Empirical Medical Treatment Research Articles

Clinical perspective and outcome of culture-negative microbial keratitis: A retrospective study.

To study the risk factors, clinical features, and treatment outcomes of patients with culture-negative keratitis (CNK). A retrospective data review of 933 patients with CNK was performed from January 2018 to December 2020. The variables such as the history of injury, visual acuity, slit-lamp findings with measurements of size and depth of ulcer, microbiological evaluation, duct patency, blood glucose levels, and treatment were considered, and clinical outcome was analyzed. Of the 933 patients with CNK, 763 (81.8%) were medically managed, with a mean treatment duration of 2.08 ± 1.7 weeks. Among them, 622 (66.7%) were both smear and culture-negative, and 311 (33.3%) showed only smear positivity. Smear-positive patients showed a positive correlation with the history of injury. A higher incidence of fungal growth on repeat culture was observed. Surgical interventions were done only in 18.2% of the patients; the rest were treated with topical medications alone. High clinical suspicion, differentiation of causative organisms based on clinical findings, and initiating empirical therapy with broad-spectrum antibiotics and antifungals improve the ultimate prognosis in patients with CNK, even though a standard protocol for empirical medical treatment may differ among institutions and surgeons based on their clinical experience and geographical variations.

Reactivation of Disseminated Histoplasmosis With Central Nervous System Involvement Following a Primary Gastrointestinal Histoplasmosis Infection: A Case Report

A 78-year-old white male with chronic pancytopenia presented with acute transient aphasia and dysarthria. He had a National Institutes of Health Stroke Scale (NIHSS) of zero. Physical examination revealed slight aphasia with mild dysarthria. Brain magnetic resonance imaging (MRI) revealed nine ring-enhancing lesions in the left precentral gyrus with significant vasogenic edema. Lung computed tomography (CT) showed no evidence of pulmonary nodules. The serology of blood and urine for infectious organisms was negative. Four weeks later, the patient was re-admitted with worsening dysarthria and right upper extremity weakness. Repeat head MRI showed a slight increase in the size of the multiple supratentorial ring-enhancing lesions. The magnetic resonance spectroscopy (MRS) findings of the evaluated lesion suggested a fungal etiology. Empiric amphotericin B treatment was initiated, which mitigated central nervous system (CNS) ring-enhancing lesions and resolved the patient’s neurological deficits. Early empiric medical treatment of CNS histoplasmosis should be considered in the setting of multiple CNS ring-enhancing lesions and a positive history of histoplasmosis infection, despite negative serological studies.

Novel Potency Assay for MSC Secretome-Based Treatment of Idiopathic Male Infertility Employed Leydig Cells and Revealed Vascular Endothelial Growth Factor as a Promising Potency Marker.

Idiopathic male infertility is a highly prevalent diagnosis in developed countries with no specific treatment options. Although empirical medical treatment is widely used to restore male fertility, its efficacy remains limited and inconclusively proven. Therefore, the development of novel therapeutic approaches in this field is a high-priority task. Since the failure of testicular microenvironment components might be involved in the pathogenesis of idiopathic male infertility, application of mesenchymal stromal cells (MSCs) as well as the MSC secretome is worth considering. Previously, we showed that the intratesticular injection of MSCs or the MSC secretome led to the recovery of spermatogenesis at least through replenishing the testicular microenvironment and its maintenance by MSC-secreted paracrine factors. However, the clinical use of such products has been limited to single trials to date. This may be due to the lack of relevant potency tests reflecting mechanisms of action of the MSC secretome in male infertility models. Based on the presumptive MSC secretome mode of action on the testicular microenvironment, we suggest a novel approach to test the potential efficacy of the MSC secretome for idiopathic male infertility treatment. It represents a potency assay based on evaluation of testosterone production by isolated Leydig cells. We demonstrated that the MSC secretome stimulated testosterone secretion by Leydig cells in vitro. We then hypothesized that among the major factors of the MSC secretome, vascular endothelial growth factor (VEGF) could be responsible for the observed effects, which we confirmed by the revealed correlation between the extent of stimulated testosterone production and VEGF concentration in the MSC secretome. The pilot results obtained from the doxorubicin-induced male infertility murine model also indicate the important impact of VEGF in the MSC secretome’s regenerative effects. Utilizing VEGF as a surrogate factor, a novel approach to study the potency of MSC secretome-based products for idiopathic male infertility treatment is suggested. Further validation is required for its implementation into the biopharmaceutical manufacturing process.

Conservative Nonhormonal Options for the Treatment of Male Infertility: Antibiotics, Anti-Inflammatory Drugs, and Antioxidants.

The nonhormonal medical treatment can be divided into empirical, when the cause has not been identified, and nonempirical, if the pathogenic mechanism causing male infertility can be solved or ameliorated. The empirical nonhormonal medical treatment has been proposed for patients with idiopathic or noncurable oligoasthenoteratozoospermia and for normozoospermic infertile patients. Anti-inflammatory, fibrinolytic, and antioxidant compounds, oligo elements, and vitamin supplementation may be prescribed. Infection, inflammation, and/or increased oxidative stress often require a specific treatment with antibiotics, anti-inflammatory drugs, and/or antioxidants. Combined therapies can contribute to improve sperm quality.

Medical management of male infertility in the absence of a specific etiology.

Idiopathic male infertility can be diagnosis in approximately one-third of infertile males. The empirical medical treatment with or without assisted reproductive techniques appears common in male infertility practice. This type of management can be classified as hormonal treatment including gonadotropins, antiestrogens, and aromatase inhibitors and support with antioxidant supplements such as carnitine, lycopene, glutathione, and vitamin E. This review investigates the evidence of commonly used empirical medical management of male infertility when there is no demonstrable diagnosis.

Empirical medical therapy in idiopathic male infertility: Promise or panacea?

Male factors account for 20%-50% of cases of infertility and in 25% of cases, the etiology of male infertility is unknown. Effective treatments are well-established for hypogonadotropic hypogonadism, male accessory gland infection, retrograde ejaculation, and positive antisperm antibody. However, the appropriate treatment for idiopathic male infertility is unclear. Empirical medical treatment (EMT) has been used in men with idiopathic infertility and can be divided into two categories based on the mode of action: hormonal treatment and antioxidant supplementation. Hormonal medications consist of gonadotropins, androgens, estrogen receptor blockers, and aromatase inhibitors. Antioxidants such as vitamins, zinc, and carnitines have also been widely used to reduce oxidative stress-induced spermatozoa damage. Although scientifically acceptable evidence of EMT is limited because of the lack of large, randomized, controlled studies, recent systematic reviews with meta-analyses have shown that the administration of gonadotropins, anti-estrogens, and oral antioxidants results in a significant increase in the live birth rate compared with control treatments. Therefore, all physicians who treat infertility should bear in mind that EMT can improve semen parameters and subsequent fertility potential through natural intercourse.

Clinical Application of a Microbiological Study on Chronic Suppurative Otitis Media

Our prospective study conducted over a period of 9 months includes 100 samples of ear discharge collected from 90 patients suffering from tubo-tympanic type of chronic suppurative otitis media (CSOM). The ear discharge which is collected with sterile swabs is subjected to Gram’s staining and culture of the causative organism. Antibiotic sensitivity test of cultured bacterial growth is undertaken to know the susceptibility of the causative organism. Of the 100 samples, 62 were culture positive where Pseudomonas aeruginosa was the most common pathogen followed by Staphylococcus aureus. Most of the cultured organisms in our study were sensitive to drug Ciprofloxacin. The outcome of our study enabled us to set an empirical medical treatment for an early resolution of ear discharge and inflammation in our patients with CSOM as we could understand the aetiological pathogens and their susceptibility pattern. Effective medical treatment in obtaining a discharge free ear prior to surgical treatment led us to improve the surgical outcome in our patients with CSOM.

Importance of Relieving the Most Bothersome Symptom for Improving Quality of Life in Male Patients With Lower Urinary Tract Symptoms

To highlight the importance of relieving the most bothersome symptom for improving quality of life (QoL) in male patients with lower urinary tract symptoms. From January 2010 to March 2011, 242 men with lower urinary tract symptoms visited our clinic, and 194 finished this study. At first visit, the most bothersome symptom was selected as the "core symptom." The sum of other symptoms except the core symptom was defined as "peripheral symptoms." All patients underwent empirical medical treatment for male lower urinary tract symptoms during an 8- to 12-week period, thereafter, recorded a follow-up International Prostate Symptom Score (I-PSS) questionnaire. We multivariately analyzed the patients' data after medical treatment to assess the influence of relieving their core symptom on the improvement of QoL. The patients' mean age was 64.7 years and the mean total I-PSS was 19.7 points. Nocturia was the most common core symptom (29.9%), followed by weak stream (16.5%). Multiple logistic regression revealed that relieving the core symptom (odds ratio [OR] = 39.163, 95% confidence interval [CI] = 13.536-113.309) was significantly associated with QoL improvement. Improvement of peripheral symptoms (OR = 4.849, 95% CI = 1.629-14.433) and the inclusion of the moderate symptom group at first visit (OR = 2.622, 95% CI = 1.009-6.811) were also significant factors in predicting QoL improvement. In treating benign prostatic hyperplasia or lower urinary tract symptoms, we should focus more on relieving the individual patient's most bothersome symptom to help improve patient QoL.

Dyspareunia in gynaecological practice

Dyspareunia is a form of sexual dysfunction that can significantly affect quality of life and cause relationship difficulties. It is a symptom of a variety of disease states with components of both physical and organic dysfunction. Obtaining a comprehensive sexual history in an outpatient setting requires a high level of professionalism. A systematic examination of the lower genital tract is necessary to rule out any obvious cause, though further investigations such as ultrasound infrequently provides additional information. Diagnostic laparoscopy is an invasive procedure that is of limited use in the first line investigation of dyspareunia but may help detect pelvic adhesions or endometriosis in those where this condition is suspected. Before embarking on a laparoscopy it is important for the patient to be aware of a management plan in the event that the laparoscopy is negative. There are data to suggest that empirical medical treatment after a clinical diagnosis of endometriosis is effective and has the advantage of avoiding any invasive procedures. Psychosexual causes are important to consider during the assessment of the patient experiencing dyspareunia.

Comparative analysis of tuberculous and brucellar spondylodiscitis

Our aim was to compare the clinical, radiological and prognostic features of spontaneous spondylodiscitis secondary to tuberculosis (TS) and brucellosis (BS). This prospective study involved 41 patients diagnosed with spondylodiscitis. Of these, 18 (43.1%) had BS and 23 (56.1%) had TS. The mean age of TS patients was 52 ± 13.43 years and older than BS patients (P < 0.001). A prolonged clinical course of the disease, constitutional symptoms, lymphocytosis, increased erythrocyte sedimentation rate (ESR), presence of posterior vertebrae lesions and psoas abscesses were significantly more frequent in the TS group. There are significant clinical, biological and radiological differences between TS and BS. These differences permit a presumptive aetiological diagnosis and orient the initial empirical medical treatment while awaiting a final microbiological diagnosis.

Evaluation and Management of Laryngopharyngeal Reflux

Laryngopharyngeal reflux (LPR) is a major cause of laryngeal inflammation and presents with a constellation of symptoms different from classic gastroesophageal reflux disease. To provide a practical approach to evaluating and managing cases of LPR. The PubMed database and the Ovid Database of Systematic Reviews were systematically searched for laryngopharyngeal reflux, laryngopharyngeal reflux fundoplication, laryngopharyngeal reflux PPI treatment, and gastroesophageal reflux AND laryngitis. Pertinent subject matter journals and reference lists of key research articles were also hand-searched for articles relevant to the analysis. Reflux of gastric contents is a major cause of laryngeal pathology. The pathophysiology and symptom complex of LPR differs from gastroesophageal reflux disease. Laryngeal pathology results from small amounts of refluxate--typically occurring while upright during the daytime--causing damage to laryngeal tissues and producing localized symptoms. Unlike classic gastroesophageal reflux, LPR is not usually associated with esophagitis, heartburn, or complaints of regurgitation. There is no pathognomonic symptom or finding, but characteristic symptoms and laryngoscopic findings provide the basis for validated assessment instruments (the Reflux Symptom Index and Reflux Finding Score) useful in initial diagnosis. There are 3 approaches to confirming the diagnosis of LPR: (1) response of symptoms to behavioral and empirical medical treatment, (2) endoscopic observation of mucosal injury, and (3) demonstration of reflux events by impedance and pH-monitoring studies and barium swallow esophagram. While pH monitoring remains the standard for confirming the diagnosis of gastroesophageal reflux, the addition of multichannel intraluminal impedance technology improves diagnostic accuracy for describing LPR events. Ambulatory multichannel intraluminal impedance assessment allows for identification of gaseous as well as liquid refluxate and detection of nonacid reflux events that are likely significant in confirming LPR. Although some patients respond to conservative behavioral and medical management, as is the case with gastroesophageal reflux, most require more aggressive and prolonged treatment to achieve regression of symptoms and laryngeal tissue changes. Surgical intervention such as laparoscopic fundoplication is useful in selected recalcitrant cases with laxity of the gastroesophageal sphincter. Laryngopharyngeal reflux should be suspected when the history and laryngoscopy findings are suggestive of the diagnosis. Failure to respond to a 3-month trial of behavioral change and gastric acid suppression by adequate doses of proton pump inhibitor medication dictates need for confirmatory studies. Multichannel intraluminal impedance and pH-monitoring studies are most useful in confirming LPR and assessing the magnitude of the problem.

Overlap Syndromes

In hepatology, the term overlap syndrome describes variant forms of the major hepatobiliary autoimmune diseases, autoimmune hepatitis (AIH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC). Patients with overlap syndromes present with both hepatitic and cholestatic biochemical and histological features of AIH, PBC, and/or PSC, and usually show a progressive course toward liver cirrhosis and liver failure without adequate treatment. AIH-PBC overlap syndromes have been reported in almost 10% of adults with AIH or PBC, whereas AIH-PSC overlap syndromes were found in 6 to 8% of children, adolescents, and young adults with AIH or PSC. A minority of patients may also show transition from stable PBC to AIH, AIH to PBC, or AIH to PSC, as documented by single case reports and small case series. Single cases of AIH and autoimmune cholangitis (antimitochondrial antibody-negative PBC) overlap have also been reported. Empiric medical treatment of AIH-PBC and AIH-PSC overlap syndromes includes anticholestatic therapy with ursodeoxycholic acid and immunosuppressive therapy with corticosteroids and azathioprine. In end-stage disease, liver transplantation is the treatment of choice.

Appropriateness and diagnostic yield of EGD: a prospective study in a large Asian hospital

Background The appropriateness has become an important issue as the use of EGD becomes more widespread. No study of the appropriateness of EGD has been performed in the Asia-Pacific region. This study examined the appropriateness of EGD in a large Asian hospital by using the American Society for Gastrointestinal Endoscopy 2000 guidelines. A secondary aim was to correlate appropriateness with the presence of positive findings at EGD. Methods A cross-sectional study was conducted of consecutive diagnostic EGDs performed at a university-affiliated, teaching hospital, which has an open-access endoscopy system for doctors who work in the hospital. The main indication(s) for EGD was recorded and assessed as appropriate or inappropriate by using American Society for Gastrointestinal Endoscopy criteria. EGD findings were recorded and classified as positive or negative. Referrals were categorized as being from endoscopists, primary care physicians, and others. Results Of 1076 referrals for EGD, 88.3% were deemed appropriate. The group with the highest rate of appropriate referral was endoscopists (90.2%), followed by primary care physicians (89.6%) and “others” (81.9%). The rate of appropriate referrals was significantly higher for endoscopists and primary care physicians compared with “others” (respectively, p = 0.001 and p = 0.022). The most common appropriate indication was “upper abdominal distress that persists despite an appropriate trial of therapy” (35.4%). The most common inappropriate indication was “dyspepsia in patients aged 45 years or below without adequate empirical medical treatment” (48.4%); 42.2% with an appropriate indication had positive findings compared with only 25.6% of those with inappropriate indications ( p = 0.006). On multivariate analysis, the following were identified as independent predictive factors for positive findings at EGD: male gender ( p = 0.005), age over 45 years ( p = 0.011), smoking ( p = 0.005), none/primary education ( p<0.001), and secondary education ( p = 0.026). Conclusions The proportion of patients referred for open-access EGD with an appropriate indication(s) was high for all doctor groups in a large university-affiliated medical center in Asia. EGDs performed for appropriate indications had a higher yield of positive findings. Independent predictive factors of positive findings were male gender, age over 45 years, lower education level, and referral by an endoscopist.

Dyspareunia in gynaecological practice

Dyspareunia is a form of sexual dysfunction that can significantly affect quality of life and cause relationship difficulties. It is a symptom of a variety of disease states with components of both physical and organic dysfunction. Obtaining a good sexual history in an outpatient setting requires a high level of professionalism. A systematic examination of the lower genital tract is necessary to rule out any obvious cause, although further investigations such as ultrasound do not often offer additional information. Diagnostic laparoscopy is an invasive procedure that is of limited use in the management of dyspareunia, but may help detect pelvic adhesions or endometriosis in those where this condition is suspected. Before embarking on a laparoscopy, it is important for the patient to be aware of a management plan if the laparoscopy does not show any obvious cause. There are data to suggest that empirical medical treatment after clinical diagnosis of endometriosis is effective and has the advantage of avoiding any invasive procedures. Psychosexual causes are important to consider during assessment of the patient experiencing dyspareunia.

Role of Gastroesophageal Reflux in Older Children With Persistent Asthma

Gastroesophageal reflux (GER) plays a role in inducing or exacerbating asthma. We evaluated asthma outcome before and after anti-GER treatment in older children (age range, 5 to 10.5 years) who had persistent moderate asthma and were being treated with short- and long-acting bronchodilators, inhaled corticosteroids, and leukotriene antagonists. Forty-six such consecutive children underwent extended esophageal pH monitoring. Of the 27 patients (59%) who had evidence of GER disease, 18 patients underwent medical treatment (lifestyle changes, proton pump inhibitors, and prokinetics) and 9 patients opted for surgical treatment (Nissen fundoplication) of GER. Of the 19 patients with normal pH study findings, 8 patients underwent empiric medical anti-GER treatment and the remaining 11 patients served as a control group. Data on all patients were collected from 6 months prior to performing the pH studies and for 12 months after initiation of anti-GER treatment. The frequency of oral and inhaled corticosteroids, short- and long-acting bronchodilators, and leukotriene antagonists was prospectively recorded. There was a significant reduction in the use of short- and long-acting bronchodilators as well as inhaled corticosteroids after anti-GER treatment was instituted in patients with GER disease (p < 0.05). Two patients (25%) without evidence of GER disease showed significant reduction in need for asthma medication after anti-GER treatment, but none of the patients without GER disease and no GER treatment showed any significant reduction in the need for asthma medications. Anti-GER treatment in patients with GER disease and asthma results in a significant reduction in the requirement of asthma medications.

Should doctors be the judges of medical orthodoxy? The Barker case of 1920

The continuing rise of complementary medicine, with a sympathetic report from the House of Lords1, provides an incentive for revisiting an incident in the early twentieth century when the issues of empirical and orthodox medical treatment exploded into the public arena. Empirical treatment was represented by Mr Herbert Barker, a bonesetter, and the extent to which his activities had penetrated to the core of public life is illustrated by the transcript of the discussion of the Parliamentary Standing Committee dealing with the Dentists Bill in June 19212. Colonel Wedgwood (Newcastle-under-Lyme), who throughout the discussion was vocal in defence of liberty, pointed out that the Bill as it stood made dentists different from doctors, for they would not be permitted to practise even without fee or reward unless registered. He said: ‘We know that in the case of the medical profession, men like Barker, the bone-setter, can continue to practise without being fined, so long as they have no legal right to claim payment of fees. I believe Barker does bone-setting rather better than some of the registered practitioners. Does this mean that if a Barker springs up in the dental profession and cures people of the tooth-ache without the usual paraphernalia of pincers, and so forth, he will be fined £100, or will he be able to practise as long as he has not the legal right to recover fees? In other words, are you making a distinction between the dental profession and the medical profession?’ In reply Sir Kingsley Wood (Woolwich, West), said, ‘Future practitioners must comply with the regulations and examinations of the Board, but I hope that if a Barker does arise he will be just as successful with the Dental Association as he has been in the medical world.’ So who was Barker, and just how successful was he with the medical world? The account that follows of the extraordinary events that surrounded Herbert Atkinson Barker (Figure 1) in 1920 and 1921, and which led to his name being so familiar that he could be used as the stereotype empiricist, is gleaned mainly from a press cuttings file at Lambeth Palace (Davidson Papers Vol. 404) and from Barker's autobiography3. Figure 1 Herbert Atkinson Barker. Augustus John. 1916 [By courtesy of the National Portrait Gallery, London]

Evaluation and treatment of oligoasthenospermia in the era of assisted reproductive techniques

The management of oligoasthenospermia has undergone changes in this era of assisted reproductive techniques (ART), bringing hope for previously untreatable cases of oligospermia. However, the overenthusiastic use of ART has deprived some patients of primary treatment for their disease. Oligoasthenospermia is the most common identifiable anomaly found in semen analysis, and it can be treated or improved in many cases. The patient deserves a chance to be evaluated and helped, and a specific treatment should be offered to achieve pregnancy whenever available. Where this is not possible, suitable candidates should be selected for empirical medical treatment. The aim of pharmacological treatment is to improve the sperm concentration and the fertility potential of sperms. This twofold approach is helpful in both natural and assisted fertilization. ART are, however, an excellent alternative when other therapies fail.

Treatment of infantile spasms: An evidence-based approach

The object of this work was to subject established empirical medical treatment regimens for infantile spasms to evidence-based medicine analysis in order to determine the current best practice for the treatment of infantile spasms in children. Clinical studies of infantile spasms reported during the presteroid era were reviewed critically to define the natural history of the disorder. Treatment trials of infantile spasms conducted since 1958 were rigorously assessed using MEDLINE and hand searches of the English language literature. Inclusion criteria were the documented presence of infantile spasms and hypsarrhythmia. Outcome measures included complete cessation of spasms, resolution of hypsarrhythmia, relapse rate, developmental outcome, the presence or absence of epilepsy, and/or an epileptiform electroencephalogram. Evidence was defined as class I, II, or III, and practice parameter recommendations were made using the framework devised by the American Academy of Neurology. Class I and III evidence support a standard of practice recommendation for the use of vigabatrin in the treatment of infantile spasms in children with tuberous sclerosis. Class I and III evidence support a guidelines recommendation for the use of either ACTH or vigabatrin in infantile spasms in nontuberous sclerosis patients. There is no strong evidence that successful treatment of infantile spasms improves the long-term prognosis for cognitive outcome or decreases the incidence of later epilepsy. A practice option recommendation for the use of oral corticosteroids in the treatment of infantile spasms is supported by limited and inconclusive class I and III data. Based on the evidence, no recommendation can be made for the use of pyridoxine, benzodiazepines, or the newer antiepileptic drugs in the treatment of infantile spasms. ACTH and vigabatrin are the most effective agents in the treatment of infantile spasms, but concerns remain about the risk/benefit profiles of these drugs.

A Review of Bowel and Bladder Control Development in Children: How Gastrointestinal and Urologic Conditions Relate to Problems in Toilet Training

Urologic and gastrointestinal problems in children are of great concern to parents. In most cases, such problems represent no organic disease or serious behavior disorder but nevertheless can cause more serious complications in toilet training than parents recognize. Although bowel and bladder symptoms in otherwise healthy children typically are transient, untreated issues can spiral into physical, behavioral, and developmental problems that disrupt toilet training and maintenance of bowel and/or bladder continence. Chronic wetting and soiling may persist well into the school years and often are refractory to empirical medical treatment. Clinical experience, however, suggests that in most children these problems can be managed successfully within the realm of general pediatric practice. Two important tools for evaluation are available to the pediatrician: good normative data on bowel and bladder function in children, and management algorithms for toilet training that emphasize pathophysiologic patterns within the context of normal development. Interventions emphasize early anticipation, breaking predictable behavioral and dietary cycles that can turn acute problems into chronic problems. This is especially important during the toilet training years. Almost all children have wetting and/or soiling accidents at one time or another. As with other models of developmental milestones, transient regressions or delays in toilet training logically can be expected. Bowel maturation typically precedes bladder maturation, which is not surprising, given the respective complexities of the developmental processes.1 An estimated 15% to 20% of children will become partially toilet trained but continue to have wetting accidents after age 5.2,,3 Additionally, at least 20% of developmentally normal children 18 to 30 months of age may refuse stool toilet training at some point.4 ### Encopresis Children with encopresis (chronic fecal soiling at age 4 and older) typically soil during the day and are unaware of and unable to control their soiling accidents.5 Soiling …

Multiple Brain Abscesses at King Khalid University Hospital

The authors reviewed six cases of multiple brain abscesses that were treated at King Khalid University Hospital (KKUH) over an eight year period. This represented 22% of the total brain abscesses treated during the same period. The series is unusual in that the infective pathogens were fungi (Fonsecaea pedrosoi) in two patients (33%) and an aerobic actinomycete (Nocardia asteroides) in one patient (16%). Two patients treated elsewhere with antibiotics empirically for one month died at three and 28 days following admission. The poor outcome was probably related t the delay in obtaining a microbiological diagnosis and commencing the appropriate antimicrobial therapy. The importance of early identification of the pathogen in patients with multiple brain abscesses is stressed.