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PubMed2000

Successful treatment of aspergillus brain abscess in a child with acute lymphoblastic leukemia.

Cerebral aspergillosis carries a high mortality in immunocompromised patients. However, favorable outcome can be achieved by the prolonged use of antifungal agents and the maintenance of adequate drug levels. The authors report a 2-year-old girl who developed an aspergillus brain abscess during treatment for acute lymphoblastic leukemia. Predisposing factors for the fungal infection and details of the antifungal therapy are described. Prolonged treatment with AmBisome and 5-flucytosine successfully eradicated the lesion, but the girl's antileukemic therapy was compromised due to the infection. She developed a central nervous system and bone marrow relapse 9 and 15 months, respectively, after the initial presentation. The report emphasizes the need for further consideration of effective, long-term antifungal prophylaxis and a careful balance between aggressive treatment for severe infection and antileukemic therapy.

Amphotericin B↗

PubMed2005

Successful treatment of aspergillus brain abscess in a child with acute lymphoblastic leukemia and liver failure.

Invasive fungal infection continues to pose a significant threat to immunocompromised patients, with cerebral aspergillosis being among the most feared ones. The authors describe an adolescent girl with acute lymphoblastic leukemia (ALL) with subsequent acute liver failure, who developed an aspergillus brain abscess. The patient was treated with combined antifungal therapy using amphotericin B local instillation, prolonged systemic amphotericin B colloidal dispersion along with vinca alkaloids-containing chemotherapy, followed by neurosurgical débridement and oral voriconazole in the setting of ongoing antileukemic maintenance chemotherapy. Her ALL remains now in complete remission 30 months from diagnosis, with no evidence of fungal infection.

Adolescent↗

PubMedDate not supplied

Sinogenic brain abscess.

The otolaryngological contribution to the combined treatment of intracranial suppuration secondary to sinusitis can vary from observation to external approach sinus exploration. Limited surgical intervention using the endoscopic approach, in conjunction with neurosurgical drainage, has recently been adopted at our department as the initial therapeutic strategy in the management of such cases. A retrospective analysis of the otolaryngological input into the treatment of 16 patients with sinogenic brain abscess at the Department of Otolaryngology/Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland is presented. This study reveals that it is generally a disease of young adult males without an antecedent history of sinus disease and that Strep. Milleri is the most common causative organism. It is demonstrated that there is a lack of a consistent approach to the management in the acute phase and that there is an inadequate initial radiologic evaluation of the paranasal sinuses. There are two forms of presentation: 1) an ENT complaint with development of an abscess, and 2) an idiopathic abscess with subsequent identification of a paranasal sinus infective source. Extensive initial intervention seems to be associated with an increased incidence of revision surgery, thus suggesting that a limited endoscopic approach combined with neurosurgical drainage is the optimal course in the first-line management of sinogenic abscess.

Adolescent↗

PubMed1998

Brain abscess caused by Salmonella enteritidis in an immunocompetent adult patient: successful treatment with cefotaxime and ciprofloxacin.

A previously healthy 43-y-old man, who had spent 2 weeks in northern India, was admitted to hospital after a 2-day history of pyrexia, confusion and frontal headache. Cranial computerized tomography (CT) showed an abscess in the right parietal lobe. Spinal fluid and blood cultures gave growth of Salmonella enteritidis within 24 h. Treatment with cefotaxime was initiated, but ceased after 3 weeks due to drug fever, and ciprofloxacin was then given orally for 4 months. After 6 months, the patient was considered cured. Cases of salmonella brain abscesses are reviewed.

Adult↗

PubMed2000

Brain abscess at the University Hospital of the West Indies.

Surgical infections of the central nervous system are still attended by high rates of morbidity and mortality, although substantial progress has been made since the advent of computed tomography (CT) scanning technology. In this retrospective review of 25 surgically treated patients with either brain abscess or subdural empyema at the University Hospital of the West Indies, the majority of patients were male and between the ages of 10 and 30 years with a mean age of 16.9 years. Almost half the patients had a hemiparesis on presentation while 60% had fever. Subdural empyema was more common than a localized intracerebral abscess which was most frequently located in the frontal lobe. The most common predisposing factors were sinusitis and congenital heart disease. Streptococci spp and Staphylococci spp were the most frequently isolated organisms. All patients underwent CT scanning and surgical intervention. The mortality rate was 20%, and 21% of the survivors had late seizures. There must be a high index of clinical suspicion and early referral to specialist centres where neuroradiological investigation and prompt neurosurgical intervention can be carried out to minimize morbidity and mortality.

Adolescent↗

PubMed2005

First successful treatment of Nocardia farcinica brain abscess with moxifloxacin.

Nocardia farcinica is an emerging pathogen in immunosuppressed patients causing both localized and disseminated infections. Many strains of this species are multidrug-resistant and require long-term antibiotic therapy, and consequently the choice of an oral treatment can be problematic. We report here the first case of successful treatment of N. farcinica brain abscess in a renal transplant recipient with an extended-spectrum fluoroquinolone, moxifloxacin.

Anti-Infective Agents↗

PubMed2005

Vertically acquired neonatal citrobacter brain abscess - case report and review of the literature.

Vertically acquired citrobacter meningitis in the neonate is very rare and carries a very high mortality and morbidity. Overall, approximately 30% of neonates with Citrobacter meningitis die and 50% sustain some damage to the CNS. The authors describe a case of a newborn with Citrobacter koseri meningitis with multiple brain abscesses, with a successful outcome following multiple burr-hole aspirations and prolonged antibiotic therapy. An aggressive surgical approach combined with intravenous antibiotics (including imipenems, to which the organism is very sensitive) for a minimum of 4 weeks appears to improve the outcome of infection with this virulent organism.

Anti-Bacterial Agents↗

PubMed2005

[Pulmonary nocardiosis complicated with multiple brain abscess].

A 52-year-old woman was taking 10 mg of prednisolone on alternate days for the treatment of autoimmune hemolytic anemia. She was informed of an abnormality on a chest X-ray film about 3 months previously and was admitted to our hospital with sudden onset of chest pain and fever. On the following day, she underwent transthoracic needle biopsy and the lung lesion was diagnosed as pulmonary nocardiosis. She showed improvement of fever and the lung lesion with administration of an antibacterial agent, but suddenly developed vomiting and headache. Brain MRI revealed multiple brain abscesses at more than 20 sites. A subsequent change of the antibacterial agent achieved control of the lung lesion and brain lesions. This case shows that prednisolone can cause nocardiosis as an opportunistic infection even at a low dose and that antibacterial agents act differently on the lung and brain lesions caused by this organism.

Anemia, Hemolytic, Autoimmune↗

PubMed1999

[Direct Gram staining of blood culture sample enabled the early diagnosis of brain abscess due to Listeria monocytogenes].

A 58 year old woman had a long history of immunocompromised state. Since age 28 she had multiple endocrine neoplasm type 2A: her thyroid gland and bilateral adrenal glands were removed because of pheochromocytoma and thyroid medullary carcinoma. Corticosteroid and levothyroxine were supplemented. At age 57 she was afflicted with systemic lupus erythematodes and nephrotic syndrome. Prednisolone therapy was started. Two months later she developed fever, lethergy, headache and left hemiparesis. MRI revealed multiple ring-enhancing lesions in the right cerebrum. CSF was negative for microorganisms. Blood culture hemolysed after 24 hours. Direct gram staining of the blood culture sample revealed gram-positive short rods without spore, suggested listeria. This enabled prompt initiation of high dose penicillin therapy before the official report of listseria infection. Neurological abnormality including left hemiparesis disappeared completely within one month. Enhancement of abscess wall decreased every month, but it persisted for five months despite continuous intravenous penicillin therapy. Listeria monocytogenes is well-recognized as an opportunistic pathogen. It requires prolonged therapy with antibiotics, since it is the intracellular organism. Monitoring of the brain abscess wall by the enhanced MRI is useful to determine the completion of therapy. Since listerial contamination is common among raw meat and unpasteurized milk, immunocompromised patients should be alarmed not to eat uncooked food products.

Bacteriological Techniques↗

PubMed2001