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Clinical Microbiology and Infection :... Jan 2024These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in...
SCOPE
These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults.
METHODS
Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low).
QUESTIONS ADDRESSED BY THE GUIDELINES AND RECOMMENDATIONS
Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). No recommendation is offered for early transition to oral antimicrobials because of a lack of data, and oral consolidation treatment after ≥6 weeks of intravenous antimicrobials is not routinely recommended (conditional and very low). Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low). Research needs are addressed.
Topics: Adult; Child; Humans; Anti-Infective Agents; Brain Abscess; Communicable Diseases
PubMed: 37648062
DOI: 10.1016/j.cmi.2023.08.016 -
Pathogens and Global Health Feb 2023infection in the central nervous system commonly occurs among immunodeficient patients. Its prevalence is high in countries with a high burden of HIV and low coverage... (Review)
Review
infection in the central nervous system commonly occurs among immunodeficient patients. Its prevalence is high in countries with a high burden of HIV and low coverage of antiretroviral drugs. The brain is one of the predilections for infection due to its low inflammatory reaction, and cerebral toxoplasmosis occurs solely due to the reactivation of a latent infection rather than a new infection. Several immune elements have recently been recognized to have an essential role in the immunopathogenesis of cerebral toxoplasmosis. Although real-time isothermal amplification, next-generation sequencing, and enzyme-linked aptamer assays from blood samples have been the recommended diagnostic tools in some in-vivo studies, a combination of clinical symptoms, serology examination, and neuroimaging are still the daily standard for the presumptive diagnosis of cerebral toxoplasmosis and early anti-toxoplasma administration. Clinical trials are needed to find a new therapy that is less likely to affect folate synthesis, have neuroprotective properties, or cure the latent phase of infection. The development of a vaccine is being extensively tested in animals, but its efficacy and safety for humans are still not proven.
Topics: Animals; Humans; Toxoplasmosis, Cerebral; AIDS-Related Opportunistic Infections; Toxoplasma; Antibodies, Protozoan
PubMed: 35694771
DOI: 10.1080/20477724.2022.2083977 -
Clinical Microbiology and Infection :... Sep 2017A brain abscess is a focal infection of the brain that begins as a localized area of cerebritis. In immunocompetent patients, bacteria are responsible for >95% of brain... (Review)
Review
BACKGROUND
A brain abscess is a focal infection of the brain that begins as a localized area of cerebritis. In immunocompetent patients, bacteria are responsible for >95% of brain abscesses, and enter the brain either through contiguous spread following otitis, sinusitis, neurosurgery, or cranial trauma, or through haematogenous dissemination.
AIMS
To identify recent advances in the field.
SOURCES
We searched Medline and Embase for articles published during years 2012-2016, with the keywords 'brain' and 'abscess'.
CONTENT
The triad of headache, fever and focal neurological deficit is complete in ∼20% of patients on admission. Brain imaging with contrast-preferentially magnetic resonance imaging-is the reference standard for diagnosis, and should be followed by stereotactic aspiration of at least one lesion, before the start of any antimicrobials. Efforts should be made for optimal management of brain abscess samples, for reliable microbiological documentation. Empirical treatment should cover oral streptococci (including milleri group), methicillin-susceptible staphylococci, anaerobes and Enterobacteriaceae. As brain abscesses are frequently polymicrobial, de-escalation based on microbiological results is safe only when aspiration samples have been processed optimally, or when primary diagnosis is endocarditis. Otherwise, many experts advocate for anaerobes coverage even with no documentation, given the sub-optimal sensitivity of current techniques. A 6-week combination of third-generation cephalosporin and metronidazole will cure most cases of community-acquired brain abscess in immunocompetent patients.
IMPLICATIONS
Significant advances in brain imaging, minimally invasive neurosurgery, molecular biology and antibacterial agents have dramatically improved the prognosis of brain abscess in immunocompetent patients over the last decades.
Topics: Anti-Infective Agents; Brain Abscess; Drainage; Humans; Neurosurgical Procedures
PubMed: 28501669
DOI: 10.1016/j.cmi.2017.05.004 -
Frontiers in Immunology 2019is a widespread parasitic pathogen that infects over one third of the global human population. The parasite invades and chronically persists in the central nervous... (Review)
Review
is a widespread parasitic pathogen that infects over one third of the global human population. The parasite invades and chronically persists in the central nervous system (CNS) of the infected host. Parasite spread and persistence is intimately linked to an ensuing immune response, which does not only limit parasite-induced damage but also may facilitate dissemination and induce parasite-associated immunopathology. Here, we discuss various aspects of toxoplasmosis where knowledge is scarce or controversial and, the recent advances in the understanding of the delicate interplay of with the immune system in experimental and clinical settings. This includes mechanisms for parasite passage from the circulation into the brain parenchyma across the blood-brain barrier during primary acute infection. Later, as chronic latent infection sets in with control of the parasite in the brain parenchyma, the roles of the inflammatory response and of immune cell responses in this phase of the disease are discussed. Additionally, the function of brain resident cell populations is delineated, i.e., how neurons, astrocytes and microglia serve both as target cells for the parasite but also actively contribute to the immune response. As the infection can reactivate in the CNS of immune-compromised individuals, we bring up the immunopathogenesis of reactivated toxoplasmosis, including the special case of congenital CNS manifestations. The relevance, advantages and limitations of rodent infection models for the understanding of human cerebral toxoplasmosis are discussed. Finally, this review pinpoints questions that may represent challenges to experimental and clinical science with respect to improved diagnostics, pharmacological treatments and immunotherapies.
Topics: Animals; Blood-Brain Barrier; Brain; Chronic Disease; Host-Parasite Interactions; Humans; Toxoplasmosis, Cerebral
PubMed: 30873157
DOI: 10.3389/fimmu.2019.00242 -
Journal of the International... 2019Cerebral toxoplasmosis is the most common cause of expansive brain lesions in people living with HIV/AIDS (PLWHA) and continues to cause high morbidity and mortality.... (Review)
Review
Cerebral toxoplasmosis is the most common cause of expansive brain lesions in people living with HIV/AIDS (PLWHA) and continues to cause high morbidity and mortality. The most frequent characteristics are focal subacute neurological deficits and ring-enhancing brain lesions in the basal ganglia, but the spectrum of clinical and neuroradiological manifestations is broad. Early initiation of antitoxoplasma therapy is an important feature of the diagnostic approach of expansive brain lesions in PLWHA. Pyrimethamine-based regimens and trimethoprim-sulfamethoxazole (TMP-SMX) seem to present similar efficacy, but TMP-SMX shows potential practical advantages. The immune reconstitution inflammatory syndrome is uncommon in cerebral toxoplasmosis, and we now have more effective, safe, and friendly combined antiretroviral therapy (cART) options. As a consequence of these 2 variables, the initiation of cART can be performed within 2 weeks after initiation of antitoxoplasma therapy. Herein, we will review historical and current concepts of epidemiology, diagnosis, and treatment of HIV-related cerebral toxoplasmosis.
Topics: Anti-Retroviral Agents; Antiprotozoal Agents; Brain; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome; Toxoplasmosis, Cerebral; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 31429353
DOI: 10.1177/2325958219867315 -
The New England Journal of Medicine Oct 2014
Topics: Anti-Infective Agents; Brain Abscess; Humans; Stereotaxic Techniques
PubMed: 25354114
DOI: 10.1056/NEJMc1410501 -
Tidsskrift For Den Norske Laegeforening... Apr 2021The diagnosis of intracerebral fungal abscesses may be difficult due to the paucity of laboratory tests and similar radiological appearance to other lesions.
BACKGROUND
The diagnosis of intracerebral fungal abscesses may be difficult due to the paucity of laboratory tests and similar radiological appearance to other lesions.
CASE PRESENTATION
We present an immunocompromised woman in her forties who was admitted with a diagnosis of bacterial meningitis. MRI examination showed findings suggestive of fungal abscesses, and a subsequent lumbar puncture showed PCR positive for non-fumigatus Aspergillus. The patient received antifungal treatment and had satisfactory clinical, biochemical and radiological response. Consecutive MRI examinations over the following weeks showed gradual decrease of abscesses, with almost complete resolution within 12 weeks.
INTERPRETATION
Adequate management of brain abscesses requires correct identification of the causative agent, so that proper treatment can be initiated as soon as possible. MRI plays an important role in distinguishing between pyogenic and fungal brain abscesses. Headaches or focal neurological deficits in immunocompromised patients should cause CNS fungal infection to be considered.
Topics: Antifungal Agents; Aspergillosis; Brain Abscess; Female; Headache; Humans; Magnetic Resonance Imaging
PubMed: 33876620
DOI: 10.4045/tidsskr.20.0825 -
Arquivos de Neuro-psiquiatria Feb 2022
Topics: Brain Abscess; Humans; Telangiectasia, Hereditary Hemorrhagic
PubMed: 35352758
DOI: 10.1590/0004-282X-ANP-2021-0389 -
Turkiye Parazitolojii Dergisi Mar 2021is an intracellular protozoan parasite. Approximately 30% of the global population is infected by . In chronically infected individuals, the parasite resides in tissue... (Review)
Review
is an intracellular protozoan parasite. Approximately 30% of the global population is infected by . In chronically infected individuals, the parasite resides in tissue cysts, especially in the brain. There is a growing interest in the role of parasitologic agents in the causation of neuropsychological disorders. In this review, we have explained the interactions between and its host, mechanisms, and consequences on neural and psychological diseases.
Topics: Brain; Chronic Disease; Host-Parasite Interactions; Humans; Neurocognitive Disorders; Toxoplasma; Toxoplasmosis; Toxoplasmosis, Cerebral
PubMed: 33685069
DOI: 10.4274/tpd.galenos.2020.6973 -
Neurology India 2023Melioidosis is a bacterial infection caused by Burkholderia pseudomallei that is endemic in Southeast Asia, northern Australia, and Africa. Neurological involvement is... (Review)
Review
BACKGROUND
Melioidosis is a bacterial infection caused by Burkholderia pseudomallei that is endemic in Southeast Asia, northern Australia, and Africa. Neurological involvement is rare and reported in 3-5% of total cases.
OBJECTIVE
The purpose of this study was to report a series of cases of melioidosis with neurological involvement and a brief review of the literature.
MATERIALS AND METHODS
We collected the data from six melioidosis patients having neurological involvement. Clinical, biochemical, and imaging findings were analyzed.
RESULT
All patients in our study were adults (age range 27 to 73 years). The presenting symptoms were fever of varying duration (range 15 days to 2 months). Altered sensorium was noted in five patients. Four cases had brain abscess, one had meningitis, and one had a spinal epidural abscess. All cases of brain abscesses were T2 hyperintense with an irregular wall showing central diffusion restriction and irregular peripheral enhancement. The trigeminal nucleus was involved in one patient, but there was no enhancement of the trigeminal nerve. Extension along the white matter tract was noted in two patients. Magnetic resonance (MR) spectroscopy done in two patients showed increased lipid/lactate and choline peak in both of them.
CONCLUSION
Melioidosis can present as multiple micro-abscesses in the brain. Involvement of the trigeminal nucleus and extension along the corticospinal tract may raise the possibility of infection by B. pseudomallei. Meningitis and dural sinus thrombosis, although rare, can be presenting features.
Topics: Adult; Humans; Middle Aged; Aged; Melioidosis; Magnetic Resonance Imaging; Brain Abscess; Brain; Lactic Acid
PubMed: 36861583
DOI: 10.4103/0028-3886.370442