Absceso cerebral por Cladophialophora bantiana en un paciente con trasplante renal: reporte de un caso / Brain abscess caused by Cladophialophora bantiana after renal allograft loss: A case report

Resumen Las feohifomicosis cerebrales son infecciones graves causadas por mohos dematiáceos, entre los cuales Cladophialophora bantiana es una de las especies más comúnmente aislada. Esta tiene tropismo por el sistema nervioso central y frecuentemente produce abscesos cerebrales en pacientes inmunocompetentes; además, en los inmunocomprometidos también puede ocasionar infección diseminada. Pese a la disponibilidad de medicamentos antifúngicos de amplio espectro, a menudo se requiere también la intervención quirúrgica; de todas maneras, la mortalidad es elevada. El diagnóstico debe hacerse interviniendo para tomar la muestra y hacer el cultivo y las pruebas de sensibilidad. Se presenta aquí el caso de un paciente con trasplante renal que presentó un absceso cerebral por C. bantiana, el cual se extrajo mediante resección quirúrgica. El paciente recibió tratamiento con voriconazol, con adecuada respuesta, mejoría y sin secuelas neurológicas.

Abstract Cerebral feohifomycosis are severe infections caused by dematiaceous fungi. Cladophialophora bantiana is one of the most commonly isolated species; it has central nervous system tropism and it often manifests as a brain abscess in immunocompetent patients. In immunocompromised patients, it can lead to brain abscesses and disseminated infections. Despite the availability of broad-spectrum antifungal drugs, it is a must to perform surgical management, in addition to drug therapy. However, mortality is high. The diagnostic approach must be invasive to establish a timely diagnosis and direct treatment based on culture and susceptibility tests. We report a case of brain abscess caused by C. bantiana in an immunosuppressed patient who was treated with surgical resection and voriconazole with an adequate response to therapy and without neurological sequels.

Actinomicosis diseminada con compromiso de sistema nervioso central / Disseminated actinomycosis with central nervous system involvement

Resumen La actinomicosis diseminada es muy infrecuente, así como la afección del sistema nervioso central (SNC) asociada, con mortalidad de hasta 28%. Sus manifestaciones pueden ser similares a cuadros infecciosos de otras etiologías, por lo que el conocimiento de la entidad aumenta la sospecha clínica y permite brindar un tratamiento oportuno. Se presenta el caso clínico de un adulto con edema en una extremidad superior como manifestación de una tromboflebitis y una lesión abscedada axilar, en que se confirmó una infección por actinomicetos. Presentó una diseminación hematógena con compromiso de SNC, de evolución fatal.

Actinomycosis is very rare, as well as the central nervous system (CNS) condition associated with it, presenting a mortality up to 28%. Its manifestations could be similar to infectious conditions from other etiologies, thus, having a better understanding of the entity increases clinical suspicion and also it can provide a timely treatment. The clinical case of an adult with edema in an upper extremity is presented as a manifestation of thrombophlebitis and an abscessed axillary lesion, in which actinomycetes infection was confirmed. He presented a haematogenous spread with CNS involvement, with fatal ending.

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.

The accessory gene regulator (agr) controls Staphylococcus aureus virulence in a murine intracranial abscesses model

Background: Intracranial abscesses are associated with high mortality. Staphylococcus aureus is one of the main pathogens that cause intracranial infection. Until now, there is no report to identify the key effectors of S. aureus during the intracranial infection. Methods: The murine intracranial abscesses model induced by S. aureus was constructed. The vital sign and survival rate of mice were observed to evaluate the infection. Histological examination was used to diagnose the pathological alterations of mouse tissues. The sensitivity of S. aureus to whole blood was evaluated by whole-blood killing assay. Results: In murine intracranial abscesses model, it was shown that the mortality caused by the accessory gene regulator (agr) locus deficient strain was significant decreased compared with its parent strain. Moreover, we found that RNAIII, the effector of agr system, was essential for the intracranial infection caused by S. aureus. In the further investigation, it was shown that restoration the expression of α-toxin in agr deficient strain could partially recover the mortality in the murine intracranial abscesses model. Conclusion: Our data suggested that the agr system of S. aureus is an important virulence determinant in the induction and mortality of intracranial abscesses in mice. .

Cerebritis bifrontal y absceso cerebral por Streptococcus del grupo anginosus, en paciente previamente sano: Caso clínico / Bifrontal cerebritis and brain abscess caused by Sreptococcus anginosus group: Report of one case

The etiology of brain abscesses is mostly polymicrobial. Streptococci and anaerobic bacteria are the most commonly isolated pathogens. We report a previously healthy female without predisposingfactors, presenting with a bifrontal cerebritis caused by a Streptococcus anginosus group infection. The patient developed a brain abscess and a subdural collection with severe intracranial hypertension offatal evolution. The etiologic diagnosis was made culturing the material obtained from the subdural collection. It is presumed that, within the Streptococcus anginosus group, Streptococus intermedius could have been the causing bacteria, given its central nervous system tissue tropism and its predisposition to form brain abscesses.

Nocardia abscessus brain abscess in an immunocompetent host

Nocardia brain abscesses typically occur in immunocompromised patients. Most cases of nocardiosis are caused by the Nocardia asteroides complex and Nocardia brasiliensis. Here, we present a patient with a Nocardia abscessus brain abscess. The diagnosis was confirmed by DNA sequencing, and the organism was susceptible to linezolid, clarithromycin, ceftriaxone, imipenem, tobramycin, amikacin, minocycline and sulfamethoxazole. The patient was successfully treated medically in combination with surgical excision

Magnetic resonance imaging of central nervous system tuberculosis: an experience of 50 cases from central India

Central Nervous System Tuberculosis [CNSTB] continues to be a common problem world-wide and particularly in India. With the widespread availability of Magnetic Resonance Imaging [MRI], it is increasingly used for the diagnosis and follow up of CNSTB. This study presents a review of 50 cases of CNSTB seen in central India. Between 2006 and 2009, 50 cases of CNSTB [28 Spinal, 22 Cerebral] were diagnosed and followed up. MRI was performed using either a0.2Tor 1.5T unit using a standard protocol. Contrast study was needed in 32 cases. The diagnosis was later confirmed either by histopathological or microbiological examination in most cases and by a positive treatment response in some cases. All patients underwent routine radiograph of the chest to look for associated pulmonary tuberculosis, haematological tests and in some cases CT scan guided aspiration / biopsy and CSF analysis. There were 20 male and 30 female patients with age range of 4 to 65 years. Most common spinal lesion noted was the typical paradiscal involvement followed by skip lesion and posterior element lesion. The lesion was extradural in 19 and intradural in 3 cases. The most common cerebral lesion was meningitis followed by tuberculomas, abscess and obstructive hydrocephalus. Response to treatment was assessed using MRI in 30 cases. MRI has revolutionized the imaging of CNSTB. The diagnosis can be made with reasonable certainty, obviating the need for an invasive procedure both for diagnosis and treatment. This was confirmed by the resolution of brain and spinal cord pathological changes after anti-tubercular chemotherapy. MRI also allows for monitoring the response to treatment of patients with CNSTB. However in some cases confirmation of diagnosis by needle aspiration and histopathological analysis may be indicated when the imaging findings are not conclusive

Absceso cerebral posquirúrgico causado por Propionibacterium acnes / Post-surgery cerebral abscess due to Propionibacterium acnes

Los abscesos cerebrales por Propionibacterium acnes son poco frecuentes. Es importante para el médico clínico la rápida identificación de este patógeno para la elección de una terapéutica antibiótica adecuada. En este caso se describe un paciente con una exéresis de un glioblastoma multiforme donde a los 9 meses se evidenció la existencia de una recidiva tumoral, se efectuó una extirpación tumoral subtotal y la colocación de implantes de quimioterapia en el lecho tumoral residual. Al cabo de un mes de esta reoperación presentó una lesión ocupante compatible con un absceso cerebral, motivo por el cual se realizó nueva craneotomía y drenaje del mismo. En los cultivos de las biopsias y del material purulento se aisló P. acnes como flora única. Para la identificación se realizaron pruebas bioquímicas y se aplicó el sistema API20A. Se determinó la concentración inhibitoria mínima (CIM) a clindamicina, penicilina, amoxicilina y metronidazol, los valores de CIM (ug/ml) obtenidos fueron: 0.250, 0.040, 0.023 y 256, respectivamente. El paciente recibió cefepime más metronidazol por vía endovenosa durante un período de 30 días y completó tratamiento con clindamicina por vía oral durante 60 días, dada la posible complicación ósea en el sitio de la infección. Luego de 8 meses de la intervención quirúrgica y el drenaje del absceso cerebral no hubo evidencia de signos clínicos de recidiva tumoral e infecciosa. P. acnes es un patógeno infrecuente como causal de abscesos cerebrales, sin embargo no se debe desestimar en muestras neuroquirúrgicas.

Brain abscesses by Propionibacterium acnes are rare. The rapid identification of this pathogen is important in order to choice the appropriate antibiotic therapy. We describe the case of a patient with excision of a multiform glioblastoma who 9 months later presented a tumor recurrence. A subtotal tumor excision was made and implants chemotherapy were placed in the residual tumor. After one month of surgery the patient presented a brain abscess. A craniotomy for drainage was performed. P. acnes was isolated from the biopsy and from purulent material. Identification was made by conventional biochemical tests and by the API system 20 A. The Minimum Inhibitory Concentration (MIC) to clindamycin, penicillin, amoxicillin and metronidazole was determined. The values of MIC (ug/ml) obtained were: 0.250, 0.040, 0.023 and 256, respectively. The patient received cefepime and metronidazole intravenously during 30 days and completed treatment with oral clindamycin for 60 days, considering the possibility of adjacent bone involvement. Eight months after the drainage the patient had no evidence of infection or tumor recurrence. Although P. acnes is a rare cause of post-neurosurgical infection, it should be considered as a possible pathogen in postoperative brain abscesses.

Cerebral phaeohyphomycosis due to Cladophialophora bantiana.

Cladophialophora bantiana, a dematiaceous fungus and a member of the family Phaeohyphomycetes, is primarily a neurotropic fungus causing central nervous system (CNS) infection. We report a case of a well preserved, young adult male presenting with a capsuloganglionic abscess caused by C. bantiana, a rare entity. Diagnosis was made based on the mycology and histopathology findings of the aspirate from the abscess through a burr hole. The patient responded clinically to amphotericin B.

Brain abscess caused by Cladophialophora Bantiana in an immunocompetent host: need for a novel cost-effective antifungal agent.

We report a 53-year-old male who presented with headache, tremor and memory disturbance. Radiological evaluation was suggestive of brain abscess. He underwent gross total excision of the cerebral abscess. The histopathological examination and pus culture was suggestive of brain abscess caused by Cladophialophora bantiana. Authors report a rare case of biopsy and culture proven Cladophialophora bantiana brain abscess in an immunocompetent host. The authors review the relevant literature and current treatment options while emphasizing the need for a cost-effective novel antifungal drug to salvage a subset of patients suffering from this rare but increasingly frequent condition.

Nocardial brain abscess in an immunocompetent host.

Nocardial infection of the central nervous system is rare and usually manifests as brain abscess. Here we describe an elderly gentleman who presented with signs and symptoms of an intracranial mass lesion localising to the frontal lobe. Clinical examination and CT scan suggested neoplasia as the probable diagnosis. A biloculated abscess was seen at surgery. Aspiration of the contents and examination of pus revealed Nocardia asteroides . Treatment included total excision and prolonged antibiotic therapy which resulted in an excellent outcome.

Nocardia brain abscess in a diabetic patient.

Brain abscess due to disseminated nocardia infection is an acute medical emergency among immunocompromised patients. We report a case of rapidly progressive nocardia brain abscess in an apparently healthy diabetic individual. The close similarity of the radiological features with those of malignancy and tuberculosis may delay the diagnosis of central nervous system (CNS) nocardiosis. A high index of suspicion and early intervention like stereotactic brain biopsy remain the cornerstone to increase the chance of positive clinical outcome.

Clinical pattern of nocardiosis in Saudi Arabia: a case series

We aimed to study the clinical pattern of nocardiosis in a tertiary care hospital in Saudi Arabia using a retrospective review of cases from 1987 to 2003. A total of 19 patients were identified as having culture-proven nocardial infection. The most common underlying condition was renal transplantation in 8 patients [42%]. Lungs were the most common sites of involvement in 12 patients [63%]. Three Nocardia species were isolated in our series: N. asteroides [58%], N. brasiliensis [21%], and N. otitidiscaviarum [21%]. A high index of suspicion is essential in susceptible patients presenting with pulmonary infiltrate, cerebral abscess or deep soft-tissue abscess and usually requires an active diagnostic workup and early administration of appropriate therapy

Magnetic resonance spectroscopy in the diagnosis and etiological definition of brain bacterial abscesses

We report two patients with bacterial brain abscesses whose etiological diagnosis was correctly proposed by association of diffusion weighted images (DWI) and magnetic resonance spectroscopy (MRS) with conventional MRI. Both patients presented ring enhancing lesions with evidences of restricted diffusion. On MRS, the abscess caused by aerobic bacteria presented lactate and aminoacids peaks and the abscess caused by anaerobic facultative bacteria showed also acetate and succinate peaks. These results are in agreement with an unique previous study that related MRS pattern with bacterial etiology. Conventional MRI, associated with DWI and MRS is effective in diagnosing bacterial abscess and promising in exploring its etiology.

Apresentamos dois pacientes com abscessos bacterianos cerebrais cujos diagnósticos etiológicos foram corretamente auxiliados pela associação de difusão e espectroscopia à ressonância magnética convencional. Ambos apresentavam lesões com captação anelar de contraste e evidências de restrição à difusão de moléculas de água. Na espectroscopia, o abscesso causado por bactéria aeróbia apresentou picos de lactato e aminoácidos, enquanto o abscesso causado por bactéria anaeróbia facultativa mostrou, além destes, picos de acetato e succinato. Tais resultados concordam com um único estudo prévio que relacionou o padrão de espectroscopia nos abscessos com sua etiologia bacteriana. A ressonância magnética convencional, associada à difusão e à espectroscopia é uma técnica eficiente no diagnóstico de abscessos bacterianos e promissora em explorar suas etiologias.

Cerebral abscess caused by Serratia marcescens in a premature neonate

BACKGROUND: Cerebral abscesses are extremely rare in neonates. Serratia marcescens is an unusual cause of sepsis and neurological spread is especially ominous. PURPOSE: To report the case of a 34-week neonate who developed this rare condition and to discuss diagnostic and therapeutic measures. CASE REPRT: A 34-week male neonate sequentially developed respiratory distress syndrome, early sepsis and necrotizing enterocolitis; later cultures revealed S. marcescens. After deterioration, a cerebral abscess became evident, which revealed S. marcescens. Clinical improvement ensued after high-dose amikacin and meropenem. CONCLUSION: Clinical signs are often non-specific. Proper diagnostic measures, neurosurgical consultation and aggressive antibiotic therapy are essential for these high-risk neonates.

INTRODUÇÃO: Abscessos cerebrais são extremamente raros em neonatos. Serratia marcescens é causadora incomum de sepse nestes pacientes e a disseminação no sistema nervoso central é grave. OBJETIVO: Relatar um prematuro de 34 semanas que desenvolveu esta condição e discutir as medidas diagnósticas e terapêuticas. RELATO DE CASO: Prematuro masculino de 34 semanas desenvolveu síndrome do desconforto respiratório, sepse neonatal e enterocolite necrotizante; hemoculturas revelaram S. marcescens. Após deterioração clínica, evidenciou-se um abscesso cerebral cuja drenagem revelou S. marcescens. Houve melhora após introdução de amicacina e meropenem. CONCLUSÃO: Os sinais clínicos são inespecíficos. Passos diagnósticos apropriados, avaliação neurocirúrgica precoce e antibioticoterapia agressiva são essenciais para estes prematuros.

Cerebellar abscess by Gemella morbillorum in a patient with inter-atrial communication

Gemella morbillorum, a commensal of the oropharynx, upper respiratory, urogenital and gastrointestinal tract is rarely associated with infections in humans. However, an increasing number of infectious processes in different locations have been reported. Cerebral abscesses caused by these bacteria are extremely uncommon with only four cases previously described in the literature. We present the case of a cerebellar abscess by Gemella morbillorum in a 50 years-old man with inter-atrial communication dealt by surgical excision and antimicrobial therapy.

Gemella morbillorum, uma bactéria comensal da orofaringe, vias aéreas superiores e aparelhos urogenital e gastrointestinal, raramente causa infecções em humanos. No entanto, um crescente número de processos infeciosos em diferentes localizações tem sido referido. Abcessos cerebrais provocados por esta bactéria são extremamente raros, encontrando-se apenas quatro casos previamente descritos na literatura. Apresentamos o caso de um abscesso cerebelar por Gemella morbillorum em um homem de 50 anos com comunicação inter-atrial, tratado por excisão cirúrgica e terapêutica antimicrobiana.

Bilateral mycotic cerebral abscess due to aspergillosis--a case report.

Aspergillosis of central nervous system is an uncommon infection mainly occurring in immunocompromised patient. It may be present in several forms: abscess, meningitis, mycotic aneurysm, infarction and in tumoral form. Here we report a case of cerebral aspergillosis presenting as bilateral frontal lobe abscess without evidence of any underlying systemic disorder or extracranial disease.

Brain abscess secondary to frontal osteomyelitis / Abscesso cerebral secundário à osteomielite frontal

Frontal osteomyelitis is a rare complication of sinusitis. Common intracranial complications of the frontal osteomyelitis are meningitis, epidural empyema, subdural empyema and brain abscess. We described a case of frontal osteomyelitis with brain abscess caused by Staphylococcus aureus with improve after needle aspiration and antibiotics to brain abscess for eight weeks and for chronic osteomyelitis for four months.

A osteomielite de osso frontal é uma complicação rara da sinusite frontal. As complicações intracranianas mais comuns da osteomielite frontal são: meningite, empiema epidural, empiema subdural e abscesso cerebral. Relatamos um caso de osteomielite frontal com abscesso cerebral cujo agente etiológico foi o Staphylococcus aureus. Houve melhora significativa após drenagem guiada por agulha e antibiótico por oito semanas e para a osteomielite crônica por quatro meses.