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Neurology Apr 2023Epilepsy in patients with brain abscess is frequent, but risk factors and prognosis remain undetermined. This study examined risk factors of epilepsy among survivors of...
BACKGROUND AND OBJECTIVES
Epilepsy in patients with brain abscess is frequent, but risk factors and prognosis remain undetermined. This study examined risk factors of epilepsy among survivors of brain abscess and associated prognosis.
METHODS
Nationwide, population-based healthcare registries were used to compute cumulative incidences and cause-specific adjusted hazard rate ratios (adj. HRRs) with 95% CIs for epilepsy among 30-day survivors of brain abscess from 1982 through 2016. Data were enriched with clinical details by medical record review of patients hospitalized from 2007 through 2016. Adjusted mortality rate ratios (adj. MRRs) were examined using epilepsy as a time-dependent variable.
RESULTS
The study included 1,179 30-day survivors of brain abscess among whom 323 (27%) developed new-onset epilepsy after a median of 0.76 years (interquartile range [IQR] 0.24-2.41). At admission for brain abscess, the median age was 46 years (IQR 32-59) in patients with epilepsy compared with 52 years (IQR 33-64) in those without epilepsy. The proportion of female individuals was similar in patients with and without epilepsy (37%). Adj. HRRs for epilepsy were 2.44 (95% CI 1.89-3.15) for aspiration or excision of brain abscess, 2.37 (1.56-3.60) for alcohol abuse, 1.75 (1.27-2.40) for previous neurosurgery or head trauma, 1.62 (1.17-2.25) for stroke, and 1.55 (1.04-2.32) for age group 20-39 years. Cumulative incidences were increased in patients with alcohol abuse (52% vs 31%), aspiration or excision of brain abscess (41% vs 20%), previous neurosurgery or head trauma (41% vs 31%), and stroke (46% vs 31%). Analysis using clinical details from medical record review of patients from 2007 through 2016 demonstrated adj. HRRs of 3.70 (2.24-6.13) for seizures at admission for brain abscess and 1.80 (1.04-3.11) for frontal lobe abscess. By contrast, adj. HRR was 0.42 (0.21-0.86) for occipital lobe abscess. Using the entire registry-based cohort, patients with epilepsy had an adj. MRR of 1.26 (1.01-1.57).
DISCUSSION
Important risk factors of epilepsy were seizures during admission for brain abscess, neurosurgery, alcoholism, frontal lobe abscess, and stroke. Epilepsy was associated with an increased mortality. Antiepileptic treatment may be guided by individual risk profiles, and a specialized follow-up is highlighted by an increased mortality in survivors with epilepsy.
Topics: Humans; Female; Middle Aged; Young Adult; Adult; Cohort Studies; Alcoholism; Epilepsy; Stroke; Seizures; Risk Factors; Prognosis; Brain Abscess
PubMed: 36810235
DOI: 10.1212/WNL.0000000000206866 -
Acta Neurochirurgica Mar 2023Data on critically ill patients with spontaneous empyema or brain abscess are limited. The aim was to evaluate clinical presentations, factors, and microbiological...
BACKGROUND
Data on critically ill patients with spontaneous empyema or brain abscess are limited. The aim was to evaluate clinical presentations, factors, and microbiological findings associated with the outcome in patients treated in a Neurocritical Care Unit.
METHODS
In this retrospective study, we analyzed 45 out of 101 screened patients with spontaneous epidural or subdural empyema and/or brain abscess treated at a tertiary care center between January 2012 and December 2019. Patients with postoperative infections or spinal abscess were excluded. Medical records were reviewed for baseline characteristics, origin of infection, laboratory and microbiology findings, and treatment characteristics. The outcome was determined using the Glasgow outcome scale extended (GOSE).
RESULTS
Favorable outcome (GOSE 5-8) was achieved in 38 of 45 patients (84%). Four patients died (9%), three remained severely disabled (7%). Unfavorable outcome was associated with a decreased level of consciousness at admission (Glasgow coma scale < 9) (43% versus 3%; p = 0.009), need of vasopressors (71% versus 11%; p = 0.002), sepsis (43% versus 8%; p = 0.013), higher age (65.1 ± 15.7 versus 46.9 ± 17.5 years; p = 0.014), shorter time between symptoms onset and ICU admission (5 ± 2.4 days versus 11.6 ± 16.8 days; p = 0.013), and higher median C-reactive protein (CRP) serum levels (206 mg/l, range 15-259 mg/l versus 17.5 mg/l, range 3.3-72.7 mg/l; p = 0.036). With antibiotics adapted according to culture sensitivities in the first 2 weeks, neuroimaging revealed a progression of empyema or abscess in 45% of the cases.
CONCLUSION
Favorable outcome can be achieved in a considerable proportion of an intensive care population with spontaneous empyema or brain abscess. Sepsis and more frequent need for vasopressors, associated with unfavorable outcome, indicate a fulminant course of a not only cerebral but systemic infection. Change of antibiotic therapy according to microbiological findings in the first 2 weeks should be exercised with great caution.
Topics: Adult; Humans; Middle Aged; Brain Abscess; Empyema; Empyema, Subdural; Retrospective Studies; Sepsis; Aged; Aged, 80 and over
PubMed: 35618853
DOI: 10.1007/s00701-022-05241-7 -
Child's Nervous System : ChNS :... Jan 2022A fetal scalp electrode (FSE) is a frequently used investigation during labor. However, it is an invasive procedure which can lead to complications. Our patient...
A fetal scalp electrode (FSE) is a frequently used investigation during labor. However, it is an invasive procedure which can lead to complications. Our patient developed a very large brain abscess after initial superficial infection of the skin site due to an FSE. The patient was admitted to the hospital after an asymmetric growth of the skull was noticed with no further signs of clinical illness. MRI showed a very large brain abscess which was aspirated and treated with antibiotics for 10 weeks. A 2-year follow-up showed only a slight developmental delay in gross motor skills. Only once before a similar case has been described at which the patient developed a brain abscess after superficial infection of the scalp following an FSE. In both cases, the brain abscess was noticed due to an asymmetric growth of the skull without any further signs of clinical illness. A brain abscess has a high mortality and morbidity rate, and early diagnosis is vital for the optimal outcome. We therefore recommend to organize an out-patient clinical follow-up for every infant with a superficial infection of the skin site after placement of an FSE.
Topics: Brain Abscess; Electrodes; Humans; Infant, Newborn; Scalp; Scalp Dermatoses; Skull
PubMed: 33825051
DOI: 10.1007/s00381-021-05150-7 -
Journal of Stomatology, Oral and... Nov 2022Odontogenic infections can spread through different routes to more remote anatomical areas, such as the brain. Brain abscesses have an incidence of 0.3-1.3 / 100,000...
PURPOSE
Odontogenic infections can spread through different routes to more remote anatomical areas, such as the brain. Brain abscesses have an incidence of 0.3-1.3 / 100,000 population and only 2-5% are of dental origin. The main objective is to research brain complications derived from odontogenic infections. Secondary objectives were to identify the most common symptoms in brain abscess, to describe the microbiology involved in these infectious processes, report which parts of the brain complex are most commonly affected and report the sequelae of this patients.
METHODS
A systematic review following the PRISMA Guide and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports was carried out in PubMed, Scopus and Web of Science. The search terms were: Brain infection, brain abscess, oral health oral origin, odont* infect*.
RESULTS
The database search identified a total of 1000 articles. A total of 18 publications were identified after applying inclusion and exclusion criteria. A total of 38 patients were analyzed. Mean age was 49.64±18.80 years.
CONCLUSION
The most common symptoms of patients with brain abscess are neurological affectations first and then fever and headache second, without necessarily presenting as a symptomatological triad. Microbiological diagnosis is key to determining the origin of the infection. Anaerobic pathogens such as Streptococcus (F. Milleri), Fusobacterium Nucleatum and Porfiromonas Gingivalis families are common bacterial agents. The frontal lobe is the most frequently affected, followed by the parietal and temporal lobe. The most frequent brain complications are neurological disorders. However, most patients with brain abscesses recover without sequelae.
Topics: Humans; Adult; Middle Aged; Aged; Brain Abscess; Incidence; Brain
PubMed: 35908649
DOI: 10.1016/j.jormas.2022.07.018 -
Acta Otorhinolaryngologica Italica :... Apr 2019
Review
Topics: Adolescent; Anti-Bacterial Agents; Brain Abscess; Child; Child, Preschool; Databases, Factual; Female; Humans; Male; Oral Health; Periodontal Abscess
PubMed: 31097823
DOI: 10.14639/0392-100X-2281 -
BMJ Case Reports Oct 2021Cerebral phaeohyphomycosis refers to central nervous system infection by dematiaceous mould or by dark walled fungi which contain the dark pigment melanin in their cell...
Cerebral phaeohyphomycosis refers to central nervous system infection by dematiaceous mould or by dark walled fungi which contain the dark pigment melanin in their cell wall which adds to the virulence of fungus. These dematiaceous fungi can cause a variety of central nervous infections including invasive sinusitis, brain abscess, meningitis, myelitis and arachnoiditis. among these dematiaceous fungi is the most common cause of brain abscess in immunocompetent and immunocompromised individuals and is known to occur worldwide though is predominantly reported from subtropical regions especially the Asian subcontinent. It is difficult to differentiate these abscesses radiologically from high-grade gliomas, primary central nervous system lymphoma or other infections including toxoplasmosis, nocardiosis, tuberculosis and listeriosis. We describe a 19-year-old male patient with a cerebral abscess caused by where the diagnosis could be suspected by typical MR spectroscopic findings and by identifying the fungus from a lymph node biopsy.
Topics: Adult; Antifungal Agents; Ascomycota; Brain Abscess; Humans; Immunocompromised Host; Lymphadenitis; Male; Young Adult
PubMed: 34706919
DOI: 10.1136/bcr-2021-246108 -
Emergency Medicine Clinics of North... Nov 2016Central nervous system (CNS) infections, including meningitis, encephalitis, and brain abscess, are rare but time-sensitive emergency department (ED) diagnoses. Patients... (Review)
Review
Central nervous system (CNS) infections, including meningitis, encephalitis, and brain abscess, are rare but time-sensitive emergency department (ED) diagnoses. Patients with CNS infection can present to the ED with nonspecific signs and symptoms, including headache, fever, altered mental status, and behavioral changes. Neuroimaging and CSF fluid analysis can appear benign early in the course of disease. Delaying therapy negatively impacts outcomes, particularly with bacterial meningitis and herpes simplex virus encephalitis. Therefore, diagnosis of CNS infection requires vigilance and a high index of suspicion based on the history and physical examination, which must be confirmed with appropriate imaging and laboratory evaluation.
Topics: Brain Abscess; Central Nervous System Infections; Emergency Service, Hospital; Encephalitis; Humans; Meningitis
PubMed: 27741995
DOI: 10.1016/j.emc.2016.06.013 -
Nagoya Journal of Medical Science Aug 2012This study retrospectively analyzed 12 patients with brain abscesses. Half of the patients were diagnosed inaccurately in the initial stage, and 7.2 days were required...
This study retrospectively analyzed 12 patients with brain abscesses. Half of the patients were diagnosed inaccurately in the initial stage, and 7.2 days were required to achieve the final diagnosis of brain abscess. The patients presented only with a moderately elevated leukocyte count, serum CRP levels, or body temperatures during the initial stage. These markers changed, first with an increase in the leukocyte count, followed by the CRP and body temperature. The degree of elevation tended to be less prominent, and the time for each inflammatory index to reach its maximum value tended to be longer in the patients without ventriculitis than in those with it. The causative organisms of a brain abscess were detected in 10 cases. The primary causative organisms from dental caries were Streptococcus viridians or milleri, and Fusobacterium nucleatum. Nocardia sp. or farcinica were common when the abscess was found in other regions. The primary causative organisms of unrecognized sources of infection were Streptococcus milleri and Prolionibacterium sp. Nocardia is resistant to many antibiotics. However, carbapenem, tetracycline and quinolone were effective for Nocardia as well as many other kinds of bacteria. In summary, the brain abscesses presented with only mildly elevated inflammatory markers of body temperature, leukocyte and CRP. These inflammatory markers were less obvious in the patients without ventriculitis and/or meningitis. The source of infection tended to suggest some specific primary causative organism. It was reasonable to initiate therapy with carbapenem.
Topics: Adult; Aged; Brain Abscess; Carbapenems; Female; Fusobacterium nucleatum; Humans; Male; Middle Aged; Nocardia; Quinolones; Retrospective Studies; Streptococcus milleri Group; Tetracycline; Viridans Streptococci
PubMed: 23092104
DOI: No ID Found -
Microbiology Spectrum Apr 2022Forty-one stored samples from cases of spontaneous brain abscess were investigated to gain insight into the natural history, causative agents, and relevant laboratory...
Forty-one stored samples from cases of spontaneous brain abscess were investigated to gain insight into the natural history, causative agents, and relevant laboratory diagnostics of a rare infection. Samples from a larger collection were selected based on retrospective analysis of patient records. All samples were subjected to amplicon sequencing of 16S rRNA gene fragments. Supplementary culture on selected media was performed as suggested by bioinformatics analysis. For three cases, no microorganism was disclosed, while Toxoplasma gondii, Aspergillus fumigatus, and various bacteria were the cause of 1, 2, and 35 cases, respectively. Bacterial infections were monomicrobial in 20 cases and polymicrobial in 15; the microorganisms of the latter cases were restricted to residents of cavum oris. Amplicon sequencing did not further enhance the importance of the Streptococcus anginosus group, which was involved in 17 cases, and the single primer set used may be suboptimal for amplification of and . But, amplicon-based sequencing unquestionably expanded the number of polybacterial infections, with focus on the Fusobacterium nucleatum group, , and . Culture on selective media confirmed the presence of F. nucleatum group bacteria, which attained a prominence in spontaneous brain abscess similar to the group. Metagenomics is a powerful tool to disclose the spectrum of agents in polymicrobial infections, but a reliable cutoff value for substantial detection is complex. Commercial media for isolation of F. nucleatum group bacteria from mixed infections are available, and these pathogens should be carefully characterized. Isolation of and in polymicrobial infections has not been resolved. Polymicrobial brain abscess is a challenge to the clinical microbiology laboratory due to the aggregative nature of the dental and oral microbiota. Because polymicrobial infections may escape detection by conventional culture methods, directed therapy toward a single detected bacterium is problematic. Amplicon-based sequencing provides important clues to these infections, but only cultured microorganisms can be fully characterized, subjected to antimicrobial susceptibility testing, and formally named. By use of specific selective culture plates, we successfully isolated bacteria of the Fusobacterium nucleatum group, and these bacteria rose to the same prominence as the widely recognized pathogen, the Streptococcus anginosus group. Named and unnamed members of the Fusobacterium nucleatum group must be further investigated to gain insight into a rare but grave disease.
Topics: Bacteria; Brain Abscess; Coinfection; Fusobacterium nucleatum; Humans; RNA, Ribosomal, 16S; Retrospective Studies
PubMed: 35404098
DOI: 10.1128/spectrum.02407-21 -
Turkish Neurosurgery 2012To study clinical, microbiological and radiological profile of pyogenic brain abscess patients along with modes of treatment and their outcome.
AIM
To study clinical, microbiological and radiological profile of pyogenic brain abscess patients along with modes of treatment and their outcome.
MATERIAL AND METHODS
This retrospective as well as prospective study included One hundred and fourteen patients of Brain Abscess who were admitted and evaluated in the Department of Neurosurgery over a period of ten years .This study had a retrospective component from Oct 2001 to May 2009 in which eighty six patients were included and a prospective component from June 2009 to Oct 2011 which included twenty eight patients. Patients were managed medically including intravenous antibiotics and surgical management including single burr hole and total resection with open craniotomy or craniectomy. To evaluate abscess size after aspiration, CT or MR imaging was performed [~ 24 hours after aspiration] and as and when demanded by worsening of the clinical condition or no response to medical and surgical treatment.
RESULTS
It was observed that majority of the patients in our study were males numbering 83(72.8%) where as there were only 31 females (27.2%). It was observed that among the underlying factors CSOM predominated with 57 patients ie (50%).
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brain; Brain Abscess; Child; Child, Preschool; Craniotomy; Disease Management; Female; Humans; Infant; Male; Middle Aged; Neurosurgical Procedures; Prospective Studies; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 23208897
DOI: 10.5137/1019-5149.JTN.5458-11.3