Case Of Brain Abscess Research Articles

Frontal Abscess Caused by a Rare Pathogen: Streptococcus constellatus

Streptococcus constellatus is a microorganism that lives commensally in the oropharyngeal region, urogenital region, and intestinal tract. However, it can cause infection in patients with certain predisposing factors. We present a rare case of a right-sided frontal abscess caused by Streptococcus constellatus in a 47-year-old male with well-controlled type 2 diabetes mellitus patient who was injured by shrapnel pieces in the head and who was malnourished. The patient was successfully treated by surgical evacuation and antibiotherapy. Very few cases of brain abscesses caused by S. Constellatus have been reported in the literature. Only four cases in an immunocompetent patient have been reported to date.

Nocardia cyriacigeorgica brain abscess in a patient on low dose steroids: a case report and review of the literature

BackgroundNocardia cyriacigeorgica was first described in 2001. It is an emerging pathogen that mainly affects immunocompromised patients. A brain abscess caused by N. cyriacigeorgica has been reported only in immunocompromised hosts. We present a rare case of brain abscess caused by N. cyriacigeorgica in an adult male receiving low dose steroids.Case presentationA 75-year-old male weekend gardener without an immunocompromising condition presented with neurological complaints that were initially attributed to an ischemic stroke. Due to the unusual presentation and rapid progression, his condition was thought to be caused by a cerebral space-occupying lesion. He underwent an emergent right-sided parietal craniotomy and the histopathological report of the specimen was an abscess caused by N. cyriacigeorgica. The patient received appropriate antibiotic treatment and completely recovered without sequelae.ConclusionsNocardia species are a rare cause of brain abscess in immunocompetent patients. Their clinical presentation can mimic other more common cerebral diseases, such as brain tumors (primary and secondary) and stroke. The possibility of an abscess caused by N. cyriacigeorgica should also be considered in the differential diagnosis in an immunocompetent patient.

Retrospective Review of the Clinical Outcomes of Surgically Managed Patients with Intracranial Abscesses: A Single-Center Review

This study analyzed patient, radiologic, and clinical factors associated with operative brain abscesses and patients' functional outcomes. A retrospective analysis was conducted of neurosurgical cases of brain abscesses from 2009 to 2019 at a Canadian center. Functional outcome was recorded as Modified Rankin Scale score and Extended Glasgow Outcome Scale score. Multivariate analysis was conducted to identify relevant prognostic factors. We identified 139 patients managed surgically for brain abscesses. Resection alone was performed in 64% of patients, whereas 26.6% underwent aspiration alone. Most were adults (93.2%) and male (68.3%). Immunocompromise risk factors included diabetes (24.5%), cancer (23.7%), and immunosuppressive therapy (11.5%). Likely sources were postoperative (17.3%), systemic spread (16.5%), and poor dentition (12.9%). Microorganisms cultured from abscess samples were mixed growth (28%), Streptococcus anginosus (24.5%), and Staphylococcus aureus (7.9%). Disposition was home (42.4%) or repatriation to a home hospital (50.4%). By Extended Glasgow Outcome Scale, 25.2% had an unfavorable outcome including a mortality of 11.5%. Factors on multivariate analysis associated with poor outcome included diabetes (odds ratio, 2.8; 95% confidence interval [CI], 1.2-5.0) and ventricular rupture (odds ratio, 5.0; 95% CI, 1.7-13.5; hazard ratio, 12; 95% CI, 3.9-37.0). Supratentorial superficial eloquently located abscess was also associated with poor outcome (hazard ratio, 5.5; 95% CI, 1.8-16.7). Outcomes were similar with surgical excision and aspiration. Ventricular rupture and diabetes are significant risk factors for poor outcomes in intraparenchymal brain abscesses. No clear difference in outcomes was found between surgical excision or aspiration in our retrospective cohort.

A rare case of Corynebacterium accolens isolated from brain abscess following mild nonpenetrating head trauma

Corynebacterium accolens ( C. accolens) was first described by Neubauer et al. in 1991. Infection of the CNS with this germ is still extremely rare and no previous case of brain abscess was reported yet. The authors report here the first case of brain abscess due to C. accolens, in a 60-year-old male patient after a nonpenetrating mild head trauma. Diagnosis was made after abscess aspiration followed by staining and incubation of the aspirate. Postoperative course was uneventful. This is the first reported case of brain abscess associated with C. accolens. The risk factors for this infection remain unclear. However, and for some unknown reasons, Corynebacterium may favor previously traumatized sites.

Aspiration Surgery with Appropriate Antibiotic Treatment Yields Favorable Outcomes for Bacterial Brain Abscess

Even in the era of advanced medical treatment, brain abscess still has a high mortality rate. At our institution, brain abscess has been treated mainly using stereotactic or echo-guided aspiration followed by relatively long-term antibiotic treatment, achieving favorable outcomes. To evaluate the efficacy of our strategy involving less-invasive aspiration surgery and long-term selective antibiotic administration for brain abscess, a single-institution series of cases was investigated. We retrospectively reviewed and analyzed the medical records of 25 cases of brain abscess treated at Saitama Medical University Hospital between 2008 and 2021. The patients comprised 16 men and 9 women aged between 39 and 85years (median 62years). Neurosurgical intervention was performed for 23 (92.0%) of the patients and the remaining 2 received antibiotics alone. Among the neurosurgery patients, 22 (95.7%) underwent echo-guided or stereotactic aspiration, and only 1 underwent craniotomy. Anaerobic bacteria were detected in 11 patients. In the surgical and conservative groups, the median duration of antibiotic treatment was 16weeks and 23weeks, respectively. Since 2014 when metronidazole first became available, it has replaced meropenem to cover anaerobic bacteria. The overall mortality rate was 4.0% and a favorable outcome (Glasgow Outcome Scale 4 or 5) was achieved in 76% of the patients. There was no surgical mortality or morbidity. Most patients underwent aspiration surgery and achieved favorable outcomes. Along with antibiotic treatment for a sufficiently long period to cover anaerobes, this approach can be expected to yield good results.

Brain abscess due to Aggregatibacter aphrophilus in association with atrial septal defect：Case report and literature review

BackgroundAggregatibacter aphrophilus（A. aphrophilus）is one of the organisms of the HACEK group. Previously reported cases of brain abscesses caused by A. aphrophilus infection have occurred in children with a basis for congenital heart disease, or in adults with a basis for dental disease. Rare cases of brain abscess caused by A. aphrophilus have been reported in adults with congenital heart disease or in patients without dental disease history. Herein we present a rare case of brain abscess caused by A. aphrophilus, who was in association with atrial septal defect for more than 20 years, and had no dental disease and did not develop infective endocarditis. Case presentationA 51-year-old female was admitted due to progressively worsening headache and left limb weakness for more than 10 days. She denied the history of chronic diseases such as hypertension and diabetes, and no periodontal disease. While she had a history of atrial septal defect, a form of congenital heart disease with severe pulmonary hypertension for more than 20 years. After admission, echocardiographic illustrated congenital heart disease with severe pulmonary hypertension. CT and MRI showed brain abscess. Cerebrospinal fluid (CSF) results also confirmed the presence of intracranial infection. Empirical therapy with vancomycin 1.0 g i.v q12h and meropenem 2.0 g i.v q8h was initiated from the day of admission. On the fourth day after admission, brain abscess resection and decompressive craniectomy were performed, and the pus drained on operation were cultured and Gram-negative bacilli grew, which was identified as A.aphrophilus. Vancomycin was discontinued and meropenem was continued（2.0 g i.v q8h）for 5 weeks, followed by oral levofloxacin 0.5 qd for 4 weeks of out-patient antibiotics. The patient recovered fully within 9 weeks of treatment. ConclusionsThis is the first case of A. aphrophilus to cause brain abscess in adult with a history of congenital heart disease for more than 20 years, who had no dental disease and did not develop infective endocarditis. We also highlight the value of bacterial 16 S rDNA PCR amplification and sequencing in identifying bacteria in abscesses which are culture-negative, and prompt surgical treatment，choosing effective antibiotics and appropriate course of treatment will get better clinical effect.

Brain Abscess Caused by Eikenella corrodens in an Immunocompetent Child: Case Report and Literature Review

Abstract Objective Eikenella corrodens is a slow-growing, fastidious, non-motile, facultative anaerobic, Gram-negative bacillus that is commonly found in the human oropharynx. Although many cases have been reported in the adult population, only few cases of brain abscesses caused by E.corrodens have been reported in children so far. Methods Here, we reported the case of a 29-month-old female with complaints of weakness in the right leg twice in the past 3 weeks. Imaging studies revealed a brain abscess in the left parietofrontal lobe. The patient underwent surgery for abscess drainage, microbiological samples were obtained and empirical antibiotic treatment was started. Abscess culture showed the growth of E.corrodens. The bacteria were found to be sensitive to ceftriaxone; hence, the therapy was continued for 46 days with ceftriaxone. A final computed tomography showed the resolution of the abscess. The patient's clinical condition improved and she was discharged without any sequelae. Conclusion Brain abscess should be considered when patients present with neurological deficits. As far as we know, there are only six reported cases of brain abscesses only due to E.corrodens in the pediatric population. Since it is a slow-growing pathogen, early diagnosis and treatment are crucial for patient survival. This case supports the combination of surgical drainage and antibiotics for treatment.

A case of brain abscess caused by Listeria monocytogenes extending along the central nervous system fiber tract

A case of brain abscess caused by <i>Listeria monocytogenes </i>extending along the central nervous system fiber tract

Time-dependent Diffusion in Brain Abscesses Investigated with Oscillating-gradient Spin-echo.

Oscillating-gradient spin-echo sequences enable the measurement of diffusion weighting with a short diffusion time and can provide indications of internal structures. We report two cases of brain abscess in which the apparent diffusion coefficient (ADC) values appear higher at short diffusion times in comparison with those at long diffusion times. Diffusion time dependence of the ADC in brain abscesses suggests not only substrate viscosity but also restricted diffusion due to the structure within the lesions.

Penicillium chrysogenum

Brain abscess is a severe intracranial infection with a very high mortality rate and usually secondary to an external infection. Fungal infections are now been increasingly reported especially with Candida sp. We present a case of brain abscess in a 63-year-old woman, which was managed successfully by surgical evacuation and was diagnosed radiologically as a fungal infection and on culture detected to have Penicillium chrysogenum.

A case of brain abscess suspected to be caused by patent foramen ovale in a pediatric patient treated with percutaneous closure to prevent recurrence

A case of brain abscess suspected to be caused by patent foramen ovale in a pediatric patient treated with percutaneous closure to prevent recurrence

An Eight Year Clinico-Microbiological Retrospective Study on Brain Abscesses in India.

Background:Intracranial abscesses have been a diagnostic and therapeutic challenge since time immemorial for both the microbiologists and the neurosurgeons. There is paucity of detailed studies documenting the infecting organism causing brain abscesses in South India.Aims:The study aimed at identifying and assessing the prevalence of aerobic, anaerobic bacteria and fungi associated with brain abscesses at a tertiary care hospital in South India.Methods and Material:Eight years data was collected from the records of culture reports from 2007 to 2010 and 2013 to 2018. The corresponding clinical case records were retrieved for the assessment of risk factors. Risk factors of brain abscess development were assessed based on clinical cases records.Results:Data from 140 brain abscess cases obtained over a period of 8 years were analyzed. Out of the 140 samples, 66 (47.14%) were culture positive in which 33 (50%) had single aerobic/facultative anaerobic bacteria, 20 (30.3%) had mixture of more than one aerobic/facultative anaerobic bacteria, 12 (18.18%) had single obligate anaerobic bacteria and 1(1.5%) sample had Mycobacterium tuberculosis isolated. Among the total 92 isolates, Pseudomonas aeruginosa (21/92, 23%) and Staphylococcus aureus (20/92, 22%) predominated. Bacteroides fragilis group was the most common obligate anaerobe isolated. There were no fungal isolates. As there were various isolates isolated, hence there is heterogeneity of isolates detected Neuroanatomically, parietal lobe (45/140, 32%) was the most common location. Otogenic infection was the major risk factor for parietal and temporal lobe abscess (P value < .05).Conclusions:It has become essential for the microbiologists to be aware of unusual isolates from brain abscess and its complex nature. Obscurity and difficulty in their microbiological diagnosis calls for more such detailed studies.

Analysis of 93 Brain Abscess Cases to Review the Effect of Intervention to Determine the Feasibility of the Management Protocol: A Tertiary Care Perspective.

Context:Brain abscess is a suppurative process within the brain parenchyma, which remains a challenge for clinicians. Surgical excision or aspiration combined with prolonged antibiotics (usually 4–8 weeks) or only conservative management remains the treatment of choice.Aims:The purpose of this study is to analyze the epidemiology of brain abscess and to determine the potential factors leading to better outcomes.Settings and Design:This was a retrospective analysis of 93 patients undergoing various treatment options for brain abscess in a tertiary care center.Materials and Methods:Their preoperative status, etiology, and microbiological and clinical outcomes were analyzed.Statistical Analysis Used:Statistical analysis was done by Chi-square, one-way analysis of variance, and post hoc Newman–Keuls multiple comparison test wherever applicable using SPSS software.Results:Among 93 brain abscess cases, only 21 cases had a diameter <2.5 cm. Among them, conservative treatment was done for 38% of patients (8/21), aspiration for 47.6% (10/21) of patients, and excision for only 3 (14.2%) of cases. About 37.5% (3/8) persons among these conservatively managed patients had recurrence. None of the patients of <2.5 cm abscess having surgical management had recurrence or any new neurological deficits postsurgery during the 6-month follow-up.Conclusions:There was a significantly high recurrence among the nonsurgically treated patients with lesions <2.5 cm and there was no recurrence or neurological deficit after aspiration among these patients. Probably, aspiration has better results among these patients contrary to previous recommendations of antibiotic therapy alone.

A case report of brain abscess caused by Nocardia farcinica

BackgroundBrain abscess due to the Nocardia genus is rarely reported and it is usually found in immunocompromised patients. Treatment of Nocardia brain abscess is troublesome and requires consideration of the severity of the underlying systemic disease. The difficulties in identifying the bacterium and the frequent delay in initiating adequate therapy often influence the prognosis of patients.Case presentationHere, we report a rare case of brain abscess caused by Nocardia farcinica. The patient’s medical history was complicated: he was hospitalized several times, but no pathogens were found. At last, bacteria were found in the culture of brain abscess puncture fluid; the colony was identified as Nocardia farcinica by mass spectrometry. Targeted antibiotic treatment was implemented, brain abscess tended to alleviate, but the patient eventually developed fungal pneumonia and died of acute respiratory distress syndrome (ARDS).ConclusionBrain abscess caused by Nocardia farcinica can appear in non-immunocompromised individuals. Early diagnosis, reasonable surgical intervention, and targeted antibiotic treatment are critical for Nocardia brain abscess treatment. In the treatment of Nocardia brain abscess, attention should paid be to the changes in patients’ immunity and infection with other pathogens, especially fungi, avoided.

Molecular identification and antibiotic resistance pattern of actinomycetes isolates among immunocompromised patients in Iran, emerging of new infections

Recent advancements in DNA-based approaches have led to the identification of uncommon and rare bacterial pathogens. In this study, by utilizing a DNA-based approach, a total of 1043 clinical specimens were processed for the identification of actinobacteria targeting the 16S rRNA and gyrB genes. Drug susceptibility testing was also conducted using micro-broth dilution and PCR. Two isolates of Nocardia flavorosea and Rhodococcus erythropolis were reported for the first time in Iran. Also, Nocardiopsis dassonvillei, Streptomyces olivaceus, and Streptomyces griseus were reported for the first time in Asia. Infections caused by Nocardia caishijiensis and Prauserella muralis have also been reported in this study. The first Asian case of pulmonary infection caused by Nocardia ignorata and the first global case of brain abscess caused by Nocardia ninae and Nocardia neocaledoniensis have been reported in this study. Overall 30 isolates belonging to 6 genera (Nocardia, Streptomyces, Rodoccoccus, Nocardiopsis, Rothia, and Prauserella) were detected in 30 patients. All 30 isolates were susceptible to amikacin and linezolid. Three isolates including Nocardia otitidiscaviarum (n = 2) and Nocardia flavorosea (n = 1) were resistant to trimethoprim-sulfamethoxazole which were the first trimethoprim-sulfamethoxazole resistant clinical actinomycetes in Iran. Isolation of rare species of actinomycetes particularly Nocardia spp. requires urgent action before they spread clinically particularly among immunocompromised patients.

A case of brain abscess induced by skull base osteomyelitis

A case of brain abscess induced by skull base osteomyelitis

Profile of Patients with Brain Abscess

Introduction: Despite of the advent of modern neurosurgical techniques and antibiotics, brain abscess possesses a major neurosurgical challenge in treatment. In this study we present the profile , clinical features , radiological features , treatment received and their outcome of cases of brain abscess that we managed in our center.&#x0D; &#x0D; Methods: Total 30 patients diagnosed with brain abscess who underwent treatment in last four months were included in this study. A descriptive observational data of brain abscess and the outcome variables in the form of Glasgow Outcome Scale (GOS) at discharge , hospital stay, and mortality were studied. The ultimate outcome was measured in Glasgow Outcome Score.&#x0D; &#x0D; Results: Total number of cases was 30, outwith male dominance 19 (63.3%) . Age ranged from 2 months to 60 years. Twenty-five patients were of acute pyogenic abscess while and rest were tubercular abscess. Common clinical features were headache (70%), fever (30%), vomiting (23%), seizure (23%) and focal neurological deficits (16.7%). Overall mean hospital stay was 31 days. The common aetogenic factors included chronic suppurative otitis media (16.7%), tuberculosis (16.7%), post-traumatic (10%), congenital heart disease (10%) and rest (46%) were of unknown source. lobe Temporal lobe and cerebellar were most common site involved (20%) each followed by frontal (16.7%). Surgery was done in 25 (83.3%) cases out of which 12 underwent burr hole and aspiration and 12 patients underwent craniotomy and excision and one patient underwent burr hole and followed by craniotomy. Five patients were managed conservatively. Complete resolution of abscess with complete recovery of preoperative neurological-deficit was seen n 28 (93.3%) cases.&#x0D; &#x0D; Conclusion: Early diagnosis and timely intervention improves the outcome of brain abscess. Most of the cases required surgical intervention and drainage of pus and had good postoperative outcome.

Abcès cérébral et maladie de Rendu-Osler-Weber : pensez à rechercher des malformations artério-veineuses pulmonaires

IntroductionOsler-Rendu-Weber syndrome or hereditary hemorrhagic telangiectasia affects between 1/5000 and 1/8000 people. It is characterized by presence of recurrent epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations. It is a genetic disease with autosomal dominant transmission inducing an endothelial cells hyper-proliferation. Case reportA 68-year-old women with Osler-Rendu-Weber syndrome was referred for management of general impairment with confusional syndrome and hyperthermia. Various examinations have allowed us to conclude at diagnosis of brain abscess with ventriculitis probably favored by right–left shunt secondary to pulmonary arteriovenous malformations. Evolution was favorable after antibiotic treatment and endovascular embolization. ConclusionIn case of brain abscess without obvious promoting factor, don't forget to looking for a right–left shunt providing septic or aseptic emboli. Furthermore, diagnosis of Rendu-Osler-Weber syndrome should be considered presence of telangiectasias and/or epistaxis.

A rare case of brain abscess caused by Actinomyces meyeri

BackgroundBrain abscesses are the rare and most severe form of actinomycosis, which usually manifests as abscesses of the occipital or parietal lobe due to direct expansion from an adjacent area, the oral cavity. In the medical literature, there are only a few reported cases of brain abscess caused by Actinomyces meyeri. In this report, we present a 35-year-old male patient who experienced an insidious headache and left-sided weakness and was diagnosed with an Actinomyces meyeri brain abscess.Case presentationA 35-year-old Nepalese man came to our institute with the primary complaint of insidious onset of headache and left-sided weakness. His physical examination was remarkable for the left-sided weakness with power 2/5 on both upper and lower limbs, hypertonia, hyperreflexia and positive Babinski sign, with intact sensory function. Cardiac examination revealed systolic murmur with regular S1 and S2, and lung examination was normal. The patient had poor dental hygiene. Biochemistry and haematology panel were normal. Urinalysis, chest X-ray and electrocardiogram revealed no abnormality. A transthoracic echocardiogram revealed mitral regurgitation. However, there was no evidence of valvular vegetation. A magnetic resonance imaging (MRI) of the brain was performed, which showed a bi-lobed rim enhancing lesion with a conglomeration of two adjoining round lesions in the right parietal parasagittal region. Perilesional oedema resulting in mass effect over the right lateral ventricle and mid-right uncal herniation with midline shift was noted. Craniotomy was performed, and the lesion was excised. Gram staining of the extracted sample revealed gram variable filamentous rods. Creamy white, moist, confluent colonies were observed after performing anaerobic culture in chocolate agar. On the gram staining, they showed gram-positive filamentous rods. Actinomyces meyeri was identified based on matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) technology. Based on the susceptibilities, he was successfully treated with ampicillin-sulbactam.ConclusionsIn conclusion, Actinomyces should be considered in the differential diagnosis of brain abscess in patients with poor dental hygiene, and early diagnosis and appropriate treatment can lead to better results.

Precision diagnosis and therapy of a case of brain abscesses associated with asymptomatic pulmonary arteriovenous fistulas

BackgroundBrain abscesses, a severe infectious disease of the CNS, are usually caused by a variety of different pathogens, which include Streptococcus intermedius (S. intermedius). Pulmonary arteriovenous fistulas (PAVFs), characterized by abnormal direct communication between pulmonary artery and vein, are a rare underlying cause of brain abscesses.Case presentationThe patient was a previous healthy 55-year-old man who presented with 5 days of headache and fever. Cerebral magnetic resonance imaging (MRI) suggested a brain abscess. Thoracic CT scan and angiography demonstrated PAVFs. Aiding by metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid (CSF) sample which identified S. intermedius as the causative pathogen, the patient was switched to the single therapy of large dose of penicillin G and was cured precisely and economically.ConclusionsIt is an alternative way to perform mNGS to identify causative pathogens in patients with brain abscesses especially when the results of traditional bacterial culture were negative. Further thoracic CT or pulmonary angiography should also be undertaken to rule out PAVFs as the potential cause of brain abscess if the patient without any known premorbid history.