Cause Of Brain Abscess Research Articles

Brain abscess caused by Mycobacterium tuberculosis in an immunocompetent patient: a case report and literature review.

Brain abscesses caused by Mycobacterium tuberculosis are rarely reported and are typically found in immunocompromised patients. The challenges in identifying the pathogen and the frequent delays in initiating appropriate therapy often result in a poor prognosis for patients. We herein report a rare case of a brain abscess caused by M. tuberculosis in a 63-year-old patient with a history of hypertension but no history of pulmonary tuberculosis. The patient was hospitalized twice because of worsening right upper limb weakness and speech difficulties. Both a pus culture and cerebrospinal fluid culture were negative. Ultimately, the diagnosis of M. tuberculosis infection was confirmed through next-generation sequencing and the tuberculosis-specific T-cell test (T-SPOT). The patient's symptoms improved following anti-tuberculosis treatment. This case highlights the importance of considering M. tuberculosis as a potential cause of brain abscesses, even in immunocompetent individuals, and underscores the need for early diagnosis for effective treatment.

Changes in the epidemiology of pediatric brain abscesses pre- and post-COVID-19 pandemic: a single-center study

BackgroundAn increased incidence of brain abscesses was observed post-COVID-19 pandemic. However, it remains unclear how the COVID-19 pandemic influenced the epidemiology of brain abscesses. This study aimed to investigate changes in the epidemiology of brain abscesses pre- and post-COVID-19 pandemic.MethodsA retrospective study of demographic, clinical, radiological, and laboratory characteristics of patients with brain abscesses in Children's Hospital of Soochow University from 2015–2023 was performed.ResultsA total of 34 patients were admitted to the hospital during the study. The post-COVID-19 cohort had an average of 5.5 cases/year, which is a 129.2% increase compared to the pre-COVID-19 cohort's average of 2.4 cases/year. Additionally, the rates of fever upon admission (86.36% vs 50%, p = 0.04) and experiencing high-grade fever within 6 weeks before admission (40.91% vs 8.33%, p = 0.044) were significantly increased. A potential rise in the rate of intensive care unit admission was observed (36.36% vs 8.33%, p = 0.113). The average value of globulin in the post-COVID cohort was significantly higher compared to the pre-COVID cohort (31.60 ± 5.97 vs 25.50 ± 5.08, p = 0.009). Streptococcal infections were the predominant cause of brain abscesses in both cohorts (40% vs 43.75%, p = 0.57).ConclusionsThere was a significant increase in the number of brain abscess patients after the COVID-19 pandemic. This underscores the importance of children receiving the streptococcal vaccine.

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.

Oral microbes and the formation of cerebral abscesses: A single-centre retrospective study

ObjectiveIntracranial abscesses are relatively uncommon, but can result in significant mortality and morbidity. Whilst many potential causes of brain abscesses are recognised, in many cases the origin of infection remains clinically unidentified. Our objective was to investigate the role of bacteria found in the oral cavity in the development of brain abscesses. MethodsA retrospective analysis was performed using data from 87 patients admitted to a single UK neurosurgical unit with brain abscesses over a 16-year period. Using microbiological data obtained from abscess sampling and peripheral cultures, species of bacteria were categorised in patients where no primary source of infection was identified (NSI) for their brain abscess (n = 52), or where an infective source (ISI) was identified. The microbiological data was then screened to identify common oral bacteria in each group. ResultsBrain abscesses from the ISI group (n = 35) demonstrated a significantly lower preponderance of oral bacteria (n = 8), than the NSI group (n = 29) (p < 0.05). Brain abscesses from the NSI group also had significantly higher counts of Streptococcus anginosus compared to ISI (p < 0.05), with brain abscesses being most common in the frontal and parietal lobes for both ISI and NSI. ConclusionsThese findings suggest that the oral cavity could be considered as a source of occult infection in cases of brain abscess where no clear cause has been identified. Future studies should include oral screening and microbiome analysis to better understand the mechanisms involved and develop approaches for prevention. Clinical significance statementOral bacteria may be an under-recognised cause of brain abscesses. Careful review of oral health in brain abscess patients may help establish causation, particularly in patients with no cause for their abscess identified. Good levels of oral health may help prevent the development of brain abscesses in some individuals.

Non-functioning ventricular catheter as a cause of brain abscess in a child: case report

Introduction. The occurrence of a brain abscess caused by a non-functioning ventricular catheter is a rare complication. This approach can be considered a preventive measure for the occurrence of infectious complications. Klebsiella pneumoniae, as an etiological factor in the occurrence of brain abscess, is relatively rare according to literature.Aim. To present our experience of treating a child with hydrocephalus who developed a brain abscess caused by a nonfunctioning ventricular catheter.Materials and methods. The material for the study was the clinical history of a 4-year-old patient with a brain abscess caused by a non-functioning ventricular catheter left after the replacement of the shunt system.Results. The prevention of such a complication is the complete removal of the elements of the ventriculoperitoneal shunting during its replacement. When an abscess is formed, the most appropriate method is its open removal along with a non-functioning catheter, since this allows the pathological focus to be sanitized as much as possible. This approach can be considered a preventive measure for the occurrence of infectious complications in the future. If a condition occurs when there is a combination of a brain abscess against the background of a non-functioning catheter, SPS and there are no inflammatory changes in the cerebrospinal fluid, it is advisable to remove the brain abscess along with the capsule and catheter, as well as removing the peritoneal catheter from the abdominal cavity. This tactic is also justified when the total removal of the abscess capsule is impossible, or there are already inflammatory changes in the cerebrospinal fluid and it is necessary to sanitize it.Of great clinical interest is also the study of the microbiological aspects of this pathology. Klebsiella pneumoniae, which was isolated during a microbiological study in this clinical example, as an etiological factor in the occurrence of a brain abscess, is rare according to the literature.Conclusion. The problem of the occurrence and treatment of infectious complications after liquor-reshunting operations during hydrocephalus is an urgent task in neurosurgery. Based on the analysis of the literature, it can be said that the rarity of publications on this topic makes even individual reports relevant, and today there is no way to propose a specific strategy for a non-functioning ventricular catheter.

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.

Streptococcus Intermedius Brain and Liver Abscesses After Dental Manipulation: a Case Report

Background: Brain abscesses are intracerebral infections with pus accumulation that can be fatal in most cases without appropriate treatment. The most common cause of brain abscesses are infections with streptococci and staphylococci. Streptococcus anginosus is a group of streptococci that are part of the normal flora of the oropharynx and are rarely the cause of severe bacterial infections. Case Report: Our patient is a 64-year-old man who underwent a dental procedure, and presented a few days later with a high-grade fever and decreased level of consciousness. He was found to have multiple brain abscesses and a liver abscess, and blood cultures revealed Streptococcus intermidius, which belongs to the Streptococcus anginosus group. The patient received appropriate treatment and recovered completely. Conclusion: Dental procedures, even simple tooth brushing, can cause bacteremia leading to multiple abscesses in different parts of the body, especially if a germ of the Streptococcus anginosus group has been detected in the blood culture.

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.

Factors Influencing Outcome and Mortality of Brain Abscess in Mosul City

Background: Brain abscess by definition is a crucial pus collection inside the brain, resulted from the infection by a variety of bacteria, fungi, and parasite. It can be single or multiple. The size, position, and number of lesions, as well as the organism's pathogenicity, host reactions, and the severity of cerebral edema, all influence the presentation. Objective: To assess how well a brain abscess was managed and to evaluate the patients with favorable and unfavorable Glasgow outcome scale (GOS). Patients and methods: From January 2014 to January 2021, the study was achieved and conducted in the Neurosurgical Department of Ibn-Sina Teaching Hospital on Mosul's left coast. The neurosurgery unit managed a case series investigation of 70 patients who had a brain abscess. Age, sex, duration of illness, initial neurosurgical status, and abscess features are among the clinical data. A comparison was performed between patient with Favorable Glasgow outcome scale (GOS), moderate disability or those with good recovery and those with Unfavorable GOS, death or persist vegetate status outcome at discharge. Results: The study involved 48 male and 22 female patients (male / female ratios 2.2:1). The series consist of 52 patients who experienced favorable outcome and 18 resulted from an unfavorable outcome. The mean of age for those patients was 20 years. The difference between males and females regarding favorable and unfavorable outcomes is insignificant. P-value was significant in cyanotic congenital heart diseases as cause of brain abscess were particularly prevalent among the children (adult VS children = 1:9). The most common site for single abscesses was the frontal lobe (25 patients), and majority of patients treated with burr hole drainage, which had the best results. Conclusion: Although there were technological improvement of imaging and antibiotics treatment, the mortality of brain abscesses is still relatively high, especially among those with decreased level of consciousness on admission.

Simultaneous brain and intramedullary spinal abscesses in a patient with Streptococcus intermedius infection

• Streptococcus intermedius is a known cause of brain abscesses. • Concurrent disseminated CNS infections in brain and spinal column is rare. • Imaging revealing either spinal or brain abscesses may prompt evaluation of other anatomical sites. A male patient in his thirties presented to the hospital with meningismus and altered mental status. Cerebrospinal fluid (CSF) analysis confirmed meningitis, but no microorganisms were identified. Head imaging (MRI) revealed multiple brain abscesses. Surgically-collected brain specimens revealed Gram-positive cocci and subsequently grew Streptococcus intermedius . MRI of the thoracic spine subsequently also identified an intramedullary spinal abscess. While brain abscesses and spinal abscesses caused by S. intermedius have been previously reported, the extent of disseminated disease in the patient was noteworthy.

Nocardia abscessus brain abscess in an immunocompetent patient with bronchiectasis

A 56 year-old woman presented with new onset focal seizure with a history of bronchiectasis. Brain abscess was diagnosed by magnetic resonance. She was confirmed to be immunocompetent and had histoplasmosis, tuberculosis, and infective endocarditis ruled out. Nocardia sp. was isolated from the brain abscess and identified as Nocardia abscessus complex by 16S rRNA sequencing. She was discharged on trimethoprim/sulfamethoxazole. Nocardia sp. is a cause of brain abscesses in patients with underlying pulmonary structural disease like bronchiectasis. Nocardia identification is of paramount importance as it is not treated with empiric antimicrobial therapy.

Nocardia abscessus brain abscess in an immunocompetent patient with bronchiectasis

A 56 year-old woman presented with new onset focal seizure with a history of bronchiectasis. Brain abscess was diagnosed by magnetic resonance. She was confirmed to be immunocompetent and had histoplasmosis, tuberculosis, and infective endocarditis ruled out. Nocardia sp. was isolated from the brain abscess and identified as Nocardia abscessus complex by 16S rRNA sequencing. She was discharged on trimethoprim/sulfamethoxazole. Nocardia sp. is a cause of brain abscesses in patients with underlying pulmonary structural disease like bronchiectasis. Nocardia identification is of paramount importance as it is not treated with empiric antimicrobial therapy.

Pseudomonas Pseudoalcaligenes Caused Otogenic Cerebellar Brain Abscess In Indonesian Child

Otogenic brain abscess is a common intracranial complication from chronic supurative otitis media.Pseudomonas pseudoalcaligenes is a rare cause of brain abscess. Prompt diagnosis and decision making issignificant in order to decrease the mortality rate from this type of abscess. We described A 13-year-old boypresented with decreased consciousness, positive meningeal signs, and pathological reflexes. There was ahistory of chronic suppurative otitis media. A head CT scan revealed multiple left cerebellar abscesses andbrain edema. The abscess wall culture revealed P. pseudoalcaligenes. After being managed with surgicalabscess drainage, mastoidectomy, ear flushing, and antimicrobial therapy for six weeks, his consciousnesslevel improved. Cerebellar neurological impairment was still observed. Physical and neurologicalrehabilitation was performed in order to improve the patient’s condition.

Clinical Presentation, Management, and Outcomes of Patients With Brain Abscess due to Nocardia Species.

BackgroundNocardial brain abscesses are rare, and published literature describing brain abscesses due to Nocardia species is limited to individual case reports or small series. We report one of the largest contemporary retrospective studies describing risk factors, diagnostic evaluation, management, and outcomes of nocardial brain abscess.MethodsRetrospective review of all adults with brain abscess due to culture-confirmed Nocardia species at our institution between January 1, 2009, and June 30, 2020.ResultsOverall, 24 patients had nocardial brain abscesses during the study period. The median age at presentation was 64 years, and 62.5% were immunocompromised. Pulmonary and cutaneous infections were the most common primary sites of nocardial infection. All 24 patients had magnetic resonance imaging performed, and the frontal lobe was the most commonly involved. The most common organism isolated was Nocardia farcinica, followed by Nocardia wallacei and Nocardia cyriacigeorgica. Thirteen patients were managed with antimicrobial therapy alone, while 11 had both medical and surgical management. In all patients, dual therapy was recommended for the initial 6 weeks of treatment, and 22 patients received at least 1 oral agent as part of their final antibiotic regimen, predominantly trimethoprim-sulfamethoxazole and linezolid. Fourteen patients achieved complete clinical and radiographic resolution of infection.Conclusions Nocardia is an important cause of brain abscess in the immunocompromised host. Early diagnostic and therapeutic aspiration may help health care providers confirm the diagnosis, choose an appropriate antimicrobial regimen, and achieve source control.

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.

&lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; Brain Abscess and Endophthalmitis after Acute Epiglottitis

&lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; is an unusual cause of brain abscess. Among the few cases of &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; brain abscess that have been reported, most were associated with another underlying primary focus of infection. Endogenous endophthalmitis caused by &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; is an infrequent but often devastating septic metastatic infection. We report a rare case of &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; brain abscess and endophthalmitis after acute epiglottitis.

Unusual cause of Brain Abscess in Paediatric Age Group

Unusual cause of Brain Abscess in Paediatric Age Group

Group A Streptococcus Brain Abscess in a Patient on Adalimumab Therapy

Brain abscesses represent a group of dangerous infections typically caused by a number of classic organisms. Group A Streptococcus is a rare cause of brain abscesses and those patients that do have this particular condition will typically have a distal source of infection. We present a case of patient with a biopsy confirmed Group A Streptococcal without a distal source of infection. His only identifiable risk factor was his adalimumab therapy for ankylosing spondylitis. While adalimumab has not been linked to Streptococcal infection in the past, it has been associated with multiple atypical infections and some of the consequences of its mechanism as a tissue necrosis factor alpha inhibitor can theoretically predispose patients to Streptococcal infection when considered in conjunction with known Streptococcal virulence factors. This case raises the question of whether the patient’s adalimumab therapy may have contributed to his unusual presentation of Streptococcal infection and prompts further consideration and study of the risks of adalimumab and other similar immunosuppressant monoclonal antibodies.

Multiple brain abscesses treated by extraction of the maxillary molars with chronic apical lesion to remove the source of infection

BackgroundBrain abscess is a life-threatening condition that occurs due to complications during a neurosurgical procedure, direct cranial trauma, or the presence of local or distal infection. Infection in the oral cavity can also be considered a source of brain abscess.Case presentationA 45-year-old male patient was transported with brain abscess in the subcortical white matter. Navigation-guided abscess aspiration and drainage was performed in the right mid-frontal lobe, but the symptoms continued to worsen after the procedure. A panoramic radiograph showed alveolar bone resorption around the maxillary molars. The compromised maxillary molars were extracted under local anesthesia, and antibiotics were applied based on findings from bacterial culture. A brain MRI confirmed that the three brain abscesses in the frontal lobe were reduced in size, and the patient’s symptoms began to improve after the extractions.ConclusionThis is a rare case report about multiple uncontrolled brain abscesses treated by removal of infection through the extraction of maxillary molars with odontogenic infection. Untreated odontogenic infection can also be considered a cause of brain abscess. Therefore, it is necessary to recognize the possibility that untreated odontogenic infection can lead to serious systemic inflammatory diseases such as brain abscess. Through a multidisciplinary approach to diagnosis and treatment, physicians should be encouraged to consider odontogenic infections as a potential cause of brain abscesses.

Brain abscess in a kidney transplant recipient due to an unusual fungal infection: A case report and review

Invasive mycosis is a serious complication of solid organ transplantation. Fungal infections even if appropriately diagnosed and treated with current antifungal agents, have a high mortality rate. A high index of suspicion is required and an attempt should be made to confirm the microbiological diagnosis from each site involved to rule out multiple infections. We report here a 41-year-old allograft recipient, who presented with fever associated with chills and one episode of generalized tonic clonic seizure 1-year post transplantation. Neuroimaging revealed a brain abscess, stereotactic biopsy from which yielded Scedosporium apiospermum on fungal culture. Whole blood quantitative cytomegalovirus (CMV) polymerase chain reaction done was positive. He also developed pulmonary aspergillosis and secondary hemophagocytosis later in the course of his hospital stay. His tacrolimus and mycophenolate were stopped and he was managed with i.v ganciclovir, amphoterecin b, voriconazole, high dose i.v immunoglobulins and surgical draingae of abscess. With all measures, he showed improvement in his general and neurological condition and maintained good graft function. Scedosporium is a rare cause of brain abscess. CMV co-infection leads to increased chances of other opportunistic infections. Good microbiological workup from each site involved in immunosuppressed subjects is the need of the hour as early diagnosis can lead to lesser mortality and morbidity.