Multiple Brain Abscesses Research Articles

Multiple primary brain abscesses in a 14 years old immunocompetent boy: A tale of Proteus mirabilis infestation from Pakistan

Brain abscess (BA) formation that may be due to due to Gram-positive bacteria commonly and less commonly due Gram-negative bacteria affects pediatric population. Most cases are secondary to the involvement of ear, nose, throat and sinuses (ENTS). We describe a rare case of a 14 year old patient presenting with generalized tonic clonic seizures for the last six months associated with fever, vomiting and headache. ENTS examination was normal. Neuroimaging was suggestive of multiple left fronto-pariettal space occupying lesions. Modified pterional craniotomy was done to excise the multiloculated, encapsulated lesion with yellow-green pus. Culture sensitivity yielded Proteus mirabilis. Patient was discharged from the hospital uneventfully. The diagnosis of multiple primary brain abscesses secondary to Proteus mirabilis is very rare and it should be considered in the list of differentials of multiple brain abscesses when the systematic examination is normal. Early surgical excision is the key to a successful outcome. doi: https://doi.org/10.12669/pjms.40.12(PINS).11033 How to cite this: Khokhar TI, Qadri HM, Fatima I, Ghafoor A, Bilal MT. Multiple primary brain abscesses in a 14 years old immunocompetent boy: A tale of Proteus mirabilis infestation from Pakistan. Pak J Med Sci. 2024;40(12):S87-S89. doi: https://doi.org/10.12669/pjms.40.12(PINS).11033 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

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

Multiple brain abscess in systemic lupus erythematosus patients

Introduction: Because SLE patients receive immunosuppressive and glucocorticoid medication, they are more susceptible to opportunistic infections. Multiple brain abscesses are an extremely uncommon side effect of systemic lupus erythematosus (SLE). Case description: The purpose of this case study is to raise awareness of the 14-year-old girl who reported experiencing weakness in her limbs. A year ago, she received a diagnosis of systemic lupus erythematosus. Upon physical examination, nervus VII central paresis was discovered; the lower extremities' muscular strength was 3333/2222 and the upper extremities' 3333/2222. A head CT scan revealed findings that were consistent with lupus cerebritis. Multiple ring lesions with extensive edoema were detected by magnetic resonance imaging, raising the possibility of multiple brain abscesses. For six weeks, the patient had intravenous metronidazole and ceftriaxone. The patient was allowed to go home with instructions to keep taking corticosteroids and mycophenolic acid as well as to schedule routine outpatient appointments. This case study aims to raise awareness about the 14-year-old girl who reported experiencing weakness in her limbs. Her condition was identified by specialists as systemic lupus erythematosus a year ago. Upon physical examination, nervus VII central paresis was discovered; the lower extremities' muscular strength was 3333/2222 and the upper extremities' 3333/2222. A head CT scan revealed findings that were consistent with lupus cerebritis. Multiple ring lesions with extensive edoema were detected by magnetic resonance imaging, raising the possibility of multiple brain abscesses. For six weeks, the patient received metronidazole and ceftriaxone intravenously. We sent the patient home with instructions to keep taking mycophenolic acid and corticosteroids and to make routine outpatient appointments. This case study aims to raise awareness about the 14-year-old girl who reported experiencing weakness in her limbs. Her condition was identified by specialists as systemic lupus erythematosus a year ago. Upon physical examination, nervus VII central paresis was discovered; the lower extremities' muscular strength was 3333/2222 and the upper extremities' 3333/2222. A head CT scan revealed findings that were consistent with lupus cerebritis. Multiple ring lesions with extensive edoema were detected by magnetic resonance imaging, raising the possibility of multiple brain abscesses. For six weeks, the patient received metronidazole and ceftriaxone intravenously. We sent the patient home with instructions to keep taking mycophenolic acid and corticosteroids and to make routine outpatient visits. Conclusion: It is critical to being aware that individuals with impaired immune systems should always be suspected of having an opportunistic central nervous system infection when they experience new neurologic symptoms. A brain abscess is a chronic infection of the central nervous system that can arise from a number of risk factors and infection sources. A brain abscess is one of the uncommon side effects of SLE.

Listeria brain abscess: a therapeutically challenging rare presentation of listeriosis

We report a very rare case of Listeria multiple brain abscesses manifested as delirium, which represented diagnostic and therapeutic challenges overcome only by the close cooperation between Infectious Diseases and Neuroradiology, without which a satisfactory outcome would not be achieved.An elderly man presented with confusion and drowsiness with a background of type-II diabetes mellitus. Although computed tomography of the brain only showed frontal lobe oedema, contrast magnetic resonance (MR) imaging showed numerous irregular rim-enhancing lesions containing central diffusion restriction, suggesting multiple pyogenic cerebral abscesses of unclear aetiology. Thereafter, Listeria monocytogenes was isolated from blood cultures, suggesting this as the causative organism. Deemed unsuitable for neurosurgical drainage, the patient received medical management with a protracted course of antibiotics. This case was extremely challenging, due to 1) the impossibility of source control, 2) the small number of effective antibiotics available to treat this condition, and 3) the inevitable antibiotic side-effects, derived from long-term exposure. A successful outcome was only possible thanks to strict close multidisciplinary follow up, requiring frequent MR imaging and a judicious antibiotic choice, including monitoring of their side-effects. Due to the rarity of this condition, there is lack of guidance on its management, hence the importance of multidisciplinary involvement with very close imaging and antibiotic monitoring.

Stereotactic Aspiration of Multiple Brain Abscesses in a Child with a Single Ventricle

Stereotactic Aspiration of Multiple Brain Abscesses in a Child with a Single Ventricle

Klebsiella pneumoniae invasive syndrome with liver, lung, and brain abscesses complicated with pulmonary fungal infection: a case report and review of the literature

BackgroundKlebsiella pneumoniae invasion syndrome (KPIS) is a severe multi-site infection that is usually caused by hypervirulent Klebsiella pneumoniae. The bacteria are relatively common in Asian diabetics and can cause organ abscesses or sepsis. When patients develop intracranial infection, the prognosis is poor. After anti-infective treatment, the Klebsiella pneumoniae-induced liver and lung abscesses and pulmonary fungal infection were relieved, but the brain abscesses worsened. Such complex and severe infection cases are rarely reported. Early identification of intracranial infection, selection of antibiotics with high concentrations in cerebrospinal fluid, and active treatment of complications such as diabetes and fungal infection are of great significance for the prognosis of patients.Case presentationA 71-year-old patient diagnosed with liver abscess in another hospital was transferred to our hospital due to a worsening condition. On day 1 (day of admission), the patient was given invasive mechanical ventilation, continuous renal replacement therapy combined with endotoxin adsorption, antimicrobial treatment with imipenem-cilastatin, and percutaneous catheter drainage for liver abscess. Metagenomic next-generation sequencing in bronchoalveolar lavage fluid indicated Klebsiella pneumoniae (K. pneumoniae), Candida albicans, and Aspergillus flavus complex, and no viruses were detected. Blood and pus cultures revealed K. pneumoniae that was sensitive to piperacillin/tazobactam. The anti-infection therapy was adjusted to piperacillin/tazobactam combined with voriconazole. On day 14, a head computed tomography (CT) scan showed no significant changes, and a chest CT scan showed absorption of multiple abscesses in both lungs. The patient was still unconscious. After the endotracheal tube was removed, cranial magnetic resonance imaging (MRI) showed multiple brain abscesses. Finally, his family gave up, and the patient was discharged and died in a local hospital.ConclusionIn cases of K. pneumoniae infection, the possibility of intracranial, liver, lung, or other site infections should be considered, and physicians should be vigilant for the occurrence of KPIS. For patients suspected of developing an intracranial infection, cerebrospinal fluid should be tested and cultured as soon as possible, a head MRI should be performed, and antibiotics with high distribution in cerebrospinal fluid should be used early. When patients are complicated with diabetes, in addition to glycemic control, vigilance for concurrent fungal infections is also needed.

Surgical treatment of multiple bilateral brain abscesses and subdural empyas in a 6-year-old child with purulent rhinosinusitis

Introduction. Bacterial brain abscesses and subdural empyema are often rare complications of rhinosinusitis, which is especially important in pediatric practice. Intracranial purulent clusters are life-threatening diseases which require urgent, and as a rule, surgical management.
 Purpose. To illustrate successful surgical treatment of a patient with multiple bilateral brain abscesses and subdural empyemas as a result of purulent inflammation - paranasal sinusitis, which had not been diagnosed at the prehospital stage.
 Material and methods. A case of a 6-year-old boy with multiple bilateral brain abscesses and subdural empyemas is described in the article. The patient had antibacterial therapy; paranasal sinuses were sanitized; all intracranial purulent foci were removed with minimally invasive approaches and accurate calculations based on findings of MRI examination.
 Results. It had been confirmed that abscesses and subdural empyemas in the described patient was a complication of purulent inflammation in paranasal sinuses. To control treated foci and to exclude development of new purulent intracranial clusters in dynamics, multiple MRI examinations of the brain were performed. For successful management of purulent foci, the technique of incision, drainage, sanitation with antiseptic solutions and intraoperative exudate aspiration was applied.
 Conclusion. Abscesses and empyemas of children’s brain are serious, life-threatening pathologies that always require hospitalization and emergency measures. Multiple abscesses and subdural empyemas is, as a rule, complication of rhinosinusitis. Multiple dynamic CT/MRI examinations of the brain is of a key importance, both for controlling removed foci and for excluding development of new purulent intracranial clusters. Active surgical tactics in the combination with antibacterial therapy leads to successful outcomes in patients with intracranial purulent lesions complicating the course of rhinosinusites.

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

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

Successful treatment of multiple intracerebral aspergillosis with voriconazole alone in an Egyptian diabetic patient with autoimmune hemolytic anemia

Aspergillosis is a common fungus that lives in soil and decaying vegetation. Inhalation of the spores causes infection mostly in immunocompromised patients. Invasive aspergillosis has an extremely high mortality, and a definitive diagnosis requires histopathological evidence of deep tissue invasion or positive culture; however, this evidence is often difficult to obtain due to the critical nature of the patients in these situations. The sensitivity of culture in this setting is also low. The galactomannan test is a recent antigen–antibody serologic test that depends on detecting an antigen which is a molecule found in the cell wall of aspergillus species. A positive result supports the diagnosis of invasive aspergillosis. We present a case of multiple intracerebral brain abscesses in an immunosuppressed patient due to an aspergillus species diagnosed by the galactomannan test with an excellent response to the treatment with the novel voriconazole alone, without any surgical intervention, and the purpose is to alert the physicians, neurologists, and infectious disease specialists to consider the intracranial aspergillosis among the differential diagnosis of the acute onset encephalitis especially in immunocompromised patients as early diagnosis and treatment may be life-saving.

Multiple Brain Abscesses In A Child With Infective Endocarditis

Background: Infective endocarditis is a lethal infection affecting the endocardium of the heart and the valves.The causes are varied with staphylococcus aureus and streptococcus as the major causative agents.The triad of fever exceeding 38oc,vegetation in the heart and blood culture of the causative agents are the hallmarks of the diagnosis .The disease is known to be affect all ages with the very young age group, those with congenital heart disease and those on cardiac prosthesis as the most vulnerable. Septic emboli from the septic vegetation can spread to the brain, kidney, spleen, and lungs resulting in massive metastatic infections.It therefore has multisystemic manifestations and complications. Though neurological complications are common, brain abcess is known to be rare constituting only 1.0% of neurological complications. Objective: The study aimed at reporting occurrence of both cerebral and cerebellar micro- and macro-abscesses in a 3 year boy with infective endocarditis; a rare occurrence in the literature. Methods: This case report was carried out at University College Hospital Ibadan. Results: The boy presented with fever of 38oc for five weeks, convulsions and altered state of consciousness for ten days..In course of treatment patient however developed irritability and aggressive behaviour, which attracted the use of largactil to which he reacted with extrapyramidal signs and convulsions. Within the week he developed yellowness of the eyes and increase in abdominal girth. Patient had cranial computed tomography (CT) after plain skull X-rays and was referred to University College Hospital Ibadan as a result of the radiologically diagnosed brain abscess seen on CT images. child had grunting respiration with dyspnea, and the respiratory rate was 50/mm. However, the chest was clinically clear. In the cardiovascular system (CVS); the pulse was 140/mm, with moderate volume. The blood pressure (BP) was l60/110 mmHg. The first and second heart sounds were heard with a gallop rhythm. Cranial CT scan showed multiple ring enhancing hypodense lesions with surrounding hypodensity measuring 1cm in diameter and above with only a few measuring less than 1.0cm in both cerebral hemispheres and cerebelli in keeping with multiple cerebral and cerebellar abscesses. An echocardiography showed a brightly echogenic spot attached to the papillary muscle in the left ventricle suggesting vegetation consistent with an infective endocarditis. Retroviral test was negative for both type I and II.Blood culture — was negative, however urine culture yielded klebsiella sp. Serum urea, creatinine, Ca2+ and P04 were all elevated.The abdominal ultrasound scan confirmed the hepatosplenomegaly with decreased echogenicity but both kidneys appeared normal.There was no demonstrable ascitis. The boy was placed on antimicrobials; and had craniotomy for the drainage of the macroabscesses. He improved significantly. His renal and cardiac condition equally improved; he was subsequently discharged to continue treatment in the the paediaric outpatient. The infective endorcarditis still poses enormous challenge in management and the condition calls for multi disciplinary approach. It requires high index of suspicion for early detection; as well deployment of multiple imaging modalities by the cardiologists and radiologists to arrive at a more accurate diagnosis for effective patient management. This may save financial and material resources on part of the patients, care givers, the facility managers and the society at large.

Multiple brain abscesses with tetralogy of fallot (TOF): a case report

Introduction: Patients with multiple brain abscesses and a secondary diagnosis of tetralogy of fallot (TOF) rarely occur fatal complications. Brain abscess is a very uncommon but potentially fatal infection of the brain parenchyma that can affect 5%-18.7% of the CHD population. The degree of right-to-left shunt is responsible for brain tissue hypoxia, which can lead to cerebral infarction, which is a precursor to cerebral abscess. Therefore, this study aimed to report on a patient with several brain abscesses and TOF. Case description: A 30-year-old cyanotic male with a chief complaint of gradually decreased consciousness since 2 weeks ago without a history of vomiting. The patient has a clubbing finger. The patient has a TOF history without a prior infection, such as toothache, ear discharge, paranasal infection, cough, or flu. Physical examination revealed the Glasgow Coma Scale of E4VxM6 (global aphasia), right hemiparesis, increased physiological reflexes and positive pathological reflexes in the right of the body. Laboratory results showed slight leucocytosis and hyponatremia and elevated CRP. Head MRI spectroscopy was performed 3 days later, revealing multiple brain abscesses. The patient was given therapy antibiotics, namely ceftriaxone injection and metronidazole injection intravenously. Conclusion: A brain abscess should be suspected in patients with TOF who arrive with a fever and an acute neurological condition. Besides antibiotics, patients should be encouraged to have corrective surgery as soon as possible to avoid future deadly consequences.

Guided Surgery with Intraoperative Ultrasonography and Endoscopy in Multiple Occipital Brain Abscess

Introduction: Brain abscess is a focal infection of the brain parenchyma, in which different treatment methods are used, most authors agree that conservative methods with antibiotic therapy are effective in the cerebritis phase, while in the encapsulated phases the Minimally invasive surgery is the best option. Objective: To describe the clinical, imaging and surgical characteristics in patients with multiple brain abscesses. Case Report: Male, white, 20-year-old, right-handed patient, with a history of molar infection 3 months prior, comes to the emergency department of our hospital due to intense headache and tonic-clonic seizures. widespread. Tomography and cranial resonance studies were performed, which demonstrated the presence of multiple brain abscesses that were successfully treated using an occipital approach with endoscopic support and trans-surgical ultrasonographic guidance. Discussion: In the international literature consulted, the largest number of patients with brain abscesses are treated by conservative measures, in cases in late encapsulation phases where drugs do not penetrate the capsule, surgical alternatives are the most recommended, which depend on size, location, proximity to the ventricular system and number of lesions. Conclusion: Brain abscess is a neurosurgical entity, in which surgery by minimally invasive methods associated with exact localization techniques and antibiotic therapy is the most effective treatment alternative.

Stereotactic biopsy for multiple intra-axial brain lesions: impact on consequent treatment Regimen

Background and objectivesMultiple brain lesions represent a serious challenge in which biopsy is commonly the first step to help overcome patients' mental anxiety and decide the following treatment step. This study presents an effective decisional algorithm that could guide in dealing with such a challenge. We evaluate the feasibility and safety of frame-based stereotactic biopsy to obtain the histopathologic diagnosis of the multiple intra-axial brain lesions and to decide the further treatment.Patients and methodsThirty-two patients with multiple intracerebral lesions underwent stereotactic serial biopsies for brain lesions at the Neurosurgery Department, Tanta University Hospital. All the stereotactic biopsies were obtained under local anesthesia using Riechert–Mundinger (RM) system or Cosman–Roberts–Wells (CRW) system.ResultsThe histopathological diagnosis revealed multifocal malignant gliomas in 43.75% of patients (18.75% anaplastic astrocytoma and 25% multiform glioblastoma) and metastatic tumor in 37.5% of patients (all were adenocarcinoma). In addition, 12.5% had multiple brain abscesses, and 6.25% had malignant lymphoma. We reported no mortality secondary to the surgical procedure.ConclusionsStereotactic biopsy is considered the best choice to allow histopathologic diagnosis of multiple brain lesions with minimal morbidity and no mortality. Histopathologic findings gained with stereotactic procedures guided the choice of proper treatment thus eliminating the hazards associated with blind treatments.

Concomitant brain abscess and spinal cord abscess in an immunocompetent teenage male: illustrative case.

Multiple bilateral brain abscesses occur rarely in immunocompetent patients. Hematogenous spread to the central nervous system (CNS) allows suppuration and abscess formation in the privileged immune environment of the CNS; hematogenous spread to the spinal cord is extremely rare and the combination of multifocal brain abscesses and intramedullary abscesses has not been reported. This report presents a rare presentation and diagrams a treatment algorithm involving iterative minimal access surgeries and prolonged medical management. The authors present a case of an 18-year-old male with numerous multifocal and bilateral intraparenchymal abscesses and a medically resistant C5 intramedullary spinal cord abscess. The symptomatic patient had a left oculomotor palsy and left hemiparesis, ultimately undergoing ultrasound-guided aspiration of abscesses in the left frontal and left cerebral peduncle. Following transient motor improvement, he evolved tetraparesis prompting spinal cord imaging and emergent ultrasound-guided needle aspiration of an occult C5 intramedullary spinal cord abscess. The patient received appropriate medical therapy, completed inpatient rehabilitation, and made a full recovery. Needle- and ultrasound-guided catheter drainage of CNS abscesses should be considered for symptomatic lesions. Following the neurological examination closely is extremely important; if the expected neurological improvement is delayed or regresses, then expanded imaging is warranted.

Intramedullary spinal cord abscess with brain abscess due to subacute infective endocarditis

BackgroundIntramedullary spinal cord abscesses (ISCA) are rare, even more so in association with brain abscesses. Infective endocarditis is an uncommon cause of ISCA. In this case study, we report a patient with intramedullary abscesses and multiple brain abscesses due to subacute infective endocarditis.Case presentationA 54-year-old man presented with a 7-day history of head and neck pain and numbness in both lower limbs. Intramedullary abscess combined with multiple brain abscesses was diagnosed based on blood culture, head and spinal magnetic resonance imaging (MRI), contrast-enhanced MRI, and magnetic resonance spectroscopy. Echocardiography revealed vegetations on the mitral valve and severe mitral regurgitation, which the authors believe was caused by subacute infective endocarditis. With ceftriaxone combined with linezolid anti-infective therapy, the patient's symptoms and imaging was improved during follow-up.ConclusionsThis case hopes to raise the vigilance of clinicians for ISCA. When considering a patient with an ISCA, it is necessary to complete blood culture, MRI of the brain and spinal cord, and echocardiography to further identify whether the patient also has a brain abscess and whether the cause is infective endocarditis.

АБСЦЕССЫ ГОЛОВНОГО МОЗГА

In this article summarized results of treatment 130 patients with brain abscesses in different by origin groups: contact, metastatic, traumatic and cryptogenic. Achieved results allowed clarify a number important patterns, typically for process cerebral abscess formation. In particular, distinguish age groups of risk, received new data about formation of single and multiple brain abscesses. Specified indications for surgical treatment of brain abscesses with recommendation about selection methods they removal. Studied outcomes of operated patients. Identified reasons of lethality with recommendations her descension.

Multiple brain abscesses in a newborn with Down syndrome: heart disease or meningeal infection?

Introduction: Cerebral abscess is a rare pathology in the newborn, most often secondary to meningeal involvement, but congenital heart disease is to be feared. Objectives: To review a case of multiple cerebral abscesses in the newborn with a doubtful diagnosis through a clinical case. Observation: Newborn at D6 of life, from a fullterm pregnancy, with a negative infectious anamnesis, admitted for fever at 38. The first one appeared at D4 of life, in whom the clinical examination found an icteric newborn, with a trisomic face, tachycardia at 180bpm, axial hypotonia, FANT and RS+, systolic cardiac murmur and light sub-costal draught. In front of this picture, a lumbar puncture was carried out objectifying a lymphocytic meningitis, At J8 of life, the newborn presented a convulsion, An ETF was carried out objectifying a hypoechogenic image with hyperchogenic border in cocarde evoking an abces confirmed by CT. The echocardium performed as part of the etiological workup, objective a single ventricle, CIA ostium primum large, IVC admission, single atrio ventricular valve, complete atrio ventricular canal, persistence of the ductus arteriosus and Coarctation of the aorta. The newborn was put on parenteral antibiotic therapy based on C3G meningeal dose + vancomycin + metronidazole by intravenous route then oral relay, with a scannographic control and neurological clinical evaluation. In front of this case, the question that arises: are his abscesses secondary to meningitis or to congenital heart disease? Conclusion: Brain abscess is a rare pathology, with heavy after-effects, and the prognosis of patients has improved thanks to the progress of imaging techniques, the use of ATB treatments, and minimally invasive neurosurgery. It is to be feared in front of congenital cardiopathies with right-left shunt.

A Canadian National Survey of the Neurosurgical Management of Intracranial Abscesses.

Intracerebral abscess is a life-threatening condition for which there are no current, widely accepted neurosurgical management guidelines. The purpose of this study was to investigate Canadian practice patterns for the medical and surgical management of primary, recurrent, and multiple intracerebral abscesses. A self-administered, cross-sectional, electronic survey was distributed to active staff and resident members of the Canadian Neurosurgical Society and Canadian Neurosurgery Research Collaborative. Responses between subgroups were analyzed using the Chi-square test. In total, 101 respondents (57.7%) completed the survey. The majority (60.0%) were staff neurosurgeons working in an academic, adult care setting (80%). We identified a consensus that abscesses >2.5 cm in diameter should be considered for surgical intervention. The majority of respondents were in favor of excising an intracerebral abscess over performing aspiration if located superficially in non-eloquent cortex (60.4%), located in the posterior fossa (65.4%), or causing mass effect leading to herniation (75.3%). The majority of respondents were in favor of reoperation for recurrent abscesses if measuring greater than 2.5 cm, associated with progressive neurological deterioration, the index operation was an aspiration and did not include resection of the abscess capsule, and if the recurrence occurred despite prior surgery combined with maximal antibiotic therapy. There was no consensus on the use of topical intraoperative antibiotics. This survey demonstrated heterogeneity in the medical and surgical management of primary, recurrent, and multiple brain abscesses among Canadian neurosurgery attending staff and residents.

Ceftazidime-resistant Burkholderia pseudomallei masquerading as isolated atypical neuromelioidosis

A middle-aged recently diagnosed uncontrolled diabetic from Mumbai, India presented with fever and headache for 8 weeks. Two weeks prior to his symptoms, he travelled to Lonavala during the monsoons and gave history of indoor swimming in a chlorinated pool. Investigations showed isolated neurological involvement with multiple brain abscesses. Abscess cultures grew a non-lactose fermenter. Automated systems failed to identify it. After assessment of his background history and detailed microbiological analysis of the organism, specific investigations were requested which confirmed the suspected diagnosis of melioidosis. We report an unusual presentation of ceftazidime-resistant Burkholderia pseumodmallei as isolated neuromelioidosis with brain abscesses.

S3.2 Challenging clinical cases

S3.2 Challenging clinical cases, September 21, 2022, 4:45 PM - 6:15 PMA case of hepato-splenic-renal candidiasis will be discussed with the aim to track down the causative organism and its likely susceptibility. The role of BDG, selection of the antifungal agent, and duration of therapy will be discussed. A case of an HIV-infected patient with cryptococcal meningitis, pulmonary infection, and pulmonary IRIS will be discussed. A case of Candida auris fungemia and organ infection in a liver transplant recipient who developed serially increasing MIC will be presented. The relevance of MIC, tentative breakpoints, and selection of antifungal agents based on PK PD considerations will be discussed. Talamycosis is usually seen in HIV-infected individuals from North East India. Here we discuss a 3-year-old girl with acute lymphoblastic leukemia from Western India who developed cavitary pneumonia and multiple brain abscesses due to talaromyces. The case posed significant management challenges pertaining to both the fungal infection and cancer. Renal mucormycosis in healthy immunocompetent hosts is an entity generally reported only from India and China. We discuss the case of a previously healthy 3-month-old infant who presented with acute renal failure and renal mucormycosis. The case is unique with respect to the source of infection and management strategy. Treatment of fungal infections involving the draining system of the kidney is challenging mainly due to limited antifungal drug penetration at the site of infection. Challenges in the treatment of amphotericin-resistant Aspergillus terreus pelvicalyceal infections will be discussed. CAPA is a well-known complication of coronavirus disease 2019 (COVID-19), but usually involves the lung alone and rarely disseminates when treated. This case illustrates a rare complication of COVID-19, namely endocarditis caused by Aspergillus. Rhinosporidiosis is a well-known disease that usually involves mucosal surfaces in the head and neck. This case illustrates a rare occurrence, namely dissemination to multiple areas and mimicking the clinical presentation of other cutaneous mycoses.