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Hwang JH, Park JS, Bae TW, Hwang JH, Lee J. Community-Acquired Solitary Brain Abscesses Caused by Hypervirulent Klebsiella pneumoniae in a Healthy Adult. Microorganisms 2024; 12:894. [PMID: 38792724 PMCID: PMC11124120 DOI: 10.3390/microorganisms12050894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 04/26/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
A 42-year-old man was admitted to the emergency room complaining of fever and headache. His cerebrospinal fluid showed a cloudy appearance, and his white blood cell count was elevated at 2460/mm3, with a predominance of neutrophils (81%), and abnormal protein and glucose levels (510.7 mg/dL and 5 mg/dL, respectively). A lobulated lesion with rim enhancement, suggestive of abscess, was detected through magnetic resonance imaging. Klebsiella pneumoniae was detected in nasopharyngeal swab and blood cultures. The capsular serotype of K. pneumoniae was K2 and the sequence type determined by multilocus sequence typing was 23. The hypervirulent phenotype was associated with multiple virulent genes, including rmpA, rmpA2, entB, ybtS, kfu, iucA, iutA, iroB mrkD, allS, peg-344, peg-589, and peg-1631. After six weeks of receiving appropriate antibiotics and exhibiting clinical resolution of the brain abscesses, the patient was discharged. We present the first reported case of a healthy community-dwelling adult with solitary brain abscesses, and no other invasive abscesses, related to hypervirulent K. pneumoniae.
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Affiliation(s)
- Joo-Hee Hwang
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Republic of Korea;
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Jung Soo Park
- Department of Neurosurgery, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Republic of Korea;
| | - Tae Won Bae
- Department of Laboratory Medicine, Presbyterian Medical Center, Jeonju 54987, Republic of Korea;
| | - Jeong-Hwan Hwang
- Department of Internal Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Republic of Korea;
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
| | - Jaehyeon Lee
- Research Institute of Clinical Medicine of Jeonbuk National University—Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Republic of Korea
- Department of Laboratory Medicine, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Republic of Korea
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2
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Mantova MC, Moya BT. A thalamic brain abscess in an immunocompetent patient. Br J Hosp Med (Lond) 2023; 84:1-3. [PMID: 38153023 DOI: 10.12968/hmed.2023.0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Affiliation(s)
- Maria C Mantova
- Department of Acute Medicine, King's College Hospital, London, UK
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3
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Tahir M, Vansant M, Elkadi O. Peculiar Case of Brain Abscess Caused by Propionibacterium acnes in an Immunocompetent Individual Without Prior Neurosurgical Intervention: A Case Report and Literature Review. Cureus 2023; 15:e43647. [PMID: 37724199 PMCID: PMC10505261 DOI: 10.7759/cureus.43647] [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: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
Propionibacterium acnes (P. acnes) is a slow-growing, anaerobic, gram-positive bacillus that commonly colonizes the skin and is a rare cause of CNS infections. It was previously viewed as a culture contaminant but is now recognized to infrequently cause indolent cases of CNS infections. It is even more rarely associated with abscesses in patients without a prior history of neurosurgical intervention. Due to being a slow-growing bacteria, P. acnes is frequently discovered to be the causative organism after 16S rRNA sequencing. In this case, the culture was positive. There are only five other reported cases of patients with a P. acnes abscess without prior neurosurgical intervention. Here we present the sixth case of an immunocompetent young male who was found to have a P. acnes brain abscess.
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Affiliation(s)
- Muhammad Tahir
- Pathology and Laboratory Medicine, University of South Alabama Health Hospital, Mobile, USA
| | - Mary Vansant
- Internal Medicine, Navy Medical Center San Diego, San Diego, USA
| | - Osama Elkadi
- Pathology and Laboratory Medicine, University of South Alabama Health Hospital, Mobile, USA
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4
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Teoh RJJ, Lai YP, Alias R. Fatal Orbital Cellulitis With Intracranial Abscess: A Case Report. Cureus 2023; 15:e42435. [PMID: 37637668 PMCID: PMC10448917 DOI: 10.7759/cureus.42435] [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: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
Orbital cellulitis is a sight- and life-threatening condition. Prompt diagnosis and immediate intervention are required. We report a case of fatal odontogenic orbital cellulitis complicated with intracranial abscesses in a 55-year-old gentleman. The patient presented with painful swelling of the left eye associated with reduced eye movement, blurry vision, and a headache. There was generalized periodontitis. Initial imaging was suggestive of left eye orbital cellulitis with intracranial abscess, and intensive systemic antibiotic therapy was initiated. After six weeks of antibiotic therapy, there was an improvement in ocular signs and symptoms. However, the patient developed signs of meningism with a persistent fever. Serial brain imaging demonstrated worsening intracranial abscesses. The patient died eight weeks after the initial onset of presentation. This case emphasized that brain abscesses could be a fatal complication of odontogenic orbital cellulitis. A high index of suspicion is important in diagnosing orbital cellulitis and its complications. Early consideration of surgical intervention is necessary in cases not responding to antibiotic therapy.
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Affiliation(s)
| | - Yin Peng Lai
- Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, MYS
| | - Rohanah Alias
- Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, MYS
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Schmidt C, Kesztyüs D, Haag M, Wilhelm M, Kesztyüs T. Proposal of a Method for Transferring High-Quality Scientific Literature Data to Virtual Patient Cases Using Categorical Data Generated by Bernoulli-Distributed Random Values: Development and Prototypical Implementation. JMIR MEDICAL EDUCATION 2023; 9:e43988. [PMID: 36892938 PMCID: PMC10037169 DOI: 10.2196/43988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Teaching medicine is a complex task because medical teachers are also involved in clinical practice and research and the availability of cases with rare diseases is very restricted. Automatic creation of virtual patient cases would be a great benefit, saving time and providing a wider choice of virtual patient cases for student training. OBJECTIVE This study explored whether the medical literature provides usable quantifiable information on rare diseases. The study implemented a computerized method that simulates basic clinical patient cases utilizing probabilities of symptom occurrence for a disease. METHODS Medical literature was searched for suitable rare diseases and the required information on the respective probabilities of specific symptoms. We developed a statistical script that delivers basic virtual patient cases with random symptom complexes generated by Bernoulli experiments, according to probabilities reported in the literature. The number of runs and thus the number of patient cases generated are arbitrary. RESULTS We illustrated the function of our generator with the exemplary diagnosis "brain abscess" with the related symptoms "headache, mental status change, focal neurologic deficit, fever, seizure, nausea and vomiting, nuchal rigidity, and papilledema" and the respective probabilities from the literature. With a growing number of repetitions of the Bernoulli experiment, the relative frequencies of occurrence increasingly converged with the probabilities from the literature. For example, the relative frequency for headache after 10.000 repetitions was 0.7267 and, after rounding, equaled the mean value of the probability range of 0.73 reported in the literature. The same applied to the other symptoms. CONCLUSIONS The medical literature provides specific information on characteristics of rare diseases that can be transferred to probabilities. The results of our computerized method suggest that automated creation of virtual patient cases based on these probabilities is possible. With additional information provided in the literature, an extension of the generator can be implemented in further research.
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Affiliation(s)
- Christian Schmidt
- Medical Data Integration Center, Department of Medical Informatics, University Göttingen, Göttingen, Germany
| | - Dorothea Kesztyüs
- Medical Data Integration Center, Department of Medical Informatics, University Göttingen, Göttingen, Germany
| | - Martin Haag
- GECKO Institute, Heilbronn University of Applied Sciences, Heilbronn, Germany
| | - Manfred Wilhelm
- Department of Mathematics, Natural and Economic Sciences, Ulm University of Applied Sciences, Ulm, Germany
| | - Tibor Kesztyüs
- Medical Data Integration Center, Department of Medical Informatics, University Göttingen, Göttingen, Germany
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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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7
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Farias LABG, Firmino NN, Sousa MM, Lira ML, Meireles LN, Stolp ÂMV, Maia KM, Costa SF, Perdigão LV. Streptococcus constellatus causing concomitant extra and intracranial abscesses complicated with sagittal sinus thrombosis. Rev Inst Med Trop Sao Paulo 2023; 65:e10. [PMID: 36722672 PMCID: PMC9886223 DOI: 10.1590/s1678-9946202365010] [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] [Accepted: 12/13/2022] [Indexed: 02/02/2023] Open
Abstract
Streptococcus constellatus is a gram-positive coccus member of the Streptococcus anginosus group (SAG). It can be found in the oral flora, and may cause abscess more commonly in the gastrointestinal tract, lungs, and heart. Brain abscesses are severe neurological infections with high mortality rates. Streptococcus species other than S. pneumoniae are rare causes of brain abscesses. This case report highlights a severe case of extra and intracranial abscesses due to S. constellatus in an immunocompetent host.
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Affiliation(s)
- Luís Arthur Brasil Gadelha Farias
- Secretaria de Saúde do Estado, Programa de Residência Médica em Infectologia, Fortaleza, Ceará, Brazil,Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil,Universidade de São Paulo, Faculdade de Medicina, São Paulo, São Paulo, Brazil
| | - Natália Nogueira Firmino
- Secretaria de Saúde do Estado, Programa de Residência Médica em Infectologia, Fortaleza, Ceará, Brazil,Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | - Marcos Maciel Sousa
- Secretaria de Saúde do Estado, Programa de Residência Médica em Infectologia, Fortaleza, Ceará, Brazil,Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | - Mateus Lavor Lira
- Secretaria de Saúde do Estado, Programa de Residência Médica em Infectologia, Fortaleza, Ceará, Brazil,Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | | | - Ângela Maria Veras Stolp
- Laboratório Central de Saúde Pública do Estado do Ceará, Fortaleza, Ceará, Brazil,Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Kelma Maria Maia
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | - Silvia Figueiredo Costa
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, São Paulo, Brazil,Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Lauro Vieira Perdigão
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil,Universidade de São Paulo, Faculdade de Medicina, São Paulo, São Paulo, Brazil
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8
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Luo W, Yin Y, Liu W, Ren H. Intramedullary spinal cord abscess with brain abscess due to subacute infective endocarditis. BMC Neurol 2023; 23:18. [PMID: 36647036 PMCID: PMC9841633 DOI: 10.1186/s12883-023-03050-8] [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] [Received: 11/08/2022] [Accepted: 01/03/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Intramedullary spinal cord abscesses (ISCA) are rare, even more so in association with brain abscesses. Infective endocarditis is an uncommon cause of ISCA. In this case study, we report a patient with intramedullary abscesses and multiple brain abscesses due to subacute infective endocarditis. CASE PRESENTATION A 54-year-old man presented with a 7-day history of head and neck pain and numbness in both lower limbs. Intramedullary abscess combined with multiple brain abscesses was diagnosed based on blood culture, head and spinal magnetic resonance imaging (MRI), contrast-enhanced MRI, and magnetic resonance spectroscopy. Echocardiography revealed vegetations on the mitral valve and severe mitral regurgitation, which the authors believe was caused by subacute infective endocarditis. With ceftriaxone combined with linezolid anti-infective therapy, the patient's symptoms and imaging was improved during follow-up. CONCLUSIONS This case hopes to raise the vigilance of clinicians for ISCA. When considering a patient with an ISCA, it is necessary to complete blood culture, MRI of the brain and spinal cord, and echocardiography to further identify whether the patient also has a brain abscess and whether the cause is infective endocarditis.
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Affiliation(s)
- Weigang Luo
- grid.452209.80000 0004 1799 0194Department of Neurology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuanyuan Yin
- grid.452209.80000 0004 1799 0194Department of Neurology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wanhu Liu
- grid.452209.80000 0004 1799 0194Department of Neurology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huiling Ren
- grid.452209.80000 0004 1799 0194Department of Neurology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Outcome of medical treatment of otogenic brain abcess without therapeutic drainage: A case of central vertigo. Radiol Case Rep 2022; 17:3559-3563. [PMID: 35923347 PMCID: PMC9340120 DOI: 10.1016/j.radcr.2022.06.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
Otogenic brain abscess is a severe infection that must be treated as early as possible. Rare cases with a high mortality rate can be reduced by recognizing the red flags of a brain abscess, such as headaches, mental status changes, fever, and focal neurological deficits. Those could be supported by modern diagnostic management and adequate antibiotic therapy that was able to penetrate the central nervous system and abscesses. We report a case of a cerebellar abscess of the 49-year-old man with the chief complaint of vertigo. It was accompanied by chronic progressive headache, fever, bidirectional nystagmus, abnormal Romberg test, and abnormal cerebellar signs. Magnetic resonance imaging (MRI) of the head with contrast showed a right cerebellar abscess with an infectious source of otitis media and mastoiditis. The MRI evaluation showed improvement after admistered metronidazole 500 mg every 6 hours (week 22) and cefixime 200 mg every 12 hours (week 13). Long-term antibiotic treatment can be an alternative if surgery cannot be performed. However, surgery is still considered if there is no good clinical response during medical therapy.
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10
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Cerebral abcess of dental origin about a case in the department of stomatology maxillofacial surgery of university hospital center Yalgado Ouedraogo. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2022. [DOI: 10.1016/j.adoms.2022.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Robot-assisted stereotactic multiple brain abscesses' puncture: technical case report. Acta Neurochir (Wien) 2022; 164:845-851. [PMID: 34410501 DOI: 10.1007/s00701-021-04955-4] [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: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022]
Abstract
We report a case of multiple brain abscesses' puncture, employing the ROSA™ Brain surgical robot (Zimmer Biomet) and the O-arm® O2 Imaging System (Medtronic). A 51-year-old man was diagnosed with multiple supratentorial ring enhancing cystic lesions consistent with brain abscesses. A neurological deterioration occurred despite broad spectrum antibiotic therapy, due to mass effect of the abscesses. Stereotactic aspiration was performed using the described technique, allowing a single stage puncture of the cerebral lesions. In this case, the robot-assisted and image-guided procedure permitted an accurate, quick, and efficient targeting of the multiple abscesses for drainage.
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12
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Alam MS, Backiavathy V, Noronha V, Mukherjee B. Orbital abscess: 20 years' experience at a tertiary eye care center. Orbit 2022; 41:751-758. [PMID: 35195044 DOI: 10.1080/01676830.2021.2013901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To study the clinical, microbiological profile and management outcomes of orbital abscess at a tertiary care center in South India. MATERIAL AND METHOD In a retrospective interventional case series, we reviewed all patients diagnosed with orbital cellulitis from 2000-2020. The data analyzed included demographic profile, clinical and radiological features, microbiological profile, and management outcome. RESULTS A total of 921 cases of orbital and periorbital infections were reviewed. Seventy-two cases were diagnosed as orbital cellulitis. Thirty-four cases (47.22%) had radiological evidence of orbital abscess. The median age was 20.63 years. Three patients (8.82%) were neonates. A male preponderance was noted (23, 67.65%). Sinusitis (10, 29.41%) and diabetes (5, 14.7%), were the most common predisposing factors. Optic neuropathy was seen in 15 (44.11%) patients, cavernous sinus thrombosis in two patients (5.88%), and septicemia in one patient (2.94%) Multiple orbital abscesses were noted in 7 (20.59%) cases. All patients underwent surgical drainage. Methicillin-sensitive Staphylococcus aureus was the most common organism isolated in 14 patients (41.18%). Vision improvement or stabilization was seen in all except 3 (8.82%). CONCLUSION Orbital abscess is a potential sight-threatening orbital infection. The infective process can spread and ascend up to involve cavernous sinus thereby becoming life-threatening. A timely diagnosis and intervention can halt the disease process and help restore vision in many cases.
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Affiliation(s)
- Md Shahid Alam
- Orbit, Oculoplasty, Aesthetic & Reconstructive Services, Aditya Birla Sankara Nethralaya, Kolkata, India
| | - Varsha Backiavathy
- Orbit, Oculoplasty, Aesthetic & Reconstructive Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - Veena Noronha
- Department of Radiology, Sankara Nethralaya, Medical Research Foundation, Chennai, India
| | - Bipasha Mukherjee
- Orbit, Oculoplasty, Aesthetic & Reconstructive Services, Sankara Nethralaya, Medical Research Foundation, Chennai, India
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13
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Smith JL, Cruz‐Gordillo P, Luiselli G, Daci R, Owusu‐Adjei B, Ogagan C, Moses ZB. Spontaneous Propionibacterium Acnes abscess with intraventricular rupture in an immunocompetent adult without prior neurosurgical intervention. Clin Case Rep 2022; 10:e05216. [PMID: 35106159 PMCID: PMC8787723 DOI: 10.1002/ccr3.5216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/18/2021] [Accepted: 12/03/2021] [Indexed: 01/17/2023] Open
Abstract
Previously viewed as a culture contaminant, Propionibacterium Acnes can cause infection following neurosurgical intervention. Its role in brain abscess in the immunocompetent, surgically naïve population has been infrequently reported. Herein, we describe an immunocompetent 55-year-old man with no risk factors found to have a thalamic abscess with intraventricular rupture.
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Affiliation(s)
- Jordan L. Smith
- Medical Scientist Training ProgramUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
- Department of Neurological SurgeryUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| | - Peter Cruz‐Gordillo
- Medical Scientist Training ProgramUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
- Department of Neurological SurgeryUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| | - Gabrielle Luiselli
- Department of Neurological SurgeryUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
- School of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| | - Rrita Daci
- Department of Neurological SurgeryUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
- University of Massachusetts Chan Medical School Neurological Surgery ResidencyWorcesterMassachusettsUSA
| | - Brittany Owusu‐Adjei
- Department of Neurological SurgeryUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
- University of Massachusetts Chan Medical School Neurological Surgery ResidencyWorcesterMassachusettsUSA
| | - Charles Ogagan
- Department of Neurological SurgeryUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
- School of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
| | - Ziev B. Moses
- Department of Neurological SurgeryUniversity of Massachusetts Chan Medical SchoolWorcesterMassachusettsUSA
- UMass Memorial Health CareWorcesterMassachusettsUSA
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14
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Catroux M, Garcia M, Lévêque N, Page P, Moal GL, Boutolleau D, Roblot F, Burrel S. Post-herpetic encephalitis cerebral abscess: Viral reactivation or latency site within central nervous system? Curr Res Transl Med 2021; 69:103297. [PMID: 34139602 DOI: 10.1016/j.retram.2021.103297] [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: 08/18/2020] [Revised: 04/22/2021] [Accepted: 05/17/2021] [Indexed: 11/27/2022]
Abstract
Herpetic encephalitis results from central nervous system invasion by herpes simplex virus. We report the case of a man who developed a cerebral abscess fifteen months after initial Herpetic encephalitis. Retrospectively, antiviral should not have been associated with antibiotics during abscess episode, as transcriptomic analysis reported no viral reactivation.
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Affiliation(s)
- Mélanie Catroux
- Tropical Infectious Diseases Department, Poitiers University Hospital, Poitiers, France.
| | - Magali Garcia
- Virology and Mycobacteriology Department, Poitiers University Hospital, Poitiers, France; EA 4331, LITEC, University of Poitiers, Poitiers, France.
| | - Nicolas Lévêque
- Virology and Mycobacteriology Department, Poitiers University Hospital, Poitiers, France; EA 4331, LITEC, University of Poitiers, Poitiers, France.
| | - Philippe Page
- Department of Neurosurgery, Poitiers University Hospital, Poitiers, France.
| | - Gwenael Le Moal
- Tropical Infectious Diseases Department, Poitiers University Hospital, Poitiers, France.
| | - David Boutolleau
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), and AP-HP, University Hospital Pitié-Salpêtrière - Charles-Foix, National Reference Center for Herpesviruses, Virology Department, Paris, France.
| | - France Roblot
- Tropical Infectious Diseases Department, Poitiers University Hospital, Poitiers, France.
| | - Sonia Burrel
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), and AP-HP, University Hospital Pitié-Salpêtrière - Charles-Foix, National Reference Center for Herpesviruses, Virology Department, Paris, France.
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15
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Isaiah S, Loots DT, Solomons R, van der Kuip M, Tutu Van Furth AM, Mason S. Overview of Brain-to-Gut Axis Exposed to Chronic CNS Bacterial Infection(s) and a Predictive Urinary Metabolic Profile of a Brain Infected by Mycobacterium tuberculosis. Front Neurosci 2020; 14:296. [PMID: 32372900 PMCID: PMC7186443 DOI: 10.3389/fnins.2020.00296] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/16/2020] [Indexed: 12/12/2022] Open
Abstract
A new paradigm in neuroscience has recently emerged - the brain-gut axis (BGA). The contemporary focus in this paradigm has been gut → brain ("bottom-up"), in which the gut-microbiome, and its perturbations, affects one's psychological state-of-mind and behavior, and is pivotal in neurodegenerative disorders. The emerging brain → gut ("top-down") concept, the subject of this review, proposes that dysfunctional brain health can alter the gut-microbiome. Feedback of this alternative bidirectional highway subsequently aggravates the neurological pathology. This paradigm shift, however, focuses upon non-communicable neurological diseases (progressive neuroinflammation). What of infectious diseases, in which pathogenic bacteria penetrate the blood-brain barrier and interact with the brain, and what is this effect on the BGA in bacterial infection(s) that cause chronic neuroinflammation? Persistent immune activity in the CNS due to chronic neuroinflammation can lead to irreversible neurodegeneration and neuronal death. The properties of cerebrospinal fluid (CSF), such as immunological markers, are used to diagnose brain disorders. But what of metabolic markers for such purposes? If a BGA exists, then chronic CNS bacterial infection(s) should theoretically be reflected in the urine. The premise here is that chronic CNS bacterial infection(s) will affect the gut-microbiome and that perturbed metabolism in both the CNS and gut will release metabolites into the blood that are filtered (kidneys) and excreted in the urine. Here we assess the literature on the effects of chronic neuroinflammatory diseases on the gut-microbiome caused by bacterial infection(s) of the CNS, in the context of information attained via metabolomics-based studies of urine. Furthermore, we take a severe chronic neuroinflammatory infectious disease - tuberculous meningitis (TBM), caused by Mycobacterium tuberculosis, and examine three previously validated CSF immunological biomarkers - vascular endothelial growth factor, interferon-gamma and myeloperoxidase - in terms of the expected changes in normal brain metabolism. We then model the downstream metabolic effects expected, predicting pivotal altered metabolic pathways that would be reflected in the urinary profiles of TBM subjects. Our cascading metabolic model should be adjustable to account for other types of CNS bacterial infection(s) associated with chronic neuroinflammation, typically prevalent, and difficult to distinguish from TBM, in the resource-constrained settings of poor communities.
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Affiliation(s)
- Simon Isaiah
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
| | - Du Toit Loots
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
| | - Regan Solomons
- Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Martijn van der Kuip
- Pediatric Infectious Diseases and Immunology, Amsterdam University Medical Center, Academic Medical Center, Emma Children’s Hospital, Amsterdam, Netherlands
| | - A. Marceline Tutu Van Furth
- Pediatric Infectious Diseases and Immunology, Amsterdam University Medical Center, Academic Medical Center, Emma Children’s Hospital, Amsterdam, Netherlands
| | - Shayne Mason
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
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