Delayed Occurrence of Escherichia coli Subdural Empyema Following Head Injury in an Elderly Patient: A Case Report and Literature Review

Diagnostic, monitoring, and prognostic value of combined detection of lactate dehydrogenase, β2-transferrin, and interleukin-10 for acute intracranial infections

OBJECTIVE

To investigate the value of the combined detection of lactate dehydrogenase (LDH), β2-transferrin (β-2Tf), and interleukin-10 (IL-10) for identification of acute intracranial infections such as meningitis.

METHODS

A total of 103 patients were placed in the suppurative meningitis group (SMG), 124 patients in the viral meningitis group (VMG). Another 86 patients without any infectious diseases of the central nervous system constituted the control group (CG). The levels of LDH and β-2Tf in the cerebrospinal fluid were determined by enzymatic methods; IL-10 expression was measured by ELISA. The correlation between infection and the LDH, β-2Tf, and IL-10 levels was analyzed by linear correlation analysis, and ROC curve analysis was applied to determine the diagnostic value of combined detection of LDH, β-2Tf, and IL-10 levels for intracranial infections.

RESULTS

LDH, β-2Tf, and IL-10 levels negatively correlated with the treatment time in both the SMG (r = -0.52, -0.97, and -0.24, respectively, P < 0.01) and VMG (r = -0.70, -0.91, and -0.25, respectively, P < 0.01). Sensitivity and specificity of combined detection of LDH, β-2Tf, and IL-10 for the diagnosis of SM was 80.47% and 75.33%, respectively, while those for VM were 84.24% and 79.24%, respectively.

CONCLUSION

Combined detection is an excellent indicator for the diagnosis and treatment of intracranial infections.

Subdural Empyema by Enterobacter cloacae: Case Report

Infections 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.

Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.