Multiple Brain Abscesses Research Articles

Chronic Granulomatosis Disease With Meningitis and Multiple Brain Abscesses

A 3-year-old boy with fever, fatigue, and vomiting was admitted to the hospital after failing to respond to antibiotics. His history included frequent throat infections. His physical examination and laboratory findings revealed high body temperature, hyperemic oropharynx with multiple crypts on the tonsils, and elevated acute phase reactants. During follow-up, his temperature normalized but his vomiting increased. With a suspected diagnosis of meningitis, magnetic resonance imaging (MRI) was performed. The MRI findings suggested multiple abscesses (Figs 1 and 2 )a nd meningitis (Fig 1). At surgery the lesions were consistent with abscesses, but no organisms were identified. Additional studies revealed a positive nitroblue tetrazolium test, leading to diagnosis of chronic granulomatous disease (CGD).

Hyperimmunoglobulin E syndrome and multiple brain abscesses

Hyperimmunoglobulin E (HyperIgE) syndrome is a rare primary immunodeficiency disease characterizedby recurrent skin and pulmonary infections and an elevated serum IgE level. We report a female neonatewith hyperIgE syndrome who presented with multiple brain abscesses and superficial cold abscesses causedby Staphylococcus aureus and also developed pneumonia later on. On follow-up, she developed pneumoniatwice and cold abscess once. She responded well to conservative management.

Bacillus Cereus Bacteremia and Multiple Brain Abscesses During Acute Lymphoblastic Leukemia Induction Therapy

Bacillus cereus can cause serious infections in immunosuppressed patients. This population may be susceptible to B. cereus pneumonia, bacteremia, cellulitis, and rarely cerebral abscess. Here we report an 8-year-old boy undergoing induction therapy for acute lymphoblastic leukemia who developed multifocal B. cereus cerebral abscesses, highlighting the propensity for B. cereus to develop cerebral abscesses. A review of the literature over the past 25 years identified another 11 cases (3 children and 8 adults) of B. cereus cerebral abscess in patients undergoing cancer therapy. B. cereus cerebral abscesses were associated with a high mortality rate (42%) and significant morbidity. Notably, B. cereus bacteremia with concomitant cerebral abscess was associated with induction chemotherapy for acute leukemia in both children and adults (10 of 12 case reports). Our case report and review of the literature highlights the propensity for B. cereus to develop cerebral abscess(es). Therefore, early consideration for neuroimaging should be given for any neutropenic cancer patient identified with B. cereus bacteremia, in particular those with acute leukemia during induction therapy.

Multiple brain abscesses of gynecologic origin caused by Fusobacterium nucleatum

Multiple brain abscesses of gynecologic origin caused by Fusobacterium nucleatum

Utilization of multidisciplinary surgical techniques to successfully manage 20 brain abscesses in a child

This study describes a case of multiple brain abscesses in a four-year-old boy who presented with a history of fever and disorientation. Medical investigations revealed severe leukocytosis and the presence of 20 hypodense lesions in the boy's cerebrum. Initial medical treatment included intravenous antibiotics, antiepileptics, and dexamethasone. The boy underwent five surgical interventions within a period of 5weeks that included frameless stereotactic craniotomies for aspiration and resection of the abscesses. At the 3-month follow-up, the boy displayed no neurological deficits and no lesions were detected in his brain. This study reveals the importance of instituting a standardized protocol to determine the urgency of surgical intervention in cases of brain abscess so that surgical treatment can be applied in the appropriate time period. This case also shows that rewarding results can be obtained in treating brain abscesses in children when the proper treatment method is initiated in the appropriate amount of time.

Clinical Pathway in the Treatment of Nocardial Brain Abscesses following Systemic Infections.

Nocardial infections are commonly encountered in patients with immunocompromised states. Cerebral nocardiosis is an uncommon clinical entity, representing only 2% of all cerebral abscesses. It has a higher mortality rate, especially for multiple cerebral lesions in immunocompromised hosts following systemic infections. However, an optimal treatment policy to deal with these immunocompromised patients in Asia is still lacking. We retrospectively reviewed the subjects with nocardial brain abscesses from 2001 to 2011 at our medical center. All of them had multiple brain abscesses, underlying with immunocompromised state following systemic infections. All cases were under steroid control due to their comorbidities for more than six months. The comorbidities and misdiagnosis often lead to poor prognosis. The change in the environments of the microorganisms caused by immunosuppressive agents and multiple antibiotic uses may play an important role in this critical disorder. Aggressive craniotomy should be performed in time to avoid grievous neurological outcomes. Our conclusion is that early diagnosis and appropriate antibiotic uses should be implemented promptly, and aggressive craniotomy should be performed for nocardial brain abscesses in subjects with systemic infections under an immunocompromised status.

Therapeutic success in a case of anaerobic sepsis with multiple brain abscesses in the context of an efficient interdisciplinary cooperation

Background Brain abscess is one of the most serious complications of head infections, with significant case-fatality rates. Great progress was made after introduction of antimicrobial therapy with improved microbiologic culture techniques, particularly for anaerobes, and stereotactic brain biopsy and aspiration techniques. The incidence of neurological sequelae in patients who survive a brain abscess is high.

Scedosporium aurantiacum brain abscess after near-drowning in a survivor of a tsunami in Japan

Many victims of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011 developed systemic disorders owing to aspiration pneumonia. Herein, we report a case of tsunami lung wherein Scedosporium aurantiacum was detected in the respiratory tract. A magnetic resonance image of the patient's head confirmed multiple brain abscesses and lateral right ventricle enlargement. In this case report, we describe a potential refractory multidrug-resistant infection following a tsunami disaster.

症例 Taussig-Bing奇形に多発性脳膿瘍を併発し,化学療法単独で治癒した1症例

症例 Taussig-Bing奇形に多発性脳膿瘍を併発し,化学療法単独で治癒した1症例

Multiple intracranial tumors in Philadelphia chromosome-positive acute lymphoblastic leukemia

A three-year-old female presented with prolonged fever and petechiae. Her initial complete blood workup showed a white blood cell (WBC) count of 159 9 10/L with 92 % lymphoblasts, hemoglobin of 9.3 g/dL, and a platelet count of 22 9 10/L. Marked elevations of C-reactive protein (CRP) and lactate dehydrogenase were identified. The immunophenotype of the blast cells was CD10, CD19, HLA-DR, smIg, and smIg j=k , which is compatible with a diagnosis of precursor B cell lymphoblastic leukemia (pre-B ALL). CD66c expression was also detected, so we confirmed the bcr/abl rearrangement by fluorescence in situ hybridization analysis, and used transcriptase-polymerase chain reaction analysis to detect the minor bcr/abl fusion gene transcript. Given these results, the patient was diagnosed with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph ALL). By conventional cytogenetic analysis of bone marrow and peripheral blood cells at the onset, abnormalities of 9pq and 22q were suggested, but the complete karyotype of this case could not be confirmed at the time; however, the karyotype was later revealed at her first relapse to be 46, XX, dup(1)(q25q32), add(1)(q32), del(3)(q2?), der(9)t(9;22)(q34;q11)del(9)(p13), del(14)(13). As she presented with severe hyperleukocytosis, she received intravenous hyperhydration and prednisone at low doses for the purpose of cytoreduction until the beginning of remission induction therapy. A broad-spectrum antibacterial agent and fluconazole were also administered intravenously against her suspected systemic infection. However, her blood culture was negative, and her serum b-D glucan was not elevated. Whole-body computed tomography (CT) imaging was performed and high-density multiple intracranial tumors were detected (Fig. 1a–c) despite the absence of focal neurological symptoms or meningeal irritation. However, an analysis of her cerebrospinal fluid (CSF) showed no nucleated cells, and normal protein (18 mg/dL) and glucose (69 mg/dL) levels. The CRP level became negative at 3 days before starting induction chemotherapy, so both the antibacterial agent and fluconazole were stopped. During the period of myelosuppression after starting induction therapy, she remained afebrile with no elevation of CRP. Head CT scans at 16 days and 30 days after induction therapy, showed the intracranial masses to be markedly reduced compared with those on her head CT scans before induction therapy (Fig. 2a–c). Her intracranial tumors completely disappeared after two cycles of chemotherapy and never recurred. Unfortunately, she died from refractory leukemia, although she received allogeneic cord blood transplantation twice. At first, the intracranial lesions were suspected to be multiple brain abscesses or cerebral hemorrhage. If either were the case, rapid regression of intracranial lesions such as those observed in the present case would not be expected to occur. Moreover, several patients with acute leukemia who developed multiple intracranial hemorrhages associated with hyperleukocytosis have been reported. In such patients, severe neurological symptoms are commonly N. Hatakeyama (&) T. Hori M. Yamamoto N. Inazawa K. Igarashi H. Tsutsumi N. Suzuki Department of Pediatrics, Sapporo Medical University School of Medicine, South-1, West-16 Chuo-ku, Sapporo, Hokkaido 060-8543, Japan e-mail: nhatake@sapmed.ac.jp

Multiple Brain Abscess - Think out of the Box

Multiple Brain Abscess - Think out of the Box

Multiple nocardial brain abscesses in an immunocompromised patient with myasthenia gravis

Introduction: Nocardia are gram positive, variably acid-fast positive diphtheroidlike to branched, filamentous, aerobic actinomycetes. Nocardiosis is an opportunistic infection that has been noted in patients with malignancies, systemic lupus erythematosus, HIV infection, hematopoietic stem cell transplant recipients and long-term steroid users. A 32- year-old female presented with history of myasthenia gravis on long-term glucocorticoid therapy. During her last admission, wound culture of her left shoulder abscess showed diptheroid organisms. Patient presented with severe headache, nausea, vomiting and altered mental status. She was initially diagnosed with metastatic cerebral abscess and treated with empiric antimicrobial therapy. Imaging study of the brain showed bilateral occipital ring enhancing lesions. Biopsy results came back as culture positive for nocardia. Patient was subsequently treated with intravenous antibiotics for a total of six months. Cases of nocardiosis may go undiagnosed, either because they respond to empiric antimicrobial treatment or because Nocardia spp. may be difficult to identify in cultures of clinical specimens. They may be mistaken for nonpathogenic microorganisms (diphtheroids) and discarded. High suspicion and early long term institution of therapy are key to a favorable outcome of this disease which has high mortality rates.

Cerebral Phaeohyphomycosis in a Patient with Neurosarcoidosis on Chronic Steroid Therapy Secondary to Recreational Marijuana Usage

Cerebral phaeohyphomycosis is often a fatal disease that typically takes a hematogenous spread after inhalation or accidental skin inoculation of pathogens. We present a patient with a history of heavy marijuana smoking while being on chronic steroid therapy for treatment of neurosarcoidosis who was found to have multiple brain abscesses from Curvularia sp. This is a ubiquitous soil-dwelling dematiaceous fungus that is generally thought to affect solely plants, but there is increasing evidence in the literature of it affecting humans and animals. We review the radiographic findings of neurosarcoidosis and cerebral phaeohyphomycosis as well as the pathophysiology of dematiaceous fungi infections.

Identification of Streptococcus intermedius Central Nervous System Infection by Use of PCR and Electrospray Ionization Mass Spectrometry

We describe the utility of PCR and electrospray ionization with mass spectrometry (PCR/ESI-MS) of culture-negative cerebrospinal fluid (CSF) in order to identify Gram-positive cocci noted on a Gram stain of CSF from a previously healthy 26-year-old man with community-acquired pneumonia (CAP) and multiple brain abscesses. CSF samples were obtained 2 weeks apart, first by lumbar puncture and 2 weeks later from an external ventricular drain that was inserted into the right ventricle. Both CSF cultures were negative. A Gram stain of bronchoalveolar lavage (BAL) fluid was notable for many Gram-positive cocci (GPC), but cultures of BAL fluid and subcarinal lymph node biopsy tissue were negative. PCR/ESI-MS detected Streptococcus intermedius, a common cause of brain abscesses, in both CSF samples as well as in the fixed tissue from the biopsy. This unique case confirms S. intermedius pulmonary infection as the source of metastatic CNS infection and reveals the potential of PCR/ESI-MS to detect a streptococcal pathogen not captured by conventional cultures.

Cerebral aspergillus infection in pediatric acute lymphoblastic leukemia induction therapy

Angioinvasive pulmonary infection from filamentous fungi is not an uncommon occurrence in immunocompromised patients like acute lymphoblastic leukemia (ALL). Rarely, these lesions can spread via the hematogenous route and involve multiple visceral organs. We report a case of a 14-year-old boy with ALL who developed angioinvasive pulmonary aspergillosis early in the course of induction therapy, which was followed by hematogenous dissemination and formation of multiple brain abscesses. The patient was treated with intravenous amphotericin B. There was no response to the therapy and the patient succumbed to disseminated infection. Postmortem lung biopsy confirmed angioinvasive pulmonary aspergillosis. Poor penetration of amphotericin B across the blood-brain barrier could be one of the contributory factors for poor response to antifungal therapy. We discuss the various antifungal agents with respect to their penetration in brain.

Daptomycin efficacy in the central nervous system of a patient with disseminated methicillin-resistant Staphylococcus aureus infection: a case report

IntroductionStaphylococcus aureus has emerged as a major nosocomial pathogen in the last decades and also represents the second most common pathogen isolated from patients in outpatient settings. Although methicillin-resistant S.aureus infections were traditionally limited to hospitals, community-associated cases of methicillin-resistant S.aureus infections have been reported. In our case, we observed an unexpected event during treatment.Case presentationA 60-year-old Caucasian man developed fever and multiple muscle and brain abscesses caused by Panton-Valentine leukocidin-negative community-associated methicillin-resistant S. aureus.ConclusionAlthough our patient was given antimicrobials active against the isolated methicillin-resistant S. aureus strain, it was only after the introduction of daptomycin that his skin, soft tissue and muscle lesions and also brain manifestations improved.

Multiple Fungal Brain Abscesses in a Child with Acute Lymphoblastic Leukemia

Fungal infection is a severe problem in children suffering from cancer. We report a case of a four-year-old girl who was diagnosed with acute lymphoblastic leukemia and multiple Aspergillus niger abscesses at the induction phase of the treatment. She was treated with granulocyte transfusions, liposomal amphotericin B with a combination of voriconazole for four months, followed by oral variconazole alone for 17 months. She was successfully treated with this combination without any sequel, and the planned chemotherapy was also completed. Our experience revealed that antifungal treatment including intravenous amphotericin B and variconazole augmented by granulocyte transfusion is an alternative option for the management of this catastrophic complication.

多発性脳膿瘍, 化膿性心外膜炎, 膿胸を合併した感染性心内膜炎の1救命例

多発性脳膿瘍, 化膿性心外膜炎, 膿胸を合併した感染性心内膜炎の1救命例

MRI with Magnetic Resonance Spectroscopy of multiple brain abscesses secondary to Scedosporium apiospermum in two immunocompromised patients

Scedosporium apiospermum is a deadly fungal infection that can infect the central nervous system, particularly in immunocompromised patients. We present two cases of Scedosporium brain abscesses. The first case was fatal and relevant conventional MRI and MR spectroscopy findings are discussed. To our knowledge, this is the first reported case of MR spectroscopy in Scedosporium apiospermum abscesses. In the second case, the patient recovered and conventional MR findings are followed over several months. In the appropriate clinical setting, conventional MR imaging and MR spectroscopy may facilitate diagnosis, earlier initiation of antifungal pharmacotherapy and surgical intervention in this frequently fatal infection.

Brain Abscesses Complicating Acute Pneumococcal Meningitis During Etanercept Therapy

Brain abscess formation as a sequelae of community-acquired pneumococcal meningitis is extremely rare, accounting for less than 1% of all meningitis complications. Although metastatic seeding from a distal peripheral septic focus has been observed, this phenomenon most commonly occurs in the context of ear, nose and throat infections, post-cranial neurosurgical procedures, traumatic open cranial injury, or immunosuppression. We present the case of a man, 61 years old, on etanercept therapy for ankylosing spondylitis who developed multiple brain abscesses as a complication of pneumococcal meningitis. We believe that the predisposition to this extremely rare complication of a particularly aggressive pneumococcal meningitis was most likely due to the underlying immunosuppression resulting from etanercept therapy. As far as we know, this case is the first report linking multiple brain abscess formation in a patient with community-acquired pneumococcal meningitis with etanercept therapy.