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Microbiology, chemotherapy and mortality of brain abscess in Newcastle-upon-Tyne between 1979 and 1988.

71 patients admitted to Newcastle Regional Neurosurgical Centre between 1979 and 1988 with a diagnosis of brain abscess are reviewed. The overall mortality was 9.9%, with an operative mortality of 7%. The bacteriology of these abscesses is discussed in detail, together with the importance of effective standardized antimicrobial treatment regimens. The low mortality figures appeared to be in direct relationship to early recognition of this condition, prompt surgical intervention and effective chemotherapy.

Ampicillin↗

Haematogenous brain abscess complicating a case of Austrian syndrome.

Austrian syndrome includes pneumococcal endocarditis, meningitis and rupture of the aortic valve. This study reports a case with a haematogenous brain abscess. Physicians should be aware of the risk factors and dramatic evolution of this rare disease, to avoid delays in diagnosis, and to prevent embolic complications and rupture of the aortic valve.

Aortic Valve Insufficiency↗

Citrobacter sedlakii meningitis and brain abscess in a premature infant.

Citrobacter sedlakii was isolated from blood and cerebrospinal fluid cultures of a 5-day-old premature infant with sepsis, meningitis, and brain abscess. This newly described organism was difficult to identify due to discrepancies between the Vitek and API 20E identification systems. To our knowledge, this is the first report of the isolation of C. sedlakii from cerebrospinal fluid.

Brain Abscess↗

Brain abscess following mastitis in a 3-month-old infant.

Neonatal mastitis is rare and generally carries a good prognosis, once treated appropriately, but systemic spread could lead to complications. A case of a 3-month-old infant is presented who developed a brain abscess associated with neonatal mastitis.

Brain Abscess↗

[Brain abscess in patients with cyanotic heart defects].

As a result of hypoxia following right-to-left shunts, cerebral bacterial spreading and an altered blood-brain-barrier permeability, brain abscesses (BA) are typical complications in patients with cyanotic congenital heart disease. In 483 prospectively followed patients the incidence of BA was 0.45%/year. It was higher (0.57%/year) for patients with tetralogy of Fallot where the cumulative risk within the first two decades of life was 12.1 +/- 1.7%. The risk of BA complicating cyanotic heart disease is inconstant and continuously increasing up to approximately age 12 (instantaneous risk at that time: 1.75 +/- 0.12%), decreasing thereafter. With respect to etiology, infectious endocarditis, infections per continuitatem, bacterial meningitis, bacterial lung diseases with intrapulmonary shunts, and thromboembolic complications of systemic infections have to be differentiated. The stepwise diagnosis includes CCT to demonstrate the typical contrast enhancement and a lumbar puncture which shows granulocytic pleocytosis. If the cerebral spinal fluid fails to demonstrate the typical findings, cerebral angiography may be necessary to exclude a malignant vascularized neoplasma. In cases of doubt, stereotactic cerebral biopsy should be performed. Optimal antibiotic therapy after determining the minimal bactericidal concentration and combination of antibiotics is of utmost prognostic significance. Cranial computed tomography should be repeated after 6, 14, and 24 days. Infections resistant to antibiotics may necessitate local instillation of antibiotics.

Adolescent↗

Time dependence of serial diffusion-weighted imaging features in a case of pyogenic brain abscess.

Both signal intensity on trace images and apparent diffusion coefficient measurements on mapped images evolved rapidly on serial diffusion-weighted sequences in a case of pyogenic brain abscess that was monitored primarily by MRI before a biopsy was performed. Considering only the signal intensities on the trace images would have led to an underestimation of the intrinsic tissue changes.

Adolescent↗

[Serratia marcescens brain abscess in a newborn].

The patient was born by emergency cesarean section for fetal distress at 35 weeks gestation with a weight of 2740 g. The early neonatal course was complicated by transient tachypnea and renal failure. He was receiving oxygen and diureticus in incubator for 5 days and his condition was very improved on day 5. On day 7 he became lethargy and there was inability to tolerate feeding. Investigation of the cerebrospinal fluid revealed 8,000 leukocytes/microliter. S. marcescens was grown from cultures of both blood and cerebrospinal fluid. Treatment was started with cefotaxime and ampicillin every 6 hour. On day 14 the CT showed a brain abscess located parietooccipitally on the left side and diffuse infarction on the right side. On day 14 and 23 recurrence of increased leukocytes in the cerebrospinal fluid, high values of serum CRP and deterioration of clinical symptoms were observed. It is thought that the episodes show rupture of the abscess into the lateral ventricle. On day 55 surgical drainage was performed for the hydrocephalus. On day 110 the abscess was not found in the brain CT scan. His psychomotor development 3 years later was equivalent to two years old and he had secondary epilepsy.

Brain Abscess↗

Nocardial brain abscesses in a pregnant woman.

We describe what we believe to be the second case in which a pregnancy was complicated by the formation of brain abscesses due to Nocardia asteroides; this case may be the first one in which no risk factor for the infection (other than the pregnancy itself) could be found. Craniotomy with surgical drainage of the abscesses, combined with prolonged antimicrobial therapy, led to clinical cure in the mother, and she gave birth to an unaffected infant. This case illustrates the difficulty in treating a nocardial infection of the brain during pregnancy as well as the importance of achieving adequate surgical drainage of the abscesses.

Adult↗

Brain abscess caused by Nocardia cyriacigeorgica in a patient with human immunodeficiency virus infection.

Nocardia cyriacigeorgica is a recently characterized species within the genus of Nocardia. We report a brain abscess, following a primary pulmonary colonization, due to this species in a human immunodeficiency virus-infected patient. This case confirms that isolation of Nocardia in sputum is associated with a high risk of disseminated infection in immunocompromised patients.

AIDS-Related Opportunistic Infections↗

Cure of brain abscess caused by Nocardia asteroides resistant to multiple antibiotics.

A 29-year-old man with pulmonary infiltrates due to pulmonary alveolar proteinosis had Nocardia asteroides pneumonia and brain abscess. The nocardial infections persisted after therapy with sulfonamides, minocycline, and cefotaxime. Based on the susceptibility studies and serum antibiotic concentrations, he was treated with minocycline, 400 to 600 mg daily, cefotaxime, 12 to 30 gm daily, and probenecid for 15 months. Proteinuria observed near the completion of therapy was transient. Three years after therapy, the infections appear to have been cured.

Adult↗

[Brain abscess].

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Brain Abscess↗

Pulmonary arteriovenous malformations, hereditary hemorrhagic telangiectasia, and brain abscess.

Hereditary hemorrhagic telangiectasia (HHT) is a systemic angiodysplasia inherited as an autosomal dominant disease. Patients with HHT and pulmonary arteriovenous malformations (PAVMs) are at increased risk for brain abscess (BA), a potentially preventable condition as effective treatment for PAVMs is available. In a center dedicated to HHT, a history of BA was found in 6 out of 128 patients with a definite diagnosis: herewith, their histories are reported focusing on mistakes in the diagnosis and management of the disease. Patients with PAVMs and BA had a higher mean hemoglobin concentration (15.1 g/dl vs. 12.2 g/dl, p < 0.006 by Student's t test) compared to patients with PAVMs alone. Other clinical features (genetics, bacteriology, types of PAVMs, treatments, outcomes) are also discussed. Prompt diagnosis and screening for visceral involvement is pivotal for HHT patients and their relatives.

Adult↗

Recurrent brain abscesses in an HIV-positive patient with hereditary hemorrhagic telangiectasia and arteriovenous malformations of the lung.

Patients with hereditary hemorrhagic telangiectasia are at risk for the development of brain abscesses. The history of a 47-year-old man infected with the human immunodeficiency virus and with hereditary hemorrhagic telangiectasia is reported. Within eight months, the patient presented twice with life-threatening cerebral abscesses at different sites. On both occasions, Streptococcus anginosus was cultured from the abscess material. Treatment consisted of parenteral antibiotics and neurosurgical drainage. After treatment of the second occurrence, the patient was placed on a prophylactic regimen of clindamycin. He remains relapse-free and is clinically stable 24 months after the second episode.

Anti-Bacterial Agents↗

Recurrent brain abscess due to an unexpected foreign body.

We report an exceptional case of a patient with chronic frontal sinusitis complicated by chronic osteomyelitis and a cutaneous fistula. A recurrent brain abscess developed and was only cured after a very unusual wooden retained foreign body was removed at surgery. The hazards of wood as a foreign body are discussed and it is stressed that the possibility of a retained foreign body, even unsuspected, must always be borne in mind.

Adult↗