Multiple Brain Abscesses of Odontogenic Origin. May Oral Microbiota Affect Their Development? A Review of the Current Literature

Nicola Montemurro,Bipin Chaurasia,Paolo Perrini,Antonio Scarano,Walter Marani,Massimo Corsalini,Biagio Rapone

doi:10.3390/app11083316

Abstract

In the last few years, the role of oral microbiota in the setting of oral diseases such as caries, periodontal disease, oral cancer and systemic infections, including rheumatoid arthritis, cardiovascular disease and brain abscess (BA), has attracted the attention of physicians and researchers. Approximately 5–7% of all BAs have an odontogenic origin, representing an important pathological systemic condition with a high morbidity and mortality. A systematic search of two databases (Pubmed and Ovid EMBASE) was performed for studies published up to 5 January 2021, reporting multiple BAs attributed to an odontogenic origin. According to PRISMA guidelines, we included a total of 16 papers reporting multiple BAs due to odontogenic infections. The aim of this review is to investigate the treatment modality and the clinical outcome of patients with multiple BAs due to odontogenic infections, as well as to identify the most common pathogens involved in this pathological status and their role, in the oral microbiota, in the onset of oral infections. A multidisciplinary approach is essential in the management of multiple BAs. Further studies are required to understand better the role of microbiota in the development of multiple BAs.

Highlights

Brain abscess (BA), defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis and subsequently is converted into a collection of pus within a well-vascularized capsule [1], represents a universal health problem with a high long-term morbidity, and a mortality rate of up to 9.5% reported in some studies [2,3,4]
The aim of this review is to assess the more common pathogens involved in multiple brain abscess (BA), the possible surgical and medical treatments, the antibiotic therapies taken into account and the role of microbiota in the onset of oral infections and blood dissemination, leading to the development of multiple BAs
The most common pathogens involved in the development of multiple BAs were Streptococcus viridans, that was identified in 31.3% of cases, and Aggregatibacter actinomycetemcomitans (18.8% of cases)

Summary

Introduction

Brain abscess (BA), defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis and subsequently is converted into a collection of pus within a well-vascularized capsule [1], represents a universal health problem with a high long-term morbidity, and a mortality rate of up to 9.5% reported in some studies [2,3,4]. The reported incidence of BAs was estimated at 0.3 to 1.3 cases per 100,000 people per year [5], with a male predominance (ratio resulted from 2:1 to 3:1) and a median age of 30 to 40 years in most pediatric and adult series, the age distribution varies depending on the predisposing condition leading to the formation of BA [5]. 5–7% of all BAs are caused by dental infection and manipulation. Some microorganisms are more common causative than others; a well-known condition, not fully clarified [6,7]

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