Incidence Of Brain Abscess Research Articles

Cerebral Abscess In A Child With Unknown Origin Of Infection

Introduction: The incidence of brain abscesses is higher in developing countries. The classic triad of fever, headache, and focal neurological signs was seen in 9–28% of the pediatric cases. Brain abscesses occur infrequently with potentially life-threatening conditions. Case Report: The patient was a child 1 year 8 months old with a main complaint of weakness in the left arm and leg progressively for one month. She had a local seizure on her left arm and leg one month before admission with a duration of 30 minutes. She was irritable for the last two weeks. The strength of the upper and lower extremities was 3 respectively. The physiology reflex was hyper-reflex on the upper and lower extremities. A Head non-contrast CT scan showed a hypodense lesion on the right parietal with a perifocal edema lesion. A head contrast CT scan showed a hypodense lesion on the right parietal with ring enhancement measuring approximately 6,2 cm x 4,5 cm. Craniotomy evacuation abscess with near total capsulectomy was done on initial and capsule resection was done. Discussion: Brain abscess is a focal pyogenic infection of the brain parenchyma, and the frontotemporal lobe is the most common site of brain abscess, followed by frontal-parietal, parietal, occipital lobes, and cerebellar. The most common risk factors that predispose a child to the formation of a brain abscess include congenital heart disease, sinus and otogenic infections, and poor dental hygiene. The triad of brain abscess, including headache, fever, and neurological symptoms is only present in (15%) of the cases reported. Medical treatment is recommended in patients without increased intracranial pressure, with symptoms of less than 1 week long and abscess of less than 2 cm seen in tomography. The suggested time of treatment is between 6 and 8 weeks with intravenously administered antibiotics. A full recovery rate from the infection of about 60–70% is reported in the case of early diagnosis and proper therapy Conclusion: Cerebral abscess in pediatrics with unknown origin of infection may happen in 12%. Early diagnosis and treatment of pediatric cerebral abscesses can reduce morbidity and mortality rates. A broadspectrum antibiotic is an optimal treatment in the postoperative evacuation of cerebral abscess cases with unknown origin infection.

Brain abscess incidence and microbial etiology in Turkey: a nationwide cross-sectional study.

Brain abscess, a localized purulent central nervous system infection, arises from a variety of microorganisms. Expedited diagnosis and formulation of effective treatment strategies are crucial for mitigating mortality risks in patients with brain abscesses. A nuanced understanding of potential microbial agents is pivotal for the development of empirical antibiotic therapies. This study aimed to explore the incidence and microbial etiology of brain abscesses. This study is a nationwide cross-sectional analysis of patients diagnosed with brain abscesses in Turkey, employing the ICD 10 diagnosis code from January 1, 2015, to December 31, 2021. Data pertaining to age, sex, comorbidities, and microorganisms isolated from central nervous system samples were meticulously recorded and analyzed. This study included 11,536 patients diagnosed with brain abscesses. The incidence fluctuated between 0.98 and 3.68 during the review decrease post-2017, with a notable increase in male patients during time. Diabetes constituted 56.5% of the patients. The predominant isolated pathogens were Staphylococcus (37.6%), Streptococci (13.3%), and Klebsiella spp. (7.8%), Escherichia coli (6.4%), and Candida species (6.1%). The incidence of brain abscesses is decreasing in Turkey. Although staphylococci remain the most isolated agents, the frequent occurrence of Gram-negative bacteria and Candida species warrants consideration during empirical antibiotic selection.

Antibiotic use and serious complications following acute otitis media and acute sinusitis: a retrospective cohort study.

Most people with acute otitis media (AOM) and acute sinusitis (AS) do not benefit from antibiotics, and GPs are under increasing pressure to reduce antibiotic prescribing. Concern about the risk of complications can drive unnecessary prescribing. To describe the incidence of serious complications following AOM and AS, and to determine whether antibiotics are protective. This was a retrospective cohort study using the Clinical Practice Research Datalink database to identify patients diagnosed in general practice with AOM or AS between 1 January 1982 and 31 December 2012. The incidence of brain abscess and acute mastoiditis following AOM, and of brain abscess and orbital cellulitis following AS, were calculated, as was the association between antibiotics and the development of these complications and numbers needed to treat (NNT). The incidence of brain abscess and acute mastoiditis following AOM were 0.03 (95% confidence interval [CI] = 0.01 to 0.20) and 5.62 (95% CI = 4.81 to 6.56) per 10 000 AOM episodes, respectively. The incidence of brain abscess and orbital cellulitis following AS was 0.11 (95% CI = 0.05 to 0.26) and 1.50 (95% CI = 1.17 to 1.90) per 10 000 AS episodes, respectively. Antibiotic prescription for AOM was associated with lower odds of developing acute mastoiditis (odds ratio [OR] 0.54; 95% CI = 0.37 to 0.79); NNT to prevent one case was 2181 (95% CI = 1196 to 5709). Antibiotic prescribing for AS was associated with lower odds of subsequent brain abscess (OR 0.12; 95% CI = 0.02 to 0.70); NNT to prevent one case was 19 988 (95% CI = 4951 to 167 099). No significant association between antibiotic prescription and development of orbital cellulitis following AS were found (OR 0.56; 95% CI = 0.27 to 1.12). Serious complications following AOM and AS are rare. Antibiotics are associated with lower odds of developing complications, but the NNT are large.

Outcome of management of brain abscess in children.

Objective:To find out the outcome of management of brain abscess in children.Methods:This is prospective observational study conducted in the Department of Paediatric Neurosurgery at Children’s Hospital and Institute of Child Health, Multan from July 2014 to June 2017. Children up to the age of 14 years suffering from brain abscess were admitted. After taking clinical history, general and systemic physical examination and necessary investigations, abscess was evacuated and abscess wall excised after performing craniotomy. Data was collected on a predesigned performa. Results were analyzed and compared with national and international literature through statistical package for social sciences (SPSS-20).Results:Twenty five patients up to 14 years of age were included. Seventeen (68%) were male and eight (32%) female. Fever and vomiting were present in all 25 (100%) patients. Paranasal sinusitis was predisposing causative factor in 9(36%) followed by otitis media in 7 (28%). Abscess was present in frontal lobe in 9 (36%), temporoparietal region in 8 (32%), posterior fossa in 5 (20%) and multiple abscesses in 3 (12%). Craniotomy was performed, pus evacuated and abscess wall excised in all 25 (100%) patients. Three (12%) patients expired.Conclusion:Incidence of brain abscess can be decreased by treatment of its predisposing causes as sinusitis and otitis media. Small abscess less than 2cm can be treated with antibiotics. Complete evacuation of pus and excision of abscess wall after performing craniotomy along with appropriate antibiotics is gold standard management of brain abscess in children.

A Brain Tumor Mimicking Brain Abscess

A brain tumor could be mimicking brain abscess in some cases. Not just in imaging but also both of has a similar symptoms, physician must anamnesis properly and run several tests. A brain abscess is an intraparenchymal collection of pus. The incidence of brain abscesses is approximately 8% of intra-cranial masses in developing countries and 12% in the western countries. In this case, we reports a male patient with gradually left hemiplegia, left deviation of tongue, left hemifacial paresis, and visual hallucination and psychological disturbance. Initial imaging showed the possibilities of space occupying lessions (SOL) with suspect to Astrocytoma. But, based from the history taking, there is bad habit of oral hygiene, that the patient usually sticks his gum with tooth stick and after confirmation from second head CT scan with contrast enhancement, confirmed right cerebral abscess with perifocal oedem. After 2 weeks empirical antibiotic therapy, there is significant clinically improvement. But, after we confirm with second Head CT scan with contrast enhancement, there is a very minimum decreased size of the abscess lesion, so surgical drainage is indicated. We collect Xanthochromic liquid from surgical drainage (not purulent), and from microscopic evaluation inflammation lesion confirmed. But by microbiological culture, there is no growth of aerobic bacteria from drainage liquid culture, we assume because of empirical antibiotic therapy was started before the microbiological culture test. After surgical drainage, there is no complication, and clinical become more improve.

New insights into Citrobacter freundii sepsis in neonates.

The aim of this study was to investigate the clinical features of neonatal sepsis caused by Citrobacter freundii as well as the current status and treatment strategy for multi-drug resistance of infection with this bacterium. Nine newborns were diagnosed with C.freundii sepsis between January 2014 and December 2017. We collated and analyzed a range of data for these nine patients, including general information, laboratory tests during infection, blood culture and treatment. One of the patients died after only 7h of infection. In the remaining eight cases, three patients developed meningitis, although none had brain abscess. A reduction of white blood cells (WBC) was detected <24h after the start of infection, compared with at 48-72h, when WBC count had increased and platelets progressively decreased. In all nine cases the infection was susceptible to tigecycline and was resistant to cephalosporins, carbapenems, and quinolones. In eight cases the infection was susceptible to co-trimoxazole and in the other case it was susceptible to amikacin. Of the eight patients who were cured, three received meropenem, two received ceftriaxone, one received amikacin, and two received tigecycline. Reduction in WBC could take place in the early stages of C.freundii infection in newborns. The incidence of brain abscess was not high, but multi-drug resistance was common. Some non-sensitive drugs can also treat C.freundii sepsis effectively.

Neuroradiological worsening of brain abscess after adalimumab and methotrexate withdrawal: Do not forget Immune Reconstitution Inflammatory Syndrome

The incidence of brain abscess is higher among immunosuppressed patients. We report a case of a brain abscess in the temporal lobe in a patient under treatment with adalimumab and methotrexate, who developed radiological worsening. Clinical remission was essential to suspect Immune Reconstitution Inflammatory Syndrome and to continue empirical antimicrobial therapy due to the low suspicion of worsening of the abscess itself.

Brain and Spinal Epidural Abscess

Brain abscesses and spinal epidural abscesses are serious, potentially life-threatening infections of the central nervous system. This article outlines the clinical presentation, evaluation, and management of brain abscesses and spinal epidural abscesses, with a specific focus on bacterial infections. The overall incidence of brain abscesses has declined, in part because of fewer brain abscesses associated with otogenic infections. However, emerging patient populations at high risk for brain abscess include those with a history of penetrating head trauma, neurosurgery, or immunodeficiency. Improved mortality rates for brain abscess are attributable to modern diagnostic imaging, stereotactic-guided aspiration, and newer antimicrobials that readily penetrate into the central nervous system and abscesses. Brain MRI is more sensitive than CT for brain abscess, particularly in the early stages, but CT remains more widely available and can adequately identify potential abscesses and confirm response to treatment. With the advent of minimally invasive neurosurgical techniques, surgical excision is often employed only for posterior fossa, multiloculated, or superficial well-circumscribed abscesses. In select clinical scenarios, conservative medical management may be a safe alternative to a combined surgical and medical approach. Unlike brain abscess, the incidence of spinal epidural abscess is on the rise and has been attributed to higher prevalence of predisposing factors, including spinal procedures and instrumentation. Successful diagnosis and management of brain abscess and spinal epidural abscess requires a collaborative approach among neurologists, neurosurgeons, radiologists, and infectious disease physicians. The foundation of management of brain abscess includes surgical intervention for diagnostic purposes if a pathogen has not been identified or for decompression of larger abscesses or those with mass effect and significant surrounding edema; appropriate dosing and adequate duration of an antimicrobial regimen tailored to the presumptive source of infection and available culture data, and eradication of the primary source of infection. For spinal epidural abscesses, neurologic status at the time of presentation is directly related to outcomes, underscoring the importance of prompt recognition and intervention.

Clinical characteristics and course of primary brain abscess.

Due to improved diagnostic methods, the incidence of brain abscess is still rising. Therefore, clear and evidence-based therapy for the patients who suffer from brain abscesses is necessary. Brain abscesses are potentially life-threatening conditions that possibly lead to permanent injuries even after sufficient healing has taken place. The aims of this study were to analyze the clinical aspects of patients with brain abscesses and thereby to reveal the relevant aspects for the future treatment of the brain lesions. We retrospectively identified 47 patients (24 male, 23 female) who had received surgery or undergone the frameless stereotactic drainage of brain abscesses in our center from March 2009 to May 2017. We analyzed the clinical characteristics of the patients, as well as comorbidities and outcomes. The mean age was 58 (range 7 to 86). Focus identification was successful in 28 patients (60%), with the most frequent causes of brain abscesses including the following: sinusitis (25%), dental infections (25%), and mastoiditis (21%). The mean Charlson Comorbidity Index was 1.57. Among the patients, 34% showed immunosuppressive conditions. We performed 1.5 surgeries per patient (53% via craniotomy, 28% biopsies or stereotactic drainage, 19% both procedures), followed by antibiotic treatment for 6.5weeks (mean). In 30% of patients, no bacteria could be isolated. During the follow-up period (a median of 12months), 23.4% of the patients died. The mortality rate during the initial hospital stay was 4.3%. One third of the patients with brain abscesses showed immunosuppressive conditions, whereas brain abscesses also often occur in patients with good medical conditions. The isolation of the focus of infection is often possible. Surgical procedures showed very good outcomes. Patients over 60years showed significantly worse clinical outcomes.

Epidemiology of brain abscess in Taiwan: A 14-year population-based cohort study.

Brain abscess (BA) is a severe neurological emergency, which remains a challenge for physicians despite medical advancements. The purpose of this study is to describe the epidemiology of BA in Taiwan and to investigate potential factors affecting the survival of patients with BA. By using the Taiwan National Health Insurance Research Database, we identified hospitalized patients with a discharge diagnosis of pyogenic BA (324.X) between 2000 and 2013. The incidence and in-hospital mortality of BA were calculated based on both age and sex. A total of 6027 BA cases were identified. The overall incidence of BA was 1.88 (95% CI: 1.83–1.93) per 100,000 person-years and increased with age, from 0.58 per 100,000 person-years in individuals aged 0–14 years to 4.67 per 100,000 person-years in those over 60 years of age. The male-to-female incidence ratio was 2.37 (95% CI: 2.24–2.50), with a mountain-shaped distribution across ages peaking at 40–44 years. The in-hospital mortality also increased with age, from 4.22% (95% CI: 2.54–6.97) at 0–14 years to 17.34% (95% CI: 15.79–19.02) in individuals over 60 years of age, without a gender difference (11.9% for males, 12.5% for females). Age, stroke, septicemia, pneumonia, meningitis, and hepatitis were associated with increased risk of in-hospital mortality. There was a male predominance for BA, and both the incidence and in-hospital mortality rates increased with age. Infection-related disease such as septicemia, pneumonia and meningitis were important factors associated with in-hospital mortality. In addition to the original treatment of BA, we suggest paying close attention to potential infections to improve the outcome of BA patients.

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.

Brain abscess: Awareness make a difference

Brain abscess is still a common clinical entity in both developed and developing countries. The incidence of brain abscess is decreasing from 1.3/100,000 patient-years from 1935 to 1944 in comparison to 0.9/100,000 patient-years from 1965 to 1981.[1] Despite the development of antibiotics with good blood-brain barrier penetrance, the morbidity, and the mortality cause by brain abscess is significant, moreover, almost 25% of the patients are children. The early diagnosis and immediate institution of a holistic treatment plan is the key of success in management of brain abscess. However, this is always a challenge to the young surgeons as there are a wide variety of causes of brain abscess. The eradication of the source of infection is the most important step in preventing recurrence of the brain abscess after initial treatment or surgical drainage. The causes of brain abscess are divided into three categories, which are contiguous suppurative focus (45-50% of cases), hematogenous spread from distant focus (25% of cases) and trauma (10% of cases). First category includes otologic, rhinologic or odontogenic infections.[2,3] Second category includes cardiac diseases, chronic lung infections skin infections, abdominal and pelvic infections, transplantation, esophageal dilatation, injection drug use, and human immunodeficiency virus infection.[4,5] The awareness of various clinical presentations especially the symptoms in relation to the area of brain involved is required in anticipating the source of infections particularly if the primary infection is not apparent. This aspect is well-explained and highlighted by Alvis-Miranda et al. in their paper “brain abscess: Current management.”[6] The contrast enhanced computed tomography (CECT) still remained the main modality in confirming the diagnosis of brain abscess. The availability of CECT in other hospital apart from tertiary hospital facilitates early diagnosis and referral of these cases from the rural hospital to the neurosurgery team. The use of magnetic resonance imaging (MRI) in these cases is increasing since the past decades. Diffusion protocol in the MRI is specific in differentiating cerebral vascular lesion, cerebral tumor, and brain abscess. Tumor, radiation necrosis, and abscess present with different spectral profiles, if the metabolite peaks are examined with Magnetic resonance (MR) spectroscopy.[7] Management of brain abscess comprise of two arms that is medical treatment and surgical intervention. The selection of antibiotics is important in preventing advancement of the disease. Surgical drainage of the abscess is still the mainstay of the treatment. Needle aspiration is preferred if the speech, motor or sensory cortex area are involved. Multiloculated abscesses and recurrent cases are usually managed with craniotomy.[8] Besides the neurosurgeons, other disciplines such as oromaxillofacial surgeon, rhinologist, or otologist should be involved in management of the primary source of infection in cases of brain abscess. All the above aspects are well-described by Alvis-Miranda et al.[6]

Intracranial Abscesses: Changes in Epidemiology and Management Over Five Decades in Merseyside

To review the changing patterns in incidence, etiology, management, morbidity, and mortality for intracranial abscesses over the last decade and compare them with two previous studies spanning four decades, conducted at the regional neurological surgical unit on Merseyside. A retrospective review of case notes and laboratory records of all cases of intracranial abscess admitted to the regional neurosurgical unit between January 1995 and January 2005 was performed. Forty-seven cases of intracranial abscesses were identified. The incidence of these, in our study, was an average of five cases per year as opposed to eight cases per year in the previous decades. The mean age at presentation was 46 years, and the male-to-female ratio was 4:1. Diagnosis by computerized tomography scan was performed in majority of patients (85.1%) within 48 h of presentation. The incidence of otogenic abscess was 12.8% (6/47), much lower than that seen in previous decades. An association with previous neurosurgical procedures was noted in 19.1% of cases, similar to that seen in the previous decade. In 73.4% (36/49) of samples, organisms were isolated. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from two patients (4.3%); an isolate not reported in the previous two studies. Nine patients (19.1%) died during their hospital stay as compared to the overall mortality of 43%and 24%seen in the earlier reviews. Of the 38 who survived, 47.3% had a good outcome at discharge. In comparison with the two previous studies, the overall incidence of intracranial abscesses is decreasing on Merseyside. Moreover, the predisposing factors for intracranial abscesses have changed over the decades. The number of otogenic cases has declined. The incidence of brain abscesses following neurosurgical procedures is still a major cause for concern, as is the emergence of MRSA, as a significant pathogen.

Management of brain abscesses in children

Brain abscesses occur infrequently but continue to be problematic for the pediatric neurosurgical community. The incidence of brain abscesses in children has not changed much, although individual reports may show an increase or decrease in the number of reported cases depending on the patient population studied. An increase could be attributed to earlier detection due to advancements in imaging modalities and/or to an increase in the number of children with immunodeficient states caused by AIDS, chemotherapy for malignant lesions, and immunosuppressive therapy for organ transplantation. A decrease in the incidence of brain abscesses could be attributed to practices such as antibiotic treatment for otitis media, sinusitis, and/or prophylactic antimicrobial treatment for congenital heart disease in children. The morbidity and mortality rates associated with brain abscesses have not changed dramatically in the antibiotic and imaging era, and their preferred management can vary among healthcare providers. These lesions have been successfully treated by neurosurgeons. The causes of brain abscesses are highly variable in children, which is also the case in adults, but the predisposing factors in the pediatric population differ in prevalence. Cyanotic congenital heart disease, hematogenous dissemination, contiguous infection, and penetrating traumatic injuries are the most common causes of brain abscesses in children. In this review, the authors discuss the causes and medical and surgical management of brain abscesses in children.

Postoperative Central Nervous System Infection: Incidence and Associated Factors in 2111 Neurosurgical Procedures

Postoperative central nervous system infection (PCNSI) in patients undergoing neurosurgical procedures represents a serious problem that requires immediate attention. PCNSI most commonly manifests as meningitis, subdural empyema, and/or brain abscess. Recent studies (which have included a minimum of 1000 operations) have reported that the incidence of PCNSI after neurosurgical procedures is 5%-7%, and many physicians believe that the true incidence is even higher. To address this issue, we examined the incidence of PCNSI in a sizeable patient population. The medical records and postoperative courses for patients involved in 2111 neurosurgical procedures at our institution during 1991-2005 were reviewed retrospectively to determine the incidence of PCNSI, the identity of offending organisms, and the factors associated with infection. The median age of patients at the time of surgery was 45 years. Of the 1587 cranial operations, 14 (0.8%) were complicated by PCNSI, whereas none of the 32 peripheral nerve operations resulted in PCNSI. The remaining 492 operative cases involved spinal surgery, of which 2 (0.4%) were complicated by PCNSI. The overall incidence of PCNSI was 0.8% (occurring after 16 of 2111 operations); the incidence of bacterial meningitis was 0.3% (occurring after 4 of 1587 operations), and the incidence of brain abscess was 0.2% (occurring after 3 of 1587 operations). The most common offending organism was Staphylococcus aureus (8 cases; 50% of infections), followed by Propionibacterium acnes (4 cases; 25% of infections). Cerebrospinal fluid leakage, diabetes mellitus, and male sex were not associated with PCNSI (P>.05). In one of the largest neurosurgical studies to have investigated PCNSI, the incidence of infection after neurosurgical procedures was <1%--more than 6 times lower than that reported in recent series of comparable numerical size. Cerebrospinal fluid leak, diabetes mellitus, and male sex were not associated with an increased incidence of PCNSI. The results from this study indicate that the true incidence of PCNSI after neurosurgical procedures may be greatly overestimated in the literature and that, in surgical procedures associated with a high risk of infection, prophylaxis for S. aureus and/or P. acnes infection should be of primary concern.

Brain Abscess: A Need to Screen for Pulmonary Arteriovenous Malformations

Background: Pulmonary arteriovenous malformations (PAVMs) are direct connections between an artery and a vein in the pulmonary circulation associated with hereditary hemorrhagic telangiectasia in up to 88% of cases. Patients with PAVMs are at increased risk of brain abscess (BA). This study aimed to provide preliminary data on the prevalence of PAVMs among BA patients. Methods: Administrative hospital discharge forms were used to identify patients with BA; possible PAVM patients were screened. Results: 126 patients with BA were identified. Two patients had undiagnosed PAVMs at the time of admission for BA. The age-adjusted incidence of BA was 6.3 cases/1 million/year, with a male:female ratio of 2.0. Conclusion: Although PAVMs are rare conditions, they play a role in the development of BA. PAVMs are usually not recognized at the time of BA, thus exposing patients to life-threatening risks.

The efficacy of trovafloxacin versus ceftriaxone in the treatment of experimental brain abscess/cerebritis in the rat

Current estimates of the mortality associated with brain abscesses range from 0–24%, with neurological sequellae in 30–55% of survivors. Although the incidence of brain abscess appears to be increasing, likely due to an increase in the population of immunosuppressed patients, the condition is still sufficiently uncommon to make human clinical trials of therapy problematic. An animal model to study the efficacy of new treatment regimens, specifically, new antimicrobial agents is therefore necessary. This study uses a well-defined experimental paradigm as an inexpensive method of inducing and studying the efficacy of antibiotics in brain abscess. The rat model of brain abscess/cerebritis developed at this institution was used to determine the relative efficacy of trovafloxacin as compared to ceftriaxone in animals infected with Staphylococcus aureus. S. aureus (≈10 5 CFU in 1 microliter) was injected with a Hamilton syringe, very slowly, over the course of 70 minutes after a two mm burr hole was created with a spherical carbide drill just posterior to the coronal suture and four mm lateral to the midline. Eighteen hours later treatment was begun; every 8 hours the rats were dosed with subcutaneous ceftriaxone ( n = 10), trovafloxacin ( n = 11) or 0.9% sterile pyogen-free saline ( n = 10). After four days of treatment the brains were removed and sectioned with a scalpel. The entire injected hemisphere was homogenized and quantitative cultures performed. The mean ± SEM log 10 colony forming units/ml S. aureus recovered from homogenized brain were as follows: controls 6.10 ± 0.28; ceftriaxone 3.43 ± 0.33; trovafloxacin 3.65 ± 0.3. There was no significant difference in bacterial clearance between ceftriaxone versus trovafloxacin (p = 0.39). Trovafloxacin or other quinolones may provide a viable alternative to intravenous antibiotics in patients with brain abscess/cerebritis.

Brain abscess following marrow transplantation: experience at the Fred Hutchinson Cancer Research Center, 1984-1992.

The etiology of brain abscess in patients undergoing marrow transplantation at the Fred Hutchinson Cancer Research Center in Seattle was assessed in a retrospective review. Fifty-eight patients with histology- or culture-proven brain abscess diagnosed between January 1984 and March 1992 were identified. A fungus was isolated in 92% of cases. Aspergillus species were the most prevalent fungi (58% of cases), and Candida species were second in frequency (33%); sporadic cases were caused by Rhizopus, Absidia, Scopulariopsis, and Pseudallescheria species. Bacteria were involved in fewer than 10% of cases. There was no appreciable variation from year to year in the incidence of brain abscess over this period. Aspergillus brain abscess was associated with concomitant pulmonary disease (87% of cases), whereas candida brain abscess often occurred in association with fungemia (63% of cases) or neutropenia (63%). Mortality was high (97%); the risk of death was unrelated to etiology or therapeutic regimen. Since the etiology of brain abscess in patients undergoing marrow transplantation is primarily fungal, the development of better antifungal therapeutic and/or prophylactic modalities is warranted.

Incidence and Prognosis of Brain Abscess in a Defined Population: Olmsted County, Minnesota, 1935–1981

The incidence of brain abscess was studied on all cases occurring in residents of Olmsted County, Minn., from 1935 through 1981. Thirty-eight cases (9 cases first diagnosed at autopsy) were identified and followed through the Rochester Olmsted County medical record-linkage system at the Mayo Clinic. The incidence rate was 1.3/100,000 person-years (PY), 1.9 in males and 0.6 in females. Incidence decreased from 2.7 in 1935-44 to 0.9 in 1965-81. Rates were higher in children 5-9 years old (2.4) and after age 60 (2.6 PY). An etiologic agent was identified in 29 cases (76%) with streptococci being the most frequently isolated. Case-fatality ratio was 38% (11/29), stable over time. Concurrent bacterial meningitis was the strongest predictor of death. Neurologic sequelae were observed in 8 (44%) of the 18 surviving patients including epilepsy (5 cases), deafness and motor impairment.

Brain abscess in Saudi Arabia

There are significant variations among countries in the incidence of brain abscess. We report here 26 cases of brain abscess treated at the Neurosurgery Department of King Faisal University and Dammam Central Hospital Saudi Arabia over a six year period (1982-1988). This is 2.3% of total admissions to the two neurosurgery departments serving a population of approximately 1.2 million in the same period. Young males were most often affected (M/F ratio 3.3:1; 31% were less than 15 years old, 46% aged between 15-39 years, and 23% older than 40 years). Streptococcus was found to be the most common microorganism (38.4%). Mixed infection was seen in 15.3%, and sterile abscesses were found in 11.5% of the patients after aerobic and anaerobic cultures of the pus. Chronic otitis media and paranasal sinusitis predisposed the patients to abscess formation in 57.6% of the cases. The temporo-parietal area was the commonest site. Epilepsy was a complication in 30.7% of our patients, and the mortality rate was 15.3%.