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Rafaelian A, Won SY, Trnovec S, Behmanesh B, Barz S, Busjahn C, Reuter DA, Zhang L, Mlynski R, Freiman T, Gessler F, Dubinski D. Otogenic Brain Abscess and Concomitant Acute COVID-19 Infection: Case Report and Review of the Literature. J Neurol Surg A Cent Eur Neurosurg 2025. [PMID: 39566535 DOI: 10.1055/a-2479-5462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2024]
Abstract
BACKGROUND 2019 coronavirus disease (COVID-19) has attracted global attention primarily because of the severe acute respiratory symptoms associated with it. However, nearly one third of the patients also present with neurological symptoms. This report describes a case of a previously healthy woman with acute COVID-19 infection, who developed acute facial nerve palsy and rapid progression to coma due to otogenic brain abscess. CASE DESCRIPTION A 63-year-old woman with acute COVID-19 infection exhibited acute facial nerve paresis, high fever, and purulent secretion from her left ear within 48 hours after COVID-19 onset. Cranial computed tomography scan confirmed acute mastoiditis, precipitating an urgent mastoidectomy. A postoperative contrast-enhanced magnetic resonance imaging on the same day revealed a subdural empyema, which prompted an urgent craniotomy and decompression. Intraoperative microbiological swabs confirmed a Streptococcus pyogenes infection; however, reverse transcription polymerase chain reaction was negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After immediate intravenous antibiotic treatment, extubation was achieved 4 days after operation, and the patient was discharged without neurological deficits 19 days after postoperatively. CONCLUSION This finding adds a layer of insight into the specific nature of the infection, suggesting a potential absence of SARS-CoV-2 involvement in otogenic subdural empyema. However, the impact of SARS-CoV-2 in otogenic brain abscess cannot be excluded to date and should be further prospectively investigated. The complete recovery of neurological status emphasizes the importance of prompt and interdisciplinary interventions in managing rare and severe complications associated with COVID-19.
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Affiliation(s)
- Artem Rafaelian
- Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Sae-Yeon Won
- Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
- Department of Neurosurgery, University Hospital of Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Svorad Trnovec
- Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Bedjan Behmanesh
- Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Susanne Barz
- Department of Anesthesiology, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Christoph Busjahn
- Department of Anesthesiology, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Daniel A Reuter
- Department of Anesthesiology, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Lichun Zhang
- Department of Otorhinolaryngology, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Robert Mlynski
- Department of Otorhinolaryngology, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Thomas Freiman
- Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
| | - Florian Gessler
- Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Daniel Dubinski
- Klinik und Poliklinik für Neurochirurgie, Universität Rostock, Rostock, Mecklenburg-Vorpommern, Germany
- Department of Neurosurgery, Universitätsmedizin Rostock, Rostock, Mecklenburg-Vorpommern, Germany
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de la Rosa MF, Uribarrena GC, Munarriz PM, Moroño SI, Melé MV, Miñano JMV, Hurtado AG, García MEL, Guzmán M, García CF, Forte D. Impact of the COVID-19 pandemic on the incidence of pediatric intracranial empyemas in Spain. Childs Nerv Syst 2025; 41:107. [PMID: 39915322 DOI: 10.1007/s00381-025-06763-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Accepted: 01/29/2025] [Indexed: 05/07/2025]
Abstract
INTRODUCTION Intracranial infections due to sinusitis and otitis, although rare, can progress rapidly and result in significant morbidity, necessitating multifaceted management including extended antibiotic therapy and surgical intervention. Predominantly affecting infants and older children, these infections have seen a perceived increase in incidence following the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES Our study aims to describe the clinical and epidemiological characteristics of intracranial infections secondary to sinusitis or otitis in the pediatric population and assess changes in incidence and clinical presentation post-pandemic. Specific objectives include analyzing neurosurgical management practices, the role of ENT-neurosurgery cooperation, incidence of epileptic seizures, and management of associated venous thrombosis. MATERIALS AND METHODS A retrospective multicentric study was conducted in hospitals across the Iberian Peninsula, including data from January 2018 to December 2022. Data were divided into pre-lockdown (January 2018 to March 2020) and post-lockdown (March 2020 to December 2022) periods for analysis. RESULTS The study included 60 pediatric cases (38 post-pandemic and 22 pre-pandemic). The average age was 9.8 years, with a male predominance (61.67%). Sinusitis was the most frequent cause (86%), and the frontal region was the most common site of infection (75%). Neurological symptoms were more prevalent post-pandemic (55.26% versus 23.68%). The primary pathogen was S. intermedius (29.6%). Most patients required neurosurgical intervention (81.7%), with a significant portion undergoing combined ENT-neurosurgery procedures (52.9%). The average antibiotic treatment duration was 6.6 weeks. Complications included venous sinus thrombosis (20%) and seizures (39.2%). Mortality was 3.3%. CONCLUSION Although there was a perceived increase in cases post-pandemic, our study observed a normalization of incidence after the lockdown, with a decrease in diagnoses during confinement. The accepted antibiotic regimen lasts 6 weeks, extendable to 8 weeks in non-surgical patients, with at least 2 weeks of intravenous treatment. Sinus surgery combined with antibiotics may suffice to avoid craniotomy in some cases, while combined surgery has a lower reoperation rate in others. Anticoagulation should be individualized and discontinued upon recanalization. Prophylactic antiepileptic drug use remains controversial and should be tailored to patients with specific risk factors. Prolonged antiepileptic drug (AED) therapy may be warranted for those with early seizures and hemorrhagic lesions, whereas others may gradually taper off AEDs after the acute stage.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Marta Guzmán
- Neurosurgery Department, Hospital Reina Sofía de Córdoba, Cordoba, Spain
| | | | - Dalila Forte
- Neurosurgery Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Gil E, Hatcher J, de Saram S, Guy RL, Lamagni T, Brown JS. Streptococcus intermedius: an underestimated pathogen in brain infection? Future Microbiol 2025; 20:163-177. [PMID: 39552595 PMCID: PMC11792871 DOI: 10.1080/17460913.2024.2423524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 10/28/2024] [Indexed: 11/19/2024] Open
Abstract
Streptococcus intermedius is an oral commensal organism belonging to the Streptococcus anginosus group (SAG). S. intermedius causes periodontitis as well as invasive, pyogenic infection of the central nervous system, pleural space or liver. Compared with other SAG organisms, S. intermedius has a higher mortality as well as a predilection for intracranial infection, suggesting it is likely to possess virulence factors that mediate specific interactions with the host resulting in bacteria reaching the brain. The mechanisms involved are not well described. Intracranial suppuration (ICS) due to S. intermedius infection can manifest as an abscess within the brain parenchyma, or a collection of pus (empyema) in the sub- or extra-dural space. These infections necessitate neurosurgery and prolonged antibiotic treatment and are associated with a considerable burden of morbidity and mortality. The incidence of ICS is increasing in several settings, with SAG species accounting for an increasing proportion of cases. There is a paucity of published literature regarding S. intermedius pathogenesis as well as few published genomes, hampering molecular epidemiological research. This perspective evaluates what is known about the clinical features and pathogenesis of ICS due to S. intermedius and explores hypothetical explanations why the incidence of these infections may be increasing.
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Affiliation(s)
- Eliza Gil
- UCL Respiratory, Division of Medicine, University College London, London, WC1E 6JF, UK
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Division of Infection, University College London Hospital, London, NW1 2BU, UK
- Department of Microbiology, Virology & Infection Control, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 1EH, UK
| | - James Hatcher
- Department of Microbiology, Virology & Infection Control, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 1EH, UK
- Department of Infection, Immunity & Inflammation, UCL Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
| | - Sophia de Saram
- Division of Infection, University College London Hospital, London, NW1 2BU, UK
| | - Rebecca L Guy
- Healthcare-Associated Infection & Antimicrobial Resistance Division, UK Health Security Agency, London, NW9 5EQ, United Kingdom
| | - Theresa Lamagni
- Healthcare-Associated Infection & Antimicrobial Resistance Division, UK Health Security Agency, London, NW9 5EQ, United Kingdom
| | - Jeremy S Brown
- UCL Respiratory, Division of Medicine, University College London, London, WC1E 6JF, UK
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Arbuckle BB, Abo Kasem R, Shaik A, Downes A, Hwang S, Passias PG, Agarwal N, Jea A, Janjua M. Microbial Analyses of Subdural Empyema: A Case Report and Literature Review. Cureus 2025; 17:e76800. [PMID: 39897219 PMCID: PMC11786810 DOI: 10.7759/cureus.76800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2024] [Indexed: 02/04/2025] Open
Abstract
Subdural empyema (SDE) is an infection between the dura and arachnoid mater, presenting with symptoms such as fever, headache, altered sensorium, neurological deficits, and seizures. Due to its rapidly progressive nature, early diagnosis and treatment are crucial. This paper aims to identify common pathogens, imaging findings, and the necessity of emergent neurosurgical intervention. We present the case of a 49-year-old woman with an SDE who underwent craniotomy to evacuate pus and hematoma. Cultures confirmed Streptococcus intermedius, and the patient improved postoperatively with the complete evacuation of the SDE and resolution of midline shift seen on the CT scan. A PubMed literature review focused on consolidating data to identify common pathogens, demographic details, treatment methods and duration, and outcomes in SDE. SDE requires prompt diagnosis and treatment. Contrast-enhanced brain MRI is crucial for diagnosis, showing features distinct from subdural hematoma or hygroma. Neurosurgical intervention is urgent, including craniotomy and evacuation. Postoperative broad-spectrum antibiotic therapy is essential until specific pathogens are identified, and a multidisciplinary approach is recommended.
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Affiliation(s)
- Benjamin B Arbuckle
- Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Rahim Abo Kasem
- Neurological Surgery, Medical University of South Carolina, Charleston, USA
| | - Adnan Shaik
- Neurological Surgery, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Angela Downes
- Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Steven Hwang
- Orthopedic Surgery, Shriners Children's Philadelphia, Philadelphia, USA
| | | | - Nitin Agarwal
- Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Andrew Jea
- Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Muhammad Janjua
- Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Gkrinia E, Brotis AG, Vallianou K, Ntziovara AM, Hajiioannou J. Otogenic brain complications: a systematic review and meta-analysis. J Laryngol Otol 2024; 138:828-837. [PMID: 38440882 DOI: 10.1017/s0022215124000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE This study aimed to form astute deductions regarding the presentation, treatment and mortality of otogenic brain complications. METHODS A systematic literature search of four medical databases (PubMed, Embase, Web of Science and Scopus) was conducted. Studies associated with otogenic brain complications were considered eligible. Fixed- and random-effects model meta-analysis was developed to assess the proportion estimate for each outcome individually. RESULTS Twenty-eight studies, with 1650 patients in total, were included. In 66 per cent of patients there was a known history of chronic otitis media. The most common symptoms were purulent otorrhoea (84 per cent), headache (65 per cent) and otalgia (45 per cent). A brain abscess was observed in 49 per cent of patients, followed by meningitis (34 per cent) and sinus thrombosis (22 per cent). A combination of surgical and conservative therapy was chosen in 84.3 per cent of cases and the mortality rate approached 11.1 per cent. CONCLUSION Otogenic brain complications are a possibly life-threatening condition. Prompt imaging examination may set the final diagnosis and lead to an effective treatment.
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Affiliation(s)
- Eleni Gkrinia
- ENT Department, University Hospital of Larissa, Larissa, Greece
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Gupta P, Singh H, Vashisht N, Dhingra GS, Sharma V. A Rare Confluence: Brain Abscess in an Adult With Tetralogy of Fallot. Cureus 2024; 16:e63860. [PMID: 39100046 PMCID: PMC11297518 DOI: 10.7759/cureus.63860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
Tetralogy of Fallot (TOF) is a common congenital heart disease (CHD) characterized by four distinct cardiac abnormalities. Brain abscess, though rare, is a life-threatening complication in patients with cyanotic congenital heart disease (CCHD), including TOF. This case report describes a 24-year-old female with unrepaired TOF who presented with symptoms of a brain abscess, including altered sensorium, fever, projectile vomiting, and headache. Diagnostic imaging with non-contrast-enhanced computed tomography (NCCT) revealed a well-defined hypodense lesion with a midline shift, prompting urgent drainage of the abscess. Subsequent cultures of the pus material identified Streptococcus intermedius as the causative agent, and the patient was maintained on antibiotics. This case highlights the importance of early diagnosis and surgical repair of TOF to prevent severe complications such as brain abscess, thereby reducing morbidity and mortality.
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Affiliation(s)
- Palak Gupta
- Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, IND
| | | | - Naveya Vashisht
- Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, IND
| | | | - Vanshdeep Sharma
- Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, IND
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7
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SamimiArdestani S, Firouzifar M, Akbarpour M, Karimi Yarandi K, SamimiArdestani S. Endoscopic Access to Brain Abscess Due to Sinonasal Infection. World Neurosurg 2024; 185:e662-e667. [PMID: 38417625 DOI: 10.1016/j.wneu.2024.02.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Brain abscesses caused by sinonasal infections have become more common during the coronavirus pandemic, particularly due to the increase in sinonasal mucormycosis. This study aimed to evaluate the efficacy and safety of endoscopic endonasal brain abscess drainage as a therapeutic technique for these cases. METHODS Clinical outcomes and retrospective evaluations were performed in patients who underwent endoscopic endonasal brain abscess drainage between May 2019 and August 2022. A total of 7 patients diagnosed with 9 brain abscesses caused by sinonasal infections were included in the study. The main outcome of this study was to evaluate the success and safety of this technique. RESULTS The average age of the patients was 40.71 ± 14.17 years. The most common symptom observed in these patients was nasal discharge, and the frontal lobe was the most common site of abscess. Notably, the majority of cases were associated with COVID-19. CONCLUSIONS Based on the results of this study, endoscopic endonasal brain abscess drainage is considered a viable treatment option for skull base brain abscesses caused by sinonasal infections. Further research in this field can help establish this technique as a mainstay approach for managing brain abscesses at the skull base.
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Affiliation(s)
- SeyedHadi SamimiArdestani
- Otorhinolaryngology Research Center, AmirAlam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Firouzifar
- Otorhinolaryngology Research Center, AmirAlam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maliheh Akbarpour
- Otorhinolaryngology Research Center, Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Kourosh Karimi Yarandi
- Department of Neurosurgery, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Bodilsen J, D'Alessandris QG, Humphreys H, Iro MA, Klein M, Last K, Montesinos IL, Pagliano P, Sipahi OR, San-Juan R, Tattevin P, Thurnher M, de J Treviño-Rangel R, Brouwer MC. European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect 2024; 30:66-89. [PMID: 37648062 DOI: 10.1016/j.cmi.2023.08.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
SCOPE These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults. METHODS Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I2 tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low). QUESTIONS ADDRESSED BY THE GUIDELINES AND RECOMMENDATIONS Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). No recommendation is offered for early transition to oral antimicrobials because of a lack of data, and oral consolidation treatment after ≥6 weeks of intravenous antimicrobials is not routinely recommended (conditional and very low). Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low). Research needs are addressed.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Mildred A Iro
- Department of Paediatric Infectious diseases and Immunology, The Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Matthias Klein
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Hospital of the Ludwig-Maximilians University, Munich, Germany; Emergency Department, Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Katharina Last
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Inmaculada López Montesinos
- Infectious Disease Service, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Pasquale Pagliano
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Unit of Infectious Diseases, University of Salerno, Baronissi, Italy; UOC Clinica Infettivologica AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Oğuz Reşat Sipahi
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey; Infectious Diseases Department, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
| | - Rafael San-Juan
- CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, 12 de Octubre University Hospital, Madrid, Spain; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections in Compromised Hosts (ESGICH), Basel, Switzerland
| | - Pierre Tattevin
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Majda Thurnher
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rogelio de J Treviño-Rangel
- Faculty of Medicine, Department of Microbiology, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; European Society of Clinical Microbiology and Infectious Diseases, Fungal Infection Study Group (EFISG), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Antimicrobial Stewardship (ESGAP), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Genomic and Molecular Diagnostics (ESGMD), Basel, Switzerland
| | - Matthijs C Brouwer
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Kavya S, Arvinda HR, Veenakumari HB, PrabuRaj AR, Smitha NR, Jyothi D, Dwarakanath S, Nagarathna S. Pertinence of Streptococcus anginosus group in intracerebral abscesses in the era of extended antibiotic resistance. Indian J Med Microbiol 2023; 45:100395. [PMID: 37573041 DOI: 10.1016/j.ijmmb.2023.100395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/30/2023] [Accepted: 05/26/2023] [Indexed: 08/14/2023]
Abstract
AIMS • To study the incidence of Streptococcus anginosus group (SAG) in pyogenic or community acquired intra cerebral abscess. • To understand the risk factors for the same. • To analyze the specific radiological features and clinical outcome after surgery and antibiotic therapy. METHODS This is a retrospective observational study of case series over a period of one year. Patients diagnosed with intracerebral abscess were included in the study. Pus collected from were received in the laboratory and processed according to the standard protocols. Data regarding the clinical findings and demographics were collected from medical records. FINDINGS A total of 202 samples were studied. 103 were found to be pyogenic. SAG were isolated from 21 samples (20.38%) and all the isolates were sensitive to Penicillin. Age of the patients ranged from 18months to 68years. Male preponderance was noted with male to female ratio of 4:1. Otogenic infections were the most common predisposing factors and focus of infection could not be ascertained in 5 patients. All patients were treated with surgical intervention and antibiotics (Vancomycin, Amikacin and Metronidazole) for 6 weeks and recovery was remarkable. One patient succumbed to the illness. CONCLUSION SAG can be an aggressive pathogen with propensity for abscess formation. Chronic Suppurative Otitis Media (CSOM) is still a major cause of intracerebral abscess in developing country like India which is a benign and curable disease and should not be neglected. Injudicious use of antibiotics and negligence regarding the dose and duration of therapy from both patients and health care providers is the major cause for common infections to become more difficult to treat and succumbing to complications.
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Affiliation(s)
- S Kavya
- Department of Neuromicrobiology, NIMHANS, India
| | - H R Arvinda
- Department of Neuro Imaging and Interventional Radiology, NIMHANS, India
| | | | | | - N R Smitha
- Department of Neuromicrobiology, NIMHANS, India
| | | | | | - S Nagarathna
- Department of Neuromicrobiology, NIMHANS, India.
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10
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Ngo TM, Okabe A, Nguyen KB, Tong A, Chang J, Lui F. Cryptogenic Pontine Abscess Treated With Stereotactic Aspiration: A Case Report. Cureus 2023; 15:e41463. [PMID: 37546074 PMCID: PMC10404128 DOI: 10.7759/cureus.41463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Brainstem abscesses are localized collections of pus or infected material within the brainstem, which can cause inflammation, tissue damage, and compression of adjacent structures. This can lead to a variety of symptoms, including headache, fever, and focal neurological deficits, among many others. Brainstem abscesses are potentially life-threatening and considered to be rare, and pontine abscesses are even rarer. Both are often caused by the spread of infection from nearby structures like the middle ear, sinuses, and mastoid air cells, but they can also result from distant infectious sites that have spread to the bloodstream. Ambiguous clinical presentation can delay appropriate care and lead to poorer outcomes. We present a rare case of pontine abscess in a 54-year-old male with both undetermined causal origins and unclear infectious signs, namely, the lack of fever, fatigue, and chills. We will discuss the etiologies, diagnosis, and treatment of cryptogenic brainstem lesions in this case report.
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Affiliation(s)
- Taylor M Ngo
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Anna Okabe
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Kailey B Nguyen
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Anhtho Tong
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Jason Chang
- Neurology, Kaiser Permanente South Sacramento Medical Center, Sacramento, USA
| | - Forshing Lui
- Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA
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11
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Velnar T, Kocivnik N, Bosnjak R. Clinical infections in neurosurgical oncology: An overview. World J Clin Cases 2023; 11:3418-3433. [PMID: 37383906 PMCID: PMC10294202 DOI: 10.12998/wjcc.v11.i15.3418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/05/2023] [Accepted: 04/13/2023] [Indexed: 05/25/2023] Open
Abstract
Central nervous system (CNS) infections are urgent conditions with high morbidity and mortality. Bacteria, viruses, parasites or fungi can cause them. Intracranial infections after craniotomies are an important complication of treatment, especially in oncological patients that are already immunologically compromised due to the disease and treatment. The consequence of CNS infections in oncological patients includes longer treatment with antibiotics, additional surgical procedures, higher treatment costs and poorer treatment outcomes. Additionally, the management of primary pathology may be prolonged or postponed as a result of the active infection. By introducing new and improved protocols, tightening controls on their implementation, constantly educating the entire team involved in patient treatment and educating both patients and relatives, the incidence of infections can be reduced effectively.
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Affiliation(s)
- Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Alma Mater Europaea - ECM Maribor, Maribor 2000, Slovenia
| | - Nina Kocivnik
- Faculty of Pharmacy, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
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12
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Su J, Hu B, Zhang Y, Li Y. Clinical and radiological characteristics of brain abscess due to different organisms in hospitalized patients: A 6-year retrospective study from China. Heliyon 2023; 9:e16003. [PMID: 37215846 PMCID: PMC10192766 DOI: 10.1016/j.heliyon.2023.e16003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/22/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023] Open
Abstract
Background Brain abscess (BA) is a rare but life-threatening infection. Early identification of the pathogen is helpful to improve the outcomes. This study aimed to describe the clinical and radiological features of patients with BA caused by different organisms. Methods A retrospective, observational study of patients with known etiologic diagnosis of BA in Huashan Hospital Affiliated to Fudan University in China between January 2015 and December 2020 was conducted. Data on patient demographics, clinical and radiological presenting features, microbiological results, surgical treatment, and outcomes were collected. Results Sixty-five patients (49 male, 16 female) with primary BAs were included. Frequent clinical presentations included headache (64.6%), fever (49.2%) and confusion (27.3%). Streptococcus viridans was associated with thicker wall of abscesses (6.94 ± 8.43 mm for S. viridans versus 3.66 ± 1.74 mm for other organisms, P = 0.031) and larger oedema (89.40 ± 15.70 mm for S. viridans versus 74.72 ± 19.70 mm for other organisms, P = 0.023). The independent factor associated with poor outcome identified by multivariate analysis was confusion (Odds ratio 6.215, 95% confidence interval 1.406-27.466; P = 0.016). Conclusions Patients with BAs caused by Streptococcus species had nonspecific clinical signs, but specific radiological features, which might be helpful for early diagnosis.
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Affiliation(s)
- Jiachun Su
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Hu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yixin Zhang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Li
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
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13
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Yang RX, Chen B, Zhang Y, Yang Y, Xie S, He L, Shi J. Development of subdural empyema from subdural effusion after suppurative encephalitis: A case report. World J Clin Cases 2023; 11:2315-2320. [PMID: 37122516 PMCID: PMC10131016 DOI: 10.12998/wjcc.v11.i10.2315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/18/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people. Herein, we report a patient misdiagnosed with subdural effusion, who was eventually diagnosed with chronic subdural empyema (SDE) caused by Streptococcus pneumoniae.
CASE SUMMARY A 63-year-old man was brought to our emergency room with a headache, vomiting, and disturbed consciousness. Computed tomography (CT) revealed a bilateral subdural effusion at the top left side of the frontal lobe. Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis, which improved after anti-infective therapy. However, the patient then presented with acute cognitive dysfunction and right limb paralysis. Repeat CT showed an increase in left frontoparietal subdural effusion, disappearance of the left lateral ventricle, and a shift of the midline to the right. Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae. His condition improved after adequate drainage and antibiotic treatment.
CONCLUSION Patients with unexplained subdural effusion, especially asymmetric subdural effusion with intracranial infection, should be assessed for chronic SDE. Early surgical treatment may be beneficial.
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Affiliation(s)
- Rui-Xi Yang
- Department of Infectious Diseases, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Bei Chen
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Yun Zhang
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Yao Yang
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Shu Xie
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Lin He
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Jian Shi
- Department of Psychosomatic Medicine, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
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14
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Dietler S, Willms J, Brandi G, Wang S, Burkerth A, Keller E. Spontaneous empyema and brain abscess in an intensive care population: clinical presentation, microbiology, and factors associated with outcome. Acta Neurochir (Wien) 2023; 165:651-658. [PMID: 35618853 PMCID: PMC10006247 DOI: 10.1007/s00701-022-05241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/02/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Data on critically ill patients with spontaneous empyema or brain abscess are limited. The aim was to evaluate clinical presentations, factors, and microbiological findings associated with the outcome in patients treated in a Neurocritical Care Unit. METHODS In this retrospective study, we analyzed 45 out of 101 screened patients with spontaneous epidural or subdural empyema and/or brain abscess treated at a tertiary care center between January 2012 and December 2019. Patients with postoperative infections or spinal abscess were excluded. Medical records were reviewed for baseline characteristics, origin of infection, laboratory and microbiology findings, and treatment characteristics. The outcome was determined using the Glasgow outcome scale extended (GOSE). RESULTS Favorable outcome (GOSE 5-8) was achieved in 38 of 45 patients (84%). Four patients died (9%), three remained severely disabled (7%). Unfavorable outcome was associated with a decreased level of consciousness at admission (Glasgow coma scale < 9) (43% versus 3%; p = 0.009), need of vasopressors (71% versus 11%; p = 0.002), sepsis (43% versus 8%; p = 0.013), higher age (65.1 ± 15.7 versus 46.9 ± 17.5 years; p = 0.014), shorter time between symptoms onset and ICU admission (5 ± 2.4 days versus 11.6 ± 16.8 days; p = 0.013), and higher median C-reactive protein (CRP) serum levels (206 mg/l, range 15-259 mg/l versus 17.5 mg/l, range 3.3-72.7 mg/l; p = 0.036). With antibiotics adapted according to culture sensitivities in the first 2 weeks, neuroimaging revealed a progression of empyema or abscess in 45% of the cases. CONCLUSION Favorable outcome can be achieved in a considerable proportion of an intensive care population with spontaneous empyema or brain abscess. Sepsis and more frequent need for vasopressors, associated with unfavorable outcome, indicate a fulminant course of a not only cerebral but systemic infection. Change of antibiotic therapy according to microbiological findings in the first 2 weeks should be exercised with great caution.
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Affiliation(s)
- Sabeth Dietler
- Neurocritical Care Unit, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Jan Willms
- Neurocritical Care Unit, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Giovanna Brandi
- Neurocritical Care Unit, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sophie Wang
- Neurocritical Care Unit, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Astrid Burkerth
- Neurocritical Care Unit, Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Emanuela Keller
- Neurocritical Care Unit, Dept. of Neurosurgery and Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
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15
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Mansour MA, Burns TC, El-Sokkary S, Ayad AA. A 42-Year-Old Man with a Seizure. NEJM EVIDENCE 2023; 2:EVIDmr2200320. [PMID: 38320057 DOI: 10.1056/evidmr2200320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
A 42-Year-Old Man with a SeizureA 42-year-old man with acute myeloid leukemia presented for evaluation after an episode of convulsions. Six weeks before this event, he had a cough productive of yellow sputum. Two weeks later, he started having a headache and fevers. How do you approach the evaluation, and what is the diagnosis?
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Affiliation(s)
- Moustafa A Mansour
- from the Neurological Surgery Residency Program, Al-Azhar University, Cairo, Egypt
| | - Terry C Burns
- from the Neurological Surgery Residency Program, Al-Azhar University, Cairo, Egypt
| | - Soliman El-Sokkary
- from the Neurological Surgery Residency Program, Al-Azhar University, Cairo, Egypt
| | - Ahmad A Ayad
- from the Neurological Surgery Residency Program, Al-Azhar University, Cairo, Egypt
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16
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Borni M, Znazen M, Kolsi F, Zaher Boudawara M. Clinico-radiological assessment and therapeutic management of intracranial suppurations: Bicentric series of 43 cases with literature review. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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Ye Y, Tian Y, Kong Y, Ma J, Shi G. Trends of Antimicrobial Susceptibility in Clinically Significant Coagulase-Negative Staphylococci Isolated from Cerebrospinal Fluid Cultures in Neurosurgical Adults: a Nine-Year Analysis. Microbiol Spectr 2022; 10:e0146221. [PMID: 35138154 PMCID: PMC8826829 DOI: 10.1128/spectrum.01462-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/04/2022] [Indexed: 11/21/2022] Open
Abstract
Coagulase-negative staphylococci (CoNS) are the main pathogens in health care-associated ventriculitis and meningitis (HCAVM). This study aimed to assess antimicrobial susceptibility. Moreover, the treatment and clinical outcome were described. All neurosurgical adults admitted to one of the largest neurosurgical centers in China with clinically significant CoNS isolated from cerebrospinal fluid cultures in 2012 to 2020 were recruited. One episode was defined as one patient with one bacterial strain. Interpretive categories were applied according to the MICs. The clinical outcomes were dichotomized into poor (Glasgow Outcome Scale 1 to 3) and acceptable (Glasgow Outcome Scale 4 to 5). In total, 534 episodes involving 519 patients and 16 bacteria were analyzed. Over the 9 years, eight antimicrobial agents were used in antimicrobial susceptibility tests, including six in over 80% of CoNS. The range of resistance rates was 0.8% to 84.6%. The vancomycin resistance rate was the lowest, whereas the penicillin resistance rate was the highest. The linezolid (a vancomycin replacement) resistance rate was 3.1%. The rate of oxacillin resistance, representing methicillin-resistant staphylococci, was 70.2%. There were no significant trends of antimicrobial susceptibility over the 9 years for any agents analyzed. However, there were some apparent changes. Notably, vancomycin-resistant CoNS appeared in recent years, while linezolid-resistant CoNS appeared early and disappeared in recent years. Vancomycin (or norvancomycin), the most common treatment agent, was used in 528 (98.9%) episodes. Finally, 527 (98.7%) episodes had acceptable outcomes. It will be safe to use vancomycin to treat CoNS-related HCAVM in the immediate future, although continuous monitoring will be needed. IMPORTANCE Coagulase-negative staphylococci are the main pathogens in health care-associated ventriculitis and meningitis. There are three conclusions from the results of this study. First, according to antimicrobial susceptibility, the rates of resistance to primary antimicrobial agents are high and those to high-level agents, including vancomycin, are low. Second, the trends of resistance rates are acceptable, especially for high-level agents, although long-term and continuous monitoring is necessary. Finally, the clinical outcomes of neurosurgical adults with coagulase-negative staphylococci-related health care-associated ventriculitis and meningitis are acceptable after treatment with vancomycin. Therefore, according to the antimicrobial susceptibility and clinical practice, vancomycin will be safe to treat coagulase-negative staphylococci-related health care-associated ventriculitis and meningitis.
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Affiliation(s)
- Yi Ye
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ye Tian
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yueyue Kong
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiawei Ma
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guangzhi Shi
- Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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18
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Dodson DS, Heizer HR, Gaensbauer JT. Sequential Intravenous-Oral Therapy for Pediatric Streptococcus anginosus Intracranial Infections. Open Forum Infect Dis 2022; 9:ofab628. [PMID: 35028336 PMCID: PMC8753039 DOI: 10.1093/ofid/ofab628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Streptococcus anginosus group is a common cause of pediatric intracranial infections but treatment recommendations, including use of oral therapy, are poorly defined. Methods We performed a retrospective review from 2004 to 2019 of all patients with S anginosus group pyogenic intracranial infections at Children's Hospital Colorado, highlighting patients transitioned to oral therapy. The primary endpoint was worsening infection necessitating intravenous antibiotics or a source control procedure after transition to oral therapy. Results Of 107 patients with S anginosus intracranial infections, 61 were transitioned to exclusive oral therapy after a median intravenous duration of 37 days, overwhelmingly with a levofloxacin-based regimen. Only 1 treatment failure was noted in a patient who did not fill their prescription. Patients with epidural infections were more likely to be transitioned to oral therapy within the first 28 days of treatment (defined as "early"). Patients with parenchymal infections, bacteremia, co-pathogens, higher inflammatory markers, and requiring >1 source control procedure were less likely to be transitioned early to oral therapy. Complications of a central catheter and/or intravenous medications contributed to 56% of oral transitions. Conclusions Levofloxacin-based oral regimens were effective and well tolerated. Patients with less severe infections were more likely to be transitioned early to oral therapy. Criteria for transitioning patients to oral antibiotics for intracranial infections should be established to minimize risks inherent with central catheters.
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Affiliation(s)
- Daniel S Dodson
- Section of Pediatric Infectious Diseases, Department of Pediatrics, University of California, Davis, Sacramento, California, USA.,Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Heather R Heizer
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - James T Gaensbauer
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Pediatric Infectious Diseases, Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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19
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Pradhan A, Rutayisire FX, Munyemana P, Karekezi C. Unusual intracranial suppuration: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21570. [PMID: 35855485 PMCID: PMC9281436 DOI: 10.3171/case21570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/22/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intracranial suppuration (ICS) is a rare complication that can arise from various disease processes and is composed of brain abscess, extradural empyema, and subdural empyema. Although significant progress has been achieved with antibiotics, neuroimaging, and neurosurgical technique, ICS remains a serious neurosurgical emergency. An uncommon presentation of ICS is sterile ICS, which has yet to be fully elucidated by clinicians. The authors present 2 cases of unusual sterile ICS: a sterile subdural empyema and a sterile brain abscess. OBSERVATIONS Both patients underwent surgical treatment consisting of craniotomy to evacuate the pus collection. The blood cultures from both the patients, the collected empyema, and the thick capsule from the brain abscess were sterile. However, the necrotic brain tissue surrounding the abscess contained inflammatory cells. The authors’ review of the literature emphasizes the rarity of sterile ICS and substantiates the necessity for additional studies to explore this field. LESSONS Sterile ICS is a disease entity that warrants further investigation to determine appropriate treatment to improve patient outcomes. This study highlights the paucity of data available regarding sterile ICS and supports the need for future studies to uncover the etiology of sterile ICS to better guide management of this condition.
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Affiliation(s)
- Anjali Pradhan
- Department of Neurosurgery, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, California
- David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, University of California, Los Angeles, Los Angeles, California; and
| | | | - Paulin Munyemana
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | - Claire Karekezi
- Neurosurgery Unit, Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
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20
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Degener T, Quon S, Holtom P, Hsieh E. From prostate to the pons: The first reported case of multi-organ septic emboli and brain empyema from an untreated prostate abscess. Clin Case Rep 2021; 9:e05018. [PMID: 34786192 PMCID: PMC8578817 DOI: 10.1002/ccr3.5018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022] Open
Abstract
Prostate abscesses in developed countries are becoming increasingly less common. Left untreated these abscesses can lead to numerous complications, including some which are very rare.
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Affiliation(s)
- Tyler Degener
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Samantha Quon
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Paul Holtom
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Eric Hsieh
- Keck Medical CenterUniversity of Southern CaliforniaLos AngelesCAUSA
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21
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Cipriani D, Trippel M, Buttler KJ, Rohr E, Wagner D, Beck J, Schnell O. Cerebral Abscess Caused by Listeria monocytogenes: Case Report and Literature Review. J Neurol Surg A Cent Eur Neurosurg 2021; 83:194-205. [PMID: 34496414 DOI: 10.1055/s-0041-1729174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Listeria monocytogenes is an opportunistic gram-positive, facultative intracellular bacterium that causes invasive diseases mostly in pregnant women and immunosuppressed patients. Despite the predilection toward the central nervous system (CNS), it usually causes meningitis and meningoencephalitis, whereas brain abscesses are very uncommon. CASE PRESENTATION We describe the case of a 69-year-old homeless patient with a brain abscess due to L. monocytogenes who was successfully treated surgically by a guided stereotactic aspiration and antibiotic therapy with ampicillin and gentamicin. Our patient was discharged after 4 weeks of therapy without neurologic deficits. Additionally, we provide a review of the literature of brain abscesses caused by L. monocytogenes. CONCLUSIONS This case highlights the need to drain cerebral abscesses and culture pus to correctly treat patients with antibiotics, especially given the high mortality rate of this infectious entity.
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Affiliation(s)
- Debora Cipriani
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Michael Trippel
- Department of Stereotactic and Functional Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Klaus-Jürgen Buttler
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Eva Rohr
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Dirk Wagner
- Department of Medicine II, Division of Infectious Diseases, Medical Center University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
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22
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Bodilsen J, Dalager-Pedersen M, van de Beek D, Brouwer MC, Nielsen H. Risk Factors for Brain Abscess: A Nationwide, Population-Based, Nested Case-Control Study. Clin Infect Dis 2021; 71:1040-1046. [PMID: 31641757 DOI: 10.1093/cid/ciz890] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/05/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Knowledge on risk factors for brain abscess is limited and relies on single-center cohort studies. METHODS We accessed nationwide medical registries to conduct a population-based, nested case-control study of risk factors for brain abscess. We applied risk-set sampling for the selection of population controls (1:10), who were individually matched by age, sex, and area of residence. Conditional logistic regression was used to compute adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Population-attributable fractions were calculated. RESULTS We identified 1384 brain abscess patients in Denmark from 1982 through 2016, and 13 839 matched population controls. The median age of patients was 50 years (interquartile range 33-63) and 37% were female. Cases often had Charlson comorbidity scores >2 (16%), compared with controls (3%). Our calculated aORs were 2.15 (95% CI 1.72-2.70) for head trauma; 19.3 (95% CI 14.3-26.0) for neurosurgery; 4.61 (95% CI 3.39-6.26) for dental infections; 2.57 (95% CI 1.71-3.84) for dental surgery; 3.81 (95% CI 3.11-4.67) for ear, nose, and throat infection; 2.85 (95% CI 2.21-3.70) for ear, nose, and throat surgery; 15.6 (95% CI 9.57-25.4) for congenital heart disease; 1.74 (95% CI 1.33-2.29) for diabetes mellitus; 2.22 (95% CI 1.58-3.11) for alcohol abuse; 2.37 (95% CI 1.53-3.68) for liver disease; 2.04 (95% CI 1.30-3.20) for kidney disease and 8.15 (95% CI 3.59-18.5) for lung abscess or bronchiectasis. The aORs were 4.12 (95% CI 3.37-5.04) for solid cancer; 8.77 (95% CI 5.66-13.6) for hematological cancer; 12.0 (95% CI 6.13-23.7) for human immunodeficiency virus; and 5.71 (95% CI 4.22-7.75) for immunomodulating treatments. Population-attributable fractions showed were substantial contributors to the occurrence of brain abscess neurosurgery (12%); solid cancer (11%); ear, nose, and throat infections (7%); and immunomodulating treatments (5%). CONCLUSIONS Important risk factors included neurosurgery; cancer; ear, nose, and throat infections; and immunomodulating treatments.
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Affiliation(s)
| | - Michael Dalager-Pedersen
- Department Infectious Diseases, Aalborg, Denmark.,Department Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Diederik van de Beek
- Amsterdam University Medical Centers, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Matthijs C Brouwer
- Amsterdam University Medical Centers, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Henrik Nielsen
- Department Infectious Diseases, Aalborg, Denmark.,Department Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
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23
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Outcomes of Central Nervous System Infections Treated by an Outpatient Parenteral Antimicrobial Therapy Program in a Public Teaching Hospital. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000000933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Hu MB, Kesha K, Glenn C, Stables S, Tse R. Hemorrhagic Pseudocyst: A Rare Cerebral Mass Lesion Causing Death. A Case Report and Brief Review of Literature. Am J Forensic Med Pathol 2021; 42:77-80. [PMID: 33555675 DOI: 10.1097/paf.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Mass lesions in the brain encompass a wide range neoplastic and nonneoplastic entities. These can present as a diagnostic pitfall, with nonspecific, overlapping symptoms and similar appearances on radiology. They may cause death through varied mechanisms, either specific to the underlying pathophysiology or due to the space-occupying effect of the lesion. We report a case of fatal hemorrhagic cerebral pseudocyst, a rare mass lesion, associated with a cerebral varix, causing death in a morbidly obese individual. To the best of our knowledge, there is no previous documentation in the postmortem literature of this entity as a cause of death. This case aims to document this rare entity in the differential diagnosis of a tumor-like lesion in the brain, highlight the clinical difficulty in its assessment, and demonstrate an uncommon mechanism of death, of a mass lesion acting as a focus causing seizures, with resulting hypoxia due to effects of morbid obesity and heart failure.
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Affiliation(s)
- Mindy Bizhe Hu
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
| | - Kilak Kesha
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
| | - Charley Glenn
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
| | - Simon Stables
- From the Department of Forensic Pathology, LabPLUS, Auckland City Hospital
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25
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Song Y, Cheng D, Qiu K, Yan X, Ren J, Qiu J, Deng D, Rao Y, Zheng Y, Pang W, Dong Y, Liu Q, Ren Y, Zhao Y. Clinical outcomes of different treatments and risk factors in patients with otogenic brain abscess, a real-world evidence-based retrospective study. Acta Otolaryngol 2020; 140:919-924. [PMID: 32804559 DOI: 10.1080/00016489.2020.1800088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Otogenic Brain Abscess (OBA) is a life-threatening complication secondary to otitis media, but its appropriate management remains controversial. OBJECTIVES To understand the demographic characteristics, management, and variables that affect the outcomes of patients with OBA based on our experiences over 11 years. MATERIAL AND METHODS Clinical data were collected for 41 patients. Prognostic factors associated with mortality were assessed, and clinical outcomes compared among groups receiving different treatments. RESULTS Among the 41 patients, 19.6% did not undergo surgery, 39.0% were treated with two-stage surgery (otological surgery and neurosurgery) and 41.4% were treated with single-stage surgery (otological surgery or neurosurgery). Overall mortality rate was 32.5%, and mortality was significantly higher in patients with invasion of the petrous apex (odds ratio [OR]: 7.81, 95% confidence interval [95% CI]: 1.26-48.36), and lower in those with appropriate surgical management (single otological surgery, OR: 0.07, 95% CI: 0-0.97; single neurosurgery, OR: 0.13, 95% CI: 0.02-1.0; two-stage surgery, OR: 0.08, 95% CI: 0.01-0.64) or a higher Glasgow Coma Scale (GCS) score at admission (OR: 0.64, 95% CI: 0.44-0.93). CONCLUSIONS AND SIGNIFICANCE Data on invasiveness and pre-surgery GCS greatly aid in predicting the prognosis of OBA patients. Early evaluation will facilitate decision-making by physicians treating OBA patients.
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Affiliation(s)
- Yao Song
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Danni Cheng
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Ke Qiu
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Xiaohong Yan
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Jianjun Ren
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Jianqing Qiu
- Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Di Deng
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yufang Rao
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yongbo Zheng
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Wendu Pang
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yijun Dong
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Qiurui Liu
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yanming Ren
- Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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Celi F, Saal-Zapata G. Subdural Empyema by Enterobacter cloacae: Case Report. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1718782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractInfections of the central nervous system are a medical emergency, potentially lethal and associated with increased morbidity and mortality. We present the case of a male with risk factors and clinical deterioration, in which the brain computed tomography scan showed a subdural collection following a head injury, which underwent surgical evacuation revealing a subdural empyema. The culture of the subdural collection yielded a positive result to Enterobacter cloacae.
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Affiliation(s)
- Fernando Celi
- Department of Neurosurgery, Hospital de Emergencias José Casimiro Ulloa, Miraflores, Lima, Perú
| | - Giancarlo Saal-Zapata
- Department of Neurosurgery, Hospital Nacional Guillermo Almenara Irigoyen - EsSalud, La Victoria, Lima, Perú
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De Andres Crespo M, McKinnon C, Halliday J. What you need to know about brain abscesses. Br J Hosp Med (Lond) 2020; 81:1-7. [PMID: 32845766 DOI: 10.12968/hmed.2020.0103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A brain abscess is a focal accumulation of pus in the brain parenchyma arising from direct inoculation, contiguous spread from local anatomical structures or haematogenous seeding from a remote source of infection. It can result in significant morbidity and mortality, making early diagnosis and treatment vital. Only one fifth of patients present with the classic triad of headache, fever and focal neurological symptoms. More commonly patients show signs and symptoms of raised intracranial pressure alone, such as confusion or reduced conscious level, headache, nausea and vomiting, which can be a presentation of many intracranial pathologies. Distinguishing an abscess from other pathologies such as meningitis and tumours is crucial, as clinically these can present in similar ways, but their management and outcomes are very different. Diffusion-weighted magnetic resonance imaging brain scans can help localise the lesion and differentiate ring-enhancing lesions caused by a brain abscess from malignant tumours. Cerebral abscesses are considered a neurosurgical emergency; early stabilisation, diagnosis and management in a neurosurgical centre is important in reducing morbidity and mortality.
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Affiliation(s)
- Marta De Andres Crespo
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Chris McKinnon
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jane Halliday
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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28
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Lauda-Maillen M, Lemaignen A, Puyade M, Catroux M, Le Moal G, Beraud G, El Hajj H, Michaud A, Destrieux C, Bernard L, Rammaert B, Cazenave-Roblot F. Feasibility of early switch to oral antibiotic in brain abscesses and empyema: a multicentre retrospective study. Eur J Clin Microbiol Infect Dis 2020; 40:209-213. [PMID: 32671654 DOI: 10.1007/s10096-020-03904-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022]
Affiliation(s)
- M Lauda-Maillen
- Université de Poitiers, Poitiers, France.
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France.
| | - A Lemaignen
- Université de Tours, Tours, France
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - M Puyade
- Service de Médecine Interne, CHU de Poitiers, Poitiers, France
| | - M Catroux
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
| | - G Le Moal
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
| | - G Beraud
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
| | - H El Hajj
- Service de Neurochirurgie, CHU de Poitiers, Poitiers, France
| | - A Michaud
- Service de Microbiologie, CHU de Poitiers, Poitiers, France
| | - C Destrieux
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
- Service de Neurochirurgie, CHRU de Tours, Tours, France
| | - L Bernard
- Université de Tours, Tours, France
- Service de Médecine Interne et Maladies Infectieuses, CHRU de Tours, Hôpital Bretonneau, Tours, France
| | - B Rammaert
- Université de Poitiers, Poitiers, France
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
- INSERM U1070, Poitiers, France
| | - F Cazenave-Roblot
- Université de Poitiers, Poitiers, France
- Service de Maladies Infectieuses et Tropicales, CHU de Poitiers, 2 rue de la Milétrie CS 90577, 86021, Poitiers cedex, France
- INSERM U1070, Poitiers, France
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Darlow CA, McGlashan N, Kerr R, Oakley S, Pretorius P, Jones N, Matthews PC. Microbial aetiology of brain abscess in a UK cohort: Prominent role of Streptococcus intermedius. J Infect 2020; 80:623-629. [PMID: 32179070 PMCID: PMC7267774 DOI: 10.1016/j.jinf.2020.03.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Brain abscess is an uncommon condition, but carries high mortality. Current treatment guidelines are based on limited data. Surveillance of clinical, radiological and microbiology data is important to inform patient stratification, interventions, and antimicrobial stewardship. METHODS We undertook a retrospective, observational study of patients with brain abscess, based on hospital coding, in a UK tertiary referral teaching hospital. We reviewed imaging data, laboratory microbiology, and antibiotic prescriptions. RESULTS Over a 47 month period, we identified 47 adults with bacterial brain abscess (77% male, median age 47 years). Most of the abscesses were solitary frontal or parietal lesions. A microbiological diagnosis was secured in 39/47 (83%) of cases, among which the majority were of the Streptococcus milleri group (27/39; 69%), with a predominance of Streptococcus intermedius (19/27; 70%). Patients received a median of 6 weeks of intravenous antibiotics (most commonly ceftriaxone), with variable oral follow-on regimens. Ten patients (21%) died, up to 146 days after diagnosis. Mortality was significantly associated with increasing age, multiple abscesses, immunosuppression and the presence of an underlying cardiac anomaly. CONCLUSION Our data suggest that there has been a shift away from staphylococcal brain abscesses, towards S. intermedius as a dominant pathogen. In our setting, empiric current first line therapy with ceftriaxone remains appropriate on microbiological grounds and narrower spectrum therapy may sometimes be justified. Mortality of this condition remains high among patients with comorbidity. Prospective studies are required to inform optimum dose, route and duration of antimicrobial therapy.
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Affiliation(s)
- Christopher A Darlow
- Institute of Translational Medicine, University of Liverpool, Ashton St, Liverpool, L69 3GE, UK; Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Nicholas McGlashan
- Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Richard Kerr
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Sarah Oakley
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Pieter Pretorius
- Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Nicola Jones
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
| | - Philippa C Matthews
- Department of Infectious Diseases and Microbiology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK; Nuffield Department of Medicine, University of Oxford, Medawar Building for Pathogen Research, South Parks Road, Oxford OX1 3SY, UK; NIHR Oxford British Research Council (BRC), John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
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30
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Park J, Kim WS, Kim HK, Bae TH. Intracranial abscess from facial cellulitis. Arch Craniofac Surg 2019; 20:332-335. [PMID: 31658800 PMCID: PMC6822071 DOI: 10.7181/acfs.2019.00374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/18/2019] [Indexed: 11/11/2022] Open
Abstract
Cellulitis, one of most common diseases of everyday life, is often overlooked for its significance. Although cellulitis does not cause or lead to serious problems usually, its possibility to cause life-threatening problem should be known. In present case, a patient who had received acupuncture treatment a week earlier presented to the clinic with symptoms of facial cellulitis. The disease resolved within few weeks under empirical antibiotic treatment but recurred after 3 months. Under close history review of the patient, we found out that the patient had received craniectomy 20 years ago. The patient had blunt headache with no other neurological symptoms that could suspect cranial infection, but considering the risk originating from the patient’s surgical history, brain computed tomography (CT) was taken. CT images revealed abscess formation in the subgaleal and epidural spaces. Craniotomy with abscess evacuation was done promptly. With additional antibiotic treatment postoperatively, the disease resolved, and the 1-month postoperative follow-up brain CT showed no signs of abscess formation.
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Affiliation(s)
- Jonghyun Park
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Woo Seob Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Han Koo Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae Hui Bae
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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