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1.
J Laryngol Otol ; 135(3): 217-223, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33593449

RESUMO

OBJECTIVE: This study aimed to describe the clinical presentation, microbiological profile and management of complications of bone wax usage for surgical procedures at the skull base. METHOD: The case records of a series of five patients who developed post-operative surgical site complications because of bone wax usage during skull base surgery were reviewed. RESULTS: In all five patients, persistent site-specific clinical features were noted along with intra-operative presence of excessive bone wax. Three unique cases of presentation, one with a fungal brain abscess because of Aspergillus flavus infection, another with fungal osteomyelitis because of Trichosporon beigelii infection and a third with intradural migration of bone wax into the cerebellopontine angle cistern are highlighted. CONCLUSION: The presentation of surgical site infection at the skull base because of excessive use of bone wax can be manifold. The need for testing appropriate cultures including fungal culture is highlighted.


Assuntos
Osteomielite/microbiologia , Palmitatos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Base do Crânio/cirurgia , Infecção da Ferida Cirúrgica/microbiologia , Ceras/efeitos adversos , Adulto , Aspergilose/microbiologia , Aspergillus flavus , Basidiomycota , Abscesso Encefálico/microbiologia , Ângulo Cerebelopontino , Feminino , Migração de Corpo Estranho/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/microbiologia , Tricosporonose/microbiologia , Adulto Jovem
2.
BMJ Case Rep ; 14(1)2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33452072

RESUMO

Bacterial brain abscesses are typically spread through a haematogenous route. Open head wounds and neurosurgical interventions are uncommon aetiologies. Ectopic tissue found in the cerebral cortex is usually ascribed almost entirely from carcinomas. Here, we describe a 57-year-old gentleman who, 22 years after a fireworks related traumatic injury to the left orbit, presented with headaches and altered behaviour. Imaging revealed an abscess immediately superior to the orbit, whose bacterial aetiology was identified to be Pseudomonas aeruginosa, encapsulated by ciliated respiratory epithelium. This represents a case in which tissue was displaced during the initial trauma or craniofacial reconstructive surgery from the frontal sinus.


Assuntos
Abscesso Encefálico/etiologia , Abscesso Encefálico/patologia , Traumatismos Craniocerebrais/complicações , Infecções por Pseudomonas/etiologia , Infecções por Pseudomonas/patologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Abscesso Encefálico/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/lesões , Pseudomonas aeruginosa , Mucosa Respiratória/patologia
4.
Am J Trop Med Hyg ; 103(4): 1473-1479, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32876006

RESUMO

Phaeohyphomycosis causes a wide spectrum of systemic manifestations and can affect even the immunocompetent hosts. Involvement of the central nervous system is rare. A 48-year-old farmer presented with chronic headache, fever, and impaired vision and hearing. Serial MRIs of the brain showed enhancing exudates in the basal cisterns, and lesions in the sella and perichiasmatic and cerebellopontine angle regions along with enhancement of the cranial nerves and leptomeninges. Cerebrospinal fluid (CSF) showed lymphocytic pleocytosis with elevated protein and decreased glucose on multiple occasions. Clinical, imaging, and CSF abnormalities persisted despite treatment with antitubercular drugs and steroids for 2 years. Biopsy of the dura mater at the cervicomedullary junction revealed necrotizing granulomatous lesions, neutrophilic abscesses, and giant cells containing slender, pauci-septate, pigmented fungal hyphae. Fungal culture showed growth of Fonsecaea pedrosoi, which is classically known to cause brain abscesses. Here, we report the diagnostic odyssey in a patient with chronic meningitis from a region endemic for tuberculosis and describe the challenges in establishing the accurate diagnosis. Lack of therapeutic response to an adequate trial of empirical antitubercular therapy warrants search for alternative causes, including fungal meningitis. We highlight the uncommon manifestation of F. pedrosoi with chronic meningitis as well as the protracted clinical course despite not receiving antifungal therapy.


Assuntos
Abscesso Encefálico/microbiologia , Diagnóstico Diferencial , Meningite Fúngica/diagnóstico , Meningite/patologia , Tuberculose Meníngea/diagnóstico , Anfotericina B/administração & dosagem , Anfotericina B/uso terapêutico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Antituberculosos/uso terapêutico , Ascomicetos/isolamento & purificação , Encéfalo/patologia , Abscesso Encefálico/patologia , Humanos , Masculino , Meningite Fúngica/tratamento farmacológico , Pessoa de Meia-Idade , Feoifomicose/diagnóstico , Esteroides/uso terapêutico , Tuberculose Meníngea/tratamento farmacológico , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
5.
BMC Infect Dis ; 20(1): 389, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487026

RESUMO

BACKGROUND: Intracranial infections with Corynebacterium striatum (C. striatum) have been described sporadically in the literature over the last two decades. However, C. striatum meningitis combined with multiple abscesses has not been published before. CASE PRESENTATION: In this report, we describe the clinical and imaging findings in a 54-year-old woman with meningitis caused by C. striatum and combined with suspected brain and lung abscesses. This patient who underwent multiple fractures and a recent cut presented with headache and paraphasia. C. striatum was isolated in cerebrospinal fluid and supposedly transmitted from the skin purulent wound through blood. The patient was treated with intravenous vancomycin and had a transient improvement, but died finally. Multiple abscesses, especially in the brain, could be a reason to explain her conditions were deteriorating rapidly. CONCLUSIONS: Note that C. striatum can cause life-threatening infections. Early identification and diagnosis, early administration of antibiotics to which the bacterium is susceptible, and treatment of complications will be beneficial in patients with C. striatum-related infection.


Assuntos
Abscesso Encefálico/microbiologia , Infecções por Corynebacterium/complicações , Abscesso Pulmonar/microbiologia , Meningites Bacterianas/microbiologia , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Líquido Cefalorraquidiano/microbiologia , Corynebacterium/isolamento & purificação , Corynebacterium/patogenicidade , Infecções por Corynebacterium/tratamento farmacológico , Feminino , Humanos , Traumatismos da Perna/microbiologia , Abscesso Pulmonar/diagnóstico por imagem , Abscesso Pulmonar/tratamento farmacológico , Meningites Bacterianas/complicações , Meningites Bacterianas/tratamento farmacológico , Pessoa de Meia-Idade , Vancomicina/uso terapêutico
6.
BMC Infect Dis ; 20(1): 378, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460724

RESUMO

BACKGROUND: Brain abscesses are the rare and most severe form of actinomycosis, which usually manifests as abscesses of the occipital or parietal lobe due to direct expansion from an adjacent area, the oral cavity. In the medical literature, there are only a few reported cases of brain abscess caused by Actinomyces meyeri. In this report, we present a 35-year-old male patient who experienced an insidious headache and left-sided weakness and was diagnosed with an Actinomyces meyeri brain abscess. CASE PRESENTATION: A 35-year-old Nepalese man came to our institute with the primary complaint of insidious onset of headache and left-sided weakness. His physical examination was remarkable for the left-sided weakness with power 2/5 on both upper and lower limbs, hypertonia, hyperreflexia and positive Babinski sign, with intact sensory function. Cardiac examination revealed systolic murmur with regular S1 and S2, and lung examination was normal. The patient had poor dental hygiene. Biochemistry and haematology panel were normal. Urinalysis, chest X-ray and electrocardiogram revealed no abnormality. A transthoracic echocardiogram revealed mitral regurgitation. However, there was no evidence of valvular vegetation. A magnetic resonance imaging (MRI) of the brain was performed, which showed a bi-lobed rim enhancing lesion with a conglomeration of two adjoining round lesions in the right parietal parasagittal region. Perilesional oedema resulting in mass effect over the right lateral ventricle and mid-right uncal herniation with midline shift was noted. Craniotomy was performed, and the lesion was excised. Gram staining of the extracted sample revealed gram variable filamentous rods. Creamy white, moist, confluent colonies were observed after performing anaerobic culture in chocolate agar. On the gram staining, they showed gram-positive filamentous rods. Actinomyces meyeri was identified based on matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) technology. Based on the susceptibilities, he was successfully treated with ampicillin-sulbactam. CONCLUSIONS: In conclusion, Actinomyces should be considered in the differential diagnosis of brain abscess in patients with poor dental hygiene, and early diagnosis and appropriate treatment can lead to better results.


Assuntos
Actinomyces/isolamento & purificação , Actinomicose/microbiologia , Abscesso Encefálico/microbiologia , Actinomyces/genética , Actinomyces/fisiologia , Actinomicose/diagnóstico , Actinomicose/diagnóstico por imagem , Adulto , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/diagnóstico por imagem , Cefaleia/diagnóstico , Cefaleia/diagnóstico por imagem , Cefaleia/microbiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Radiografia
7.
BMC Infect Dis ; 20(1): 328, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32381049

RESUMO

BACKGROUND: Brain abscess due to the Nocardia genus is rare and usually found in immunocompromised patients. The most common subtype implicated is Nocardia farcinica while brain abscess due to Nocardia brasiliensis is comparatively rare. Diagnosis of brain abscess is based mainly on bacteriological culture from pus collected at the site of infection, and brain imaging. Stereotaxic aspiration or surgical resection combined with adequate duration of treatment with antibiotics to which the bacteria are sensitive represent effective treatment strategies. CASE PRESENTATION: We report a rare case of brain abscess caused by Nocardia brasiliensis in a non-immunocompromised patient. He admitted to our hospital twice with a headache. Stereotaxic aspiration was performed at the patient's first appointment at the hospital, and a craniotomy was used to excise the lesion during subsequent abscess recurrence. CONCLUSION: Early diagnosis, reasonable surgical intervention, and adequate duration of treatment with effective antibiotics are critical for treating brain abscess.


Assuntos
Abscesso Encefálico/microbiologia , Abscesso Encefálico/cirurgia , Nocardiose/diagnóstico , Nocardiose/cirurgia , Nocardia/patogenicidade , Antibacterianos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/microbiologia , Abscesso Encefálico/tratamento farmacológico , Craniotomia , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Nocardiose/tratamento farmacológico , Técnicas Estereotáxicas , Resultado do Tratamento
8.
BMC Infect Dis ; 20(1): 370, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32448130

RESUMO

BACKGROUND: Brain abscesses, a severe infectious disease of the CNS, are usually caused by a variety of different pathogens, which include Streptococcus intermedius (S. intermedius). Pulmonary arteriovenous fistulas (PAVFs), characterized by abnormal direct communication between pulmonary artery and vein, are a rare underlying cause of brain abscesses. CASE PRESENTATION: The patient was a previous healthy 55-year-old man who presented with 5 days of headache and fever. Cerebral magnetic resonance imaging (MRI) suggested a brain abscess. Thoracic CT scan and angiography demonstrated PAVFs. Aiding by metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid (CSF) sample which identified S. intermedius as the causative pathogen, the patient was switched to the single therapy of large dose of penicillin G and was cured precisely and economically. CONCLUSIONS: It is an alternative way to perform mNGS to identify causative pathogens in patients with brain abscesses especially when the results of traditional bacterial culture were negative. Further thoracic CT or pulmonary angiography should also be undertaken to rule out PAVFs as the potential cause of brain abscess if the patient without any known premorbid history.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Penicilina G/uso terapêutico , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus intermedius/genética , Fístula Arteriovenosa/complicações , Abscesso Encefálico/líquido cefalorraquidiano , Abscesso Encefálico/microbiologia , Angiografia por Tomografia Computadorizada , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Veias Pulmonares/diagnóstico por imagem , Infecções Estreptocócicas/líquido cefalorraquidiano , Infecções Estreptocócicas/microbiologia , Streptococcus intermedius/isolamento & purificação , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(10): e18954, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150046

RESUMO

RATIONALE: In patients receiving biological therapies, serious infections are a major concern. Infections associated with anti-tumor necrosis factor antibody therapy include tuberculosis, viral, fungal, and bacterial infections. Likewise, severe infections of the upper and lower respiratory tract, lung, skin and soft tissue, urinary tract, gastrointestinal tract, joint, and bone have also been reported previously. However, infections involving the central nervous system are rare, especially an intracranial infection caused by odontogenic infection. To date, only few cases have been reported of this infection. This is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. PATIENT CONCERNS: A 39-year-old male with psoriatic arthritis receiving adalimumab treatment came to the emergency department with initial presentation of sudden onset convulsions. He had been receiving adalimumab treatment for 1 month. Two days after the third injection, the patient had an episode of sudden-onset general convulsion for nearly 5 min with the upgazing and general tonic presentation. Magnetic resonance imaging (MRI) showed left frontal lobe brain abscess. Pus culture from the brain abscess detected Streptococcus sanguinis (S. sanguinis), Fusobacterium nucleatum (F. nucleatum), and Parvimonas micra (P. micra). DIAGNOSIS: Brain abscess with odontogenic infection. INTERVENTIONS: The patient received left frontal craniotomy, abscess drainage and systemic empiric antibiotics treatment with vancomycin, cefepime, and metronidazole. Due to drug rash with eosinophilia and systemic symptoms during the treatment, vancomycin and metronidazole were discontinued, and systemic antibiotics were switched to teicoplanin and ceftriaxone. OUTCOMES: A brain MRI follow-up performed after 1 month of initial treatment revealed the reduced size of the abscess lesion and minimal oedema. The patient was discharged with stable condition. LESSONS: To the best of our knowledge, this is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. Such a rare diagnosis must be kept in mind when patients treated with adalimumab present with sudden-onset convulsions. Careful dental examination should be performed before administration of adalimumab.


Assuntos
Adalimumab/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite Psoriásica/tratamento farmacológico , Abscesso Encefálico/diagnóstico , Cérebro , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Abscesso Encefálico/microbiologia , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Terapia Combinada , Craniotomia , Diagnóstico Diferencial , Firmicutes/isolamento & purificação , Fusobacterium nucleatum/isolamento & purificação , Humanos , Imagem por Ressonância Magnética , Masculino , Periodontite/complicações , Streptococcus/isolamento & purificação , Streptococcus sanguis , Teicoplanina/administração & dosagem , Teicoplanina/uso terapêutico
12.
Artigo em Chinês | MEDLINE | ID: mdl-32086907

RESUMO

Mucormycsois, also known as zygomycosis, is an extremely serious acute invasive fungal infection(IFI). The disease progresses rapidly and the mortality rate is high. Even if cured, it may leave behind serious sequelae. Immunocompromise is at high risk of mucormycosis. Rhino-orbital-cerebral mucormycosis(ROCM) is the most common type of mucormycosis. It can manifest as headache, nasal obstruction, exophthalmos, ophthalmoplegia and nerve palsy, loss of vision, arterial embolism, etc. A case of ROCM is reported in this paper. The etiology, course of development, clinical and imaging manifestations and treatment of ROCM are described in detail.


Assuntos
Abscesso Encefálico/microbiologia , Infecções Fúngicas Invasivas/diagnóstico , Mucormicose/diagnóstico , Doenças Orbitárias/microbiologia , Humanos
13.
Transpl Infect Dis ; 22(2): e13264, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32053285

RESUMO

Cerebral abscess due to pigmented molds is a rare but usually fatal infection occasionally seen in transplant recipients. A 67-year-old man of Iraqi origin underwent a deceased donation renal transplant for renal failure and 2 months later was diagnosed with an abscess in the left posterior frontal lobe of his brain. Subsequent biopsy proved this to be due to the mold Rhinocladiella mackenziei. Further interventions included two operations to aspirate the lesion, voriconazole, then liposomal amphotericin B, then a combination of posaconazole and flucytosine which he continued for over 4 years. He also suffered from right ankle pain and was diagnosed with septic arthritis; R mackenziei was isolated from pus aspirated from the ankle joint. He responded well to the treatment and has had little loss of function, and on CT, the cerebral lesion has stabilized. Beta-D-glucan, initially at very high levels proved useful to monitor response over the 5 years and the latest sample was negative (38 pg/mL). This case is notable for the first disseminated case of this infection, its favorable outcome on a novel antifungal combination and a new approach to monitoring the course of disease.


Assuntos
Antifúngicos/uso terapêutico , Abscesso Encefálico/cirurgia , Infecções Fúngicas do Sistema Nervoso Central/terapia , Infecções Fúngicas Invasivas/terapia , Triazóis/uso terapêutico , Idoso , Anfotericina B/uso terapêutico , Artrite Infecciosa/microbiologia , Ascomicetos/efeitos dos fármacos , Abscesso Encefálico/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/etiologia , Humanos , Hospedeiro Imunocomprometido , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/etiologia , Transplante de Rim/efeitos adversos , Masculino , Resultado do Tratamento
14.
BMC Infect Dis ; 20(1): 15, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906936

RESUMO

BACKGROUND: Bacillus cereus sometimes causes central nervous system infection, especially in compromised hosts. In cases of meningitis arising during neutropenia, CSF abnormalities tend to be subtle and can be easily overlooked, and mortality rate is high. We report a survived case of B. cereus meningitis/brain abscess in severe neutropenia, presenting as immune reconstitution syndrome. CASE PRESENTATION: A 54-year-old Japanese female with acute myelogenous leukemia developed B. cereus bacteremia and meningitis during consolidation chemotherapy. At the onset, she presented with mild meningism. She had marked leukocytopenia (WBC <100/µL, neutrophils 0/µL) and lumbar puncture yielded only mild pleocytosis. She was transferred to intensive care unit, and meropenem, linezolid and vancomycin was started. With intensive therapy, she recovered and once became afebrile. On day 19, however, her fever, meningism and consciousness level dramatically worsened despite recovery of bone marrow function. The antimicrobial chemotherapy was continued and finally she was cured with no complications. CONCLUSIONS: With early diagnosis and prompt initiation and of antibiotics, the case was successfully treated without any sequelae. It is important to remember that, even under optimal antimicrobial therapy, bone marrow recovery can cause transient reaggravation of the disease. In such cases, timely and appropriate evaluation should be done to make the clinical decision to change, continue, or intensify treatment.


Assuntos
Bacteriemia/complicações , Abscesso Encefálico/complicações , Neutropenia Febril Induzida por Quimioterapia/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Meningites Bacterianas/complicações , Antibacterianos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bacillus cereus/isolamento & purificação , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/microbiologia , Leucemia Mieloide Aguda/tratamento farmacológico , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologia , Pessoa de Meia-Idade , Resultado do Tratamento
15.
J Mycol Med ; 30(1): 100918, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31926829

RESUMO

We report a case of cerebral phaeohyphomycosis, a fungal brain infection due to a dark (dematiaceous) fungi in a 6-year-old French Guyanese boy. The child presented fever and drowsiness due to several paraventricular brain abscesses. Neurological surgeries were performed to reduce intracranial hypertension and to obtain abscess biopsies. Mycological cultures of intraoperative samples led to the diagnosis of cerebral phaeohyphomycosis due to Cladophialophora bantiana. The patient neurological status deteriorated and remained critical after several weeks of combination antifungal therapy with voriconazole 8mg/kg/day, liposomal amphotericin B 10mg/kg/day and flucytosine 200mg/kg/day. A complete surgical resection was not possible because of multiple small abscesses. A multidisciplinary ethical staff decided on home medical care with palliative ventriculoperitoneal shunt, nasogastric feeding and analgesics. One year later, the patient's neurological condition had improved and cerebral lesions had regressed, while he had not received any antifungal treatment but only traditional medicines. Cerebral phaeohyphomycosis are rare diseases affecting immunocompromised but also apparently non-immunocompromised patients, as in this case. A complete surgical resection is not always possible and mortality rates are high in spite of treatments with a combination of antifungals. The diagnosis may be difficult because of these dematiaceous fungi's slowly growing and their potential pathogenicity for laboratory staff.


Assuntos
Ascomicetos/isolamento & purificação , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Feoifomicose Cerebral/diagnóstico , Antifúngicos/uso terapêutico , Ascomicetos/fisiologia , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/microbiologia , Abscesso Encefálico/terapia , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/terapia , Feoifomicose Cerebral/microbiologia , Feoifomicose Cerebral/terapia , Criança , Terapia Combinada , Nutrição Enteral , Guiana Francesa , Humanos , Imunocompetência , Intubação Gastrointestinal , Masculino , Procedimentos Neurocirúrgicos , Derivação Ventriculoperitoneal
16.
J Clin Neurosci ; 72: 474-480, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31864828

RESUMO

INTRODUCTION: Abscesses associated with tumors are a rare entity. Imaging to differentiate abscess from other entities is often non-diagnostic, and often the source of infection is unknown. We present an unusual case of peritumoral abscess infected with both gram-negative and gram-positive bacteria. METHODS: A 70-year-old, previously healthy male presented with a 1-day history of right-sided facial weakness sparing the forehead, as well as concomitant right upper and lower extremity numbness. A homogenously enhancing mass with adjacent rim-enhancing lesion with diffusion restricting cavity seen on magnetic resonance imaging (MRI) raised the possibility of abscess. RESULTS: Separate biopsy specimens of both the tumor and adjacent fluid collection during drainage of the collection confirmed World Health Organization (WHO) grade I meningioma and bacterial abscess containing Streptococcus constellatus, Fusobacterium species, Prevotella dentalis, and Parvimonas micra. The histologic diagnosis therefore confirmed the preoperative radiologic findings of two different but associated lesions. Investigations to determine a definitive source of infection were inconclusive, including urinalysis, blood cultures, respiratory cultures, endoscopy, and an orthopantomogram. CONCLUSIONS: Gram-negative and gram-positive bacteria can both be culprits in the formation of peritumoral abscess. Although the source of infection is unconfirmed, the presence of oropharyngeal flora in the abscess suggests a subclinical odontogenic infection with hematogenous spread to the tumor and adjacent brain.


Assuntos
Abscesso Encefálico/complicações , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Positivas/complicações , Neoplasias Meníngeas/complicações , Meningioma/complicações , Idoso , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/microbiologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico
17.
J Infect Chemother ; 26(2): 305-307, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31711830

RESUMO

We report a clinical case of Filifactor alocis brain abscess in an 85-year-old man who had decayed teeth 1 week prior. In this case, the abscess was surgically drained after empirical antibiotics had been initiated. Although the causative organism could not be identified by culture, F. alocis was detected via 16S ribosomal RNA (16S rRNA) gene sequencing of the pus isolated from the abscess. The patient recovered without serious sequelae after surgical drainage and prolonged antibiotic treatment, including metronidazole, ceftriaxone and meropenem for 8 weeks. The findings in this case emphasize that 16S rRNA gene sequencing allows bacterial diagnosis of brain abscess when phenotypic identification fails, such as in cases where patients are undergoing antimicrobial treatment at the time of sampling or where patients are infected with fastidious organisms.


Assuntos
Infecções Bacterianas/diagnóstico , Abscesso Encefálico/diagnóstico , Clostridiales/genética , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Clostridiales/isolamento & purificação , Humanos , Masculino , Análise de Sequência de RNA , Resultado do Tratamento
18.
Int J Syst Evol Microbiol ; 70(3): 1478-1488, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31693476

RESUMO

We herein describe the first novel species within the genus Eikenella since it was established in 1972 by the reclassification of 'Bacteroides corrodens' to Eikenella corrodens. From a polymicrobial brain abscess, we encountered an Eikenella isolate, PXXT, that could not validly be named E. corrodens. The isolate grew on blood agar with small, translucent, pitting colonies after 3 days of anaerobic incubation. By reviewing previously collected invasive isolates, we found an additional Eikenella strain, EI-02, from a blood culture exhibiting the same properties as PXXT. Phylogenetic analyses based on both whole genome and individual house-keeping genes confirmed that the two strains allocate in a phylogenetic cluster separate from E. corrodens. Using specific amplification and sequencing of the Eikenella nusG gene, we further detected the novel Eikenella species in six historic brain abscesses previously reported to contain E. corrodens based on 16S metagenomics. Out of 24 Eikenella whole-genome projects available in GenBank, eight cluster together with PXXT and EI-02. These isolates were recovered from brain abscess (n=2), blood (n=1), bone/soft tissue (n=3), parotid gland (n=1) and unknown (n=1). It remains to be investigated whether the new species can cause endocarditis. The average nucleotide identity value between strain PXXT and the E. corrodens type strain ATCC 23834T was 92.1 % and the corresponding genome-to-genome distance value was 47.1 %, both supporting the classification of PXXT as a novel species. For this species we propose the name Eikenella exigua. The type strain of E. exigua is PXXT (DSM 109756T, NCTC 14318T).


Assuntos
Abscesso Encefálico/microbiologia , Eikenella/classificação , Filogenia , Técnicas de Tipagem Bacteriana , Composição de Bases , Hemocultura , DNA Bacteriano/genética , Eikenella/isolamento & purificação , Humanos , RNA Ribossômico 16S/genética , Análise de Sequência de DNA
20.
BMJ Case Rep ; 12(12)2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31796437

RESUMO

A cerebral abscess (focal infection of brain parenchyma) carries a high mortality and morbidity. Iatrogenic cerebral abscesses are less common and make up 10% of all cases. The presence of a cerebral abscess can rarely improve a patient's prognosis and quality of life, however this case illustrates an abscess and its treatment following a prolonged course of antibiotics leading to resolution of a severe psychotic disorder. This is a case report of a 32-year-old female inpatient at a psychiatric hospital with a long-standing history of congenital hydrocephalus, cerebral palsy and organic delusional disorder who developed an iatrogenic cerebral abscess after insertion of an implantable intracranial pressure monitoring device. After receiving treatment of 6 weeks of intravenous meropenem the patient's mental condition rapidly improved, she became stable and euthymic and was discharged home. The patient has since had no delusions or hallucinations and is living independently at home.


Assuntos
Abscesso Encefálico/tratamento farmacológico , Doença Iatrogênica , Meropeném/administração & dosagem , Esquizofrenia Paranoide/tratamento farmacológico , Administração Oral , Adulto , Antibacterianos/administração & dosagem , Abscesso Encefálico/complicações , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/microbiologia , Feminino , Humanos , Imagem por Ressonância Magnética , Monitorização Neurofisiológica/efeitos adversos , Monitorização Neurofisiológica/instrumentação , Indução de Remissão , Esquizofrenia Paranoide/complicações
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