Outcome Of Brain Abscess Research Articles

Brain abscess following solid organ transplantation: A 21-year retrospective study.

Development of brain abscess following solid organ transplantation is associated with significant morbidity and mortality. We undertook a descriptive study to evaluate the etiology, clinical manifestations, diagnosis, management, and outcomes of brain abscess in solid organ transplant (SOT) recipients at three major transplant centers in the United States. This is a retrospective study of adults with brain abscess following SOT between January 2000 and June 2021 at Mayo Clinic sites in Arizona, Minnesota, and Florida. A total of 39 patients were diagnosed with a brain abscess following SOT. The most common pathogens were Nocardia sp. (24 cases, 61.5% [Nocardia farcinica, 37.5%]), followed by fungi (12 cases, 30.7% [Aspergillus sp., 83.3%]). The majority were kidney transplant recipients (59%). Median time to brain abscess diagnosis was 1.3 years (range, 29 days-12 years) after SOT; 10 of 12 patients (83%) with fungal brain abscess were diagnosed within 1 year after SOT. Twelve patients underwent brain biopsy for diagnosis (25% Nocardia vs. 50% fungal), eight (20.5%) underwent surgical resection of the abscess, and 31 (79.5%) received antimicrobial therapy alone. Median time to brain abscess resolution was 166 days for Nocardia and 356 days for fungal pathogens. Eleven of 39 patients (28.2%) died as a result of their brain abscess, including four of 24 patients (16%) with Nocardia and six of 10 patients (60%) with Aspergillus brain abscess. All-cause mortality was 43.6%. Brain abscess remains an uncommon infectious complication following SOT. Nocardia and fungi accounted for 92% of pathogens in our cohort. Fungal brain abscess portends a poor prognosis.

Clinico-radiological presentation and outcome of brain abscess in congenital cyanotic heart disease

Introduction Patients with congenital cyanotic heart disease (CCHD) are at increased risk of developing brain abscesses. Having a brain abscess is itself a risk for the patient and concomitant cyanotic heart disease makes it a double jeopardy. The management of brain abscesses depends on the size, number, stage, and location of the abscess and can be medical and surgical. Methods This retrospective chart review was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal between January 2019 and December 2023. Demographic and clinical profiles, imaging studies, treatment modalities, and outcomes were analyzed. Results Out of 17 patients, 11 were males and six were females. The mean age of the study population was 13.41 +/- 11.08 years. The most common associated cardiac problem was Tetralogy of Fallot seen in six (35.3%) patients and the most common abscess site was the parietal lobe (38%). The most common presenting symptom was vomiting, seen in 76%. Twelve patients underwent burrhole and aspiration and 17.6% of patients underwent surgical excision of the abscess wall whereas 11.7% of the patients were managed conservatively. Positive culture was seen in 33.3%. S. aureus was the most common organism grown. There was no mortality. Conclusion High index of suspicion for brain abscess is necessary in patients with congenital cyanotic heart disease. Early diagnosis and treatment lead to a favorable outcome.

Clinical Characteristics, Risk Factor and Outcome of Brain Abscess: A Retrospective Analysis During a 10-year Period

Background: This study aimed to collect and analyze the information of patients diagnosed with primary brain abscess at our hospital over the last 10 years to determine the predisposing risk factors, clinical characteristics, and predictors of outcome.Methods: The retrospective study evaluated hospital records and radiology data of patients diagnosed with and treated for brain abscess in our hospital from 2013 to 2022. A total of 25 patients were included in this study. Clinical characteristics of patients diagnosed with brain abscess were identified, and the surgical group and the non-surgical group were compared and the risk factors for poor prognosis were investigated. In addition, the excision and aspiration groups were compared among patients who underwent surgical treatment.Results: Seventeen patients (68%) underwent surgery, and the remaining eight patients (32%) underwent conservative treatment. Of the 17 patients who underwent surgery, nine patients (52.94%) underwent stereotactic drainage, and eight (47.05%) underwent craniotomy, and excision. At discharge, nine patients (36%) had poor outcomes (modified Rankin Scale score 3-6), including one (5.88%) who died, and the remaining 16 (68%) had good outcomes (mRS score 0-2).Conclusions: The most common comorbidity in the patients with brain abscess was diabetes mellitus, and Gram-positive Staphylococcus was the most common pathogen. Headache and confusion are also associated with poor outcomes. In addition, aspiration and excision had no significant differences in terms of outcomes

Brain abscess following kidney transplantation: A single centre observational study from North India

BackgroundAmongst the infections in kidney transplant recipients, brain abscess represents an uncommon life-threatening complication. Mortality continues to be high despite improvements in diagnostics and therapeutics. MethodWe conducted an observational study, describing the incidence, presentation, implicating pathogen, management and outcome of brain abscess following kidney transplantation at our centre. ResultAmongst the 1492 patients who underwent kidney transplantation at our centre between June 1991 and January 2023 (cumulative follow-up: 4936 patient-years), five females and four males, developed brain abscesses. The incidence proportion (risk) is 0.6% with an incidence rate of 6.03 cases per 1000 patient years. The median duration from transplant to development of brain abscess was 5 weeks (range: 4 weeks to 9 years). The commonest presentation was a headache. A definitive microbiological diagnosis was established in eight out of nine patients. The commonest implicated organism was a dematiaceous fungus, Cladophialophora bantiana (3 patients, 33.3%). Despite the reduction in immunosuppression, surgical evacuation and optimal medical therapy, five (55.55%) patients succumbed to their illness. ConclusionsBrain abscesses following kidney transplantation is an uncommon, life-threatening condition. It usually occurs in the early post-transplant period and the presentation is often subtle. Unlike immunocompetent individuals, a fungus is the most common causative organism in those with solid organ transplants. The management includes a reduction in immunosuppression, early antimicrobial therapy, and surgical decompression.

Surgical Outcome of Brain Abscess after Single Burrhole Aspiration Technique in Terms of Glasgow Outcome Scale

Objectives: This case-series was aimed to determine the surgical outcome of brain abscess after a single burr hole aspiration technique in terms of the Glasgow outcome scale (GOS).
 Material & Methods: 100 cases were taken in the study with brain abscess. The favourable outcome included those patients with postoperative GOS of 4 or 5, at discharge and one month postoperatively whereas unfavourable outcome included patients with postoperative GOS of less than 4, at discharge and one month postoperatively.
 Results: Of the 100 patients included, there were 72 (72%) males and 28 (28%) females. The overall mean diameter of the abscess was 6.01 cm ± 1.90. Mean GOS was 2.95 ± 0.86 while mean GOS 3.79 ± 1.18. In this study 75% (n=75) patients presented with a GCS of 12 or less. Among these patients, 2 patients presented with a GCS of 5, 6 patients with a GCS of 7, 9 with GCS 8, 11 with GCS 9, 18 with GCS 10, 15 with GCS 11 and 14 patients presented with a GCS of 12. A favourable outcome was observed in 73 (73%) patients (GOS = 4 and 5), while 27 (27%) were in the unfavourable outcome group.
 Conclusion: Although most of the patients present with a good neurological state, those who present with lower GCS are particularly prone to the poor postoperative outcome and higher mortality. The size of the brain abscess is also an important predictor of the postoperative outcome. The overall outcome for brain abscess aspiration was good.

Profile of Patients with Brain Abscess

Introduction: Despite of the advent of modern neurosurgical techniques and antibiotics, brain abscess possesses a major neurosurgical challenge in treatment. In this study we present the profile , clinical features , radiological features , treatment received and their outcome of cases of brain abscess that we managed in our center.
 
 Methods: Total 30 patients diagnosed with brain abscess who underwent treatment in last four months were included in this study. A descriptive observational data of brain abscess and the outcome variables in the form of Glasgow Outcome Scale (GOS) at discharge , hospital stay, and mortality were studied. The ultimate outcome was measured in Glasgow Outcome Score.
 
 Results: Total number of cases was 30, outwith male dominance 19 (63.3%) . Age ranged from 2 months to 60 years. Twenty-five patients were of acute pyogenic abscess while and rest were tubercular abscess. Common clinical features were headache (70%), fever (30%), vomiting (23%), seizure (23%) and focal neurological deficits (16.7%). Overall mean hospital stay was 31 days. The common aetogenic factors included chronic suppurative otitis media (16.7%), tuberculosis (16.7%), post-traumatic (10%), congenital heart disease (10%) and rest (46%) were of unknown source. lobe Temporal lobe and cerebellar were most common site involved (20%) each followed by frontal (16.7%). Surgery was done in 25 (83.3%) cases out of which 12 underwent burr hole and aspiration and 12 patients underwent craniotomy and excision and one patient underwent burr hole and followed by craniotomy. Five patients were managed conservatively. Complete resolution of abscess with complete recovery of preoperative neurological-deficit was seen n 28 (93.3%) cases.
 
 Conclusion: Early diagnosis and timely intervention improves the outcome of brain abscess. Most of the cases required surgical intervention and drainage of pus and had good postoperative outcome.

Letter to the Editor Regarding “Normal Pressure Hydrocephalus and Parkinsonism: Preliminary Data on Neurosurgical and Neurological Treatment”

Though outcome of brain abscess has been improved due to stereotactic drainage and appropriate antibiotic treatment, late unprovoked seizure often occurs after the abscess is resolved. The purpose of this study is to reveal the factors related to the late unprovoked seizure and effect of steroid on the prevention of seizure.From January 2002 to August 2016, 119 patients with supratentorial brain abscesses were retrospectively analyzed. Initial volume of abscess, surgical methods, use of antiepileptic drugs (AEDs), and seizure free survival according to the use of steroid were compared between seizure free and late unprovoked seizure patients groups. Factors related to the late unprovoked seizure were evaluated by multivariate logistic regression model.All patients underwent surgery, which were either by burrhole aspiration or craniotomy. 22/119 patients (18.5%) had late unprovoked seizure. Initial abscess volume was significantly larger in the group of late unprovoked seizure (28.31 ± 22.68 cm3 vs. 17.03 ± 14.53 cm3, p = 0.015). The mean time to the late unprovoked seizure was 487.7 ± 446 days (range, 11–1369 days). Steroid was used to relieve perilesional edema in 35 patients. Proportion of late onset seizure was not different between the group of steroid non-use group and steroid use (17.1% vs. 19%, p = 0.52) and mean seizure free periods of steroid non-use group and steroid use group were 40.75 ± 9.23 months and 48.85 ± 8.50 months, respectively (P = 0.89, by log rank test). Initial presentation of seizure at the diagnosis of brain abscess and initial volume larger than 20.89 cm3 were risk factors for late unprovoked seizure with odds ratio of 4.1 (95% C.I 1.44–11.69) and 3.08 (95% C.I 1.19–7.96), respectively.Late unprovoked seizure in patients with brain abscess was affected by initial presentation of seizure and initial volume of the abscess whereas methods of surgical intervention and steroid use had no effect on the occurrence of late unprovoked seizure.

Clinical Profile and Outcome of Brain Abscess in Children from a Tertiary Care Hospital in Eastern Uttar Pradesh.

Background and Aims:Brain abscess is a serious and dreadful disease presenting at tertiary centre. The objective of this study was to look into the clinical profile, predisposing conditions, microbiology and outcome of children suffering from brain abscess.Methods:30 children up to 18 years with clinical and imaging evidence of brain abscess were taken for study. Patients were stabilized as per unit protocol. Necessary investigations were carried out. Neuroimaging (CT or MRI) was used to confirm the diagnosis. All parameters (clinical, investigation, outcome) were recorded in predesigned performa. Neurosurgery consultation was sought in patients with multiple abscesses, posterior fossa abscesses, abscess with air-fluid level and causing midline shift.Results:There were 16 males with 13 patients in age group (5-10 years). Mean duration of stay in hospital was 14.8 days. Most common predisposing factor was chronic suppurative otitis media (n-15). Typically, patients presented with fever, headache and seizures. On examination, motor deficits were the most common followed by signs of meningitis. Computerized tomography confirmed the diagnosis in most cases. Temporal lobe (n-11) was the commonest intracranial site for the abscess. Methicillin resistant staphylococcus and proteus mirabilis were the common pathogen isolated from blood and pus. Blood culture positivity rate was 16.7% and pus culture positivity rate was 25%. All cases were managed with intravenous antibiotics and aspiration (n-10) and excision (n-6). There were 5 deaths. There was complete immediate recovery in 13 cases with residual motor deficit in 12 cases.Conclusion:Brain abscess is a rare but serious entity in children. Late diagnosis and improper management leads to poor outcome. Early surgical intervention is helpful. Threshold for diagnosis should be low in children with chronic ear infection and congenital heart diseases.

Brain Abscess in Children: A Rare but Serious Infection.

Brain abscess is a rare disease in childhood requiring prompt medical and/or surgical treatment. The objective was to review presentation, management, and outcome of brain abscess in children. We reviewed the clinical and radiological features and outcomes of 18 children (10 females, 8 males), with a median age of 48 months (range 1-182), that presented with brain abscesses and admitted to a tertiary pediatric infectious department between December 2010 and January 2017. One (5.5%) patient underwent craniotomy and 14 (77.7%) had burr hole aspirations. The most common localization was the frontal lobe (33.3%). The survival rate was 94.4%, and long-term neurological sequelae affected 27.7% of the patients. Empiric treatment choices require knowledge of common pathogens and local resistance. The most predominant infections were still upper respiratory infections. Clinicians may treat the children with appropriate choice and duration of antibiotic treatment for upper respiratory tract infections.

Clinical characteristics and outcome of brain abscess

To define clinical characteristics, causative organisms, and outcome, and evaluate trends in epidemiology and outcome of brain abscesses over the past 60 years. We performed a systematic review and meta-analysis of studies on brain abscesses published between 1970 and March 2013. Studies were included if they reported at least 10 patients with brain abscesses, included less than 50% extra-axial CNS infections (empyema) without brain abscess, and did not solely report on brain abscesses caused by a single pathogen. We identified 123 studies including 9,699 patients reported between 1935 and 2012. There was a male predominance of 2.4 to 1, and the mean age of patients with brain abscesses was 34 years. The most common causative microorganisms were Streptococcus and Staphylococcus species, comprising 2,000 (34%) and 1,076 (18%) of 5,894 cultured bacteria. Geographical distribution of causative microorganisms over continents was similar and did not substantially change over the past 60 years. Predisposing conditions were present in 8,134 of 9,484 patients (86%) and mostly consisted of contiguous or metastatic foci of infection. The classic triad of fever, headache, and focal neurologic deficits was present in 131 of 668 (20%) of patients. Case fatality rate decreased from 40% to 10% over the past 5 decades, while the rate of patients with full recovery increased from 33% to 70%. The prognosis of patients with brain abscesses has gradually improved over the past 60 years. Important changes over time were the modality of cranial imaging, neurosurgical technique, and antimicrobial regimen.

873 ’Brain Abscess in Infants and Children: A Retrospective Study of 52 Patients in Pediatric’s Hospital of Casablanca, Morocco

Brain abscess is a serious disease of the central nerve system, it’s a rare pathology in children; to review the clinical manifestation, and predisposing factors, causative organism and outcomes of...

Clinical features and outcome analysis of 90 cases with brain abscess in central China

The purpose of this study was to investigate the clinical features and outcomes of brain abscess in patients in central China. Ninety consecutive patients with brain abscess were studied retrospectively. The rate of positive bacterial culture in the present series was 12%. The outcome of superficial abscesses was better than those of abscesses in deep-seated locations (p<0.01); multiple brain abscesses led to significantly poorer outcomes than unilocated abscesses (p<0.01). There was no significant difference between the paediatric group and the adult group (p>0.05). Differences in outcomes between intrathecal injection combined with systemic administration of antibiotics vs. only venous administration could not be found (p>0.05). The clinical effectiveness of tertiary-generation cephalosporin+vancomycin+metronidazole for bacterial brain abscess was 88%. Therefore, combined antibiotics in cases with no evidence of positive culture in brain abscess are strongly recommended.

Management and outcome of brain abscess in renal transplant recipients

Although infection is the commonest central nervous system complication following renal transplantation, brain abscess is uncommon. Over the last 11 years, five renal transplant recipients who had brain abscesses were...