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PubMed2004

Direct detection of bacterial pathogens in brain abscesses by polymerase chain reaction amplification and sequencing of partial 16S ribosomal deoxyribonucleic acid fragments.

OBJECTIVE: To evaluate the feasibility of detecting bacterial pathogens directly from the clinical brain abscess specimens by polymerase chain reaction (PCR) amplification and sequencing of bacterial 16S ribosomal deoxyribonucleic acid (rDNA). METHODS: A total of 14 specimens were tested by both culture and PCR amplification, targeting the full-length or a partial region of 16S rDNA. 16S rDNA is known to be conserved in bacteria. Sequencing of partial-length and full-length 16S rDNA was performed. The sequence data were compared with known sequences of 16S rDNA in the National Center for Biotechnology Information GenBank by using the Basic Local Alignment Search Tool (BLAST) algorithm. The species with the best match of similarity were regarded as the pathogenic species in the samples. We also developed a Streptococcus-specific multiplex PCR analysis for identifying members of the Streptococcus species, the most common pathogen of brain abscesses. RESULTS: The 10 culture-positive specimens were all PCR-positive for partial 16S rDNA, but only seven were positive for full-length 16S rDNA amplification. Bacterial DNA was not detected in the remaining four specimens with a negative culture. Species identification by phenotypes from culture was in agreement with that by sequencing results of partial-length (or full-length) 16S rDNA. The Streptococcus-specific PCR analysis could detect Streptococcus species correctly in one step. CONCLUSION: Bacterial 16S rDNA sequences provide reliable clues to the identification of unknown pathogens. PCR analysis of 16S rDNA and sequencing may identify pathogens to the species level directly from brain abscesses. This approach is rapid and is useful especially in the identification of slow-growing and fastidious organisms.

Adolescent↗
PubMed1999

Asymptomatic brain abscess as a complication of halo orthosis: report of a case and review of the literature.

The halo external orthosis has been used extensively for cervical immobilization after spine surgery or trauma, usually without serious complications. However, nine brain abscesses have been reported as complications following the use of halo orthosis. We report on a 53-year-old man who underwent anterior cervical fusion for cervical myelopathy, followed by the application of a halo orthosis. Approximately 4 weeks postfusion, loosening of the right anterior pin was recognized and the pin was tightened, as the pin-site was clean. One week later, purulent material was discharged from the pin hole when the pin was removed after it had loosened again. Enhanced computed tomography (CT) demonstrated an abscess on the right side of the brain. After the administration of antibiotics, the abscess resolved without surgical intervention. We describe asymptomatic brain abscess complicating the use of a halo orthosis and review the clinical features, symptoms, and outcomes; we also discuss the mechanism that induced brain abscess. Most reported cases of abscess have been associated with pin-site infection or tightening after late pin loosening. The present case indicates the importance of early recognition of symptoms and signs associated with brain abscess in patients with a halo orthosis.

Adolescent↗
PubMed1977

Recurrent brain abscess: manifestation of pulmonary arteriovenous fistula and hereditary hemorrhagic telangiectasia.

A unique case of recurrent brain abscess as the primary manifestation of pulmonary arteriovenous fistula is presented. In the absence of hematologic abnormalities and characteristic physical findings, the diagnosis of pulmonary arteriovenous fistula is particularly elusive. Patients with brain abscess must be carefully evaluated for the presence of pulmonary arteriovenous fistula or hereditary hemorrhagic telangiectasia.

Arteriovenous Malformations↗
PubMed1988

Stereotaxic surgery in the treatment of multiple brain abscesses.

Controversy exists regarding the optimal treatment for patients with multiple brain abscesses. These lesions are often small and located deep in the brain and close to vital structures, making surgery difficult. With this in mind the authors review their experience in treating multiple abscesses using computerized tomography (CT)-guided stereotaxic aspiration. From 1983 to 1985, 15 patients were treated for multiple brain abscesses, of whom eight underwent stereotaxic aspiration. There were a total of 28 abscesses in these eight patients: 11 abscesses were aspirated and two excised using CT-guided techniques. Most were cortical in location, although there were 12 in the deep white matter, one in the thalamus, and two in the caudate nucleus. All patients received a total of 6 weeks of antibiotic therapy. Follow-up CT showed resolution of the abscesses in all patients. Currently, four are neurologically normal, one has a mild hemiparesis, one has a well-controlled seizure disorder, and one requires supportive care. A single death occurred 5 weeks postoperatively of unrelated causes. Location, size, and age of an abscess all have bearing upon the response to management and outcome of the patient. Stereotaxic surgery is a procedure with minimal morbidity and mortality. Stereotaxic aspiration should be considered in patients with small, multiple, or deep-seated abscesses, in those who are poor operative candidates, and in those who have failed prior therapy.

Adult↗
PubMed1980

Experience with brain abscesses treated by simple aspiration.

No deaths have occurred in 15 consecutive cases of intraparenchymatous brain abscesses in Nigerian patients who were treated by aspiration, systemic antibiotics, dexamethasone and anticonvulsants. Four patients had persistent convulsions which responded well to drug therapy and two patients had hemiparesis but were able to return to their jobs. The simplicity of this method of treatment and the results, achieved without the benefit of computerised tomographic scan, raise the question as to whether the recent trend towards excision of brain abscess is justifiable.

Adolescent↗
PubMed1991

Ultrasound-guided aspiration of a neonatal brain abscess.

The authors successfully treated a Serratia marcescens brain abscess in the right parieto-occipital region of a newborn infant born at 27 weeks' gestation and weighing 800 g. Bedside ultrasound-guided aspiration techniques and local anesthesia were used to treat the abscess.

Brain Abscess↗
PubMed1985

Brain abscess after esophageal dilation for caustic stricture: report of three cases.

Of 127 patients with intracranial suppuration (brain abscess and subdural empyema) treated from 1971 to 1984, 3 were children with brain abscesses who previously had developed esophageal stricture from the ingestion of caustic substances. Each child had undergone esophageal dilation on several occasions before the development of focal neurological findings. Surgical resection of the abscess resulted in good to excellent neurological recovery in all 3 patients. Two of the patients have been followed for long periods and have developed other severe illnesses, suggesting a defective immune status. Review of the English literature provides 8 other cases of this complication of esophageal stricture, with which the reported cases are compared.

Adolescent↗
PubMed2005

Brain abscess and hypoxia in a previously healthy young female.

A case of pulmonary arteriovenous malformation and brain abscess is presented. The case report emphasizes the importance of pulmonary arteriovenous malformation which is often seen in hereditary haemorrhagic telangiectasia as predisposing factor for brain abscess formation.

Adult↗
PubMed2002

Redundant ventriculomegaly associated with brain abscess.

OBJECTIVE: The aim of this clinical retrospective review was to emphasize the recently observed high incidence of ventriculomegaly, a wellknown complication of brain abscesses. MATERIALS AND METHODS: Among twelve brain abscess cases operated on in our institution during five years, the most common surgical procedure was burr-hole aspiration applied in ten of the cases, while in the remaining two a standard craniotomy and total excision was performed. Ventriculomegaly was assessed by the "Evans' Ratio" values calculated using the frontal ventricular horn measurements made on axial tomographic images. RESULTS: The signs, symptoms, radiological findings and clinical features of the patients were in accordance to the pertinent literature. The only finding worth commenting on was the surprisingly high incidence of ventriculomegaly (5/12) and periventricular edema (4/12). Concerning the outcome, there was only one death. CONCLUSIONS: The "Evans' Ratio" either worsened or remained the same in four out of five cases during the early postoperative period (ranging from one to three months) and it got better in one case in the late postoperative control (1.5 years). Furthermore, periventricular edema persisted just in the same manner in three of the four cases.

Adolescent↗
PubMed1995

Multiple brain abscesses following esophageal dilation.

A 6-year-old boy esophageal stricture due to the ingestion of caustic 7 months prior to admission. Eight esophageal dilations and a feeding gastrostomy were performed. He presented with seizure, right-sided weakness, fever, and somnolence. Computed tomographic scans revealed multiple brain abscesses. The abscesses were treated by burr-hole drainage. The patient improved and was discharged from the hospital without neurological deficit. Brain abscesses are not very common following esophageal dilation. It should be kept in mind that brain abscess is a potential complication of esophageal dilation.

Brain Abscess↗
PubMed2000

Encephalitis, cerebritis, and brain abscess: pathophysiology and imaging findings.

This article discusses the imaging findings of encephalitis, cerebritis, and brain abscess in immunocompetent patients. MR imaging is the procedure of choice in evaluating suspected intracranial infections because of its inherent contrast resolution, multiplanar capability, improved sensitivity in the posterior fossa, sensitivity to the presence of subacute, and chronic hemorrhage, and its sensitivity to the detection of meningeal disease on postcontrast images. Discussion of pathologic conditions and imaging features of encephalitis are based on the most common causative agents of each type of disease. Imaging features and pathologic conditions of cerebritis and brain abscesses also are reviewed with emphasis on pyogenic bacteria.

Brain↗
PubMed2006

fliP influences Citrobacter koseri macrophage uptake, cytokine expression and brain abscess formation in the neonatal rat.

Citrobacter koseri causes neonatal meningitis frequently complicated with multiple brain abscesses. During C. koseri central nervous system infection in the neonatal rat model, previous studies have documented many bacteria-filled macrophages within the neonatal rat brain and abscesses. Previous studies have also shown that C. koseri is taken up by, survives phagolysosomal fusion and replicates in macrophages in vitro and in vivo. In this study, in order to elucidate genetic and cellular factors contributing to C. koseri persistence, a combinatory technique of differential fluorescence induction and transposon mutagenesis was employed to isolate C. koseri genes induced while inside macrophages. Several banks of mutants were subjected to a series of enrichments to select for gfp : : transposon fusion into genes that are turned off in vitro but expressed when intracellular within macrophages. Further screening identified several mutants attenuated in their recovery from macrophages compared with the wild-type. A mutation within an Escherichia coli fliP homologue caused significant attenuation in uptake and hypervirulence in vivo, resulting in death within 24 h. Furthermore, analysis of the immunoregulatory interleukin (IL)-10/IL-12 cytokine response during infection suggested that C. koseri fliP expression may alter this response. A better understanding of the bacteria-macrophage interaction at the molecular level and its contribution to brain abscess formation will assist in developing preventative and therapeutic strategies.

Adaptation, Physiological↗
PubMed1995

Brain abscess and psychosis as a complication of a halo orthosis.

The halo vest orthosis is commonly used for stabilization after cervical spinal cord injury. Well-documented complications of halo use include skin breakdown, pin loosening, and loss of reduction. Brain abscess associated with halo use has been rarely reported. A case of a 23-year-old man is presented with spinal cord injury and halo stabilization. He developed extreme agitation and psychosis. Diagnostic imaging showed a brain abscess. After treatment for the abscess, his behavioral symptoms resolved. This article reviews the halo orthosis, its possible complications, and its routine management. Early recognition of important signs of symptoms in patients with halos as possible indicators of brain abscess is emphasized.

Adult↗
PubMed1998

[A case of brain abscess accompanied with sudden-onset hemiplegia as initial manifestation].

A 58-year-old male experienced a sudden stroke-like onset of right hemiplegia and numbness of his right upper limb while engaged in his desk-work on April 7, 1997. He had a past history of diabetes mellitus and hyperlipidemia. On admission, he had no fever and the blood pressure was 140/70 mmHg. General physical examination was unremarkable. Neurological examination showed 4/5 strength of his right unilateral extremities and numbness of his right upper limb. Clinical features and computed tomography (CT) without contrast medium at the onset of hemiplegia suggested a stroke. Seven days after admission, his consciousness worsened and body temperature fluctuated between 37 and 38 degrees C. Subsequent Gd-enhanced magnetic resonance (MR) which demonstrated an irregular shaped ring-enhancement lesion and lumbar puncture 9 days after admission was compatible with the diagnosis of brain abscess. Surgical drainage confirmed the presence of brain abscess due to alpha-streptococcus. It improved following surgical drainage and antibiotic therapy with PAPM.BP 2 g/day and PIPC 4 g/day. An afebrile patient of sudden stroke-like onset may be a rarity to be added to the differential diagnosis of brain abscess.

Acute Disease↗
PubMed2002

Treatment of Scedosporium apiospermum brain abscesses with posaconazole.

A 41-year-old man with acute lymphoblastic leukemia developed multiple Scedosporium apiospermum brain abscesses. The infection progressed despite neurosurgical drainage and treatment with itraconazole, amphotericin B, and ketoconazole, but the brain abscesses completely resolved after treatment with posaconazole alone.

Adult↗
PubMed1991

[Health status and quality of life in patients who recovered after surgery for a brain abscess].

The authors examined a group of 13 patients who recovered after operation of a brain abscess. They evaluated also the records of two patients who were unable to attend examination. For examination the WAIS-R test was used, Wechsler's memory test, Benton's test, the Cornell Medical Index 3 and other methods of evaluation. In the group of the 13 examined subjects in 8 instances a pathological deterioration of mental abilities was found, in five patients a psychopathological symptomatology. In one patient the authors detected ethylism with degradation of personality. The results of the investigation suggest a frequent incidence of serious changes after operation of brain abscesses with consequences for the quality of life of the patients and their families.

Adolescent↗
PubMed1983

The influence of steroids on the penetration of antibiotics into brain tissue and brain abscesses. An experimental study in rats.

The interaction between glucocorticoids and antibiotics in the treatment of brain abscesses has been examined in rats. After stereotactic inoculation of Bacteroides melaninogenicus in the right frontal lobe to induce abscess formation, the animals were divided into two groups those treated with antibiotics alone and those treated with both antibiotics and corticosteroids. The antibiotics used, injected 4 days after the bacterial inoculation, were benzylpenicillin, 3H-lymecycline and 14C-metronidazole. The left hemisphere in each animal served as control. Finally a group of animals were inoculated in the right hemisphere with saline and served as controls. Antibiotic assays showed that the use of steroids reduced antibiotic concentration in uninfected and infected tissue with significant reduction in the infected tissue of animals treated with benzylpenicillin and lymecycline. In animals treated with metronidazole, no significant alteration of concentration levels was found. The use of steroids in the treatment of brain abscesses seems to only partially inhibit adequate concentrations of antibiotics in brain tissue dependent upon the antibiotics used.

Animals↗