ABSTRACT
ABSTRACT: Splenic abscess is a life-threatening condition, which is very rare in children. There is usually an infective focus or pre-disposing factors such as immunodeficiencies towards developing splenic abscesses. Only one case of splenic abscess with brain abscesses in an adult has been reported in the English literature. We, therefore, report a case of an 11-year-old boy who was otherwise healthy, but presented with fever and weight loss for 2 months, right upper abdominal pain, vomiting, hypochondrial tenderness for 1 week and later on developed a left hemiplegia and right facioparesis 2 days before presentation. Diagnosis of splenic abscess and right intracerebral abscesses was confirmed with abdominopelvic ultrasound scan and abdominal and cranial computerised tomographic scans. He subsequently had percutaneous ultrasound-guided drainage of the splenic abscess which was not successful necessitating splenectomy with aggressive antibiotics treatment to which the patient responded with resolution of the brain abscesses and recovery of power in affected limbs. This report aimed to highlight the need for increased suspicion of splenic abscesses in children who are apparently immunocompetent and to add to the knowledge of management of this rare condition in children. We conclude that splenic abscess with intracerebral abscess is a rare but life-threatening condition which is amenable to treatment with drainage of abscess and aggressive guided antimicrobial therapy.
Subject(s)
Brain Abscess , Drainage , Splenic Diseases , Tomography, X-Ray Computed , Humans , Male , Child , Splenic Diseases/surgery , Splenic Diseases/diagnosis , Splenic Diseases/diagnostic imaging , Brain Abscess/diagnosis , Brain Abscess/surgery , Brain Abscess/therapy , Brain Abscess/diagnostic imaging , Drainage/methods , Anti-Bacterial Agents/therapeutic use , Abscess/diagnosis , Abscess/surgeryABSTRACT
BACKGROUND: Cerebellar abscesses are rare, life-threatening infections often originating from bacterial sources, while metastatic brain lesions from lung adenocarcinoma are relatively common. However, the coexistence of a cerebellar abscess secondary to metastatic lung adenocarcinoma is exceedingly rare and presents unique diagnostic and management challenges. CASE PRESENTATION: We report a case of a 35 year-old Pakistani female patient with persistent headaches, nausea, and vertigo, who was found to have a large cerebellar mass with features suggestive of metastatic lung adenocarcinoma. Further investigation revealed a concomitant cerebellar abscess. Surgical excision and broad-spectrum antibiotics were initiated, resulting in a favorable outcome. CONCLUSION: This case showcases the rarity and complexity of cerebellar abscesses due to metastatic lung adenocarcinoma. Timely intervention, including surgery and targeted therapy, is crucial for successful management. Further research is needed to enhance treatment strategies.
Subject(s)
Adenocarcinoma of Lung , Anti-Bacterial Agents , Brain Abscess , Lung Neoplasms , Adult , Female , Humans , Adenocarcinoma of Lung/complications , Adenocarcinoma of Lung/pathology , Anti-Bacterial Agents/therapeutic use , Brain Abscess/diagnostic imaging , Brain Abscess/etiology , Brain Neoplasms/complications , Brain Neoplasms/secondary , Cerebellar Diseases/etiology , Lung Neoplasms/complications , Lung Neoplasms/pathology , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
BACKGROUND: Listeria monocytogenes brain abscess is a rare phenomenon that is common in immunocompromised patients. Streptococcus equinus brain abscess has never been reported in the literature to our knowledge. In this case report, we describe a case of brain abscess secondary to Listeria monocytogenes and Streptococcus equinus in an immunocompetent patient with transient low CD4 count. CASE PRESENTATION: A 27-year-old white, male patient, previously healthy, nonalcoholic, and occasional smoker, presented to the emergency department for confusion and headache. The patient was found to have a left parietal abscess, which was drained and the fluid was sent for culture. Culture grew Listeria monocytogenes and Streptococcus equinus. The patient was treated with intravenous ampicillin followed by oral amoxicillin for a total of 6 weeks. The CD4 count was low initially. However, after the resolution of the infection, the CD4 count came back within normal range. Another brain magnetic resonance imaging was done that showed a significantly decreased hyperintensity within the left parietal subcortical white matter at the site of surgery with significantly decreased enhancement and almost total resolution of the previous abscess. CONCLUSION: Transient low CD4 count is a rare phenomenon that exposes patients to unusual and atypical infections. Since low CD4 count is transient, patients treated promptly recover from their illness. Our patient developed a Listeria monocytogenes and Streptococcus equinus brain abscess, which is considered rare and has not been previously described in the literature to our knowledge.
Subject(s)
Anti-Bacterial Agents , Brain Abscess , Listeria monocytogenes , Listeriosis , Streptococcal Infections , Humans , Male , Brain Abscess/microbiology , Brain Abscess/drug therapy , Listeria monocytogenes/isolation & purification , Adult , Anti-Bacterial Agents/therapeutic use , Streptococcal Infections/drug therapy , Streptococcal Infections/microbiology , Streptococcal Infections/diagnosis , Listeriosis/drug therapy , Listeriosis/diagnosis , Listeriosis/microbiology , Magnetic Resonance Imaging , Ampicillin/therapeutic use , Immunocompetence , Amoxicillin/therapeutic use , Amoxicillin/administration & dosageABSTRACT
RATIONALE: Nocardia infection is commonly regarded as an opportunistic pulmonary pathogen affecting debilitated or immunocompromised individuals. Brain abscesses caused by Nocardia farcinica are rare and pose a diagnostic challenge. Traditional diagnostic techniques for identifying Nocardia species, such as blood culture, microscopy, and pathology, have shown inadequate performance. In the reported case, we applied metagenomic next-generation sequencing (mNGS) to diagnose a case of brain abscess due to N. farcinica. PATIENT CONCERNS: A 66-year-old female developed a brain abscess after sustaining a hand injury. The patient exhibited a gradual change in personality and experienced tremors in her right upper limb for a duration of 1 month. DIAGNOSES: The pathogen responsible for the multiple brain abscesses was identified in the cerebrospinal fluid as N. farcinica through mNGS. INTERVENTIONS: Antibiotic treatment included trimethoprim-sulfamethoxazole, linezolid, amikacin, meropenem, and moxifloxacin. OUTCOMES: The patient's symptoms and signs improved significantly after administration of antibiotics to which the pathogen is known to be sensitive. After 5 months of follow-up, magnetic resonance imaging of the head showed that the abscess was basically cured. The patient lived a normal life with no adverse drug reactions. LESSONS: Nocardia brain infection is characterized by an insidious onset and lacks distinctive clinical and imaging features. mNGS was advantageous for the timely identification and management of Nocardia-associated brain abscess in the present case and obviated the need for invasive brain surgery. Expeditious and precise diagnosis coupled with prompt antibiotic therapy can significantly reduce the mortality rate associated with this condition.
Subject(s)
Anti-Bacterial Agents , Brain Abscess , Hand Injuries , Nocardia Infections , Nocardia , Humans , Female , Nocardia Infections/diagnosis , Nocardia Infections/drug therapy , Brain Abscess/microbiology , Brain Abscess/etiology , Brain Abscess/diagnosis , Nocardia/isolation & purification , Aged , Anti-Bacterial Agents/therapeutic use , Hand Injuries/complications , Magnetic Resonance Imaging , High-Throughput Nucleotide SequencingABSTRACT
RATIONALE: Raney clips are commonly used in neurosurgical procedures to hold the scalp in place and stop bleeding during surgery. The removal of Raney clips is often the last process during cranial surgery prior to the closure of skin incision. Thus, a Raney clip found underneath the titanium mesh resulting in fever is a very rare occurrence. PATIENT CONCERNS: An 18-year-old male patient underwent cranial surgery due to intracranial abscess in the frontal lobe and subsequently underwent frontal skull repair using titanium mesh during which a Raney clip was unintentional left underneath the titanium mesh resulting in fever. DIAGNOSIS: A thin-slice computed tomography (CT) scan was used to identify the Raney clip. INTERVENTION: A third surgery was performed to remove the Raney clip. OUTCOMES: The patient fever total resolved after the third surgery with no further neurological deficits and 2-years follow-up revealed the patient is well and go about his daily activities. LESSONS: It is crucial to ensure that all foreign objects are removed after the surgery by counting all instruments used at and after each step during the operation, including all Raney clips. This will help prevent complications and ensure the safety as well as the well-being of the patient.
Subject(s)
Surgical Instruments , Surgical Mesh , Titanium , Humans , Male , Adolescent , Surgical Mesh/adverse effects , Titanium/adverse effects , Surgical Instruments/adverse effects , Foreign Bodies/surgery , Tomography, X-Ray Computed , Brain Abscess/surgery , Brain Abscess/etiology , Neurosurgical Procedures/adverse effects , Neurosurgical Procedures/methods , Fever/etiology , Postoperative Complications/surgery , Postoperative Complications/etiology , Craniotomy/adverse effects , Craniotomy/instrumentationABSTRACT
BACKGROUND: Recently, there is increasing evidence that the proportion of odontogenic brain abscesses is greater than previously known. In this study, we aim to differentiate the oral infections as triggers more precisely and to classify them in the clinical setting. METHODS: For analysis, we conducted a retrospective single center study. We reviewed patients with brain abscesses who have undergone treatment in the University Hospital of Freiburg, Germany in the period between 2000-2021. Inclusion required two main criteria: 1. The brain abscess must not have an other focus than odontogenic. 2. The microbial spectrum identified in the brain abscess must be consistent with an odontogenic origin. RESULTS: Of 217 brain abscess patients, 26 met the inclusion criteria. 42% (11 patients) suffered from immunosuppressive conditions. Odontogenic foci were diagnosed in 18 cases (69%). Neurologic deficits included vigilance reduction and hemiparesis. Pathogens of the Streptococcus anginosus group were the most frequent causative agent (21 cases, 81%). Metronidazole (54%) and ceftriaxone (42%) were part of the targeted antibiotic therapy. All brain abscesses were surgically treated. Teeth were extracted in 14 of 17 cases for focus control. 18 cases (72%) showed complete or partial resolution of neurologic symptoms and 3 cases were fatal. CONCLUSION: Apparently silent or chronic oral infections are sufficient to cause bacterial colonization of the brain, especially in immunocompromised patients. Therefore, special care should be taken to maintain good oral health. An interdisciplinary management should become a standard to prevent and treat the occurrence of brain abscesses.
Subject(s)
Brain Abscess , Humans , Brain Abscess/microbiology , Retrospective Studies , Male , Female , Middle Aged , Adult , Aged , Young Adult , Anti-Bacterial Agents/therapeutic use , Adolescent , Streptococcal Infections/epidemiology , Immunocompromised Host , Focal Infection, Dental/microbiology , Focal Infection, Dental/epidemiology , Aged, 80 and overABSTRACT
BACKGROUND: Metastatic brain abscesses caused by Klebsiella pneumoniae are extremely rare but life-threatening conditions. To depict a unique case of the middle-aged hypertensive man with an unusual presentation of metastatic brain abscesses originating from a pleural abscess caused by Klebsiella pneumoniae and subsequently leading to loss of consciousness (LOC). CASE REPORT: A 52-year-old Iranian man with a history of hypertension presented to the emergency department with a five-day history of worsening cough, high-grade fever, shortness of breath, chest pain, fatigue, and a productive cough. Laboratory tests revealed leukocytosis, elevated C-reactive protein, and respiratory alkalosis. A chest computed tomography scan confirmed pneumonia, and a brain scan revealed multiple hypodense lesions. Despite antibiotic therapy, the patient's condition worsened, leading to confusion, disorientation, and loss of consciousness. Magnetic resonance imaging revealed multiple ring-enhancing lesions, suggesting an abscess formation. Bronchial washings and BAL samples confirmed a lower respiratory tract infection. Cultures from the bronchial washings grew Klebsiella pneumoniae. CONCLUSIONS: Metastatic brain abscesses caused by Klebsiella pneumoniae are exceedingly rare but life-threatening conditions. Timely diagnosis and effective antimicrobial treatment are critical for patient outcomes. This case underscores the significance of recognizing atypical presentations of bacterial infections, as early detection and appropriate management can significantly impact patient outcomes.
Subject(s)
Anti-Bacterial Agents , Brain Abscess , Klebsiella Infections , Klebsiella pneumoniae , Humans , Male , Middle Aged , Klebsiella pneumoniae/isolation & purification , Klebsiella Infections/diagnosis , Klebsiella Infections/drug therapy , Klebsiella Infections/microbiology , Brain Abscess/microbiology , Brain Abscess/drug therapy , Brain Abscess/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Tomography, X-Ray Computed , Magnetic Resonance Imaging , Pneumonia, Bacterial/microbiology , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/complications , Unconsciousness/etiologyABSTRACT
Background: Invasive mold diseases of the central nervous (CNS IMD) system are exceedingly rare disorders, characterized by nonspecific clinical symptoms. This results in significant diagnostic challenges, often leading to delayed diagnosis and the risk of misdiagnosis for patients. Metagenomic Next-Generation Sequencing (mNGS) holds significant importance for the diagnosis of infectious diseases, especially in the rapid and accurate identification of rare and difficult-to-culture pathogens. Therefore, this study aims to explore the clinical characteristics of invasive mold disease of CNS IMD in children and assess the effectiveness of mNGS technology in diagnosing CNS IMD. Methods: Three pediatric patients diagnosed with Invasive mold disease brain abscess and treated in the Pediatric Intensive Care Unit (PICU) of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2023 were selected for this study. Results: Case 1, a 6-year-old girl, was admitted to the hospital with "acute liver failure." During her hospital stay, she developed fever, irritability, and seizures. CSF mNGS testing resulted in a negative outcome. Multiple brain abscesses were drained, and Aspergillus fumigatus was detected in pus culture and mNGS. The condition gradually improved after treatment with voriconazole combined with caspofungin. Case 2, a 3-year-old girl, was admitted with "acute B-lymphoblastic leukemia." During induction chemotherapy, she developed fever and seizures. Aspergillus fumigatus was detected in the intracranial abscess fluid by mNGS, and the condition gradually improved after treatment with voriconazole combined with caspofungin, followed by "right-sided brain abscess drainage surgery." Case 3, a 7-year-old girl, showed lethargy, fever, and right-sided limb weakness during the pending chemotherapy period for acute B-lymphoblastic leukemia. Rhizomucor miehei and Rhizomucor pusillus was detected in the cerebrospinal fluid by mNGS. The condition gradually improved after treatment with amphotericin B combined with posaconazole. After a six-month follow-up post-discharge, the three patients improved without residual neurological sequelae, and the primary diseases were in complete remission. Conclusion: The clinical manifestations of CNS IMD lack specificity. Early mNGS can assist in identifying the pathogen, providing a basis for definitive diagnosis. Combined surgical treatment when necessary can help improve prognosis.
Subject(s)
Antifungal Agents , Brain Abscess , High-Throughput Nucleotide Sequencing , Metagenomics , Humans , Female , Child , Metagenomics/methods , Brain Abscess/microbiology , Brain Abscess/diagnosis , Brain Abscess/drug therapy , Antifungal Agents/therapeutic use , Antifungal Agents/pharmacology , Invasive Fungal Infections/diagnosis , Invasive Fungal Infections/microbiology , Invasive Fungal Infections/drug therapy , Male , Central Nervous System Fungal Infections/diagnosis , Central Nervous System Fungal Infections/microbiology , Central Nervous System Fungal Infections/drug therapy , Child, Preschool , Aspergillus fumigatus/genetics , Aspergillus fumigatus/isolation & purification , Caspofungin/therapeutic useSubject(s)
Brain Abscess , Streptococcus pneumoniae , Humans , Streptococcus pneumoniae/isolation & purification , Brain Abscess/microbiology , Pneumonia, Pneumococcal/microbiology , Pneumonia, Pneumococcal/complications , Serogroup , Male , Anti-Bacterial Agents/therapeutic use , Female , Pneumococcal Vaccines , Child, PreschoolABSTRACT
OBJECTIVE: Otitis media and sinusitis are common childhood infections, typically mild with good outcomes. Recent studies show a rise in intracranial abscess cases in children, raising concerns about a link to COVID-19. This study compares a decade of data on these cases before and after the pandemic. METHODS: This retrospective comparative analysis includes pediatric patients diagnosed with otitis media and sinusitis, who later developed intracranial abscesses over the past decade. We collected comprehensive data on the number of cases, patient demographics, symptoms, treatment, and outcomes. RESULTS: Between January 2013 and July 2023, our center identified 10 pediatric patients (median age 11.1years, range 2.2-18.0 years, 60% male) with intracranial abscesses from otitis media and sinusitis. Of these, 7 cases (70%, median age 9.7 years, range 2.2-18.0 years) occurred since the onset of the COVID-19 pandemic, while the remaining 3 cases (30%, median age 13.3 years, range 9.9-16.7 years) were treated before the pandemic. No significant differences were found in otolaryngological associations, surgical interventions, preoperative symptoms, lab findings, or postoperative antibiotics between the two groups. All patients showed positive long-term recovery. CONCLUSION: This study reveals 5-fold increase of pediatric otogenic and sinogenic intracranial abscess cases in the last three-years since the onset of the COVID-19 pandemic. While further investigation is needed, these findings raise important questions about potential connections between the pandemic and the severity of otitis media and sinusitis complications in children. Understanding these associations can improve pediatric healthcare management during infectious disease outbreaks.
Subject(s)
Brain Abscess , COVID-19 , Otitis Media , Sinusitis , Humans , COVID-19/epidemiology , COVID-19/complications , Child , Male , Female , Retrospective Studies , Adolescent , Child, Preschool , Otitis Media/epidemiology , Otitis Media/complications , Otitis Media/surgery , Sinusitis/epidemiology , Sinusitis/complications , Brain Abscess/epidemiology , SARS-CoV-2 , PandemicsABSTRACT
We report a very rare case of Listeria multiple brain abscesses manifested as delirium, which represented diagnostic and therapeutic challenges overcome only by the close cooperation between Infectious Diseases and Neuroradiology, without which a satisfactory outcome would not be achieved.An elderly man presented with confusion and drowsiness with a background of type-II diabetes mellitus. Although computed tomography of the brain only showed frontal lobe oedema, contrast magnetic resonance (MR) imaging showed numerous irregular rim-enhancing lesions containing central diffusion restriction, suggesting multiple pyogenic cerebral abscesses of unclear aetiology. Thereafter, Listeria monocytogenes was isolated from blood cultures, suggesting this as the causative organism. Deemed unsuitable for neurosurgical drainage, the patient received medical management with a protracted course of antibiotics. This case was extremely challenging, due to 1) the impossibility of source control, 2) the small number of effective antibiotics available to treat this condition, and 3) the inevitable antibiotic side-effects, derived from long-term exposure. A successful outcome was only possible thanks to strict close multidisciplinary follow up, requiring frequent MR imaging and a judicious antibiotic choice, including monitoring of their side-effects. Due to the rarity of this condition, there is lack of guidance on its management, hence the importance of multidisciplinary involvement with very close imaging and antibiotic monitoring.
Subject(s)
Anti-Bacterial Agents , Brain Abscess , Listeria monocytogenes , Listeriosis , Humans , Male , Brain Abscess/microbiology , Brain Abscess/drug therapy , Brain Abscess/diagnostic imaging , Listeriosis/drug therapy , Listeriosis/microbiology , Listeriosis/diagnosis , Anti-Bacterial Agents/therapeutic use , Listeria monocytogenes/isolation & purification , Aged , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Brain/diagnostic imaging , Brain/pathology , Brain/microbiology , Delirium/drug therapyABSTRACT
OBJECTIVES: Pituitary abscess (PA) accounts for only 0.3-0.5% of sellar masses, and the lack of specific clinical symptoms makes diagnosing PA difficult without a surgical biopsy. In clinical practice, PA is often mistaken for cystic pituitary adenoma, craniopharyngioma, and Rathke's cyst. Thus, this study aims to investigate challenges in diagnosing PA and evaluate the importance of combining intraoperative surgery with postoperative antibiotic treatment. METHODS: We conducted a retrospective analysis of 19 patients diagnosed with PA through histopathology. All patients underwent transsphenoidal surgery (TSS) for pituitary adenomas after undergoing comprehensive preoperative evaluations, including routine tests, endocrine assay, and imaging examination. Furthermore, we compared different treatments for pituitary abscess (PA) to determine the most effective approach for achieving a favorable prognosis. RESULTS: The most prevalent symptom of PA was headache, especially in the frontal-temporal and vertex regions, ranging from mild to moderate severity. Hypopituitarism-related symptoms were also frequently observed, including hypaphrodisia, cold sensitivity, fatigue, weight loss, polyuria, and amenorrhea. Twelve patients exhibited abnormalities in endocrinology examinations. Diagnosing PA correctly is challenging. In our study, none of the patients were correctly diagnosed with PA prior to surgery, and many sellar lesions were misdiagnosed. The favorable prognosis was largely attributed to surgical intervention and active postoperative antibiotic therapy. CONCLUSIONS: Given the lack of clarity in preoperative diagnosis, typical intraoperative findings and effective antibiotics treatment are more indicative of the correct diagnosis than other tests. In terms of therapy, optimal surgical intervention and active postoperative antibiotic treatment contribute to resolving the challenges posed by PA.
Subject(s)
Pituitary Diseases , Humans , Female , Male , Middle Aged , Adult , Retrospective Studies , Pituitary Diseases/diagnosis , Pituitary Diseases/surgery , Pituitary Diseases/therapy , Aged , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/surgery , Pituitary Neoplasms/therapy , Pituitary Neoplasms/pathology , Brain Abscess/diagnosis , Brain Abscess/therapy , Abscess/diagnosis , Abscess/therapy , Anti-Bacterial Agents/therapeutic useABSTRACT
A 3-year-old patient in India experiencing headaches and seizures was diagnosed with a fungal infection, initially misidentified as Cladophialophora bantiana. Follow-up sequencing identified the isolate to be Fonsecaea monophora fungus. This case demonstrates the use of molecular methods for the correct identification of F. monophora, an agent of fungal brain abscess.
Subject(s)
Ascomycota , Brain Abscess , Brain Abscess/microbiology , Brain Abscess/diagnosis , Brain Abscess/drug therapy , Humans , Ascomycota/isolation & purification , Ascomycota/genetics , Ascomycota/classification , Child, Preschool , Male , Mycoses/microbiology , Mycoses/diagnosis , Antifungal Agents/therapeutic use , Antifungal Agents/pharmacology , Phylogeny , DNA, Fungal/geneticsABSTRACT
A case of neonatal sepsis caused by Edwardsiella tarda, an uncommon pathogen typically associated with aquatic lifeforms, is described. The infant presented in septic shock with seizures and respiratory failure and was found to have meningitis, ventriculitis and a brain abscess requiring drainage. Only a small number of case reports of neonatal E. tarda infection, several with sepsis with poor auditory or neurodevelopmental outcomes or meningitis, have been described in the literature. This case report suggests that E. tarda, while uncommon, can be a cause of serious central nervous system disease in the neonatal population and that an aggressive approach to pursuing and treating complications may lead to improved neurodevelopmental outcomes.
Subject(s)
Brain Abscess , Cerebral Ventriculitis , Edwardsiella tarda , Enterobacteriaceae Infections , Neonatal Sepsis , Humans , Infant, Newborn , Anti-Bacterial Agents/therapeutic use , Brain Abscess/microbiology , Cerebral Ventriculitis/microbiology , Cerebral Ventriculitis/diagnosis , Cerebral Ventriculitis/drug therapy , Edwardsiella tarda/isolation & purification , Enterobacteriaceae Infections/diagnosis , Enterobacteriaceae Infections/complications , Enterobacteriaceae Infections/drug therapy , Meningitis/microbiology , Meningitis/diagnosis , Meningitis, Bacterial/microbiology , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/complications , Neonatal Sepsis/microbiology , Neonatal Sepsis/diagnosisABSTRACT
Cerebral phaeohyphomycosis (CP) stands as an exceedingly uncommon yet severe type of fungal infection affecting the central nervous system, attributable to dematiaceous fungi. Despite the patient's immune status, CP is associated with grave prognosis. In the present study, authors describe the first case of left thalamic fungal abscess due to Rhinocladiella mackenziei in an immunocompetent 39-year-old male patient in Jaipur, Rajasthan. Early diagnosis by direct microscopy of aspirated pus and extensive management with surgical excision and prolonged antifungal coverage showed favourable outcome. The present case is one of the few cases documented globally who has survived.
Subject(s)
Antifungal Agents , Brain Abscess , Humans , Male , Adult , Brain Abscess/microbiology , Brain Abscess/diagnosis , Brain Abscess/drug therapy , Antifungal Agents/therapeutic use , Cerebral Phaeohyphomycosis/diagnosis , Cerebral Phaeohyphomycosis/microbiology , India , Thalamus/pathology , Thalamus/microbiology , Thalamus/diagnostic imaging , Treatment OutcomeSubject(s)
Antifungal Agents , Aspergillosis , Kidney Transplantation , Humans , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillosis/surgery , Male , Brain Abscess/drug therapy , Brain Abscess/surgery , Brain Abscess/diagnostic imaging , Brain Abscess/etiology , Middle AgedABSTRACT
INTRODUCTION: Whether in neurology or dentistry, odontogenic brain abscess stands as an ailment demanding undivided attention. The onset of this disease is insidious, with a relatively low incidence rate but a markedly high fatality rate. Moreover, its symptoms lack specificity, easily leading to misdiagnosis, oversight, and treatment delays. Hence, clinicians should maintain heightened vigilance when faced with pathogenic bacteria of dental origin in patients. AREAS COVERED: This paper encapsulates the latest research findings on the clinical manifestations and essential treatment points of odontogenic brain abscess. It may offer a crucial reference for prompt diagnosis and improved therapeutic approaches. EXPERT OPINIONS: Odontogenic brain abscess, an infection of the cerebral parenchyma, usually appears in immunocompromised patients with dental ailments or postdental surgeries. The main pathogenic microorganisms include Streptococcus intermedius, Fusobacterium nucleatum, Streptococcus anginosus, and Millerella. Given the undetectable and nonspecific symptoms in patients, the diagnostic process relies on microbiological methods. Therefore, clinicians should actively investigate and identify the pathogenic microorganisms of odontogenic brain abscess for early detection and selection of appropriate treatment regimens to avoid disease management delays.
Subject(s)
Brain Abscess , Humans , Brain Abscess/microbiology , Brain Abscess/diagnosis , Brain Abscess/therapyABSTRACT
OBJECTIVE: A bacterial brain abscess may damage surrounding brain tissue by mass effect, inflammatory processes, and bacterial toxins. The aim of this study was to examine cognitive and functional outcomes at 8 weeks and 1 year following acute treatment. METHODS: Prospective study of 20 patients with bacterial brain abscess (aged 17-73 years; 45% females) with neuropsychological assessment at 8 weeks and 1 year post-treatment. Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) and Patient Competence Rating Scale (PCRS) were used to assess everyday functioning and administered to patients and informants. RESULTS: Cognitive impairment was found in 30% of patients at 8 weeks and 22% at 1 year. Significant improvements were seen on tests of perceptual reasoning, attention, verbal fluency, and motor abilities (p < 0.05). At 1 year, 45% had returned to full-time employment. Nevertheless, patients and their informants obtained scores within the normal range on measures of everyday functioning (PCRS and BRIEF-A) at 8 weeks and 1 year. No significant improvements on these measures emerged over time. CONCLUSION: Residual long-term cognitive impairment and diminished work ability affected 22% and 45% of patients one year after BA. Persistent cognitive impairment emphasizes the importance of prompt acute treatment and cognitive rehabilitation.