Case Of Brain Abscess Research Articles

Detection of Gram-positive and Gram-negative bacteria in brain abscesses by 16S rRNA in situ hybridization.

In situ hybridization (ISH) staining of bacterial 16S ribosomal RNA (rRNA) is an alternative to standard histological stains (eg, Gram, Warthin-Starry), and may improve the diagnosis of bacterial brain abscesses. To evaluate the utility of 16S rRNA ISH, a 10-year retrospective cohort was assembled from a large academic medical center. Results of histological stains, cultures, and 16S rRNA sequencing were extracted from reports, and new Gram and 16S rRNA ISH stains were performed. Histologically identifiable bacteria were present in 40/63 (63%) cases and 38/57 (67%) were associated with positive cultures. Overall, 16S rRNA ISH was positive in 18/63 (29%) cases, including 16/37 (43%) with positive Gram stains, 12/38 (32%) positive by culture, and 4/8 (50%) positive by sequencing. 16S rRNA ISH highlighted bacteria in 14/40 (35%) cases with Gram-positive organisms and 9/17 (53%) with Gram-negative organisms (including 6 polymicrobial cases). Compared to a composite gold standard of Gram stain and culture, the sensitivity and specificity of 16S rRNA ISH were 35% and 93%, respectively. While sensitivity is relatively low, 16S rRNA ISH may be useful for distinguishing real organisms from artifacts and for identifying brain abscess cases suitable for 16S rRNA sequencing.

First Reported Case of Brain Abscess in an Infant Caused by Staphylococcus argenteus.

First Reported Case of Brain Abscess in an Infant Caused by Staphylococcus argenteus.

Navigating the Complexity of Thalamic Abscess: A Systematic Review of Case Studies and Evidence-Based Management.

Thalamic abscesses are rare, life-threatening conditions and represent only a few percent of the total cases of brain abscesses. Due to their deep location and critical involvement of sensory and motor pathways, they remain one of the most challenging entities to diagnose and manage. Despite advances in neuro-imaging and neurosurgical techniques, thalamic abscess continues to be a challenge or question in clinical practice regarding optimum treatment modality. Given the nature of the description, a systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Case reports were retrieved after extensive searches in PubMed and Scopus with specified inclusion criteria: isolated thalamic abscesses that needed surgical interventions. The reporting quality was assessed according to CARE (CAse REports) guidelines, while data on clinical presentation and diagnostic approach were extracted. Thirty-three cases with the diagnosis of thalamic abscess were reviewed. The most common presentations included headache, hemiparesis, and altered sensorium. CT and MRI were the common diagnostic tools for these patients; stereotactic aspiration was the most common surgical intervention performed. Streptococcus species were the most common causative organisms. At follow-up, the majority of patients had a good outcome with complete or near-complete recovery. There were rare complications, such as hydrocephalus and recurrence, and mortality was low. Thalamic abscesses are infrequent but have a good prognosis in case of appropriate diagnosis and treatment with stereotactic aspiration and appropriate antibiotic therapy. The present systematic review points out the need for adopting an individual approach to treatment and for further studies that could provide better information on diagnostic and therapeutic strategies regarding this severe disease.

Brain abscesses: the first report of disseminated Nocardia beijingensis infection in an immunocompetent individual in China

Nocardia is widely distributed in the natural environment and typically cause opportunistic infections. However, it is important to note that the pathogenicity of different Nocardia species may vary significantly. Here we reported the first case of brain abscess caused by Nocardia beijingensis (N. beijingensis) infection in China. A 70-year-old male immunocompetent individual came to our hospital for treatment due to headache. After examination, it was found that he had a brain abscess caused by N. beijingensis. By utilizing a combination of surgical intervention and antibiotic therapy, the patient ultimately achieved full recovery. In addition, we isolated this strain and displayed its ultrastructure through scanning electron microscopy. The phylogenetic tree was analyzed by 16 S rRNA sequence. A literature review of N. beijingensis infections in all immunocompetent and immunocompromised patients was presented. It highlighted that abscess formation appears to be a common manifestation of N. beijingensis infection, and N. beijingensis has become an emerging pathogen in immunocompetent individuals.

Multiple brain abscesses caused by Nocardia farcinica infection after hand injury: A case report and literature review.

Nocardia infection is commonly regarded as an opportunistic pulmonary pathogen affecting debilitated or immunocompromised individuals. Brain abscesses caused by Nocardia farcinica are rare and pose a diagnostic challenge. Traditional diagnostic techniques for identifying Nocardia species, such as blood culture, microscopy, and pathology, have shown inadequate performance. In the reported case, we applied metagenomic next-generation sequencing (mNGS) to diagnose a case of brain abscess due to N. farcinica. A 66-year-old female developed a brain abscess after sustaining a hand injury. The patient exhibited a gradual change in personality and experienced tremors in her right upper limb for a duration of 1 month. The pathogen responsible for the multiple brain abscesses was identified in the cerebrospinal fluid as N. farcinica through mNGS. Antibiotic treatment included trimethoprim-sulfamethoxazole, linezolid, amikacin, meropenem, and moxifloxacin. The patient's symptoms and signs improved significantly after administration of antibiotics to which the pathogen is known to be sensitive. After 5 months of follow-up, magnetic resonance imaging of the head showed that the abscess was basically cured. The patient lived a normal life with no adverse drug reactions. Nocardia brain infection is characterized by an insidious onset and lacks distinctive clinical and imaging features. mNGS was advantageous for the timely identification and management of Nocardia-associated brain abscess in the present case and obviated the need for invasive brain surgery. Expeditious and precise diagnosis coupled with prompt antibiotic therapy can significantly reduce the mortality rate associated with this condition.

Supraorbital Approaches for Anterior Skull Base and Parasellar Lesions: Insights From a Single-Center Experience.

Modern neurosurgery has undergone significant evolution to include minimally invasive procedures, with the supraorbital approach (SOA) being a prime example. In this study, we aim to explore the surgical techniques and outcomes of this approach in the surgical treatment of frontal lobe, anterior skull base, and parasellar lesions. This study included 33 patients aged 36-83 years who underwent surgery using the SOA for lesions in the inferior frontal lobe, anterior skull base, and parasellar area between 2015 and 2024. There were 25 cases of meningioma, 2 cases of brain abscess, 2 cases of glioma, and one case each of craniopharyngioma, hemangioma, metastasis, and Rathke's cleft cyst. The medical data and follow-up results were retrospectively analyzed. The mean size of lesion was 3.38±3.05 cm. The mean follow-up period was 48.8 months. Gross total resection was achieved in 25 patients (75.8%). There were no perioperative deaths, cases of cerebrospinal fluid rhinorrhea, or infections. Two cases of morbidity were reported as complications: one case of delayed intracerebral hemorrhage and one case of infarction due to vascular injury. All patients exhibited satisfactory cosmetic results. In comparison to the conventional pterional approach, the SOA represents a safe and effective keyhole method for the removal of both extra-axial and intra-axial skull base tumors. This is particularly beneficial for lesions in the orbitofrontal region and parasellar area, as it allows for minimal disruption of normal brain parenchyma. Moreover, the SOA promotes a swift recovery and short hospital stay. Additionally, the SOA yields superior cosmetic results, including the prevention of temporalis muscle atrophy.

Brain abscess originating from odontogenic maxillofacial fascial space abscess : report of two cases

Brain abscesses caused by dental infections are rare but potentially fatal infections with a high mortality rate. Early diagnosis and treatment are crucial, but diagnosing them is not straightforward. Various mechanisms exist through which oral bacteria can spread to the central nervous system, with hematogenous dissemination being considered the most important pathophysiological mechanism. In this report, two cases of brain abscess originating from maxillofacial fascial space infec-tion will be presented. In the first case, the infection originating from the right side secondary to the left brain abscess, and in the second case, the infection originating from the left side led to a secondary infection in the left brain abscess. In both cases, the source of the infection was traced back to dental issues. The patients showed improvement through long-term high dose antibiotic therapy and surgical treatment by oral & maxillofacial surgeon and neurosurgeon.

КЛИНИЧЕСКИЙ СЛУЧАЙ РАЗВИТИЯ АБСЦЕССА ГОЛОВНОГО МОЗГА И ОСТРОГО ОДОНТОГЕННОГО СЕПСИСА У ПАЦИЕНТА С ДЕНТОФОБИЕЙ

Background data. A clinical case of brain abscess that occurred as a complication of chronic odontogenic osteomyelitis of the mandible on the background of a severe form of dentophobia. 
 Subject. Chronic periodontitis is a possible cause of the development of potentially dangerous complications such as mediastinitis, thrombophlebitis, brain abscess, etc. Most often these complications arise due to untimely seeking medical help because of fear of dental intervention, the extreme manifestation of which is dentophobia. It is also known that odontogenic cause of cerebral abscess is foci of infection localised in the region of the maxilla.
 Objective: to study and describe a case of brain abscess, which occurred as a complication of chronic odontogenic osteomyelitis of the mandible on the background of a severe form of dentophobia.
 Materials and Methods. We analysed the medical records of a patient with odontogenic brain abscess resulting from a complication of chronic odontogenic osteomyelitis of the mandible on the background of severe dentophobia. 
 Results. A patient with brain abscess developed as a result of exacerbation of chronic odontogenic osteomyelitis of the lower jaw was urgently hospitalised to the maxillofacial surgery department of the Tyumen General Hospital No. 2. 
 From the anamnesis it is known that during 1.5 years the patient had repeatedly applied to the Tyumen General Hospital No. 2 for chronic apical periodontitis, however, he did not agree to surgical treatment because of fear of dental intervention. Further, despite the deterioration of his condition, he twice refused hospitalisation. 
 During his stay in hospital, the patient received surgical and intensive medical care. After treatment, he was discharged with residual neurological consequences. Psychocorrection of dentophobia was prescribed.
 Conclusions. 1. The cause of brain abscess may be an odontogenic inflammatory process localised in the mandible. 2. Dentophobia leads to untimely medical care and may be the cause of serious complications.

A case of brain abscess caused by <i>Bacteroides fragilis</i> following intracerebral hemorrhage

A case of brain abscess caused by <i>Bacteroides fragilis</i> following intracerebral hemorrhage

Brain abscesses: Clinical image

Brain abscesses are a rare and potentially fatal infection that can present with indolent manifestations. We present the case of brain abscesses in a 55-year-old immunocompetent man with a history of bronchiectasis, who developed significant sequalae event after appropriate antibiotic therapy and surgical drainage

Coronavirus disease 2019 (COVID-19)-associated brain abscesses caused by Pseudomonas aeruginosa and Aspergillus fumigatus: two case and a review of the literature

BackgroundBacterial and fungal superinfections are commonly reported in patients with coronavirus disease 2019.Case presentationWe report the first case of brain and intramedullary abscesses caused by Pseudomonas aeruginosa and a rare case of brain abscesses caused by Aspergillus fumigatus in two post-coronavirus disease 2019 patients. The first patient—34-year-old Iranian woman—presented with weakness of the left upper limb, headaches, and lower limb paresthesia. She had a history of undiagnosed diabetes and had received corticosteroid therapy. The second patient—45-year-old Iranian man—presented with right-sided weakness and had a history of intensive care unit admission. Both patients passed away despite appropriate medical therapy.ConclusionThe immune dysregulation induced by coronavirus disease 2019 and its’ treatments can predispose patients, especially immunosuppressed ones, to bacterial and fungal infections with unusual and opportunistic pathogens in the central nervous system. Pseudomonas aeruginosa and Aspergillus fumigatus should be considered as potential causes of brain infection in any coronavirus disease 2019 patient presenting with neurological symptoms and evidence of brain abscess in imaging, regardless of sinonasal involvement. These patients should get started on appropriate antimicrobial therapy as soon as possible, as any delay in diagnosis or treatment can be associated with adverse outcomes.

Is Metagenomics the Future Routine Diagnosis Tool for Brain Abscesses? About a Case

Shotgun metagenomics (SMg) usefulness for brain abscess diagnosis is not known. We describe a case of brain abscess diagnosed with SMg and provide a review of the literature. A 70-year-old woman was diagnosed with multiple brain abscesses. Standard culture techniques and 16S rRNA gene sequencing of abscess samples remained negative. SMg finally revealed the presence of sequences from Streptococcus anginosus and Fusobacterium nucleatum, leading to antimicrobial treatment adaptation and corticosteroids initiation. The patient finally recovered. A literature review retrieved fifteen other cases of brain abscesses diagnosed with SMg. SMg results led to changes in patient management in most cases. The existing literature about the performances of SMg, its advantages, future evolutions, and limitations is then discussed. SMg place in routine should be evaluated and defined through prospective studies.

First case of Rhinocladiella mackenziei brain abscess in Turkey: Case report and review of the literature.

Rhinocladiella mackenziei is a highly neurotropic fungus, mainly reported from the Middle East. However, in recent years, there have been some cases from outside this region. We described an additional fatal case of R. mackenziei cerebral infection for the first time from Turkey and made a literature review of all previously reported cases. During 34 years (1988-2022), there have been 42 R. mackenziei brain abscess cases. Most patients have been reported from Saudi Arabia (n = 14, 33.3%). It is noteworthy that 40.5% of patients, including our case, were immunocompetent at initial diagnosis and mostly presented with a single lesion (n = 10, 23.8%). The most frequent comorbidities were solid organ transplant (n = 9, 21.4%), diabetes mellitus (n = 6, 14.3%), malignancy (n = 6, 14.3%) and prior surgery (n = 3, 7.1%). The most commonly used initial antifungal regimen were amphotericin B together with itraconazole (n = 9, 21.4%), combinations of lipid preparations of amphotericin B, voriconazole and/or posaconazole (n = 9, 21.4%) and amphotericin B alone (n = 8, 19%). Although both surgical procedures and antifungal medication in the majority of patients were performed, mortality rates remained high (90.4%). The area at risk of R. mackenziei cerebral abscess cases extends to other countries. Clinicians should be aware of this emerging disease and take a detailed travel history in patients with atypical and undocumented brain abscesses. Our case confirms the hypothesis that this fungus might spread more widely than previously predicted regions.

Anesthetic Management of Brain Abscess with Cyanotic Congenital Heart Disease: Two Case Reports

Abstract Dextro transposition of great arteries (dTGA) and tricuspid atresia (TA) are rare causes of cyanotic congenital heart disease (cCHD). Brain abscess is a dreaded complication in these patients due to high rates of morbidity and mortality. We present the anesthetic management of two pediatric patients with dTGA and TA, who developed brain abscess, for which burr-hole and drainage were done under general anesthesia. Anesthetic management included a thorough preoperative assessment and optimization, careful selection of anesthetic agents, and close intraoperative and postoperative monitoring. Both of our patients recovered and were discharged from the hospital. Although several cases of brain abscess in cCHD have been reported, both dTGA and TA are rare conditions and this is the first case report of brain abscess in untreated TA, to the best of our knowledge.

Ruptured intraventricular brain abscesses due to Fusobacterium nucleatum with obstructive hydrocephalus: illustrative case

Fusobacterium spp. are strictly anaerobic microorganisms and normal flora of the oropharyngeal, gastrointestinal, and female genital tracts. It is commonly associated with periodontal disease, pharyngitis, mastoiditis, and tonsillitis, with a tendency to abscess formation. The authors report a case of brain abscesses complicated by ventriculitis and obstructive hydrocephalus caused by Fusobacterium nucleatum of suspected odontogenic source. While repeated bacterial cultures remained negative, the isolate was identified using bacterial sequencing. Empirical antimicrobial coverage for F. nucleatum should be considered in patients presenting with brain abscess. Genetic bacterial sequencing utilizing 16S ribosomal RNA molecular diagnostic testing may assist in microorganism identification to guide antimicrobial therapy.

Brain Abscess after COVID-19: Case Report

As the COVID-19 pandemic progresses, complications and unusual presentations of the disease have been described. Among them, the involvement of distinct parts of the neuroaxis. We report a rare case of brain abscess in elderly after SARS-Cov-2 infection readmitted in our health unit. Patient was treated with ceftriaxone, metronidazole and vancomycin with good clinical and therapeutic response. The satisfactory conduct of the case was only possible by the involvement of a multiprofessional team, which sought early diagnosis, surgical intervention and adequate duration of treatment.

Streptococcus constellatus and sinusitis: A brain abscess case series

Background: Brain abscess is an infectious process affecting the central nervous system and related structures and is many times the result of bacterial translocation from other areas of the body. Patients can present in a multitude of ways, ranging from sepsis to stroke, creating an ambiguous initial disease presentation. Through imaging, lab work, and surgical intervention and biopsy, an official diagnosis of brain abscess can be made; moreover, timely recognition and antibiotic treatment are paramount to creating positive patient outcomes. Case Description: We present a rare case of brain abscess caused by Streptococcus constellatus and Parvimonas micra from likely sinusitis, with appropriate biopsy and treatment. We aim to explore the underlying pathophysiology of brain abscesses, the different bacteria which may cause this disease process, differentials, and treatment. We also conducted a literature review for similar cases caused by Streptococcus constellatus and Parvimonas micra to highlight the rare yet dangerous nature of this infectious disease. Through our case report and series of similar cases, we presented the unusual development of brain abscess after a sinus infection and contiguous spread. Streptococcus constellatus and Parvimonas micra is an organism that can cause brain abscess but is rare to be seen in individuals without sinus or odontogenic disease. Prompt identification through clinical signs, labs, imaging, cultures and biopsy can help aid in creating better patient outcomes. Conclusion: This case series delineated the pathophysiology, diagnosis, and management of brain abscess that resulted from contiguous bacterial spread. Timely diagnosis and treatment initiation are paramount to reducing mortality associated with brain abscess.

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.

P272 Fungal brain abscess in the era of COVID 19: an experience from a tertiary care Neurosciences Institute in South India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMIntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is ruling the world for more than 2 years since 2020. In 2021, the second wave of COVID-19 attributed to the ‘delta variant’ swept across India, causing significant morbidity and mortality. In addition, the epidemic of COVID-19-associated mucormycosis affected the Indian subcontinent specifically, with a whopping 41 512 cases and 3554 deaths attributed to this dreadful disease.MethodsThe single-center retrospective cross-sectional study was aimed to determine the impact of COVID-19 on fungal brain abscess cases at a non-COVID tertiary care Neurosciences Institute in South India. The study included all cases diagnosed with fungal brain abscess microbiologically (microscopy and/or fungal culture), supported by radiological findings or by histopathological examination. Cases of brain abscess which were negative for fungal elements by microscopy, culture, and imaging were excluded from the study. Fungal culture was done on routine mycological media as per standard procedures. Fungal identification was done by microscopic morphology, MALDI-TOF MS, and ITS sequencing.ResultsA total of 406 cases of brain abscess were recorded between January 2020 and April 2022. Out of these, 26 (6.4%) were cases of fungal brain abscess. In 2020, three out of 153 (2%) cases had a fungal etiology, while it was 10.4% (22/211) in 2021 and 0.24% (1/42) till April 2022. Overall, a male preponderance was observed (20/26, 77% were males). The cases had an even distribution from 6 to 62 years, with no predilection in any particular age group. The most common underlying comorbidity was type 2 diabetes mellitus (13/26, 50%). Four cases had a past history of COVID-19. Radiological suspicion of fungal infection was present in all the cases. Mycological examination (wet mount and 20% KOH mount) of brain abscess pus from all the cases revealed fungal elements. Out of 26 cases, 23 cases showed hyaline, broad aseptate hyphae, 2 showed melanized septate hyphae and 1 showed budding yeast cells with pseudohyphae and arthroconidia on direct microscopy. Culture positivity was observed in 15 cases (57.7%). Out of 23 suspected cases of rhinocerebral mucormycosis based on clinical, radiological, and direct microscopic findings, fungal culture was positive in 13 cases, all of which were identified as Rhizopus arrhizus. Out of two cases that showed melanized hyphae in direct microscopy, one grew a dematiaceous mold that was identified as Cladophialophora bantiana. The other melanized fungus failed to grow in culture. The single case of brain abscess caused by a yeast-like fungus was attributed to Trichosporon dohaense, identified by ITS sequencing. It was initially misidentified as T. ovoides/T. mucoides by VITEK MS due to lack of mass spectral database for T. dohaense.ConclusionsA significant increase in the incidence of fungal brain abscess has been observed in the COVID-19 era, particularly with each new wave of infection. Clinical features along with imaging and mycological findings are crucial in making an early diagnosis and decision regarding antifungal therapy. Accurate identification to the species level is necessary to guide optimal antifungal therapy as several species exhibit emerging resistance to antifungal drugs.

P491 Scedosporium Apiospermum brain abscess in an immunocompetent host: Rare case from Southern India

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PMObjectives/Introduction Scedosporium apiospermum is a filamentous fungus that causes a broad spectrum of diseases in an immunocompromised host involving the lungs, skin, bones, eyes, joints, and the central nervous system. It is a rare cause of fungal brain abscess, more so in an immunocompetent individual. Here, we report a case of brain abscess in an immunocompetent host caused by S. apiospermum.MethodsA 78-year-old retired railway officer from Chennai, presented to our hospital on May 4, 2022, with a 3-month history of weakness, gait instability followed by difficulty in walking, and left hemiparesis. In all, 20 days before the presentation, he had an episode of generalized tonic-clonic seizure with worsening of his neurological state resulting in bed-bound status. His medical history included Pemphigus vulgaris for which he was on topical treatment, well-controlled diabetes mellitus, hypertension, and coronary artery disease.He underwent an MRI brain which revealed a T2 heterointense intra-axial right parietal lesion with significant perilesional edema. A provisional diagnosis of a cerebral abscess and malignancy was entertained. He was subjected to craniotomy and the surgical findings were consistent with a brain abscess and the pus was evacuated and sent for microbiological analysis. The pus fungal stain was consistent with septate hyphae and the cultures grew S. apiospermum. The histopathological findings were also consistent with a brain abscess caused by septate fungi (Aspergillus like fungi).Results/TreatmentHe was started on Liposomal Amphotericin B 5 mg/kg dose IV OD and injectable voriconazole. There was an initial clinical improvement with respect to sensorium and neurological status. He subsequently developed bradycardia with worsening sensorium to which he finally succumbed.Conclusion Scedosporium apiospermum is an asexual form of Pseudoallescheria boydii, a fungus found in soil, contaminated water, and sewage. It is a rare cause of brain abscess in immunocompromised individuals. Near drowning or trauma may be the causative factors for immunocompetent individuals. Our patient was a well-controlled diabetic host with no apparent immunosuppression. Scedosporium apiospermum is diagnosed on the basis of culture and microbiological examination. Due to the similarities in the clinical and histopathological presentation of Scedosporium with other similar fungi, culture becomes the gold standard tool for diagnosis.Treatment includes surgical drainage of the abscess along with intravenous voriconazole for at least 8-12 weeks. The prognosis depends upon the immune status, surgical intervention, and medical antifungal therapy.