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PubMed2005

Stereotactic aspiration and antibiotic treatment combined with hyperbaric oxygen therapy in the management of bacterial brain abscesses.

OBJECTIVE: Despite advances in surgical techniques in the management of the brain abscess, long-term antibiotics are as crucial to cure as the initial surgical procedure itself. This study was designed to evaluate the effect of adjuvant hyperbaric oxygen (HBO) therapy on the duration of antibiotic treatment. METHODS: Between 1999 and 2004, 13 patients with bacterial brain abscesses treated with stereotactic aspiration combined with HBO and systemic antibiotic therapy. Patients younger than 18 years of age were excluded from this study. Postoperatively, all patients were given a 4-week course of intravenous antibiotics. Additionally, patients received hyperbaric oxygen (HBO, 100% O2 at 2.5 ATA for 60 min) twice daily for five consecutive days, and an additional treatment (100% O2 at 2.5 ATA for 60 min daily) was given for 25 days. RESULTS: There were eight male and five female patients. Their ages ranged between 18 and 71 years, with a mean of 43.9 years. The average duration of follow-up was 9.5 months (range, 8-13 mo). This treatment modality allowed infection control and healing for all 13 patients with 0% recurrence rate. HBO treatment was tolerated well, and there were no adverse effects of pressurization. At the end of the follow-up period, 12 patients had a good outcome: nine are without sequelae, and three have a mild hemiparesis but are capable of self-care. One patient has a moderate hemiparesis. CONCLUSION: Although the number of patients is small, this series represents the largest reported group of brain abscess patients treated with stereotactic aspiration combined with antibiotic and HBO therapy. Our preliminary results indicate that the length of time on antibiotics can be shortened with the use of HBO as an adjunctive treatment.

Adult↗
PubMed1983

Brain abscess caused by a variety of cladosporium trichoides.

A brain abscess caused by a new variety of Cladosporium trichoides occurred in a previously healthy man. A reversed T-suppressor/helper cell ratio was noted as the only immunologic abnormality. He required three surgical procedures, the last an occipital lobectomy, and antifungal chemotherapy to control his disease. He received 2,068 mg of amphotericin B and one year of flucytosine at 6 g per day. Ten months after the last surgery he is without evidence of disease. C. trichoides var. chlamydosporum was isolated from the abscess. It differed from C. trichoides by producing chlamydospores in vitro and only hyphae in the brain abscess. On modified Sabouraud agar, the fungus did not grow at 25 degrees C and grew poorly at 30 degrees C and 37 degrees C. Histologic sections revealed necrosis, no encapsulation, and no epitheliod cells.

Amphotericin B↗
PubMed1983

Treatment of experimental brain abscess with penicillin and chloramphenicol.

Recent reports have indicated that antibiotic therapy alone may be successful in resolving brain abscesses. We utilized an animal model of brain abscess to evaluate the efficacy of penicillin with and without chloramphenicol in preventing the development of brain abscess. When penicillin therapy was initiated at the time of bacterial contamination and continued for four days, the bacteria were eliminated. When therapy was delayed for 24 hr, the number of bacteria in brain tissue samples was significantly reduced, but all samples still contained bacteria. When therapy was delayed for 48 hr, there was no therapeutic benefit. Addition of chloramphenicol to each of these regimens did not significantly alter the results. Extending the duration of therapy to eight days provided no improvement over the results obtained after four days.

Animals↗
PubMed1975

Brain abscess: a review of recent experience.

From 1961 through 1973, 60 patients with brain abscess were treated at the Mayo Clinic by surgical excision and antimicrobial therapy. The operative mortality was 17%, which was identical to a similar series reported in 1959. The patients who had the diagnosis of brain abscess confirmed at autopsy and who never underwent operation (24 patients) were more elderly than the group operated on, and a higher percentage had multiple brain abscess. Severe systemic disease or multisystem disease, or both, usually precluded a vigorous surgical approach among the nonsurgical group. Etiologic, diagnostic, and microbiologic factors were examined to develop an approach to antimicrobial therapy.

Adolescent↗
PubMed2000

[Septic-embolic and septic metastatic brain abscess].

The hematogenous spread of bacteria, fungi and protozoa may also reach the brain vessels, which happens mostly through septic emboli. From such an embolus a metastatic focal encephalitis and later a septic-embolic brain abscess may arise. The most frequently underlying infections that may cause septic emboli are bacterial endocarditis as well as bacterial infections of artificial heart valve prostheses. Congenital heart malformations with a right-to-left shunt also play here a certain role. Basically, however, all septic conditions and bacteriemias may cause septic-embolic brain abscesses. They occur frequently as multiple lesions. MRI is superior to CT in depicting the different stages of evolution from focal encephalitis, through the hardly encapsulated early abscess, to the formation of a membrane and later a dense fibrous capsule. The medical treatment of a brain abscess requires properly performed CT or MRI follow-up examinations in order to realize early enough a possible growing of such a lesion.

Brain↗
PubMed2003

Fusobacterial brain abscess: a review of five cases and an analysis of possible pathogenesis.

OBJECT: The cases of five patients with fusobacterial brain abscess are presented. The authors discuss their attempt to determine the pathogenesis. METHODS: The clinical and microbiological features of five cases of fusobacterial brain abscess are reviewed. Isolates of 2031 Fusobacterium spp. and other anaerobes collected (1989-2002) at our institution were analyzed and compared for incidences and isolation sources. The findings were correlated with extensive literature on the subject. The five patients were men between 45 and 74 years of age. All experienced an insidious onset of the disease and probable hematogenous seeding of the organism(s). One patient had a monomicrobic Fusobacterium necrophorum abscess, whereas the others had polymicrobic F. nucleatum abscesses. Despite surgery and a regimen of antibiotic medications and dexamethasone, three patients experienced a paradoxical deterioration 3 days postoperatively that necessitated reevacuation of the lesion. The evacuants observed at that time contained numerous leukocytes but no microorganisms, suggesting intensified inflammation as the likely cause of deterioration. This explanation is supported by literature that fusobacteria strongly activate neutrophils. An analysis of the 2031 anaerobes from blood, wounds, and abscesses showed the considerable virulence of Fusobacterium spp., which were able to enter and/or sustain themselves in the blood circulation. This pattern was similar to that of Clostridium spp., but different from those of Peptostreptococcus spp., Bacteroides spp., and Prevotella spp., which were less invasive but more abundant. CONCLUSIONS: Some fusobacterial brain abscesses may be associated with a paradoxical postoperative deterioration, which is probably due to intensified inflammation following treatment. The blood-borne dissemination and invasive behavior of fusobacteria likely initiate such a brain abscess, and further seeding of other synergic bacteria leads to a polymicrobic abscess.

Aged↗
PubMed2005

Brain abscesses complicating Staphylococcus aureus sepsis in a premature infant.

Brain abscess is a rare complication of staphylococcal bacteremia in infants. Here we present a case of a premature infant who developed multiple brain abscesses 12 weeks following an episode of inadequately treated Staphylococcus aureus sepsis. The abscess developed in the absence of trauma, prior surgery, cyanotic heart disease, or immune defect. The initial staphylococcal isolate exhibited identical pulsed-field gel electrophoresis pattern with that of the isolate cultured from abscess aspirate. The infant was successfully treated by surgical drainage and administration of antibiotics for 12 weeks, initially teicoplanin and meropenem followed by trimethoprim/sulfamethoxazole, without neurological or developmental sequelae. Staphylococcal bacteremia in neonates should be vigorously treated to prevent life-threatening complications.

Anti-Bacterial Agents↗
PubMed1994

Brain abscess due to infection with Entamoeba histolytica.

We successfully treated a serious case of Entamoeba histolytica infection showing brain abscess, meningitis, and liver abscess by oral administration of metronidazole, intramuscular injection of dehydroemetine, and drainage of the brain abscess. The diagnosis of amebic brain abscess was based on a combination of clinical symptoms and signs, computed tomography and magnetic resonance imaging findings, a positive serologic test result for E. histolytica, a dramatic response to anti-amebic drugs after an ineffective therapeutic history with antibacterial drugs, and application of the polymerase chain reaction method.

Administration, Oral↗
PubMed1991

Multiple brain abscesses caused by Streptococcus bovis.

A case of multiple brain abscesses caused by Streptococcus bovis in a 28-year-old man is described. Infected bronchiectasis is presumed to be the source of infection. Streptococcus bovis infection is a rare cause of brain abscess. The aetiology and manifestations of this infection are discussed.

Adult↗
PubMed1987

[Early diagnosis and complex treatment of brain abscesses of paranasal sinus origin].

The article presents data on 22 inpatients with brain abscesses of rhinosinusogenic etiology who were treated at the Burdenko Institute of Neurosurgery. It was found important that X-ray examination of the paranasal sinuses be carried out in all patients of this group even if they present with no rhioscopic changes, which is explained by an elevated number of torpid and latent sinusites. To detect rhinosinusogenic brain abscesses at an early stage, examination including a series of such objective methods as EEG, Echo-EG, cerebral angiography, gamma-topography of the brain and computer-aided tomography was carried out. A multiple-modality treatment of brain abscesses of rhinosinusogenic etiology was employed: along with complete sanitization of the paranasal sinuses the patients received conservative therapy (antibacterial, antiinflammatory, dehydrational, detoxicational, roborant) combined with various neurosurgical interventions. Radical excision of the abscess together with the capsule was performed in 20 patients, and a puncture method was used in one case. As a result of this combined treatment 19 of the 22 patients in this series were cured and only 3 died.

Adolescent↗
PubMed2004

Diffusion-weighted imaging in the assessment of brain abscesses therapy.

BACKGROUND AND PURPOSE: Surgically or conservatively treated brain abscesses may resolve, or pus may re-accumulate, requiring further intervention or treatment change. We hypothesized that diffusion-weighted (DW) imaging is useful in depicting features of abscesses related to therapeutic success or failure. METHODS: Conventional contrast-enhanced T1- and T2-weighted imaging and DW imaging were performed in seven patients (aged 30-69 years) with proved pyogenic brain abscesses. The center of the abscess was qualitatively and quantitatively analyzed at initial and follow-up imaging in all patients. We correlated the signal intensity on trace DW images and the apparent diffusion coefficients (ADCs) with the clinical and laboratory data, particularly with respect to treatment failure and repeat therapy. RESULTS: Surgical drainage was performed in six patients; one patient was treated with only antibiotics. All abscess cavities initially had high signal intensity (restricted diffusion) on DW images, with a mean ADC value of 0.52 x 10 (-3)mm (2)/s. Low signal intensity at DW imaging with high ADC were seen on follow-up images in the patient receiving medication and in four patients in whom the abscesses were drained; this correlated with a good therapeutic response. Two patients underwent drainage; their second follow-up DW images showed areas of high signal intensity and low ADC values suggesting re-accumulation of pus. Increased C-reactive protein level and WBC count correlated well with DW image findings. CONCLUSION: DW imaging was superior to conventional MR imaging in evaluating the success or failure of abscess therapy. Restricted diffusion in a drained abscess corresponded to pus.

Adult↗
PubMedDate not supplied

In vivo proton MR spectroscopy of untreated and treated brain abscesses.

MR spectroscopy was performed in three patients with brain abscesses. In two patients, MR spectroscopy revealed end-products of bacterial breakdown (acetate, succinate, amino acids, lactate) in the abscess cysts. In one of these, the spectrum was reversed to a single lactate peak after treatment. In the third patient, MR spectroscopy was performed only after treatment and showed a single nonspecific lactate peak. MR spectroscopy is a potential tool for noninvasive diagnosis of brain abscess and might be useful for evaluating changes after treatment.

Aged↗
PubMed1991

[A case of Enterococcus faecalis brain abscess in a patient with suprapharyngeal cancer].

A 55-year-old male was admitted to our hospital for the treatment of suspected brain abscess on March 18, 1989. The brain CT scan showed low density area with ring enhancement. After admission, both cefminox 2 g/day and clindamycin 500 mg/day were administered intravenously. On March 29, 1989, the patient developed cerebral herniation suddenly. Therefore emergency burr hole operation was done. Many gram-positive cocci were observed on gram-staining of the aspirated pus. Moreover neutrophils with phagocytosed gram-positive cocci were also observed. Culture of aspirated pus revealed colonies of gram-positive cocci which were subsequently identified as E. faecalis. Same species of bacteria were also isolated from fistula of right mastoid. From both findings of brain CT scan and data of MICs of E. faecalis, it may be suggested that direct infection developed from right mastoiditis to intracranial space. We experienced a severe case who developed cerebral herniation because of brain abscess due to E. faecalis which is an infrequent pathogen of brain abscess.

Brain Abscess↗
PubMed2006

Multiple brain abscesses following surgical treatment of a perianal abscess.

We report a case of multiple brain abscesses (BAs) in a 67-year-old man with symptoms of progredient disorientation and amnestic aphasia. Onset of symptoms occurred one week after surgical treatment of a perianal abscess. No other source of infection was identified and the abscesses were limited to the brain. The immune status was normal but a patent foramen ovale (pFO) was found. The patient was treated with high-dose antibiotics, leading to a complete radiological disappearance of the BAs. Hematogenous spread of infectious emboli from a perianal focus exclusively to the brain is very rare. In our patient, the mechanisms of infectious spread into the brain might have occurred via a cardiac right-to-left shunt or alternatively via the non-valvular vertebral venous system. In this manuscript, both pathways are critically reviewed.

Aged↗
PubMed1988

Non-traumatic brain abscess. Epidemiology, clinical symptoms and therapeutic results.

Two groups of patients with non-traumatic focal intracranial suppurative diseases were studied retrospectively to illustrate epidemiology, clinical symptoms and therapeutic results. The first group consists of 87 patients treated for brain abscess in the Department of Neurosurgery in Lund. During the 36-year period investigated (1947-1982) marked epidemiological changes occurred. Thus otogenic abscesses, constituting 33% of the cases below the age of 30 during the first 12 years of the study, virtually disappeared. During the third 12-year period of this study a marked increase in the number of abscesses was noted. The increase was caused particularly by the number of cryptogenic abscesses amounting to 51% of the material during 1971-1982. The second group of patients consists of all patients with pre- or post-mortem diagnosed brain abscess in the city of Malmö during 1960-1981. Since during this period 85% of all persons who died in this city were subjected to post-mortem examination this material offers a unique possibility of epidemiological studies. The combined study of these two groups of patients lends no support to the view that a real increase in the number of brain abscesses has occurred. We conclude that in patients with cryptogenic brain abscess the clinical symptoms do not usually indicate the presence of an infectious disease. In the majority of these patients a correct diagnosis has presumably not been obtained until the last decade. Furthermore, the investigation confirms the view that a mortality below 10% is nowadays feasible in unselected cases of brain abscess.

Brain Abscess↗
PubMed1994

[Brain abscess ruptured into the lateral ventricle: the usefulness of treatment by intraventricular irrigation with antibiotics. A case report].

A case is reported of a brain abscess, which ruptured into the lateral ventricle and was treated using intraventricular irrigation with antibiotics. A 37-year-old man was suffering from a headache and high fever. Precontrast CT scan revealed a heterogeneous low density area in the left temporal lobe, and postcontrast CT scan showed a multilobular ring-like enhanced mass. Diagnosed as a brain abscess, intravenous administration of antibiotics was performed. On the sixth day the patient suddenly became drowsy. Postcontrast CT scan revealed an enhanced effect in the left lateral ventricular wall. Drowsiness was attributed to increased intracranial pressure and severe ventriculitis. Bilateral continuous ventricular drainage via the anterior horn of the lateral ventricle was performed. The drainage fluid from the left lateral ventricle was just like pus. Intraventricular irrigation with antibiotics between the bilateral anterior horns of the lateral ventricle, was performed in order to save the patient. The infusion fluid, Lactate Ringer's solution containing Cefazolin sodium, was infused into the right ventricle and CSF-like pus was drained from the left ventricle. The CSF reading gradually improved, and on the 14th day postoperatively irrigation was terminated. The postoperative course was uneventful. The diagnosis, treatment, and prognosis of patients with brain abscesses have improved dramatically as a result of more reliable methods of identifying infecting organisms, more effective antibiotic regimens, the development of microsurgical techniques and CT scan. However, despite these advances, the prognosis for brain abscess ruptured into the ventricle is usually very pessimistic.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

1H MRS of human brain abscesses in vivo and in vitro.

Five patients, each with a brain abscess, were examined by means of 1H MR spectroscopic imaging in vivo. The aspirated pus was analyzed in vitro by means of 1D and 2D COSY 1H MRS. In addition to resonance lines from compounds (lactate, alanine and lipids) often found in the spectra from intracranial tumors, resonance lines were detected from a number of markers of infectious involvement (acetate, succinate, and various amino acids). These results suggest that 1H MRS in vivo might contribute in establishing noninvasively a differential diagnosis between brain abscess and tumor.

Acetates↗