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1.
Georgian Med News ; (294): 10-16, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687941

RESUMO

Aim - to evaluate pathogens and their susceptibility to antibiotic therapy (ABT) in combat-related penetrating craniocerebral gunshot wound (PCGW) patients and develop recommendations for treatment of post-traumatic meningoencephalitis. We conducted a prospective analysis of examination and treatment results of 121 patients who were admitted to the Public Institution, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine, from 25 May 2014, to 31 December 2017, and were successively enrolled in the study. Intracranial purulent-septic complications were diagnosed in 14 (11.6%) patients including eight cases of isolated meningoencephalitis, three cases of meningoencephalitis combined with ventriculitis, two cases of meningoencephalitis combined with ventriculitis and subdural empyema and one case of multiple brain abscesses. In most cases of combat-related craniocerebral wounds, infections are considered nosocomial and typically related to medical procedures and devices. In most cases, the effectiveness of first-line antibiotics was low, and it was often necessary to prescribe broad-spectrum ABT, including those related to second-line antibiotics and reserve drugs, according to the World Health Organisation classification. The use of initial de-escalation of empiric ABT with the broadest-spectrum drugs, mainly as a part of combination therapy for expected gram-positive and gram-negative aerobic and anaerobic infection pathogens, is recommended.


Assuntos
Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Infecções Bacterianas/complicações , Abscesso Encefálico/tratamento farmacológico , Traumatismos Craniocerebrais/complicações , Infecção da Ferida Cirúrgica/complicações , Infecção dos Ferimentos/tratamento farmacológico , Ferimentos Penetrantes/complicações , Adulto , Bactérias/classificação , Bactérias/isolamento & purificação , Abscesso Encefálico/epidemiologia , Abscesso Encefálico/microbiologia , Traumatismos Craniocerebrais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Ucrânia/epidemiologia , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/microbiologia
2.
Medicine (Baltimore) ; 98(48): e18156, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770258

RESUMO

RATIONALE: Streptococcus anginosus mostly colonizes the digestive and genitourinary system, including the oropharyngeal region. It commonly causes invasive pyogenic infection, but less likely causes infective endocarditis (IE). PATIENT CONCERNS: An 18-year-old woman who had an underlying mitral valve prolapse without mitral regurgitation presented to our hospital with low-grade fever, left leg weakness, and left abdominal pain. She was diagnosed with brain infarction and microabscess as well as IE. The patient totally recovered after the 6-week course of intravenous antibiotics. DIAGNOSIS: Brain magnetic resonance imaging revealed brain infarction and microabscess. Abdominal computed tomography revealed splenic and left renal infarction. Three sets of blood culture were positive for S anginosus. Transthoracic echocardiogram identified mitral valve prolapse with moderate eccentric mitral valve regurgitation, and a 0.3 × 0.6-cm vegetation was found on the left mitral valve. All of these results meet the modified Duke criteria. INTERVENTIONS: The abdominal pain and left leg weakness were improving after 2 weeks of intravenous antibiotics treatment. No neurological sequelae were noted after completing the 6-week course of medical treatment. OUTCOMES: The patient was successfully treated and discharged after completing the 6-week intravenous antibiotics treatment. LESSONS: IE should be considered in young patients with native valve disease who have prolonged fever. Though S anginosus commonly causes invasive pyogenic infection, patients with native valve disease should be checked for IE.


Assuntos
Antibacterianos/administração & dosagem , Abscesso Encefálico , Infarto Encefálico , Endocardite , Prolapso da Valva Mitral , Infecções Estreptocócicas , Streptococcus anginosus/isolamento & purificação , Administração Intravenosa , Adolescente , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Ecocardiografia/métodos , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Feminino , Humanos , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem , Recuperação de Função Fisiológica , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Resultado do Tratamento
3.
BMC Infect Dis ; 19(1): 863, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638913

RESUMO

BACKGROUND: Invasive meningococcal disease (IMD) presenting with meningitis causes significant mortality and morbidity. Suppurative complications of serogroup B meningococcal sepsis are rare and necessitate urgent multidisciplinary management to mitigate long-term morbidity or mortality. CASE PRESENTATION: We present a rare case of invasive meningococcal disease in a 28-month old boy complicated by multiple abscess formation within a pre-existing antenatal left middle cerebral artery territory infarct. Past history was also notable for cerebral palsy with right hemiplegia, global developmental delay and West syndrome (infantile spasms). Two craniotomies were performed to achieve source control and prolonged antimicrobial therapy was necessary. The patient was successfully discharged following extensive multidisciplinary rehabilitation. CONCLUSIONS: Longstanding areas of encephalomalacia in the left MCA distribution may have facilitated the development of multiple meningococcal serogroup B abscess cavities in the posterior left frontal, left parietal and left temporal lobes following an initial period of cerebritis and meningitis. A combination of chronic cerebral hypoperfusion and some degree of pre-existing necrosis in these areas, may also have facilitated growth of Neisseria meningitidis, leading ultimately to extensive cerebral abscess formation following haematogenous seeding during meningococcemia. In this case report we review similar cases of cerebral abscess or subdural empyema complicating serogroup B meningococcal meningitis.


Assuntos
Abscesso Encefálico/microbiologia , Meningite Meningocócica/complicações , Neisseria meningitidis Sorogrupo B/genética , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Infarto Cerebral/complicações , Paralisia Cerebral/complicações , Pré-Escolar , Craniotomia , Empiema Subdural/tratamento farmacológico , Empiema Subdural/microbiologia , Seguimentos , Hemiplegia/complicações , Humanos , Masculino , Meningite Meningocócica/prevenção & controle , Reação em Cadeia da Polimerase , Sepse/tratamento farmacológico , Sepse/microbiologia , Resultado do Tratamento , Vacinação
4.
Medicine (Baltimore) ; 98(36): e17044, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490396

RESUMO

RATIONALE: A single atrium is a rare congenital heart disease (CHD) involving zero atrial septal traces and preserved intact ventricular septum and atrioventricular valves, requiring careful surgical intervention. However, developing to Eisenmenger syndrome (ES) makes the surgery complicated. Based on bidirectional cardiac shunting, vegetation easily develops in case of bacterial infection. PATIENT CONCERN AND DIAGNOSES: We reported a 35-year-old woman with a single atrium, patent ductus arteriosus, pulmonary hypertension, and ES who developed infective endocarditis on her left ventricular outflow tract and complicated cerebral abscess and who underwent challenged medical treatment. INTERVENTION: Infection was successfully controlled after 4-time change in antibiotics over 4 months. However, surgery is complicated for her. OUTCOMES: The patient presented a relatively good outcome during follow-up for >6 months. LESSONS: This case report suggests that patients with complex CHD should accept surgery therapy earlier before developing ES. It is imperative to avoid invasive interventions to prevent infectious endocarditis.


Assuntos
Abscesso Encefálico/complicações , Permeabilidade do Canal Arterial/complicações , Complexo de Eisenmenger/complicações , Endocardite/complicações , Átrios do Coração/anormalidades , Adulto , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Endocardite/diagnóstico por imagem , Endocardite/tratamento farmacológico , Feminino , Humanos
5.
BMC Oral Health ; 19(1): 200, 2019 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-31470835

RESUMO

BACKGROUND: Antibiotic prophylaxis before invasive treatments, including dental extractions, is still recommended for patients at high risk of infective endocarditis. However, the risk from self-extraction of teeth in daily life of patients with intellectual disabilities is uncertain. CASE PRESENTATION: A 6-year-old patient with Ebstein's anomaly developed cerebral abscess, which appeared associated with infective endocarditis of dental origin. Two weeks after self-extraction of his deciduous teeth, he began to experience pain in his ear and developed continuous fever, followed by vomiting, facial spasm, and a loss of consciousness. He was admitted into a hospital for 2 months, during which he received intravenously administered antibiotics and a drainage tube in his brain. CONCLUSIONS: Deciduous teeth can be self-extracted before root resorption and natural shedding in patients with intellectual disabilities. When they are at high risk of infective endocarditis and frequently touch mobile deciduous teeth, it seems to be an option to extract the teeth early with antibiotic prophylaxis, rather than to wait natural fall.


Assuntos
Abscesso Encefálico/diagnóstico , Anomalia de Ebstein/complicações , Endocardite/microbiologia , Deficiência Intelectual/complicações , Extração Dentária/efeitos adversos , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Criança , Pré-Escolar , Feminino , Febre/etiologia , Humanos , Lactente , Masculino , Infecções Estafilocócicas
6.
Br J Neurosurg ; 33(5): 550-554, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31131639

RESUMO

Introduction: Brain parenchymal abscesses are relatively infrequent but potentially serious infections in the paediatric population. Surgical intervention in addition to a prolonged administration of antibiotics is generally appropriate management. This study presents our centre's experience of managing such patients in the context of relevant literature. Method: A single-centre retrospective case note review was conducted over a 15 year period (2003-2017). Patients were selected from electronic hospital records using ICD10 code G06.0. Patients < 18 years of age with a confirmed intra-parenchymal abscess were included. Patient records were reviewed for abscess location, microbiology results, surgical intervention, and outcome using the Glasgow Outcome Score at 3 months. Results: Twenty-four patients were identified (mean age: 7.4 ± 5.3 years, male n = 11). Twelve (50.0%) patients had an abscess in the frontal lobe and Streptococcus was the most common causative microorganism (n = 15). Nineteen patients (79.2%) had an identifiable source which included: ENT infections, congenital cardiac malformations, recent dental surgery and meningitis. All 24 patients underwent surgery with 20 patients having a total of 32 aspirations between them and the other 4 having craniotomy and excision. Twenty patients had 3 month follow-up data of which 18 patients scored GOS: 5, one was GOS: 4 and one was GOS: 3. Conclusions: Brain parenchymal abscess remains an uncommon pathology in the paediatric population. The majority of patients have a preceding infection with Streptococcus as the most common causative organism. Antimicrobial therapy should be selected accordingly. All of our patients underwent surgical intervention and received intravenous antibiotics with favourable outcome and no mortality.


Assuntos
Antibacterianos/administração & dosagem , Abscesso Encefálico/cirurgia , Craniotomia/métodos , Infecções Estreptocócicas/cirurgia , Abscesso Encefálico/tratamento farmacológico , Criança , Feminino , Humanos , Infusões Intravenosas , Masculino , Estudos Retrospectivos , Infecções Estreptocócicas/tratamento farmacológico , Resultado do Tratamento
7.
World Neurosurg ; 127: 199-205, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30928576

RESUMO

INTRODUCTION: Endovascular treatment is growing in popularity globally as an important treatment option for intracranial aneurysms. Cerebral infection as a complication of endovascular treatment of aneurysms is sufficiently rare that only 6 isolated cerebral abscess cases have been reported thus far. CASE REPORT: In this report, we present 2 cerebral abscesses from 3 institutions, which developed after coil embolization of anterior communicating artery and middle cerebral artery aneurysms. CONCLUSION: This report was written to discuss the possible mechanisms underlying cerebral abscess after endovascular treatment of aneurysms and to suggest potential treatment and prevention methods.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Adulto , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Procedimentos Endovasculares/tendências , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
8.
J Craniofac Surg ; 30(4): 1280-1283, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30921076

RESUMO

Anterior cranial base reconstruction is occasionally necessary following severe trauma. Several methods for reconstruction have been described and some authors have described their experiences regarding the use of a pericranial flap for anterior skull base reconstruction after trauma. A 26-year-old woman was admitted to our department with multiple facial bone fractures identified using facial bone computed tomography. Plastic surgeons performed surgery under general anesthesia for the patient's nasal bone fractures. On the seventh day after admission, the patient's brain computed tomography showed an abscess in the frontal lobe. Antibiotic treatment was started, but the lesion deteriorated. Anterior skull base reconstruction was then performed using a pericranial flap with gelfoam compression. No complications, including leakage of cerebrospinal fluid, cerebral hemorrhage, necrosis of the pericranial flap, or frontal lobe herniation, were observed 1 year following surgery. In our case, the authors performed a simple and effective treatment with reconstruction using pericranial flap and gelfoam compression without complications. This technique is useful for reconstructing defects in the base of the frontal bone resulting from various causes, as well as for fracture of the anterior skull base following trauma.


Assuntos
Ossos Faciais/lesões , Osso Frontal/cirurgia , Esponja de Gelatina Absorvível/uso terapêutico , Fraturas Cranianas/cirurgia , Retalhos Cirúrgicos/cirurgia , Adulto , Abscesso Encefálico/tratamento farmacológico , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/cirurgia , Feminino , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Base do Crânio/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Transpl Infect Dis ; 21(3): e13082, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30892778

RESUMO

Burkholderia cepacia complex (Bcc) includes several phenotypically similar but genotypically distinct gram-negative bacteria (GNB) that can colonize the respiratory tract of Cystic Fibrosis (CF) patients. Pathogens are difficult to treat due to intrinsic resistance to multiple antibiotics and are associated to a more rapid decline in lung function and to increased mortality, particularly after lung transplantation. For all these reasons, chronic infection by Burkholderia (B) cenocepacia is presently considered a relative or absolute contraindication in almost all lung transplant centres. We report the case of a young adult CF patient chronically colonized by B multivorans genomovar II, with diabetes and end-stage renal disease treated with renal replacement therapy: a few months after lung transplantation, she developed post-surgery B multivorans bacteremia and multiple brain abscesses. This severe infection did not improve despite multiple standard antibiotic regimen. The introduction of ceftazidime-avibactam, a new ß-lactam/ ß-lactamase inhibitor combination resulted in clinical recovery and in radiological and biochemical improvement.


Assuntos
Compostos Azabicíclicos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Infecções por Burkholderia/tratamento farmacológico , Ceftazidima/uso terapêutico , Fibrose Cística/complicações , Transplante de Pulmão/efeitos adversos , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Abscesso Encefálico/microbiologia , Infecções por Burkholderia/etiologia , Complexo Burkholderia cepacia/efeitos dos fármacos , Fibrose Cística/microbiologia , Complicações do Diabetes/microbiologia , Combinação de Medicamentos , Quimioterapia Combinada , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/microbiologia , Pulmão/microbiologia , Pulmão/patologia , Resultado do Tratamento
10.
BMC Infect Dis ; 18(1): 686, 2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-30572823

RESUMO

BACKGROUND: Central nervous system (CNS) infections caused by Actinomyces spp. including brain abscess, actinomycoma, subdural empyema and epidural abscess are well described, however reports of Actinomyces-associated meningitis are scarcely reported. CASE REPORT: We present the case of a 43-year-old Hungarian male patient with poor socioeconomic status who developed acute bacterial meningitis caused by Actinomyces turicensis originating from the left side mastoiditis. The bacterial cultures of both cerebrospinal fluid (CSF) and purulent discharge collected during the mastoid surgery showed slow growing Gram-positive rods that were identified by automated systems (API, VITEK) as A. turicensis The bacterial identification was confirmed by 16S rRNA PCR and subsequent nucleic acid sequencing. No bacterial growth was detected in blood culture bottles after 5 days of incubation. Hence, multiple antibacterial treatments and surgical intervention the patient passed away. CONCLUSIONS: Anaerobes are rarely involved in CNS infections therefore anaerobic culture of CSF samples is routinely not performed. However, anaerobic bacteria should be considered as potential pathogens when certain risk factors are present, such as paranasal sinusitis, mastoiditis in patients with poor socioeconomic condition. To the best of our knowledge, our case report is the first description of A. turicensis meningitis that has been diagnosed as consequence of purulent mastoiditis.


Assuntos
Actinomyces/isolamento & purificação , Actinomicose/complicações , Abscesso Encefálico/microbiologia , Empiema Subdural/microbiologia , Mastoidite/complicações , Meningites Bacterianas/microbiologia , Actinomyces/genética , Adulto , Antibacterianos/uso terapêutico , Abscesso Encefálico/líquido cefalorraquidiano , Abscesso Encefálico/tratamento farmacológico , Empiema Subdural/líquido cefalorraquidiano , Empiema Subdural/tratamento farmacológico , Evolução Fatal , Humanos , Masculino , Mastoidite/líquido cefalorraquidiano , Mastoidite/tratamento farmacológico , Mastoidite/microbiologia , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/tratamento farmacológico , Reação em Cadeia da Polimerase , Pobreza , RNA Ribossômico 16S/genética , Classe Social
11.
BMJ Case Rep ; 11(1)2018 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-30567128

RESUMO

A 63-year-old man admitted to hospital for the management of a frontal lobe abscess developed elevated liver enzymes within 48 hours of receiving meropenem. Liver enzymes reached a maximum at 5 days postadministration of meropenem, with alanine aminotransferase 1160 U/L, aspartate aminotransferase 787 U/L, alkaline phosphatase 297 U/L and gamma-glutamyltransferase 252 U/L. Meropenem was ceased and liver function normalised. Meropenem was administered for a second time later in the patient's admission and again the patient developed rapidly increasing liver enzymes, with a mixed hepatocellular/cholestatic pattern. Other possible causes of liver injury were excluded following extensive investigations, and the patient's liver enzymes continued to normalise following meropenem discontinuation. The patient was asymptomatic during the admission and was transferred to a rehabilitation facility. This case demonstrates that meropenem can cause severe liver injury and that early recognition of drug-induced liver injury is important.


Assuntos
Doença Hepática Induzida por Substâncias e Drogas/diagnóstico , Lobo Frontal/microbiologia , Hepatopatias/diagnóstico , Meropeném/efeitos adversos , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/prevenção & controle , Diagnóstico Precoce , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/patologia , Humanos , Fígado/enzimologia , Fígado/patologia , Masculino , Meropeném/administração & dosagem , Meropeném/uso terapêutico , Pessoa de Meia-Idade
12.
J Coll Physicians Surg Pak ; 28(9): S181-S183, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30173691

RESUMO

Streptococcus pluranimalium, a gram-positive aerobic coccus, has been isolated primarily from several farm animals. The pathogenicity of this species is not well characterised either in animals or humans. As per the literature, cases of S. pluranimalium infection in humans have been reported only a handful of times. We report the case of cerebral abscess caused by S. pluranimalium in a patient who presented with weakness and confusion. The diagnosis of cerebral abscess was made on imaging supported by microbiological culture. Burr hole procedure for abscess drainage followed by an antibiotic regimen based on culture and sensitivity results contributed to a successful outcome. The bacteria were identified by analytical profile index for Streptococci (API Strep) and VITEK 2 gram-positive cocci panel. The case was successfully treated with vancomycin.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/microbiologia , Testes de Sensibilidade Microbiana/métodos , Infecções Estreptocócicas/microbiologia , Streptococcus/classificação , Streptococcus/isolamento & purificação , Animais , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/cirurgia , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estreptocócicas/complicações , Streptococcus/efeitos dos fármacos , Resultado do Tratamento
13.
Clin Neurol Neurosurg ; 173: 46-51, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30086427

RESUMO

OBJECTIVE: Though outcome of brain abscess has been improved due to stereotactic drainage and appropriate antibiotic treatment, late unprovoked seizure often occurs after the abscess is resolved. The purpose of this study is to reveal the factors related to the late unprovoked seizure and effect of steroid on the prevention of seizure. PATIENTS AND METHODS: From January 2002 to August 2016, 119 patients with supratentorial brain abscesses were retrospectively analyzed. Initial volume of abscess, surgical methods, use of antiepileptic drugs (AEDs), and seizure free survival according to the use of steroid were compared between seizure free and late unprovoked seizure patients groups. Factors related to the late unprovoked seizure were evaluated by multivariate logistic regression model. RESULTS: All patients underwent surgery, which were either by burrhole aspiration or craniotomy. 22/119 patients (18.5%) had late unprovoked seizure. Initial abscess volume was significantly larger in the group of late unprovoked seizure (28.31 ± 22.68 cm3 vs. 17.03 ± 14.53 cm3, p = 0.015). The mean time to the late unprovoked seizure was 487.7 ± 446 days (range, 11-1369 days). Steroid was used to relieve perilesional edema in 35 patients. Proportion of late onset seizure was not different between the group of steroid non-use group and steroid use (17.1% vs. 19%, p = 0.52) and mean seizure free periods of steroid non-use group and steroid use group were 40.75 ± 9.23 months and 48.85 ± 8.50 months, respectively (P = 0.89, by log rank test). Initial presentation of seizure at the diagnosis of brain abscess and initial volume larger than 20.89 cm3 were risk factors for late unprovoked seizure with odds ratio of 4.1 (95% C.I 1.44-11.69) and 3.08 (95% C.I 1.19-7.96), respectively. CONCLUSION: Late unprovoked seizure in patients with brain abscess was affected by initial presentation of seizure and initial volume of the abscess whereas methods of surgical intervention and steroid use had no effect on the occurrence of late unprovoked seizure.


Assuntos
Anticonvulsivantes/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Convulsões/tratamento farmacológico , Esteroides/uso terapêutico , Adulto , Idoso , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo , Trepanação
14.
J Radiol Case Rep ; 12(3): 10-17, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29875989

RESUMO

Sleeve gastrectomy is a relatively newer bariatric surgical procedure and has become the most common of all bariatric surgeries performed. Complication rates reported with sleeve gastrectomies are relatively low and are generally due to staple line leaks, hemorrhage, or sleeve stricture. Portal vein thrombosis is an uncommon but potentially dangerous complication. We present a case of a 21-year-old woman who developed thrombosis of the portal, splenic, and right common iliac veins that then resulted in multifocal brain abscesses from presumed Fusobacterium septic emboli following an uncomplicated laparoscopic sleeve gastrectomy.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Gastrectomia/métodos , Veia Porta/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Antibacterianos/uso terapêutico , Anticoagulantes/uso terapêutico , Biomarcadores/análise , Abscesso Encefálico/tratamento farmacológico , Meios de Contraste , Quimioterapia Combinada , Feminino , Humanos , Iohexol , Compostos Organometálicos , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Trombose Venosa/tratamento farmacológico , Adulto Jovem
15.
Expert Rev Anti Infect Ther ; 16(7): 565-578, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29909695

RESUMO

INTRODUCTION: Brain abscess is an uncommon and potentially life-threatening infection of the CNS that can be caused by a range of different pathogens including bacteria, fungi, and parasites. A multidisciplinary approach is important and anti-infective treatment remains crucial. Here, we review anti-infective treatment of brain abscess. Areas covered: We used the terms '(Brain abscess[ti] AND (antibiotic* OR treatment)) NOT case report'), to conduct a search in the PubMed. Additional papers were identified by cross-reference checking and by browsing textbooks of infectious diseases and neurology. COMMENTARY: Empiric treatment of bacterial brain abscess consists of cefotaxime and metronidazole with the addition of vancomycin if meticilline-resistant Staphylococcus aureus is suspected. For severely immuno-suppressed patients, for example transplant recipients, voriconazole and trimethoprim-sulfamethoxazole or sulfadiazine should be added. Increased knowledge of the pharmacokinetic profile of anti-infective treatments may help to improve the treatment of brain abscess. Future studies should address efficacy and safety of continuous abscess drainage, mode of anti-infective administration (continuous vs. bolus), and anti-infective treatments in immuno-suppressed patients.


Assuntos
Anti-Infecciosos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Hospedeiro Imunocomprometido , Animais , Anti-Infecciosos/farmacocinética , Abscesso Encefálico/microbiologia , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Infecções Bacterianas do Sistema Nervoso Central/microbiologia , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Infecções Parasitárias do Sistema Nervoso Central/tratamento farmacológico , Infecções Parasitárias do Sistema Nervoso Central/microbiologia , Drenagem/métodos , Humanos
19.
World Neurosurg ; 116: e362-e370, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29751182

RESUMO

INTRODUCTION: Actinomycosis is an uncommon chronic suppurative infection that rarely affects the central nervous system (CNS). It is caused by filamentous Gram-positive anaerobic bacteria that is a normal commensal but causes suppurative and granulomatous inflammation after disruption of anatomical barriers. We report the largest series of 17 histologically confirmed cases of CNS actinomycosis and review clinical, imaging, and histopathologic features. METHODS: All histologically confirmed cases of CNS actinomycosis diagnosed between January 2010 and June 2016 were retrieved from the neuropathology records. The demographic profile, clinical, radiologic, microbiologic, and histologic features, treatment, and clinical outcomes were reviewed. RESULTS: Seventeen cases were histopathologically diagnosed to have CNS actinomycosis. Nine of these were primarily admitted and managed in our institute, whereas the remaining 8 were referred to us for histopathologic diagnosis. Mean age at presentation was 31.4 years, with male predilection (3.25:1). Mean duration of symptoms was 2.95 months. Systemic symptoms were noted in 5 patients, although no systemic focus was detectable. Pachymeningitis was most common type (9; 52.94%), and chronic abscess was identified in 7. History of previous surgery for osteomyelitis was forthcoming in 3. All patients underwent surgical excision/aspiration of the lesions. Histologically, lesions revealed characteristic suppurative granulomatous response with giant cells and actinomycotic colonies were detected within necrotic centers. Cultures failed to grow Actinomyces in all. Follow-up data were available in 9 patients managed in our institute, and all had good outcomes at the median follow-up period of 32 months after antibiotic treatment for mean period of 8.4weeks. CONCLUSIONS: Histopathology remains the cornerstone for diagnosis of actinomycosis as on culture confirmation is very rare.


Assuntos
Actinomicose/diagnóstico por imagem , Actinomicose/patologia , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/patologia , Actinomicose/tratamento farmacológico , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Indian J Med Microbiol ; 36(1): 97-103, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29735835

RESUMO

Purpose: Intracranial abscess caused by methicillin-resistant Staphylococcus aureus (MRSA) is rare and unexplored. The aim of the present study is to examine the prevalence, clinical and molecular characteristics, treatment options and outcome of MRSA intracranial abscess over a period of 6 years. Patientsand Methods: A total of 21 patients were included in this retrospective study. The demographic and clinical details of all the patients were collected. Molecular typing including staphylococcal cassette chromosome mec typing, spa typing and polymerase chain reaction of Panton-Valentine leucocidin toxin (PVL) gene for the latter 6 isolates was performed. Results: The paediatric population was the most affected group (33.3%). The primary route of infection was post-operative/trauma in 7 (33.3%) cases. All the patients were treated surgically either by aspiration or excision. Fifteen (71%) patients received anti-MRSA treatment with vancomycin or linezolid, where linezolid-treated patients showed better prognosis. Of the 11 patients who were on follow-up, unfavourable outcome was observed in 3 (27.3%) cases and 8 (72.7%) cases improved. The molecular typing of six isolates revealed four community-associated (CA) MRSA, one each of livestock-associated (LA) and healthcare-associated MRSA with PVL gene noted in all. Conclusion: We propose that timely diagnosis, surgical intervention and appropriate anti-MRSA treatment would contribute to better outcome. The occurrence of CA-MRSA and LA-MRSA infection in the central nervous system signifies the threat from the community and livestock reservoir, thus drawing attention towards surveillance and tracking to understand the epidemiology and implement infection control measures.


Assuntos
Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/epidemiologia , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/epidemiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Adolescente , Adulto , Antígenos de Bactérias/genética , Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Abscesso Encefálico/microbiologia , Criança , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Abscesso Epidural/microbiologia , Exotoxinas/genética , Feminino , Humanos , Índia/epidemiologia , Controle de Infecções/métodos , Leucocidinas/genética , Linezolida/uso terapêutico , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Epidemiologia Molecular , Tipagem Molecular , Proteínas de Ligação às Penicilinas/genética , Reação em Cadeia da Polimerase , Estudos Retrospectivos , Vancomicina/uso terapêutico , Adulto Jovem
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