Brain abscess of odontogenic origin in children: a systematic review of the literature with emphasis on therapeutic aspects and a new case presentation

Brain abscess from oral microbiota approached by metagenomic next-generation sequencing: A case report and review of literature

BACKGROUND

Brain abscess is a serious and potentially fatal disease caused primarily by microbial infection. Although progress has been made in the diagnosis and treatment of brain abscesses, the diagnostic timeliness of pathogens needs to be improved.

CASE SUMMARY

We report the case of a 54-year-old male with a brain abscess caused by oral bacteria. The patient recovered well after receiving a combination of metagenomic next-generation sequencing (mNGS)-assisted guided medication and surgery.

CONCLUSION

Therefore, mNGS may be widely applied to identify the pathogenic microorganisms of brain abscesses and guide precision medicine.

Brain abscess of odontogenic origin: A case report and literature review

BACKGROUND

The objective of this study is to investigate and understand the characteristics of odontogenic brain abscess.

METHODS

A case of brain abscess suspected to be caused by odontogenic infection was documented, and a comprehensive analysis and summary of odontogenic brain abscess cases reported in various countries over the past 20 years was conducted.

RESULTS

Based on the analysis and synthesis of both the present and previous reports, we have examined and consolidated the distinctive features of odontogenic brain abscess, the potential transmission pathway of pathogenic bacteria, diagnostic assertions, verification techniques, and crucial considerations during treatment.

CONCLUSION

This investigation contributes to an enhanced comprehension and improved clinical identification of odontogenic brain abscess.

Potential infection foci in the oral cavity and their impact on the formation of central nervous system abscesses: A literature review

Despite advancements in preventive, diagnostic, and therapeutic activities in medicine, inflammatory processes of the central nervous system remain a significant problem, posing a serious threat to life and health. Purulent central nervous system infections are unique, including abscesses of the brain and spine, which are severe infections occurring in 0.4% to 0.9% of 1000 patients worldwide. Central nervous system abscesses have varying etiology. For example, organized, encapsulated abscesses of the brain are a unique group of inflammatory processes in the central nervous system caused by inflammation around the teeth in 3% to 10% of cases. Sometimes, the condition of patients with brain abscesses is severe and life-threatening. Therefore, detecting and eliminating all causes early, including those potentially resulting from odontogenic infections, is important; accurate and early diagnosis enables appropriate treatment. This paper presents a review of the information available in the literature on brain abscesses and their relationship with odontogenic foci of infection in the oral cavity.

Bacterial Brain Abscesses in a Patient With Transposition of the Great Arteries and Interventricular Communication

Brain abscesses are localized infections in the brain's parenchyma, characterized by inflammation, pus formation, and the development of a surrounding capsule. These lesions typically occur due to underlying factors such as immunosuppression, ear and sinus infections, and contamination during neurosurgery. While brain abscesses are a life-threatening complication of cyanotic heart defects, they are rarely reported, with only sporadic cases previously documented. This article presents the case of an eight-year-old male patient with an uncorrected transposition of the great arteries, who was evaluated for symptoms including headache, fever, and neurological focalization. Diagnostic imaging revealed three lesions consistent with brain abscesses. Furthermore, the causal agents were identified as Streptococcus intermedius and Fusobacterium spp., representing oral microorganisms. Additionally, the patient exhibited poor oral hygiene and dental caries in multiple teeth. This article discusses and integrates the possible pathophysiological mechanisms that allowed a localized dental infection to spread hematogenously and cause brain abscesses in this patient. Prompt management of the infectious source is crucial to prevent a poor prognosis associated with brain abscesses. Therefore, this case emphasizes the importance of regular dental assessments and thromboprophylaxis for patients with underlying cardiomyopathies that cause right-to-left shunting to prevent potential complications.

Odontogenic brain abscess due to Anaerococcus prevotii infections: A case report and review article

BACKGROUND

Odontogenic brain abscess is a rare case primarily caused by normal flora such as Anaerococcus prevotii.

CASE PRESENTATION

A 60-years-old Indonesian female complained of severe left side headaches, hearing loss, a decrease of consciousness, several episodes of nausea and vomiting, and hemiparesis dextra for 5 days. Three months previously, she performed dental operative procedures on the left side of the first and second lower molar and debridement of phlegmon on the left side of the mouth. Head CT scan suggests multiple brain abscesses or high-grade glioma, non-communicating hydrocephalus and suggestive mastoiditis. The patient underwent excision surgery and abscess culture, which resulted in Anaerococcus prevotii. The patient received a metronidazole antibiotic, and on the seventh day, his condition improved.

DISCUSSION

Identifying bacterial infection in the brain abscess is crucial for effective treatment. Abscess removal in the brain and antibiotics are treatments for brain abscesses.

CONCLUSION

Odontogenic brain abscess caused by Anaerococcus prevotii infection effectiveness with surgical excision and antibiotics.

Streptococcus anginosus group infections in hospitalised children and young people

AIM

The Streptococcus anginosus group (SAG) comprises three bacterial species colonising the mouth and gastrointestinal and genitourinary tracts and capable of serious pyogenic infections. Although well-described in adults, studies in children are limited. Here, we characterise paediatric SAG infections from a single Australian centre.

METHODS

Hospitalised patients aged ≤18 years with positive SAG cultures from January 2009 to December 2019 were identified from Pathology Queensland's Gold Coast Laboratory database and their medical records were reviewed.

RESULTS

Two-hundred children (62% male), median age 12 years (interquartile range 6-16), with positive SAG cultures were identified. Overall, 90% received intravenous antibiotics, 89% underwent surgical drainage, 23% were readmitted and 15% required additional surgery. The most common sites were the abdomen (39%), soft tissues (36%) and head and neck regions (21%). Since 2011, Pathology Queensland reported SAG at the species level (n = 133). Of these, S. anginosus was the most prevalent (39%), then S. constellatus (34%) and S. intermedius (27%). Compared with the other two species, S. intermedius was most commonly associated with head and neck infections (relative risk (RR) = 2.2, 95% confidence interval (CI) 1.4-3.5), while S. constellatus (RR = 1.7, 95% CI 1.2-2.4) and S. anginosus (RR = 1.5, 95% CI 1.0-2.0) were each associated with a higher risk of intra-abdominal infection than S. intermedius. Since February 2015, the number of children admitted with SAG-associated intra-abdominal infection per 1000 hospitalisations increased by 29% annually compared with an annual decline of 8% in previous years.

CONCLUSIONS

SAG infections occur at various anatomical sites. Despite antibiotics and surgical management, almost one-quarter are re-hospitalised for further treatment.

Brain Abscess Caused by Eikenella corrodens in an Immunocompetent Child: Case Report and Literature Review

Objective Eikenella corrodens is a slow-growing, fastidious, non-motile, facultative anaerobic, Gram-negative bacillus that is commonly found in the human oropharynx. Although many cases have been reported in the adult population, only few cases of brain abscesses caused by E.corrodens have been reported in children so far.

Methods Here, we reported the case of a 29-month-old female with complaints of weakness in the right leg twice in the past 3 weeks. Imaging studies revealed a brain abscess in the left parietofrontal lobe. The patient underwent surgery for abscess drainage, microbiological samples were obtained and empirical antibiotic treatment was started. Abscess culture showed the growth of E.corrodens. The bacteria were found to be sensitive to ceftriaxone; hence, the therapy was continued for 46 days with ceftriaxone. A final computed tomography showed the resolution of the abscess. The patient's clinical condition improved and she was discharged without any sequelae.

Conclusion Brain abscess should be considered when patients present with neurological deficits. As far as we know, there are only six reported cases of brain abscesses only due to E.corrodens in the pediatric population. Since it is a slow-growing pathogen, early diagnosis and treatment are crucial for patient survival. This case supports the combination of surgical drainage and antibiotics for treatment.

Brain Abscess in the Current Decade (2010–2019) in India—A Review

Brain abscess outcomes have improved in recent years due to advancements in cranial imaging, microbiological techniques, minimally invasive neurosurgical procedures, and effective antibiotic treatments. However, the incidence of brain abscess remains unchanged in developing countries. We searched PubMed and Google Scholar for references using the key words “brain abscess” and “India” and reviewed both retrospective and prospective studies published in peer-reviewed journals in the current decade to understand the present status. The review shows that the patients’ ages, the predominance of male patients, the symptoms and locations of brain abscesses, and the types of bacteria associated with them have remained unchanged over the past decade. The most common predisposing condition in recent years has been chronic suppurative otitis media with a mortality rate of 7 to 10%. Middle ear infection is often neglected and not treated aggressively in Asian countries. It requires multidisciplinary treatment strategies to address the primary source of infection and better health awareness to prevent the development of brain abscess.