prinz M, Taschner CA. Freiburg Neuropathology Case Conference : Contrast-enhancing Brain Lesion 6 Months after Resection and Combined Radiotherapy and Chemotherapy of an Unmethylated but IDH R132H-mutated Glioblastoma Multiforme. Clin Neuroradiol 2021; 31:283-8. [PMID: 33625551 DOI: 10.1007/s00062-021-01006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 10/28/2022]
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22
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Adams N, Snitchler C, Kong M, Ikeda D, Skinner A, Rodriguezbarrantes J, Leverette R, Bell R. When upper respiratory tract infections go rogue: A case report of Arcanobacterium haemolyticum Cerebral Abscess. IDCases 2020; 23:e01014. [PMID: 33304814 PMCID: PMC7711139 DOI: 10.1016/j.idcr.2020.e01014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 11/18/2022] Open
Abstract
Arcanobacterium haemolyticum is an extremely rare cause of cerebral abscess. We present a unique case of Arcanobacterium haemolyticum sinusitis complicated by preseptal cellulitis and cerebral abscess. The patient initially presented with pharyngitis and then developed sinus congestion, headache and facial pain. Computed tomography and magnetic resonance imaging revealed a right gyrus rectus cerebral abscess and paranasal sinus infection. The patient underwent endoscopic sinus surgery and cultures revealed Arcanobacterium haemolyticum. Repeat imaging revealed maturation and progression of intracranial abscess. The abscess was drained and patient was treated with parenteral and oral antibiotics until complete clinical and radiological remission. This case highlights the importance of recognizing Arcanobacterium haemolyticum as a cause of invasive disease in immunocompetent hosts.
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Affiliation(s)
- Nehkonti Adams
- Departments of Medicine, US Naval Hospital Okinawa, Okinawa, Japan
- Corresponding author.
| | | | - Michael Kong
- Departments of Otolaryngology-Head and Neck Surgery, US Naval Hospital Okinawa, Okinawa, Japan
| | - Daniel Ikeda
- Departments of Surgery, US Naval Hospital Okinawa, Okinawa, Japan
| | - Anthony Skinner
- Departments of Opthaolmology, US Naval Hospital Okinawa, Okinawa, Japan
| | | | - Ryan Leverette
- Departments of Laboratory Services, US Naval Hospital Okinawa, Okinawa, Japan
| | - Randy Bell
- Department of Neurosurgery, Walter Reed National Military Medical Center, Maryland, United States
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Bodilsen J, Tattevin P, Tong S, Naucler P, Nielsen H. Treatment of community-acquired bacterial brain abscess: a survey among infectious diseases specialists in France, Sweden, Australia, and Denmark. Eur J Clin Microbiol Infect Dis 2021; 40:255-60. [PMID: 32880024 DOI: 10.1007/s10096-020-04032-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/27/2020] [Indexed: 02/08/2023]
Abstract
To examine antimicrobial management of brain abscess and prioritize future trials. Self-administered, Internet-based survey of practices for treatment of community-acquired bacterial brain abscess among infectious diseases (ID) specialists in France, Sweden, Australia, and Denmark during November 2019. Respondents were also asked to rank future randomized controlled trials (RCTs) from 1 (high priority) to 6 (low priority). 310 ID specialists (45% female) from France (35%), Sweden (29%), Australia (25%), and Denmark (11%) participated in the survey, primarily from university hospitals (69%) with an on-site neurosurgical department (61%). Preferred empiric intravenous (IV) antimicrobials were cefotaxime (154/273, 56%) or ceftriaxone (68/273, 25%) combined with metronidazole for a median of 4 weeks (IQR 4-6), 4 weeks (IQR 2-4), and 6 weeks (IQR 4-6) for aspirated, excised, and conservatively treated patients, respectively. Early transition to oral antimicrobials (i.e., < 4 weeks of IV antimicrobials) was used by 134/269 (50%), whereas consolidation therapy with oral antimicrobials after a standard IV regimen (i.e., 4-8 weeks) was used by 123/264 (47%). Median prioritization scores for future RCTs were as follows: 1 (IQR 1-2) for an early transition to oral antimicrobials and duration of therapy, 3 (IQR 2-4) for comparisons of antimicrobial regimens, use of adjunctive dexamethasone, and neurosurgical aspiration versus excision, and 4 (IQR 3-5) for intracavitary antimicrobial instillation and drainage, and for prophylactic anti-epileptic therapy. Willingness to include patients into RCTs reflected prioritization scores. Duration of intravenous antimicrobial treatment and use of oral antimicrobials varies substantially among ID specialists. RCTs are needed to define optimal treatment of brain abscess.
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Mohamed FA, Kpanidja GM, Noudamadjo A, Dohou SHM, Savi de Tove KM, Agossou J, Adedemy JD. [Brain abscess revealing trilogy of Fallot in a child: about a case at the University Teaching Hospital of Parakou, Benin]. Pan Afr Med J 2020; 34:189. [PMID: 32180863 PMCID: PMC7060948 DOI: 10.11604/pamj.2019.34.189.20282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/26/2019] [Indexed: 11/25/2022] Open
Abstract
Les abcès cérébraux sont pourvoyeurs d'une importante morbidité chez les patients atteints de cardiopathie cyanogène. Dans les pays à ressources limitées leur prise en charge est difficile et leur pronostic réservé. Nous rapportons ici un cas d'abcès cérébraux révélant une forme rare de cardiopathie cyanogène, la trilogie de Fallot à Parakou au Nord du Bénin. Il s'est agi d'un garçon de 9 ans, référé d'un hôpital primaire pour une hémiparésie gauche. L'interrogatoire et l'examen physique avaient permis de retrouver une symptomatologie évoluant depuis deux mois faite de céphalées intenses, de fièvre, de vomissements et d'une impotence fonctionnelle de l'hémicorps gauche. Un état général altéré, une cyanose généralisée; une hémiparésie gauche, un souffle systolique au foyer pulmonaire. Le scanner cérébral avait montré des abcès en région pariétale droite et temporale gauche et une hydrocéphalie. L'écho-doppler cardiaque avait montré une sténose pulmonaire serrée, une communication interauriculaire et une hypertrophie ventriculaire droite. Une antibiothérapie faite de ceftriaxone de gentamycine et métronidazole avait été démarrée en urgence et l'indication chirurgicale d'une trépano-ponction posée mais n'a pu être réalisée car l'évolution avait été rapidement défavorable. Les abcès cérébraux constituent une complication classique des cardiopathies cyanogènes. L'issue est fatale en l'absence de prise en charge adéquate d'où l'intérêt d'un diagnostic et d'une prise en charge précoces de ces cardiopathies.
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Affiliation(s)
| | | | - Alphonse Noudamadjo
- Faculté de Médecine, Département Mère Enfant, Université de Parakou, Parakou, Bénin
| | | | - Kofi Mensa Savi de Tove
- Faculté de Médecine, Département de Médecine et Spécialités Médicales, Université de Parakou, Parakou, Bénin
| | - Joseph Agossou
- Faculté de Médecine, Département Mère Enfant, Université de Parakou, Parakou, Bénin
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Shah KA, Katz JM, Dehdashti AR. Cerebral Abscess After Onyx Embolization of an Arteriovenous Malformation. World Neurosurg 2019; 135:96-99. [PMID: 31841721 DOI: 10.1016/j.wneu.2019.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endovascular embolization is being increasingly used to treat cerebral arteriovenous malformations. Common complications associated with embolization include intracranial hemorrhage and ischemic stroke; intracranial infections seldomly occur and are even less frequently reported. Although abscess formation after embolization is exceedingly rare, it is a serious condition that warrants immediate attention. CASE DESCRIPTION This 53-year-old male with a ruptured left temporal-occipital arteriovenous malformation. He underwent uncomplicated 2-stage embolization with Onyx and was discharged. Five weeks after embolization, he returned to the hospital with worsening aphasia and contralateral hemiparesis, and a cerebral abscess was detected at the site of embolization. Bacterial cultures were positive for Escherichia coli, and he was treated successfully with surgical excision of the abscess and Onyx material, followed by long-term antibiotics. CONCLUSIONS Although rare, formation of an intracranial abscess after endovascular embolization is a potential complication in the treatment of arteriovenous malformations.
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Affiliation(s)
- Kevin A Shah
- Department of Neurosurgery, North Shore University Hospital, Manhasset, New York, USA.
| | - Jeffrey M Katz
- Department of Neurology, North Shore University Hospital, Manhasset, New York, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, North Shore University Hospital, Manhasset, New York, USA
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Miossec C, Jacob S, Peipoch L, Brard M, Jolivet E, Hochedez P, Hamlat A, Desbois N. Cerebral phaeohyphomycosis due to Cladophialophora bantiana in a French Guianese child. J Mycol Med 2019; 30:100918. [PMID: 31926829 DOI: 10.1016/j.mycmed.2019.100918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 10/31/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
We report a case of cerebral phaeohyphomycosis, a fungal brain infection due to a dark (dematiaceous) fungi in a 6-year-old French Guyanese boy. The child presented fever and drowsiness due to several paraventricular brain abscesses. Neurological surgeries were performed to reduce intracranial hypertension and to obtain abscess biopsies. Mycological cultures of intraoperative samples led to the diagnosis of cerebral phaeohyphomycosis due to Cladophialophora bantiana. The patient neurological status deteriorated and remained critical after several weeks of combination antifungal therapy with voriconazole 8mg/kg/day, liposomal amphotericin B 10mg/kg/day and flucytosine 200mg/kg/day. A complete surgical resection was not possible because of multiple small abscesses. A multidisciplinary ethical staff decided on home medical care with palliative ventriculoperitoneal shunt, nasogastric feeding and analgesics. One year later, the patient's neurological condition had improved and cerebral lesions had regressed, while he had not received any antifungal treatment but only traditional medicines. Cerebral phaeohyphomycosis are rare diseases affecting immunocompromised but also apparently non-immunocompromised patients, as in this case. A complete surgical resection is not always possible and mortality rates are high in spite of treatments with a combination of antifungals. The diagnosis may be difficult because of these dematiaceous fungi's slowly growing and their potential pathogenicity for laboratory staff.
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Affiliation(s)
- C Miossec
- Laboratoire de parasitologie-mycologie, hôpital Pierre-Zobda-Quitman, CHU de la Martinique, BP 632, 97261 Fort-de-France cedex, Martinique.
| | - S Jacob
- Laboratoire de parasitologie-mycologie, hôpital Pierre-Zobda-Quitman, CHU de la Martinique, BP 632, 97261 Fort-de-France cedex, Martinique
| | - L Peipoch
- Service de réanimation pédiatrique, hôpital Pierre-Zobda-Quitman, CHU de la Martinique, BP 632, 97261 Fort-de-France cedex, Martinique
| | - M Brard
- Service de réanimation pédiatrique, hôpital Pierre-Zobda-Quitman, CHU de la Martinique, BP 632, 97261 Fort-de-France cedex, Martinique
| | - E Jolivet
- Service de pédiatrie, hôpital Pierre-Zobda-Quitman, CHU de la Martinique, BP 632, 97261 Fort-de-France cedex, Martinique
| | - P Hochedez
- Service des maladies infectieuses et tropicales, hôpital Pierre-Zobda-Quitman, CHU de la Martinique, BP 632, 97261 Fort-de-France cedex, Martinique
| | - A Hamlat
- Service de neurochirurgie, hôpital Pierre-Zobda-Quitman, CHU de la Martinique, BP 632, 97261 Fort-de-France cedex, Martinique
| | - N Desbois
- Laboratoire de parasitologie-mycologie, hôpital Pierre-Zobda-Quitman, CHU de la Martinique, BP 632, 97261 Fort-de-France cedex, Martinique
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O'Connor C, Collins A, Twomey E, Hensey C, Caird J, Gavin PJ. A case report of multiple cerebral abscess formation complicating serogroup B Neisseria meningitidis meningitis. BMC Infect Dis 2019; 19:863. [PMID: 31638913 PMCID: PMC6802112 DOI: 10.1186/s12879-019-4509-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 09/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Invasive meningococcal disease (IMD) presenting with meningitis causes significant mortality and morbidity. Suppurative complications of serogroup B meningococcal sepsis are rare and necessitate urgent multidisciplinary management to mitigate long-term morbidity or mortality. Case presentation We present a rare case of invasive meningococcal disease in a 28-month old boy complicated by multiple abscess formation within a pre-existing antenatal left middle cerebral artery territory infarct. Past history was also notable for cerebral palsy with right hemiplegia, global developmental delay and West syndrome (infantile spasms). Two craniotomies were performed to achieve source control and prolonged antimicrobial therapy was necessary. The patient was successfully discharged following extensive multidisciplinary rehabilitation. Conclusions Longstanding areas of encephalomalacia in the left MCA distribution may have facilitated the development of multiple meningococcal serogroup B abscess cavities in the posterior left frontal, left parietal and left temporal lobes following an initial period of cerebritis and meningitis. A combination of chronic cerebral hypoperfusion and some degree of pre-existing necrosis in these areas, may also have facilitated growth of Neisseria meningitidis, leading ultimately to extensive cerebral abscess formation following haematogenous seeding during meningococcemia. In this case report we review similar cases of cerebral abscess or subdural empyema complicating serogroup B meningococcal meningitis.
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Affiliation(s)
- Ciara O'Connor
- Department of Clinical Microbiology, Temple Street Children's University Hospital, Dublin 1, Ireland.
| | - Aedin Collins
- Department of Infectious Diseases, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Eilish Twomey
- Department of Radiology, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Conor Hensey
- Deparment of General Paediatrics, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - John Caird
- Department of Neurosurgery, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - Patrick J Gavin
- Department of Infectious Diseases, Temple Street Children's University Hospital, Dublin 1, Ireland
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Khera R, Rao V, Pasam MK, Tagore R, Murthy SS, Sundaram C. Isolated cerebral aspergillus abscess as a complication of pulmonary alveolar proteinosis in a child. Chin Neurosurg J 2019; 5:17. [PMID: 32922917 PMCID: PMC7398192 DOI: 10.1186/s41016-019-0165-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/11/2019] [Indexed: 11/10/2022] Open
Abstract
Abstract Background Pulmonary alveolar proteinosis (PAP) poses a risk of opportunistic infections with a variety of organisms with Nocardia being the most common pathogen followed by mycobacteria and fungi. Case presentation A 7-year-old female child, presented with headache and multiple episodes of vomiting. There was no fever or altered sensorium. On examination, there were no focal deficits or cranial nerve palsies. An MRI brain showed a small T2 hyperintense lesion in the left superior parietal lobe suggestive of an abscess. She was diagnosed as PAP based on CT chest and bronchioloalveolar lavage 7 months earlier and treated with corticosteroids. A left parieto-occipital craniotomy was done with drainage of abscess and abscess wall excision. Histopathology revealed a suppurative lesion with slender septate acute angle branching hyphae which were positive on fungal stains. Culture done on the pus was positive for Aspergillus fumigatus. The patient was treated with voriconazole and stable at 1 year follow-up. Conclusion Opportunistic infections are common in patients diagnosed with PAP. High index of clinical suspicion and early diagnosis are important for favorable outcome.
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Affiliation(s)
- Rachna Khera
- Department of Laboratory Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana 500034 India
| | - Venkateswara Rao
- Department of Neurosurgery, Basavatarakam Indoamerican Cancer Hospital and Research Institute, Hyderabad, Telangana 500034 India
| | - Mohan Krishna Pasam
- Department of Laboratory Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana 500034 India
| | - Ravindranath Tagore
- Department of Laboratory Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana 500034 India
| | - Sudha S Murthy
- Department of Laboratory Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana 500034 India
| | - Challa Sundaram
- Department of Laboratory Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana 500034 India
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Casabella AM, Perry A, Graffeo CS, Marcellino CR, Carlstrom LP, Rabinstein AA. Emergent Decompression of Intracranial Abscess in Eisenmenger Syndrome. World Neurosurg 2019; 130:133-137. [PMID: 31295595 DOI: 10.1016/j.wneu.2019.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Eisenmenger syndrome is a rare sequela of uncorrected congenital heart disease complicated by pulmonary hypertension, from which reversal of the pathologic left-to-right cardiovascular shunt and cyanosis follow. Right-to-left shunting can lead to paradoxical cerebral emboli-increasing the risk of spontaneous or iatrogenic stroke and cerebral abscess. CASE DESCRIPTION A 38-year-old man presented with new focal seizures due to a brain abscess. Ventricular septal defect and pulmonary hypertension were identified. Despite dexamethasone and broad-spectrum antibiotics, he developed hemiparesis and altered mental status and required emergent stereotactic abscess drainage. Despite the anesthetic hazards of Eisenmenger syndrome, the procedure was successful and the patient recovered completely. CONCLUSIONS Noncardiac perioperative mortality in Eisenmenger syndrome is historically reported up to 19%, and risks are further increased with prolonged case duration or hypotension, mandating vigilant attention to volume status. Correspondingly, shorter- or lower-risk procedures such as stereotactic drainage are recommended. Procedures should be performed only at centers with expertise in management of Eisenmenger syndrome and cardiac-specialized anesthesiologists whenever possible. Although a conservative approach with early, aggressive medical management is preferred, operative intervention may be required in the setting of progressive deterioration and excellent postoperative outcomes are achievable.
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Affiliation(s)
| | - Avital Perry
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Christopher R Marcellino
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lucas P Carlstrom
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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30
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Beresford R, Dolot V, Foo H. Cranial aspergillosis in a patient receiving ibrutinib for chronic lymphocytic leukemia. Med Mycol Case Rep 2019; 24:27-29. [PMID: 30899641 PMCID: PMC6409380 DOI: 10.1016/j.mmcr.2019.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/11/2019] [Accepted: 02/25/2019] [Indexed: 11/23/2022] Open
Abstract
Cerebral abscess due to Aspergillus species is a relatively uncommon presentation, even amongst immunocompromised patients. However it is increasingly being recognized as a complication of ibrutinib therapy in patients with chronic lymphocytic leukemia. We present a case of cerebral abscesses caused by Aspergillus felis in a patient receiving ibrutinib for chronic lymphocytic leukemia.
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Affiliation(s)
- Rohan Beresford
- Department of Microbiology and Infectious Diseases, NSW Health Pathology-South West Sydney, Sydney, Australia
| | - Virginia Dolot
- Department of Microbiology and Infectious Diseases, NSW Health Pathology-South West Sydney, Sydney, Australia
| | - Hong Foo
- Department of Microbiology and Infectious Diseases, NSW Health Pathology-South West Sydney, Sydney, Australia
- School of Medicine, Western Sydney University, Campbelltown, Australia
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Bodilsen J, Dalager-Pedersen M, van de Beek D, Brouwer MC, Nielsen H. Incidence and mortality of brain abscess in Denmark: a nationwide population-based study. Clin Microbiol Infect 2019; 26:95-100. [PMID: 31158518 DOI: 10.1016/j.cmi.2019.05.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/30/2019] [Accepted: 05/19/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the incidence and mortality of brain abscesses. METHODS We accessed nationwide population-based medical registries to obtain data for patients with first-time brain abscesses in Denmark from 1982 through 2016. Annual age- and sex-standardized incidence rates with 95% confidence intervals were calculated and compared by direct standardization. We used Cox regression to compute mortality rate ratios adjusted for age and year groups, sex and Charlson comorbidity index score. RESULTS We identified 1384 patients (37% female). The overall standardized incidence rate of brain abscess was 0.76 per 100 000 person-years (95% confidence interval 0.70-0.81). The incidence rates gradually increased from 0.60 during 1982-88 to 0.90 per 100 000 person-years during 2010-16, yielding an incidence rate ratio of 1.50 (95% confidence interval 1.26-1.79). This increase in incidence was most pronounced in the proportions of brain abscess patients >40 years of age and those with immuno-compromise. The 1-year mortality declined from 29% during 1982-88 to 20% during 2010-16, yielding an adjusted mortality rate ratio of 0.44 (95% confidence interval 0.31-0.63). Risk factors for death were advanced age, Charlson comorbidity index >0, immuno-compromised status and congenital heart disease. CONCLUSIONS The incidence of brain abscess in Denmark is low but increasing, especially in the elderly, along with an increasing proportion of brain abscess patients with immuno-compromise. The prognosis has improved during the last decades, but mortality remains high. Risk factors for death in our study were advanced age, presence of comorbidity, immuno-compromised status and congenital heart disease.
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Affiliation(s)
- J Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - M Dalager-Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - D van de Beek
- Department of Neurology, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - M C Brouwer
- Department of Neurology, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - H Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
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Dogan SN, Baltacioglu F, Duman İE, Kucukyuruk B, Batur S, Oz B, Kizilkilic O, Islak C, Kocer N. Cerebral Abscess Following Endovascular Treatment of Aneurysm: Report of 2 Cases and Review of the Literature. World Neurosurg 2019; 127:199-205. [PMID: 30928576 DOI: 10.1016/j.wneu.2019.02.220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Endovascular treatment is growing in popularity globally as an important treatment option for intracranial aneurysms. Cerebral infection as a complication of endovascular treatment of aneurysms is sufficiently rare that only 6 isolated cerebral abscess cases have been reported thus far. CASE REPORT In this report, we present 2 cerebral abscesses from 3 institutions, which developed after coil embolization of anterior communicating artery and middle cerebral artery aneurysms. CONCLUSION This report was written to discuss the possible mechanisms underlying cerebral abscess after endovascular treatment of aneurysms and to suggest potential treatment and prevention methods.
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Longo M, Feigen C, De la Garza Ramos R, Gelfand Y, Echt M, Agarwal V. Predictors of reoperation and noninfectious complications following craniotomy for cerebral abscess. Clin Neurol Neurosurg 2019; 179:55-9. [PMID: 30844618 DOI: 10.1016/j.clineuro.2019.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/20/2019] [Accepted: 02/24/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES There is a paucity of literature that examines predictors of reoperation and noninfectious complications following treatment of cerebral abscess with craniotomy. The goal of the present study is to identify predictors for each of these outcomes. PATIENTS AND METHODS The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database 2012-2016 file was the data source. Patients were identified using a combination of CPT and ICD-9/10 codes. Exclusions included missing age/gender, secondary surgery, and absent length of stay information. Univariate followed by multivariable analysis using logistic regression was used to identify significant predictors of reoperation and noninfectious postoperative complications (p < 0.05). RESULTS 166 patients met the above criteria. Median age was 56 (IQR 44-65) and 68.1% of patients were men. The 30-day reoperation rate was 18.1% and increasing white blood cell count (WBC) was identified as a significant risk factor for reoperation (odds ratio [OR] 1.10, 95% CI 1.02-1.19, p = 0.013). Noninfectious complications occurred at a rate of 20.5% at 30 days. Significant predictors were ASA classification ≥4 (OR 4.13, 95% CI 1.74-9.81, p = 0.001), smoking (OR 3.04, 95% CI 1.18-7.78, p = 0.020), and increasing WBC count (OR 1.11, 95% CI 1.03-1.20, p = 0.007). Emergency case status, abscess location (supratentorial versus infratentorial), nor chronic steroid use demonstrated a significant relationship with the studied outcomes. CONCLUSION Increasing preoperative WBC count predicts both reoperation and noninfectious complications following craniotomy for cerebral abscess. Less modifiable predictors for noninfectious complications which may help anticipate operative risk are smoking and high ASA classification.
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Arrache D, Zait H, Rodriguez-Nava V, Bergeron E, Durand T, Yahiaoui M, Grenouillet F, Amrane A, Chaouche F, Baiod A, Madani K, Hamrioui B. [Cerebral and pulmonary nocardiosis to Nocardia abscessus in an immunocompetent Algerian patient]. J Mycol Med 2018; 28:531-7. [PMID: 29773433 DOI: 10.1016/j.mycmed.2018.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/23/2018] [Accepted: 04/27/2018] [Indexed: 11/23/2022]
Abstract
Nocardial brain abscess is often occurring in immunocompromised patients. It is uncommon in immunocompetent individuals. Here, the authors describe a case of cerebral and pulmonary nocardiosis mimicking a metastatic tumor in an apparently health 40-year-old Algerian male. The patient presented multiple brain abscess revealed by inaugural epileptic seizure. He was afebrile and presented with left hemiparesis. Staging imaging showed a nodular lung lesion in the apical segment of the right lower lobe. The patient underwent double craniotomy for resection of the lesion. Culture of the resected specimen isolated Nocardia abscessus. The patient was initially started on intravenous trimethoprim-sulfamethoxazole and intravenous amikacine. He was switched to oral trimethoprim-sulfamethoxazole. He finished seven months of antibiotic therapy with a good clinical response. Imaging revealed reduction in the brain abscess and a complete resolution of the lung lesion. Cotrimoxazole was stopped after twelve months of therapy. After two years, the health status of our patient improves day after day. He is however regularly under medical supervision for control exams.
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Greeneway GP, West JL, Couture DE, Hsu W. Cerebral Abscess in Young Adult with Hypoplastic Left Heart Syndrome. World Neurosurg 2018; 116:201-204. [PMID: 29803061 DOI: 10.1016/j.wneu.2018.05.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Cerebral abscesses are rare, potentially life-threatening entities that result from local spread or hematogenous dissemination to the brain. Prompt diagnosis and initiation of treatment is key in lowering morbidity and preventing mortality associated with cerebral abscesses. Congenital heart diseases with right-to-left intracardiac shunts can be complicated by brain abscesses via paradoxical embolism of infected microthrombi. Hypoplastic left heart syndrome (HLHS) is a rare congenital heart disease characterized by an underdeveloped left heart that uses intracardiac shunting to achieve adequate systemic circulation. We present the first reported case of a cerebral abscess in a patient with HLHS. The pathophysiology of HLHS and how it predisposes patients to development of cerebral abscesses is discussed. CASE DESCRIPTION A 25-year-old male was transferred to our institution complaining of headache, nausea, and vomiting. The patient was not an intravenous (IV) drug user, and serologic testing was negative for human immunodeficiency virus. Magnetic resonance imaging revealed a 2.6-cm left occipital abscess, which was surgically resected without complication, and the patient was treated with IV antibiotics. CONCLUSION HLHS is a rare congenital cardiac malformation. The long-term outcome of patients with this condition continues to improve as treatment paradigms evolve. As such, patients with HLHS are living longer, and their potential to develop cerebral abscesses secondary to their unique systemic circulation is increasing with improved life expectancy. Surgeons and physicians should maintain a high index of suspicion for cerebral abscess in the setting of HLHS.
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Affiliation(s)
- Garret P Greeneway
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
| | - James L West
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Daniel E Couture
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Wesley Hsu
- Department of Neurological Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Rapalino O, Mullins ME. Intracranial Infectious and Inflammatory Diseases Presenting as Neurosurgical Pathologies. Neurosurgery 2018; 81:10-28. [PMID: 28575459 DOI: 10.1093/neuros/nyx201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/22/2017] [Indexed: 12/28/2022] Open
Abstract
There are many infectious and inflammatory processes affecting the central nervous system that can simulate other neurosurgical pathologies (e.g. tumor) and may precipitate a brain biopsy for definitive diagnosis if not suspected a priori. The challenge for the healthcare team is to recognize imaging features that support a nonsurgical pathology to avoid unnecessary interventions. This review aims to give a general overview of some common inflammatory and infectious entities that affect the central nervous system, with illustrative examples and highlighting important pearls and pitfalls.
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Affiliation(s)
- Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark E Mullins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Turki AT, Rashidi-Alavijeh J, Dürig J, Gerken G, Rath PM, Witzke O. Successful treatment of cerebral aspergillosis: case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL). BMC Infect Dis 2017; 17:797. [PMID: 29281994 PMCID: PMC5745601 DOI: 10.1186/s12879-017-2877-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/03/2017] [Indexed: 11/25/2022] Open
Abstract
Background Invasive aspergillosis involving patients with neutropenia or severe immunosuppression, such as patients with hematologic malignancies is associated with high mortality. Patients with T-cell large granular lymphocytic leukemia (T-LGL) on the other hand are considered to be less vulnerable for severe opportunistic fungal infection as their course of disease is chronic and marked by less violent cytopenia then in e.g. Aplastic Anemia. Only neutropenia is regarded as independent risk factor for severe opportunistic infection in T-LGL patients. Case presentation We report a case of a 53 year old patient with T-LGL, Immune-Thrombocytopenia (ITP) and combined antibody deficiency, who presented with fever and reduced general condition. The patient revealed a complicated infection involving the lungs and later the brain, with the presentation of vomiting and seizures. Broad microbiological testing of blood-, lung- and cerebrospinal fluid samples was inconclusive. In the absence of mycological proof, Aspergillus infection was confirmed by pathological examination of a brain specimen and finally successfully treated with liposomal amphotericin B and voriconazole, adopting a long-term treatment scheme. Conclusions Beyond typical problems in the clinical practice involving fungal infections and hematologic malignancies, this case of invasive aspergillosis in a patient with T-LGL illustrates caveats in diagnosis, therapy and follow-up. Our data support careful ambulatory monitoring for patients with T-LGL, even in the absence of neutropenia. Especially those patients with combined hematologic malignancies and immune defects are at risk. Long-term treatment adhesion for 12 months with sufficient drug levels was necessary for sustained clearance from infection.
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Affiliation(s)
- Amin T Turki
- Department of Bone Marrow Transplantation, West-German Cancer Center, University Hospital Essen, Essen, Germany.
| | | | - Jan Dürig
- Department of Hematology, West-German Cancer Center, University Hospital Essen, Essen, Germany
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University Hospital Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, University Hospital Essen, Essen, Germany
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Guenego A, Rafiq M, Michelozzi C, Januel AC, Albucher JF, Sol JC, Tall P, Cognard C, Bonneville F. Secondary cerebral abscess of an ischemic stroke treated by thrombectomy. J Neuroradiol 2017; 44:403-406. [PMID: 28867484 DOI: 10.1016/j.neurad.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/23/2017] [Accepted: 07/19/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Adrien Guenego
- Department of Interventional and Diagnostic Neuroradiology, Pierre-Paul-Riquet, Toulouse University Hospital, place du Dr-Baylac TSA 40031, 31059 Toulouse cedex 9, France.
| | - Marie Rafiq
- Department of Vascular Neurology, Toulouse University Hospital, Toulouse, France.
| | - Caterina Michelozzi
- Department of Interventional and Diagnostic Neuroradiology, Pierre-Paul-Riquet, Toulouse University Hospital, place du Dr-Baylac TSA 40031, 31059 Toulouse cedex 9, France.
| | - Anne-Christine Januel
- Department of Interventional and Diagnostic Neuroradiology, Pierre-Paul-Riquet, Toulouse University Hospital, place du Dr-Baylac TSA 40031, 31059 Toulouse cedex 9, France.
| | | | | | - Philippe Tall
- Department of Interventional and Diagnostic Neuroradiology, Pierre-Paul-Riquet, Toulouse University Hospital, place du Dr-Baylac TSA 40031, 31059 Toulouse cedex 9, France.
| | - Christophe Cognard
- Department of Interventional and Diagnostic Neuroradiology, Pierre-Paul-Riquet, Toulouse University Hospital, place du Dr-Baylac TSA 40031, 31059 Toulouse cedex 9, France.
| | - Fabrice Bonneville
- Department of Interventional and Diagnostic Neuroradiology, Pierre-Paul-Riquet, Toulouse University Hospital, place du Dr-Baylac TSA 40031, 31059 Toulouse cedex 9, France.
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Udayakumaran S, Onyia CU, Kumar RK. Forgotten? Not Yet. Cardiogenic Brain Abscess in Children: A Case Series-Based Review. World Neurosurg 2017; 107:124-129. [PMID: 28780403 DOI: 10.1016/j.wneu.2017.07.144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 07/21/2017] [Accepted: 07/24/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Brain abscess is a significant cause of morbidity in patients with uncorrected or partially palliated congenital cyanotic heart disease (CCHD). Unfortunately, in the developing world, the majority of patients with CCHD remain either uncorrected or only partially palliated. Furthermore, a risk of this feared complication also exists even among those undergoing staged corrective operations in the interval in between operations. There have been no recent articles in the literature on the outcomes of surgical management of cardiogenic brain abscess in children. In this study, we aimed to describe the clinical and demographic profile of patients with cardiogenic cerebral abscess and to highlight the fact that uncorrected or palliated CCHD continue to be at risk for brain abscess. METHODS This study was a retrospective analysis of 26 children (age <19 years) being managed for CCHD who were diagnosed with cerebral abscess managed surgically (26 of 39 of cases cerebral abscess in children), at Amrita Institute of Medical Sciences and Research Centre, Kochi, India between December 2000 and January 2014. Data collected retrospectively included demographic information, modes of presentation, diagnosis, location of abscess, details of the underlying heart disease, management of the cerebral abscess, and outcomes of management. RESULTS The patient cohort comprised 26 patients (16 males and 10 females), with a mean age of 7.19 years (range, 1.5-19 years). Ten of the 26 patients (38%) required reaspiration after the initial surgery. On follow-up, all the patients had improved symptomatically and demonstrated no signs of cerebral abscess. CONCLUSIONS Cardiogenic origin of cerebral abscess is the most common cause of cerebral abscess in children. Unresolved CCHD is a risk factor for the occurrence, persistence, and recurrence of cerebral abscess.
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Affiliation(s)
- Suhas Udayakumaran
- Division of Paediatric Neurosurgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Chiazor U Onyia
- Neurosurgery Division, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - R Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
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Karlsson WK, Harboe ZB, Roed C, Monrad JB, Lindelof M, Larsen VA, Kondziella D. Early trigeminal nerve involvement in Listeria monocytogenes rhombencephalitis: case series and systematic review. J Neurol 2017; 264:1875-1884. [PMID: 28730571 DOI: 10.1007/s00415-017-8572-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/13/2017] [Accepted: 07/13/2017] [Indexed: 01/26/2023]
Abstract
Listeria monocytogenes is associated with rhombencephalitis. However, the exact mechanisms of brainstem invasion remains poorly understood. Here, we demonstrate clinical and radiological data suggesting that Listeria may invade the brainstem via the trigeminal nerve. Three females (41, 64 and 70 years) with culture proven L. monocytogenes bacteremia and rhombencephalitis were investigated in the period of 2014-16. T2-weighted and contrast-enhanced T1-weighted MRI revealed a cerebellopontine abscess in all three patients, including the involvement of the trigeminal nerve root. In two patients, MRI also revealed selective contrast enhancement of the sensory trigeminal tract in the pons and medulla oblongata. Prior to any other neurological symptoms, two patients complained of hypoesthesia and a tingling sensation in the ipsilateral half of the face, consistent with sensory trigeminal nerve dysfunction on that side. In addition, we identified another 120 cases of Listeria rhombencephalitis following a systematic review. Cranial nerves VII, V, IX, and X, respectively, medulla oblongata, cerebellum and pons, were the most frequently involved brain structures. The present clinical and radiological findings corroborate earlier data from animal experiments, indicating that L. monocytogenes may be capable of retrograde intra-axonal migration along the cranial nerves. We suggest that in a subset of patients with rhombencephalitis L. monocytogenes enters the cerebellopontine angle through the trigeminal nerve, invading the brainstem via the sensory trigeminal nuclei.
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Affiliation(s)
- William K Karlsson
- Department of Neurology, Herlev Sygehus, Copenhagen University Hospital, Copenhagen, Denmark
| | - Zitta Barrella Harboe
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Casper Roed
- Department of Infectious Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jeppe B Monrad
- Department of Neurology, Herlev Sygehus, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette Lindelof
- Department of Neurology, Herlev Sygehus, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Neuroradiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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Clifton W, Akinduro OO, Lopez-Chiriboga S, Whitaker DA, Reimer R. Infection or Glioma? The False Dilemma of Primary Central Nervous System Histiocytic Sarcoma. World Neurosurg 2017; 106:1053.e1-1053.e5. [PMID: 28711535 DOI: 10.1016/j.wneu.2017.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/01/2017] [Accepted: 07/05/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Primary central nervous system (CNS) histiocytic sarcoma is an extremely rare lymphoproliferative disorder that affects the CNS and behaves aggressively. Only 27 cases of primary CNS histiocytic sarcoma have been reported. The paucity of literature on this entity has made diagnosis and treatment difficult both for the surgeon and the pathologist. CASE DESCRIPTION In this case of primary CNS histiocytic sarcoma, a middle-aged woman presented from an outside institution with a supposed cerebellar abscess. Intraoperative frozen pathology was initially interpreted as high-grade glioma; however, final pathology demonstrated histiocytic sarcoma. CONCLUSIONS This report makes a significant contribution to the literature on this rare malignant disease by outlining a similar presentation among several cases and providing a thorough overview of existing criteria for diagnosis and management.
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Affiliation(s)
- William Clifton
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA.
| | | | | | - Dale Alan Whitaker
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Ronald Reimer
- Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA
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Basani L, Aepala R. Neisseria Meningitidis Causing Multiple Cerebral Abscesses in Early Neonatal Period: Case Report and Review of Literature. J Clin Diagn Res 2017; 11:SD01-SD03. [PMID: 28892991 DOI: 10.7860/jcdr/2017/25284.10151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 05/01/2017] [Indexed: 11/24/2022]
Abstract
Neisseria meningitidis is a rare cause of meningitis and septicemia in neonates. There are few published case reports of neonatal meningococcal meningitis complicated by subdural empyema, cerebral abscess and hydrocephalus. Few cases of neonatal meningococcal meningitis have been reported in the literature with none of them having the complication of multiple cerebral abscesses in early neonatal period (<seven days of life). We report a case of meningococcal meningitis with multiple cerebral abscesses which presented on fifth day of life and developed hydrocephalus at five weeks of life requiring a Ventriculo Peritoneal (VP) shunt. To the best of our knowledge, this is the first documented case of neonatal meningococcal meningitis with multiple cerebral abscesses.
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Affiliation(s)
- Laxman Basani
- Neonatologist and Director Newborn Care Centre, Dolphin Children's Hospital, Hyderabad, Telangana, India
| | - Roja Aepala
- Paediatric Consultant, Newborn Care Centre, Dolphin Children's Hospital, Hyderabad, Telangana, India
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Tørring PM, Lauridsen MF, I Dali C, Andersen PE, Ousager LB, Brusgaard K, Kjeldsen A. Familial cerebral abscesses caused by hereditary hemorrhagic telangiectasia. Clin Case Rep 2017; 5:805-808. [PMID: 28588815 PMCID: PMC5457996 DOI: 10.1002/ccr3.785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/18/2016] [Accepted: 11/25/2016] [Indexed: 11/16/2022] Open
Abstract
In case of a cerebral abscess without known cause, Pulmonary arteriovenous malformations (PAVM) screening should be performed. If PAVM(s) is identified, Hereditary hemorrhagic telangiectasia (HHT) is very likely and should always be considered. This case shows the benefit of familial screening for HHT and PAVM.
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Affiliation(s)
| | | | - Christine I Dali
- Department of Clinical Genetics Rigshospitalet Blegdamsvej 9DK-2100 Copenhagen OE Denmark
| | - Poul Erik Andersen
- Department of Interventional Radiology Odense University Hospital Sdr. Boulevard 29DK-5000 Odense C Denmark
| | - Lillian Bomme Ousager
- Department of Clinical Genetics Odense University Hospital Sdr. Boulevard 29DK-5000 Odense C Denmark
| | - Klaus Brusgaard
- Department of Clinical Genetics Odense University Hospital Sdr. Boulevard 29DK-5000 Odense C Denmark
| | - Anette Kjeldsen
- Department of Otorhinolaryngology Odense University Hospital Sdr. Boulevard 29DK-5000 Odense C Denmark.,Department of Clinical Research University of Southern Denmark Odense Denmark
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Abstract
PURPOSE Melioidosis is a potentially fatal infectious disease caused by Burkholderia pseudomallei. Neurologic involvement in pediatric age group is very rare, and only a handful of cases have been reported in literature. We sought to provide a systematic review of pediatric neurologic melioidosis. METHODS Literature review was performed to analyze reported cases of pediatric neurologic melioidosis (≤16 years) by searching online database (PubMed/MEDLINE). RESULTS Twenty-seven cases were analyzed. Mean age was 6.7 years (range 2 days-14 years) and around 50% were older children (>5 years). Cranial nerve palsies and fever were most common presenting features. Major manifestations were meningoencephalitis in 16 (59%) and cerebral abscesses in eight (29%) cases. Abscesses were mostly located in parietal lobe. Among older children, abscesses were common than meningeal disease, while being converse for neonates. Mean follow-up duration was 11.5 months. Ten cases showed good to excellent outcome, while eight cases had fair (incomplete recovery) outcomes. The overall mortality rate was 18.5% (5/27) and tends to decrease with age. Among the five deaths, 4 (80%) had septicemia or pneumonia. CONCLUSIONS Pediatric neurologic melioidosis is very rare. Meningoencephalitis is the most common presentation. Mortality is the highest in neonates. Ceftazidime appears to be the drug of choice in intensive phase, although the best drug in maintenance phase cannot be commented upon, especially in very young children.
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Boudghene Stambouli O, Amrani N, Boudghéne Stambouli K, Bouali F. Dermatophytic disease with deficit in CARD9: A new case with a brain impairment. J Mycol Med 2017; 27:250-3. [PMID: 28391957 DOI: 10.1016/j.mycmed.2017.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/05/2017] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Dermatophytic disease individualized by Hadida and Schousboe in 1959 is a rare form of chronic dermatophyte infection; characterized by subcutaneous and visceral invasion and a therapeutic failure. We report a case of dermatophytic disease with brain abscess in an Algerian patient. OBSERVATIONS The patient was 47-year-old, she was born parents first cousins. She had since the age of 10 years scaly scalp lesions that became secondarily papular and nodular. At the age of 17 years, the patient had a generalized skin involvement with multiple nodular lesions, diffuse disease of the nails (plurionyxis), poly lymphadenopathies affecting the cervical, axillary and inguinal areas. Mycological tests identified Trichophyton rubrum. Histopathological examinations showed caseiform necrosis with epithelioid and giant cells. PAS staining showed hyphae in necrosis. The rest of the blood and urine tests were normal. Sequencing CARD9 allowed to highlight a homozygous mutation Q289X. The evolution was marked by an appearance at the age of 47 of a right cerebral abscess fronto-temporo-parietal, cortico-subcortical detected by MRI. The patient was given itraconazole 200mg/day with good evolution after three months of decline. DISCUSSION Dermatophytic disease is very rare. Fifty cases have been published, mostly from North Africa, a strong endogamy region. Signs and symptoms almost always start with a scalp ringworm with almost constant occurrence of complications: in our patient a cerebral localization with a good evolution with itraconazole. Immunologically it is characterized by an autosomal recessive deficiency CARD9. This observation is notable for the onset of the disease at an early age, the dermatophyte T. rubrum and the favourable outcome of the brain lesion with itraconazole. CONCLUSION Dermatophytic disease is rare, often severe. Our case is original because of the occurrence of a cerebral localization with good response to itraconazole and its mechanism of action deserves to be elucidated.
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Leentjens J, Gresnigt MS, van de Veerdonk FL, Kox M, Kullberg BJ, Pickkers P, Brouwer AE, Netea MG. Adjuvant interferon-gamma immunotherapy in a patient with progressive cerebral Nocardia abscesses. Int J Infect Dis 2017; 59:25-8. [PMID: 28342802 DOI: 10.1016/j.ijid.2017.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 11/20/2022] Open
Abstract
Despite advances in medical care, mortality due to cerebral Nocardia abscesses remains unacceptably high. The case of a typical immunocompromised patient, who deteriorated clinically despite optimal antimicrobial treatment, is reported here. Adjuvant immunotherapy with interferon-gamma resulted in partial restoration of the immune response and a corresponding clinical and radiographic recovery.
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Cossu G, Daniel RT, Messerer M. Cerebral abscess after neuro-vascular embolization: Own experience and review of the literature. Acta Neurochir (Wien) 2017; 159:583-91. [PMID: 28116528 DOI: 10.1007/s00701-016-3069-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cerebral abscesses are a rare complication after therapeutic neuro-endovascular procedures. METHOD The aim of this article is to report a case of cerebral abscess after the endovascular embolization of a cerebral aneurysm and to discuss and review all the cases of cerebral abscess secondary to neurovascular embolization described in the literature up to now. RESULTS A 40-year-old female patient was treated using an endovascular embolization for a ruptured aneurysm of the basilar artery tip. After 2 months she presented with a cerebellar abscess. Antibiotic therapy was started, and a surgical drainage of the collection was performed, with a favorable postoperative outcome. Twelve other cases were reported in the literature, in five cases secondary to the treatment of a cerebral aneurysm, in six cases secondary to a cerebral arterio-venous malformation (AVM) and in one case secondary to a dural arterio-venous fistula (DAVF). The pathophysiology and risk factors of cerebral abscess formation are discussed in detail. CONCLUSIONS The risk of cerebral abscesses after neuro-endovascular embolization is not negligible, and a growing number of patients affected by this complication may be expected in the near future because of the spreading of neuro-endovascular techniques. The role of prophylactic antibiotic therapy in specific subgroups of patients is still debated.
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Visagan R, Ellis H. Joseph Buford Pennybacker, C.B.E., M.D., F.R.C.S. (1907-1983): Continuing Sir Hugh Cairns' Oxford Legacy and Pioneer of the Modern Management of Cerebral Abscesses. World Neurosurg 2017; 104:339-45. [PMID: 28185969 DOI: 10.1016/j.wneu.2017.01.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 11/22/2022]
Abstract
The authors examine the life and contribution of Joseph Buford Pennybacker to British neurosurgery and the modern management of cerebral abscesses. Pennybacker's inspirational journey began with him aspiring to follow in the footsteps of the pioneering surgeon, Ephraim McDowell. It saw him cross the Atlantic, learn medicine at Edinburgh, train in neurology at Queen Square in London, and study neurosurgery under Sir Hugh Cairns in Oxford. Pennybacker navigated a successful career through World War II and together with Cairns established the Radcliffe Infirmary in Oxford as a highly esteemed neurosurgical unit. By increasing the operative tempo yet uncompromising the meticulousness of his operative technique, Pennybacker challenged the Halstedian and Cushing traditions. The pioneering Pennybacker system of managing cerebral abscesses stood the test of time and the ethos of preoperative imaging, intervention, and postoperative monitoring-clinically, biochemically, and with imaging results-remains today. Pennybacker contributed significantly to British neurosurgery and the training of both home-grown and international neurosurgeons and he was also a remarkably kind-hearted and calm individual. These qualities inspired many of his contemporaries and junior colleagues, and we hope will continue to do so for generations to come.
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Waqas M, Zafar S, Rehman T, Riyaz M, Bari ME, Idrees R. Cerebral aspergillosis and pulmonary tuberculosis in a child with chronic granulomatous disease. Surg Neurol Int 2016; 7:62. [PMID: 27308089 PMCID: PMC4901839 DOI: 10.4103/2152-7806.183166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 04/14/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Chronic granulomatous disease (CGD) is an immune disorder that affects phagocytes. It is characterized by recurrent or persistent bacterial and fungal infections. Reports of tuberculosis (TB) in patients with CGD are rare. In developing countries, where TB is endemic, possibility of other chronic infections is often overlooked by physicians. CASE DESCRIPTION We report the case of a 4-year-old boy who had recurrent respiratory infections and episodes of headache. He was put on antituberculosis (ATT) drugs without microbiological or pathological evidence 2 months prior to presentation. The child did not improve and was brought to our hospital where a computed tomography scan revealed multiple cerebral abscesses. These abscesses were excised. The microbiological specimen was determined to be positive for Aspergillus fumigatus. His tracheal aspirate was positive for Mycobacterium tuberculosis polymerase chain reaction assay. Further work-up confirmed the diagnosis of CGD in the child. CONCLUSION This report describes the course of the patient's illness in order to highlight the challenges associated with the management of these infections. We also aim to stress on the importance of pathological diagnosis before starting a therapy.
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Affiliation(s)
- Muhammed Waqas
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital Karachi, Pakistan
| | - Sidra Zafar
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital Karachi, Pakistan
| | - Tooba Rehman
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital Karachi, Pakistan
| | - Muhammed Riyaz
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital Karachi, Pakistan
| | - Muhammed E Bari
- Department of Surgery, Section of Neurosurgery, The Aga Khan University Hospital Karachi, Pakistan
| | - Romana Idrees
- Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital Karachi, Pakistan
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Thiagarajan S, Krishnamurthy S, Raghavan R, Mahadevan S, Madhugiri VS, Sistla S. Streptococcus oralis cerebral abscess following monkey bite in a 2-month-old infant. Paediatr Int Child Health 2016; 36:160-2. [PMID: 25839359 DOI: 10.1179/2046905515y.0000000020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Although cerebral abscesses caused by animal bites have been reported, they are extremely rare in infants and have not been described following monkey bite. A 55-day-old male infant presented with a multi-loculated Streptococcus oralis cerebral abscess following a monkey bite on the scalp. There was a clinical response to antibiotic therapy and repeated surgical aspiration followed by a ventriculoperitoneal shunt. This is the first report of a patient with a brain abscess following a monkey bite.
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Affiliation(s)
| | | | | | | | | | - Sujatha Sistla
- c Microbiology , Jawaharlal Institute of Postgraduate Medical Education and Research ( JIPMER) , Pondicherry , India
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