Neonatal Brain Abscess Research Articles

Neonatal Brain Abscess: Case Report of 12 Cases and Literature Review

Objective: To investigate the etiological characteristics, clinical manifestations, and early identification methods of neonatal brain abscess. Methods: The baseline characteristics, clinical manifestations, and laboratory results of 12 neonatal brain abscess cases were retrospectively analyzed. Results: The clinical manifestations were fever, convulsion, and lethargy. A small number of them had respiratory and circulatory failure. The diagnosis made was based on imaging examination. All 12 cases were confirmed by cranial enhanced computed tomography (CT) or magnetic resonance imaging (MRI). Blood cultures of 9 cases were positive, with Escherichia coli in 6 cases, ?-hemolytic Streptococcus in 1 case, methicillin-resistant Staphylococcus aureus in 1 case, and Enterococcus faecium in 1 case. However, only 3 of them had positive cerebrospinal fluid (CSF) cultures. All the 12 neonates were treated with antibiotic therapy upon admission, with only 3 cases treated with surgery. Among them, 4 recovered and were discharged, while the remaining 8 discontinued their therapy. Conclusion: Escherichia coli is the most common pathogen of neonatal brain abscess in our study. The clinical manifestations of neonatal brain abscess are atypical, and the prognosis is poor. Respiratory and circulatory failure in children with intracranial infection may indicate the presence of brain abscess. For children with suspected brain abscess, cranial enhanced CT or MRI should be performed as soon as possible to make an early diagnosis. The prevention of brain abscess should be prioritized; neonates with sepsis or meningitis should receive prompt and strong antibiotic therapy in an effort to prevent the development of brain abscess.

Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses

Neonatal Brain abscess is a rare sever neonatal infection requiring careful medical and neurosurgical intervention strategies to reduce morbidity and mortality rates. Gram-negative bacterial agents are the most common pathogens involved in brain abscesses of neonates. The use of wide spectrum antibiotics in combination with neurosurgical drainage of abscesses larger than 2.5 cm is the mainstay of treatment. Colistin is a polymyxin antibiotic used to treat bacterial infections caused by susceptible gram-negative bacteria but with a limited penetration in blood brain barrier. However, there is limited data on using intraventricular Colistin in neonatal intracranial infections. A 12-day-old male neonate with multiple brain abscesses in frontal and parietal lobes is presented. The abscesses were successfully managed with a combination of intravenous antimicrobial agents, intraventricular Colistin and concurrent administration of Interferon-ɣ. Subsequently, he developed ventriculomegaly which was successfully managed by endoscopic third ventriculostomy. He had an acceptable neurologic outcome. Due to reduced penetration of colistin in blood brain barrier, use of intraventricular Colistin in combination with its intravenous form can be beneficial in management of neonatal brain abscesses. Concurrent administration of Interferon-ɣ may improve the treatment process and outcome given that reduced secretion of this agent by neonatal T lymphocytes may contribute to a partial immunodeficiency state at this period of life.

Neonatal brain abscess development following fetal scalp electrode placement: a rare complication

A fetal scalp electrode (FSE) is a frequently used investigation during labor. However, it is an invasive procedure which can lead to complications. Our patient developed a very large brain abscess after initial superficial infection of the skin site due to an FSE. The patient was admitted to the hospital after an asymmetric growth of the skull was noticed with no further signs of clinical illness. MRI showed a very large brain abscess which was aspirated and treated with antibiotics for 10 weeks. A 2-year follow-up showed only a slight developmental delay in gross motor skills. Only once before a similar case has been described at which the patient developed a brain abscess after superficial infection of the scalp following an FSE. In both cases, the brain abscess was noticed due to an asymmetric growth of the skull without any further signs of clinical illness. A brain abscess has a high mortality and morbidity rate, and early diagnosis is vital for the optimal outcome. We therefore recommend to organize an out-patient clinical follow-up for every infant with a superficial infection of the skin site after placement of an FSE.

Myo-inositol utilization by Citrobacter koseri promotes brain infection

Citrobacter species are opportunistic bacterial pathogens that are implicated in both nosocomial and community-acquired infections. Among the Citrobacter species, Citrobacter koseri is often isolated from clinical material, and it can cause meningitis and brain abscesses in neonates and immunocompromised individuals, thus posing a great threat to human health. However, the virulence determinants of C. koseri remain largely unknown. Myo-inositol is an abundant carbohydrate in the environment and in certain organs of the human body, especially the brain. The C. koseri genome harbors a cluster of genes, QCQ70420.1 to QCQ70429.1 (named the Ino-cluster in this study), which encode IolBCDE, MmsA, and an ATP-binding cassette transporter. The gene cluster may be involved in the utilization of myo-inositol. To investigate the functions of the Ino-cluster in C. koseri, we constructed a mutant strain by deleting the Ino-cluster and found that the mutant could not use myo-inositol as the sole carbon source, confirming that this cluster is responsible for myo-inositol utilization. Moreover, we investigated the function of the Ino-cluster and myo-inositol utilization in C. koseri pathogenicity. Deletion of the Ino-cluster significantly impaired C. koseri colonization of the brain of infected Sprague–Dawley (SD) rats and BALB/c mice, and this increased the survival rate of the infected animals, indicating that the Ino-cluster and the ability to use myo-inositol are essential for C. koseri pathogenicity. Taken together, our findings suggest that using the Ino-cluster products, C. koseri can exploit the abundant myo-inositol in the brain as a carbon source for growth, thus promoting colonization and virulence.

Multiple brain abscesses caused by Serratia marcescens in preterm newborn

Abstract Background Brain abscesses are possible but very uncommon complications of bacterial sepsis and meningitis in neonates. We report a case of multiple brain abscesses in a preterm neonate as a complication of Serratia marcescens sepsis. Case The female preterm weighing 1990 g was delivered by cesarean section at 32 weeks of gestation. Apart from moderate respiratory distress syndrome (RDS), the baby was in a good condition with no indicators of perinatal infection. On the 3rd day of life, the clinical status deteriorated and the sepsis screen was positive. The baby was intubated and, along with other intensive measures, treated with high doses of vancomycin and imipenem. Serattia marcescens was isolated in hemoculture. The baby clinicaly improved in the following days, but the cranial ultrasound revealed multiple hypoechoic lesions in parietal lobes bilaterally. Magnetic resonance imaging (MRI) of the brain showed multiple (five) hypodense lesions with the peripheral enhancement suggestive of intra-parenchymal abscesses. The neurosurgical consilium suggested conservative treatment with antibiotics and weekly neuroimiging follow-up. The antibiotic treatment was conducted for a total of 8 weeks. The final MRI showed a total regresion of previous abscesses with the formation of small cavitations. The clinical and neurological examination of the baby was normal as was the EEG. The baby was discharged with a recommendation of neurological follow-up. Conclusion A multidisciplinary team approach, including neurosurgeons, neonatologists and infectious disease specialists, is needed for a decision on treatment of brain abscesses in neonates. Serial imaging is important in the assessment of the efficacy of treatment.

A Case of Incidentally Discovered Multiple Disseminated Fungal Brain Abscess in Asymptomatic Very Low Birth Weight Infant

Neonatal brain abscess is a very rare disease. Despite improvement of survival rate of premature infants due to the development of neonatal intensive therapy, it is still one of the important causes of death or sequelae of neonate. Fungal infection is unusual cause of neonatal brain abscess and the neonatal fungal brain abscess is a secondary result of hematogenous seeding that is rarely discovered primarily. We present a case of incidentally discovered multiple disseminated fungal brain abscess in asymptomatic very low birth weight infant.

Neonatal brain abscess: Clinical report and review of Indian cases

Septicemia, pneumonia, meningitis are common problems in neonatal age group in developing countries. Epidemiology of meningitis differs in developed and developing countries with Group B streptococci, being more common in developed countries and Klebsiella pneumoniae in developing countries. In some of the cases, meningitis can lead to complications such as abscess, ventriculitis, and communication with ventricles. Proteus is the most common organism reported for brain abscess in neonatal age group in western literature. We found more cases of K. pneumoniae from the Indian subcontinent. Hence, we collected data from all published cases of Indian origin to highlight the etiology, any risk factor, most common site, complication, and outcome. We concluded that: K. pneumoniae is the most common organisms for neonatal brain abscess with fatal outcome in cases with ventricular perforation. Frontal lobe was the most common site of abscess. Minimum 6 weeks of antibiotic therapy was mentioned in 7 of 15 cases. Survival and discharge were reported in 13 of 15 cases, suggesting good immediate outcome in such cases.

Combination of drainage and chemotherapy for treatment of a Staphylococcus aureus brain abscess in a pre-term infant

Introduction: Neonatal brain abscess is an uncommon intracranial suppuration that usually occurs as a complication of bacterial meningitis or septicaemia. Staphylococcus aureus rarely causes brain abscesses during the first months of life. Case presentation: A case of a premature infant who developed cerebellar, left temporal and left occipital lobe abscesses after S. aureus sepsis is presented. The pus provided the same S. aureus strain of the sepsis. The patient was treated with vancomycin for 37 days, accompanied by extraction of the purulent material. The abscesses resolved and no sequelae remained. Conclusion: It appears that long antibiotic treatment regimes, when associated with early pus drainage, are effective in resolving infection and abscesses caused by S. aureus in neonates.

Neonatal brain abscess: An atypical presentation

Brain abscesses occur as an uncommon complication of bacterial meningitis in the neonatal period. A 34 weeks preterm at-risk neonate presented with abnormal breathing pattern and inability to maintain the oxygen saturation in room air. Magnetic resonance imaging (MRI) study revealed intra-parenchymal brain abscesses in the left basal ganglion and bilateral fronto-parietal regions. Intravenous piperacillin – tazobactam was commenced and continued for 6 weeks in Neonatal Intensive Care Unit. No surgical intervention was required. The patient responded to the medical management and was discharged after the documentation of radiological clearance in repeat MRI study. No complications were recorded. An appropriate neuro-developmental outcome was observed on follow-up. Brain abscesses may not be preceded by meningitis in all neonates. A strong clinical suspicion is required for the diagnosis especially in cases with atypical presentation.

Clostridium Septicum Brain Abscesses in a Premature Neonate

Brain abscesses in neonates are typically caused by Gram-negative organisms. There are no previously described cases caused by Clostridium septicum. We present a case of a premature male infant who developed recurrent episodes of suspected necrotizing enterocolitis followed by brain abscesses, cerebritis and ventriculitis caused by C. septicum.

Giant Brain Abscess in a Neonate Managed with External Drainage

Brain abscesses in neonates are extremely rare and usually occur in patients with certain risk factors. A 26 days child presented to the emergency with fever, irritability and not sucking well. CT revealed a large left frontal lobe abscess which was managed with burr hole and a drainage tube with concurrent intravenous antibiotics. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7317 J Nepal Paediatr Soc. 2013;33(1):55-56

Multiple Brain Abscesses in a Neonate after Blood Stream Infection with Methicillin-Resistant Staphylococcus aureus

Multiple Brain Abscesses in a Neonate after Blood Stream Infection with Methicillin-Resistant Staphylococcus aureus

Citrobacter brain abscesses in neonates: early surgical intervention and review of the literature

Citrobacter koseri, a facultatively anaerobic, lactose-fermenting, gram-negative bacilli, has a strong propensity to form cerebral abscesses. C. koseri brain abscesses can be a devastating disease of infancy and childhood with more than 30% succumbing to the disease and more than 50% suffering severe neurological deficits. This study represents a retrospective review of two cases of C. koseri brain abscesses along with a review of the literature regarding diagnosis and treatment. Early aggressive surgical and medical treatment resulted in favorable outcomes for two children with C. koseri brain abscesses, one diagnosed at 6 weeks of age and the other at 2 months of age. C. koseri brain abscesses can be devastating and have been associated historically with significant morbidity and mortality. However, favorable outcomes are possible, and aggressive surgical and medical management should be considered for patients with C. koseri abscesses.

Neonatal brain abscesses: What sequels?

Neonatal brain abscesses: What sequels?

Clinical Features of Brain Abscesses in Neonates and Children: A Single Center Experience from 1997 to 2006

Clinical Features of Brain Abscesses in Neonates and Children: A Single Center Experience from 1997 to 2006

Brain abscess in a neonate: an unusual presentation

Neonatal brain abscesses are very rare and their clinical presentation is specific for this age group. They usually occur as a complication of bacterial meningitis or septicemia. They are most often caused by gram-negative organisms, and mortality and morbidity are still significant in this particular group of patients in spite of antibiotics and modern radiological tools. We report an unusual case of a multiloculated brain abscess in a term neonate caused by Staphylococcus aureus. The abscess developed in the absence of trauma, prior surgery, cyanotic heart disease, mother's disease, or immune defect. The onset of infection in this case was not clear and image features mimicked a brain tumor in the initial evaluation. The infant was successfully treated by primary surgical excision of the lesion and a 6-week total course of intravenous antibiotics. The interest of this case lies in the rarity of the causative organism and the atypical features of clinical and neurological images in a term neonate.

Brain abscesses in neonates: Neurosonographic diagnosis and long-term follow-up

Brain abscesses were neurosongraphically diagnosed in 3 out of 44 neonates who had confirmed purulent meningitis. In two cases, the cause was Proteus mirabillis, whereas in one the cause could not be isolated. The ultrasound finding indicated abscess cavities localised in the frontal (in one case bilaterally) and temporal regions of the CNS. Neurosurgical interventions were carried out on all of the neonates who had abscesses (including the evacuation of purulent cavity contents, and later on a ventriculoperitoneal shunt in two cases, because of the development of hydrocephalus). Follow-up on the operated infants revealed that one infant died at the age of 9 months; one, who had a bilateral abscess, demonstrated significant neurodevelopmental retardation in the third month of his life (so far it has not been brought under control); while the third one, whom we monitored until the age of 2, displayed regular psychomotor development (preserved intellect, motor skills, sight, and hearing).

Fungal brain abscesses in neonates: Sonographic appearances and corresponding histopathologic findings

Fungal brain abscesses in neonates: Sonographic appearances and corresponding histopathologic findings

Neonatal brain abscess: complication of fetal monitoring

Neonatal brain abscess: complication of fetal monitoring

The role of Citrobacter in clinical disease of children: review.

Various species of Citrobacter may cause infections in neonates and immunocompromised hosts. Citrobacter koseri (formerly Citrobacter diversus) is best known as the cause of sepsis and meningitis leading to central nervous system (CNS) abscesses in neonates and young infants. Early onset and late-onset infections occur as for other neonatal bacterial infections. The majority of cases are sporadic, with no clear source of infection. A few have been confirmed to be vertically transmitted, and nosocomial outbreaks have occurred in neonatal care units. The pathophysiology is not well understood, but a surface protein has been identified as a possible virulence factor among strains that cause citrobacter brain abscesses in neonates. Despite improvements in diagnostic imaging techniques, surgery, and antibiotic therapy, approximately one-third of infants with abscesses die, and one-half sustain CNS damage. In this article, the taxonomy, epidemiology, pathogenesis, diagnosis, treatment, and outcome of citrobacter disease in children are reviewed.