Case Of Brain Abscess Research Articles

A clinical case report of brain abscess caused by Nocardia brasiliensis in a non-immunocompromised patient and a relevant literature review

BackgroundBrain abscess due to the Nocardia genus is rare and usually found in immunocompromised patients. The most common subtype implicated is Nocardia farcinica while brain abscess due to Nocardia brasiliensis is comparatively rare. Diagnosis of brain abscess is based mainly on bacteriological culture from pus collected at the site of infection, and brain imaging. Stereotaxic aspiration or surgical resection combined with adequate duration of treatment with antibiotics to which the bacteria are sensitive represent effective treatment strategies.Case presentationWe report a rare case of brain abscess caused by Nocardia brasiliensis in a non-immunocompromised patient. He admitted to our hospital twice with a headache. Stereotaxic aspiration was performed at the patient’s first appointment at the hospital, and a craniotomy was used to excise the lesion during subsequent abscess recurrence.ConclusionEarly diagnosis, reasonable surgical intervention, and adequate duration of treatment with effective antibiotics are critical for treating brain abscess.

Cerebral Abscess: A Complex Complication of Odontogenic Infection: A Case Report and Review of the Literature

Cerebral abscess of odontogenic origin is uncommon and only accounts for a few of reported cases of cerebral abscesses [1]. The reported incidence cerebral abscess ranges from 0.4 to 0.9 cases per 100,000 people [1]. Brain abscesses represent about 1% to 2% of all intracranial masses and odontogenic cerebral abscess range between 3% to 10% of all cases of brain abscess [2].

Brain abscess with Clostridium cadaveris and Clostridium sporogenes

Brain abscess is a collection of pus in the parenchyma of brain. Most common infecting organisms are streptococci, staphylococci and anaerobes, depending upon the source from which it originates. Clostridium cadaveris and Clostridium sporogenes are common organisms found in the gastrointestinal tract of humans, rarely producing disease. Few cases of bacteremia and abscesses are reported with these organisms. We hereby report the first case of brain abscess with C cadaveris and C. sporogenes in a young male with good outcome by surgical and medical management . J Microbiol Infect Dis 2019; 9(3):129-132.

Rare Pathogens of Central Nervous System: a Systematic Literature Review and Report of Two New Cases of Cerebral Abscesses Due to Gemella morbillorum

To evaluate and characterize cases of brain abscess in immunocompetent patients due to Gemella morbillorum, an opportunistic Gram-positive coccus. Two cases of brain abscess due to this pathogen which occurred at the authors’ native institution in 2013 and 2016 were analyzed. Moreover, a literature search regarding brain abscess surgically treated due to this pathogen was performed in PubMed database, following PRISMA statement. The final review comprised ten articles for a total of 11 patients—all immunocompetent—with a median age of 50.2 years (range 28–77); almost total were males. Neurological deficits and fever were the most common initial signs; seizures were present only in two cases. Surgical treatment was based on craniotomy and excision in six cases; the remaining five underwent stereotactic aspiration. The antibiotic initial therapy was intravenous in all cases. The average duration of therapy was of six weeks with a minimum of four and maximum of ten. One patient died, while in the other cases, a complete or partial regression of presenting symptoms and disappearing of MRI signs at intermediate follow-up were obtained. In eight patients (72%), it was possible to identify a primary infection or a predisposing factor (as cardiac diseases or septic arthritis). G. morbillorum is an emerging pathogen involved in brain abscesses. Even if it is infrequently reported, the identification of specific characteristics that may increase its neurotropism and virulence also in immunocompetent patients can help to better understand such a rare pathology.

First report of intracranial epidermoid cyst infection and brain abscess caused by Salmonella Paratyphi A

We report the first case of brain abscess caused by Salmonella Paratyphi A in a young immunocompetent boy with an intracranial epidermoid cyst. A 10-year-old boy presented with gradual onset of headache, progressively increasing over one month duration. The patient was diagnosed with a benign intracranial epidermoid cyst involving the left anterior cranial fossa insinuating to left medial frontal lobe due the initial presentation, and repeat magnetic resonance Imaging taken after two weeks during to worsening of headache revealed pyogenic infection of the epidermoid cyst. The drained pus showed plenty of polymorphonuclear cells with thin Gram-negative bacilli on Gram staining and culture revealed the growth of S. Paratyphi A, which was confirmed by VITEK 2 compact system and serotyping. The isolate was susceptible to Ampicillin, Cotrimoxazole, Ciprofloxacin, Ceftriaxone and Tetracycline. The patient was successfully managed initially with empirical intravenous Meropenem for two weeks and then deescalated to oral Cefixime and Ciprofloxacin. There were no focal neurological deficits while the patient was discharged with advice on antibiotic continuation for two weeks.

Retrospective clinical analyses of otogenic intracranial infections

Objective: To investigate the clinical characteristics and treatment options for otogenic intracranial infections. Method: Clinical records of all the patients of otogenic intracranial infections admitted to the First Affiliated Hospital of Zhejiang University from 2008 to 2016 were retrospectively analyzed. Their clinical presentations, radiological findings, culture results, and medical and surgical therapy modalities, as well as treatment outcomes were studied. Results: Sixteen cases were identified. The majority of the otogenic patients had a history of cholesteatoma, other rare events included congenital cerebrospinal fluid otorhinorrhea, Gorham-Stout disease and after radiation therapy for nasopharyngeal carcinoma. Meningitis, cerebral venous thrombosis and brain abscess were the primary intracranial infection. Eight patients had received modified radical mastoidectomy at least one time. Results of routine culture for cerebrospinal and pus samples had high negative rate. All patients received initial empirical broadspectrum intravenous antibiotics therapy. Four cases of brain abscesses were drained or excised at the same time for otologic surgery. The mortality rate was 6.25% (1 case). Conclusions: Cholesteatoma is still the most commonly primary disease of otogenic intracranial complications. Diagnosis and treatment of otogenic intracranial infections require multidisciplinary cooperation. Surgical intervention for primary ear lesions and intracranial abscess is still the main option in the treatment of otogenic intracranial infections.

Clinical analysis of brain abscess after endoscopic repairment of cerebrospinal fluid rhinorrhea

Objective: To explore the clinical characteristics of the complication of brain abscesses after cerebrospinal fluid rhinorrhea repairment. Methods: A retrospective analysis was conducted on 149 patients undergone endoscopic repairment of cerebrospinal fluid rhinorrhea from October 2007 to October 2017 in Department of Otorhinolaryngology Head and Neck Surgery, Tianjin HuanHu Hospital. The clinical characteristics and treating methods of 3 brain abscess cases were analyzed. Results: Of the 149 patients accepted the endoscopic repairment of cerebrospinal fluid rhinorrhea, 3 cases were complicated with postoperative brain abscesses, which showed as frontal lobe abscess by strengthened head MRI. The incidence of abscess was 2.0%. Abscess formation time was within 10 d after surgery. One case was treated with antibiotic and reducing intracranial pressure, while other 2 cases were treated with puncture drainage. After following-up of 1 to 24 months, these 3 cases had no recurrence of cerebrospinal fluid rhinorrhea or abscess. Conclusions: The complication of brain abscess formation after endoscopic repairment of cerebrospinal fluid rhinorrhea is more common in frontal lobe, which may take place within 7-10 d postoperatively. Conservative treatment is the first choice. Under the condition of obvious symptoms and pus cavity fusion, puncture drainage can be performed.

Evaluation of MRI based diagnostic algorithm for intra-axial brain masses: A single centre experience

Background and Purpose: Preoperative evaluation and differentiation of intra-axial brain masses is essential for therapy and prognosis. The integrated Magnetic Resonance Imaging (MRI) techniques such as Diffusion Weighted Imaging (DWI), Magnetic Resonance Spectroscopy (MRS) and Dynamic Susceptibility Contrast (DSC) MRI allow insights into tumour anatomy and physiology. Our study was designed to find the sensitivity, specific and accuracy of a diagnostic algorithm comprising of these techniques. Materials and Methods: Thirty consecutive immunocompetent patients with treatment naive intra-axial brain masses underwent MRI from July 2016 to July 2017. Conventional and DWI, MRS and MR perfusion scans were performed using 1.5 T MR imaging system. The following cut-off values (ADC ?1.1 /100mm2, intralesional Cho/NAA > 2.2, perilesional Cho/NAA >1 and rCBV >1.75) were applied to the diagnostic strategy algorithm. Histopathological analysis served as the gold standard. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy were obtained. Results: Twenty one of 30 cases were correctly classified using the diagnostic algorithm. One case of primary central nervous system lymphoma (PCNSL) was misdiagnosed as metastasis, 2 cases of high-grade neoplasm (HGN) as brain abscesses, 1 case of HGN as metastasis, 1 case of HGN as low-grade neoplasm (LGN), 1 case of LGN as HGN, 1 case of LGN as abscess / tumefactive demyelinating lesion (TDL), 1 case of brain abscess as HGN, and 1 case of metastasis (breast carcinoma) as HGN. Conclusion: Diagnosing intra-axial brain masses using a combination of advanced imaging techniques (MRS, MR perfusion and ADC) is fairly accurate.

Management of a Cancer Patient with an Intrathecal Drug Delivery System and an Acute Brain Abscess

Surgical-site infection, spinal cord abscess, and catheter tip granuloma are known but rare complications of intrathecal drug delivery systems (IDDS). To date, there are no published cases of brain abscess in a patient with an IDDS. In this study, we report a case of a cancer patient with an IDDS for management of cancer pain who developed a brain abscess with profound mental status changes and clinical management challenges.

Clinical analysis of 56 cases of brain abscess

目的 分析脑脓肿的临床表现、诊断及治疗方法。 方法 回顾性分析56例脑脓肿患者的临床资料，总结脑脓肿的诊治经验。 结果 56例中，首发临床表现以头痛为主诉27例(48.2%)，发热为主诉9例(16.1%)，头痛同时发热的11例(19.6%)，癫痫发作5例(8.9%)，偏瘫2例(3.6%)，失语2例(3.6%)。隐源性感染占首位，脓肿多见于额、颞叶。保守治疗4例，立体定向穿刺引流术13例，开颅脓肿切除39例。行手术治疗的患者均行脓液涂片及细菌培养，其中涂片阳性13例，绝大部分为革兰阳性球菌；细菌培养阳性的9例，其中8例为草绿色链球菌，1例为肺炎链球菌。所有患者随访3个月，头颅CT和核磁共振扫描均显示脓肿消失。 结论 脑脓肿若能获得及时正确的诊断，采用合适的治疗方法，可取得满意的效果。

Efficacy Observation of Continuous Irrigation and Drainage with Double Cavity Catheter in the Treatment of Brain Abscess: 16 Patients Report

Background: Brain abscesses is of high morbidity and mortality despite medical advances. Today we present a single institution's experience with continuous irrigation and drainage with double cavity catheter in the treatment of brain abscess. Methods: We retrospectively analyzed 16 cases of brain abscess who underwent continuous irrigation and drainage with double cavity catheter surgical treatment and conjunction with 2 weeks to 4 weeks of intravenous vancomycin and metronidazole in the second hospital affiliated to Nantong university between June 2012 and February 2017. Patients were put in a double cavity tube into the brain abscess cavity. The medical records were analyzed for clinical presentation and outcomes. Results: Sixteen patients were treated in this group, including 15 were cured and one died of pulmonary infection. Of these patients, 13 were treated and extubated from 6 days to 14 days, 1 patients were 4 days later, 2 patients extubated in 16 days. CT or MRI were reviewed before discharge, 12 cases were fully closed, 4 cases were left with minor residual cavity, and the clinical symptoms of all the patient disappeared. A total of 15 patients were followed up from 3 years to 2 years, and no recurrence of abscess was reported. Conclusion: Continuous brain abscess cavity irrigation and drainage with double cavity catheter is an effective treatment for brain abscess and gets excellent treatment results. It is easy to operation and reduces the cost and damage to the patient, maybe the optimal choice to treat brain abscess.

Enterococcus brain abscess with lateral sinus thrombophlebitis as a complication of chronic otitis media

With widespread use of antibiotics, the occurrence of brain abscess and lateral sinus thrombosis together is rare these days, especially with enterococcus as the causative organism. We here present a case of pediatric case of brain abscess and lateral sinus thrombosis which developed an additional complication of postoperative cerebrospinal fluid leakage. The case was successfully treated by excision of the abscess, canal wall down mastoidectomy with partial obliteration of cavity, and Type III tympanoplasty with umbrella graft.

Brain Abscesses Associated with Asymptomatic Pulmonary Arteriovenous Fistulas

Brain abscess commonly occurs secondary to an adjacent infection (mostly in the middle ear or paranasal sinuses) or due to hematogenous spread from a distant infection or trauma. Pulmonary arteriovenous fistulas (AVFs) are abnormal direct communications between the pulmonary artery and vein. We present two cases of brain abscess associated with asymptomatic pulmonary AVF. A 65-year-old woman was admitted with a headache and cognitive impairment that aggravated 10 days prior. An magnetic resonance (MR) imaging revealed a brain abscess with severe edema in the right frontal lobe. We performed a craniotomy and abscess removal. Bacteriological culture proved negative. Her chest computed tomography (CT) showed multiple AVFs. Therapeutic embolization of multiple pulmonary AVFs was performed and antibiotics were administered for 8 weeks. A 45-year-old woman presented with a 7-day history of progressive left hemiparesis. She had no remarkable past medical history or family history. On admission, blood examination showed a white blood cell count of 6290 cells/uL and a high sensitive C-reactive protein of 2.62 mg/L. CT and MR imaging with MR spectroscopy revealed an enhancing lesion involving the right motor and sensory cortex with marked perilesional edema that suggested a brain abscess. A chest CT revealed a pulmonary AVF in the right upper lung. The pulmonary AVF was obliterated with embolization. There needs to consider pulmonary AVF as an etiology of cerebral abscess when routine investigations fail to detect a source.

Brain abscess by Kocuria rosea : Case report and literature review

Brain abscess is one of the most serious complications of head and neck infections (Tunkel, 2010 [1]). Defined as a focal intracranial infection that is initiated as an area of cerebritis and evolves into a collection of pus surrounded by a vascularized capsule (Tunkel and Scheld, 2011 [2]). The infectious agents depend on the pathogenesis of the infection and the presence of various predisposing conditions, however, in general: Streptococcus sp. is the most frequent microorganism (Tunkel and Scheld, 2011 [2]: Greenberg, 2010 [3]). In this article we report a case of brain abscess caused by Kocuria rosea, an entity that has not been reported previously in literature.

A case of brain abscess in a child following trivial head injury

Introduction: Brain abscess is caused by inflammation and collection of infected material, coming from local or remote infectious sources, within the brain tissue. The infection may also be introduced via a breach in the skull following head trauma or surgical procedures. Brain abscess may also be associated with congenital heart disease in the young children. Here we would like to describe a case of brain abscess secondary to seemingly trivial head injury. Case presentation: A 12 years old boy presented with left forehead and periorbital swelling for one week with fever, vomiting and headache. Parents added the history of confusion. No history of seizures or LOC was recorded. There was history of minor scalp trauma to the forehead 10 days prior. Examination reveals a febrile child with GCS of 13. Rest of systemic examination was unremarkable. Local examination showed warm tender fluctuant swelling. CT examination was ordered and it revealed, frontal subgaleal collection involving the frontal sinus and extending into intracranial portion. He was admitted for decompressive craniotomy and evacuation of intracranial empyema. The patient's condition improved gradually and was discharged with full recovery after 15 days post-admission. Discussion: Minor scalp trauma serving route of intracranial infection is a rare complication documented in the literature. Detailed history is important as patient or family may not remember it.

Brain Abscess with Anaerobic Gram-Negative Bacilli: Case Series

Brain abscess is usually of polymicrobial etiology involving aerobic and obligate anaerobic bacteria. Anaerobic bacteria are mainly seen in brain abscesses secondary to otogenic and odontogenic source. Investigating for anaerobic etiology is usually neglected considering the tedious and time consuming process of anaerobic culture. It is necessary to perform anaerobic cultures along with routine aerobic cultures as a part of microbiological workup of abscess aspirates in patients with brain abscess which aid in providing appropriate antibiotic therapy. To highlight the significance of anaerobic cultures, we report four cases of brain abscess with anaerobic etiology from a tertiary care hospital in coastal Karnataka.

Retrospective analysis of 620 cases of brain abscess in Chinese patients in a single center over a 62-year period.

Despite advances in laboratory diagnostics, antibiotic regimens, and neurosurgical techniques, brain abscess (BA) remains a potentially fatal infectious disease. This study analyzed clinical and epidemiological aspects of BA in Chinese patients treated at a single center during a 62-year period. We retrospectively analyzed 620 BA patients treated at Tianjin Medical University General Hospital, Tianjin, PR China from 1952 to 2014. Because of the initiation of imaging technology use in 1992, and other specific changes, we analyzed data over three study periods: 1952-1972, 1980-1991, and 2002-2014. Information including incidence, sex, age, community distribution, BA size and location, therapeutic method, prognosis and outcome of BA patients was collected and evaluated. Our study included 620 BA patients. The percentage mortality significantly decreased from 22.8% in 1952 to 6.3% in 2014 (p < 0.001). Although the incidence of BA was higher in males than females, there was no significant change in the male/female incidence ratio over time: 2.5 in 1952-1972, 2.6 in 1980-1991, and 2.2 in 2002-2014. The cryptogenic infection incidence significantly increased over time (p < 0.001). The number of positive bacterial cultures significantly decreased over the three study periods (p < 0.01). The prognosis of patients with BA has gradually improved over the past 62years in Tianjin, China. This may be because improvements in neurosurgical techniques, cranial imaging, and antimicrobial regimens have facilitated less invasive and more precise neurosurgical procedures.

A Case of Brain Abscess Caused by Medication-Related Osteonecrosis of the Jaw.

Reports of brain abscesses caused by medication-related osteonecrosis of the jaw (MRONJ) are very rare. We here present the case of a 76-year-old man with terminal-stage prostatic carcinoma and a brain abscess caused by MRONJ at the maxilla. The patient had been treated with zoledronic acid and denosumab for bone metastasis. For the brain abscess, an antibiotic regimen based on ceftriaxone and metronidazole and a sequestrectomy contributed to a successful outcome. In the case of maxillary MRONJ extending to the maxillary sinus, active resection of the infected bone should be considered to prevent the spread of the infection beyond the maxillary sinus, into the ethmoid sinus, and into the brain.

A Case of Brain Abscess Caused by &lt;i&gt;Nocardia farcinica &lt;/i&gt;in which the Test Results for Drug Susceptibility Conflicted with the Actual Clinical Course

Sulfamethoxazloe-trimethoprim is one of the most frequently used antibiotics in the treatment of Nocardia infection. However, in vitro studies have shown an increase in sulfonamide resistance among Nocardia species. Here, we present a case with a brain abscess caused by Nocardia farcinica in which the test results for drug susceptibility to sulfonamide conflicted with the actual clinical course. A 74-year-old woman with autoimmune hepatitis who has being treated with oral prednisolone (16 mg/day) was admitted because of headaches and fever. A CT scan and MRI revealed a brain abscess that had ruptured into the lateral ventricle. She was empirically treated with antibiotics, but her condition did not resolve. Therefore, the abscess was drained surgically. Gram and Kinyoun stains for pus revealed a modified acid-fast branching filamentous bacterium consistent with Nocardia species. The pathogen was identified as Nocardia farcinica based on its 16S rRNA sequence. Consequently, the patient was treated with sulfamethoxazole -trimethoprim and amikacin. However, susceptibility testing (broth microdilution method) showed that the strain was completely resistant to sulfamethoxazole-trimethoprim. We therefore changed the therapeutic regimen to imipenem-cilastatin and amikacin, but her symptoms worsened and the treatment was thought to have failed. She was then re-treated with sulfamethoxazole- trimethoprim, and her symptoms resolved. Some reports have suggested that interpreting the results of Nocardia susceptibility testing may be difficult especially the susceptibility of Nocardia to sulfamethoxazole-trimethoprim. The present case suggests a confliction between susceptibility testing and the clinical course of a patient with Nocardia infection.

2種類の嫌気性歯周病原性菌を起炎菌とした脳膿瘍の１例

我々は，2種類の嫌気性歯周病原性菌を起炎菌とした脳膿瘍症例の治療経験を報告する。症例は45歳男性。20XX年6月1日頃から左上肢脱力と感覚異常が出現し，近医を受診した。頭部CT画像上，脳梗塞の診断で抗血小板薬が投与された。左半身麻痺の増悪を認め，当科に紹介入院となった。頭部MRI経過から脳膿瘍診断に至り，小開頭脳膿瘍排膿術が施行された。嫌気性菌膿瘍では30％で起炎菌を証明できないことから，複数の検体を採取し，2種類の嫌気性歯周病原性菌が検出された。重度歯周病の診断がされ，歯性菌血症からcorn-cob構造の菌複合体が脳皮質に到達して膿瘍を形成したと推測された。術後14週間の抗菌剤治療に並行して口腔ケアと計画的歯科治療を行ない良好な転帰を得たが，抗菌薬選択と投与方法に再考の余地があった。