Pediatric brain abscess – etiology, management challenges and outcome in Lagos Nigeria

Background: Brain abscess in children is a neurosurgical emergency with potentially catastrophic outcome despite the advances made in neuroimaging techniques and antibiotic therapy. Symptoms are nonspecific and may vary with the child’s age, location, size, numbers and stage of abscess, and the primary source of infection. Treatment is usually with broad-spectrum antibiotics in combination and surgical evacuation in most cases or antibiotics alone in selected cases with clear-cut indications. This study was to document clinical characteristics, etiological factors, and spectrum of bacteriologic agents responsible for pediatric brain abscess in an African city, the challenges and management outcome over the study period. Methods: This was a retrospective study over an 11-year period involving 89 children who presented with brain abscess. Information of interest was extracted from the medical records of each participant. The results from data analysis were presented in charts and tables. Results: Eighty-nine children aged 0.85–15.7 years (median age of 6.4 years) met the inclusion criteria. The male-to-female ratio was 1.8:1. Headache (80%), fever (78%), and hemiparesis (78%) were the most common symptoms. Brain imaging deployed was CT scan in 56 (63%), MRI in 9 (10%), and transfontanel ultrasound scan in 24 (27%) children. Seventy-one (80%) children had antibiotics with surgical evacuation while 18 (20%) children received only antibiotics. In 19 (27%) children, the culture of the abscess was negative. In 53 (75%) children, Gram-positive aerobic organisms were isolated. A total of 75 patients (84%) had a favorable outcome. Conclusion: Pediatric brain abscess still poses significant public health challenge, especially in resource-limited regions. Successful management of brain abscess requires high index of suspicion for early diagnosis, referral, and intervention.

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Spectrum of Severe Sepsis in Critically Ill Adult Patients of Bangladesh: A Prospective Observational study

Bangladesh Critical Care Journal ◽

10.3329/bccj.v3i2.25102 ◽

2015 ◽

Vol 3 (2) ◽

pp. 45-48

Author(s):

Fatema Ahmed ◽

Mohammad Omar Faruq ◽

ASM Areef Ahsan ◽

Kaniz Fatema ◽

Md Shah Zaman

Keyword(s):

Severe Sepsis ◽

Organ Dysfunction ◽

Primary Source ◽

Cross Sectional Study ◽

Preventive Strategy ◽

Cross Sectional ◽

Female Ratio ◽

Source Of Infection ◽

Specific Objective ◽

Organ Dysfunctions

Background: Severe sepsis is the leading cause to Intensive Care Unit (ICU) admission. However few studies have described the primary source of the severe sepsis in Bangladesh.Objectives: General objective was to identify the clinical presentation of infection in severe sepsis patients & specific objective was to determine the primary and commonest source of infection in severe sepsis.Methods: This was a prospective cross sectional study done over seven months period starting from June 1, 2012 to December 31, 2012 in the dept. of Critical Care Medicine of BIRDEM General Hospital. All ICU admissions from the emergency department, medical and surgical in patients who were screened daily for the presence of severe sepsis or septic shock using a screening tool, which included definitions of sepsis and organ dysfunctions. All consecutive patients with severe sepsis were enrolled as study subjects.Results: A total of 228 patients were admitted in ICU and among them, 95 patients of severe sepsis were included . The mean age of the patients was 59.56 years & male to female ratio being 3:2. Ninety two (92% ) patients had any kind of comorbidity. Commonest comorbidity was diabetes mellitus (77%). Respiratory, renal dysfunction, and cardiovascular, were the most frequent organ dysfunctions (87% , 64%, 58%, respectively). In severesepsis patients single organ dysfunction was 30 %, double organ dysfunction was also 30% & triple organ dysfunction was 35% of patients. The most common primary source of infection were the respiratory system 70%, followed by urinary tract11% , intravascular catheter related infection 7% and abdomen 5%.Conclusion: Severe sepsis is a significant & common health problem in ICU Patients of Bangladesh. An understanding of the primary sources of severe sepsis is vital for treatment and these information will allow us to make preventive strategy for severe sepsis.Bangladesh Crit Care J September 2015; 3 (2): 45-48

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Brain Abscess in the Current Decade (2010–2019) in India—A Review

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1725230 ◽

2021 ◽

Author(s):

R. Ravikumar ◽

Daisy Vanitha John

Keyword(s):

Brain Abscess ◽

Multidisciplinary Treatment ◽

Treatment Strategies ◽

Primary Source ◽

Neurosurgical Procedures ◽

Suppurative Otitis Media ◽

Patients Âgés ◽

Source Of Infection ◽

Middle Ear Infection ◽

Microbiological Techniques

AbstractBrain abscess outcomes have improved in recent years due to advancements in cranial imaging, microbiological techniques, minimally invasive neurosurgical procedures, and effective antibiotic treatments. However, the incidence of brain abscess remains unchanged in developing countries. We searched PubMed and Google Scholar for references using the key words “brain abscess” and “India” and reviewed both retrospective and prospective studies published in peer-reviewed journals in the current decade to understand the present status. The review shows that the patients’ ages, the predominance of male patients, the symptoms and locations of brain abscesses, and the types of bacteria associated with them have remained unchanged over the past decade. The most common predisposing condition in recent years has been chronic suppurative otitis media with a mortality rate of 7 to 10%. Middle ear infection is often neglected and not treated aggressively in Asian countries. It requires multidisciplinary treatment strategies to address the primary source of infection and better health awareness to prevent the development of brain abscess.

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Clinical outcomes following surgical management of brain abscess in a tertiary care centre: retrospective analysis of 56 cases

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20200014 ◽

2020 ◽

Vol 8 (2) ◽

pp. 430

Author(s):

V. V. Ramesh Chandra ◽

B. C. M. Prasad ◽

V. Niranjan ◽

Nitin Manohar Barde

Keyword(s):

Brain Abscess ◽

Clinical Features ◽

Clinical Symptoms ◽

Tertiary Care ◽

Primary Source ◽

Complete Recovery ◽

Burr Hole ◽

Tertiary Care Centre ◽

Source Of Infection ◽

Life Issues

Background: Despite the advent of newer antibiotics and surgical strategies, the overall outcome and quality of life issues in Brain Abscess (BA) patients remain a continuous challenge for the neurosurgical community.Methods: Fifty-six patients with BA are analyzed retrospectively, that treated between January 2014 and June 2019, according to age, the clinical symptoms, etiologic factors, infecting organisms, prognostic factors, localization, diagnostic and treatment methods and outcome.Results: In acute cases, common clinical features were headache, fever, vomiting, focal deficit and seizure. In chronic abscesses, common clinical features were mild to moderate headache and progressive focal deficit. In 12(21.42%) patients had adjacent localized sinus, middle ear infection. In 27(48.21%) patients no primary source of infection was identified, predisposing factors included post neurosurgery (8.92%), post penetrating injury (3.57%), and congenital heart disease, infective endocarditis, sinusitis. The frontal lobe involved in 28.5% cases, temporal lobe and cerebellum are next to be involved. Burr hole aspiration in 29(51.78%) cases, a craniotomy was done in 15(26.78%) cases. Pus culture was negative in 36 (64.28%) cases. Mortality was noted in 2(3.57%) cases. Complete resolution of the abscess with complete recovery of preoperative neuro-deficit was seen in 71.42% cases and recovery with major neuro-deficit was observed in 16.07% cases. The best outcome was seen with a better Glasgow Coma Scale (GCS) on admission.Conclusions: BA, when surgery is required, should be done on an emergency basis. BA treated with burr hole aspiration shows excellent clinical and radiological response. A craniotomy is required in selected cases and is a primary procedure in cerebellar, postoperative and posttraumatic abscesses. Broad-spectrum antibiotic therapy should be administered for a period of minimum 6 weeks to prevent relapse.

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Parvimonas micra: A potential causative pathogen to consider when diagnosing odontogenic brain abscesses

Surgical Neurology International ◽

10.25259/sni_20_2020 ◽

2020 ◽

Vol 11 ◽

pp. 140

Author(s):

Ruth Prieto ◽

Alejandro Callejas-Díaz ◽

Rasha Hassan ◽

Alberto Pérez de Vargas ◽

Luis Fernando López-Pájaro

Keyword(s):

Antibiotic Therapy ◽

Brain Abscess ◽

Primary Source ◽

16S Rrna Gene Sequencing ◽

Rrna Gene ◽

Sequencing Analysis ◽

Surgical Drainage ◽

Source Of Infection ◽

Parvimonas Micra ◽

Brain Abscesses

Background: Brain abscess is a life-threatening entity which requires prompt and long-term antibiotic therapy, generally associated with surgical drainage, and eradicating the primary source of infection. Parvimonas micra (Pm) has only been reported once before as the lone infecting organism of an orally originated, solitary brain abscess. Diagnosing brain abscesses caused by this Gram-positive anaerobic coccus, constituent of the oral cavity flora, is challenging, and an optimal treatment regimen has not been well established. We report the diagnosis and successful treatment of a Pm caused odontogenic brain abscess. Case Description: A 62-year-old immunocompetent male with a right-parietal brain abscess presented with headache and seizures. He was started on empirical antibiotic therapy and subsequently underwent surgical drainage. The only source of infection found was severe periodontitis with infected mandibular cysts. Thus, tooth extraction and cyst curettage were performed 1 week after brain surgery. Cultures of brain abscess fluid were negative, but amplification of bacterial 16S ribosomal RNA (rRNA) with polymerase chain reaction demonstrated Pm. After 3 weeks of intravenous ceftriaxone and metronidazole, the patient was switched to oral metronidazole and moxifloxacin for 6 weeks. Conclusions: This case highlights the potential risk of untreated dental infections causing brain abscesses. Pm should be considered as a possible pathogen of odontogenic brain abscesses despite its presence usually not being detected by standard bacterial cultures. Therefore, 16S rRNA gene sequencing analysis is strongly recommended for bacterial identification before defining brain abscesses as cryptogenic.

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Pediatric brain abscess clinical profile, management and outcome at tertiary care centre in Nepal

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v14i2.20339 ◽

2018 ◽

Vol 14 (2) ◽

pp. 102-106

Author(s):

Prakash Kafle ◽

Mohan Raj Sharma ◽

Sushil Krishna Shilpakar ◽

Gopal Sedain ◽

Amit Pradhanang ◽

...

Keyword(s):

Brain Abscess ◽

Pediatric Population ◽

Tertiary Care ◽

Clinical Profile ◽

University Teaching ◽

Institute Of Medicine ◽

Tertiary Care Centre ◽

Female Ratio ◽

Profile Management ◽

Pediatric Brain

ABSTRACTBackground: Brain abscess in pediatric population is serious life threatening problem. Many risk factors are associated with this entity like congenital heart disease, ear infection and immunocompromised state. Early diagnosis and treatment with minimal invasive procedure has good outcome. Materials and Methods: This is a hospital based cross-sectional study conducted at institute of Medicine (IOM), Tribhuvan University Teaching Hospital Kathmandu, Nepal over the period of 3 years between September 2014 to August 2017. Clinical profile, management and outcome were analyzed. Results: A total of 27 cases were taken for the surgical management in the present study. There were 18 male and 9 female with the male to female ratio of 2:1. Mean age of the study population was 7.08 years. Otogenic Abscess was the most common 37.03% (n=10) and the temporal lobe was the most common site (37.5%). Headache was the most common clinical presentation seen in 74.07 %. All the cases were initially managed with the burrhole and aspiration. Only 14.8 %( n=4) of cases subsequently required surgical excision of the abscess wall. Only18.5 %( n=5) of the cases required multiple session aspiration. Positive culture was seen in 25.9% (n=7). Pseudomonas aeruginosa and E.coli were the commonest organisms grown. Mortality rate was 3.7%.Conclusion: Modern advances in radio imaging and multidisciplinary team involvement has decreased the morbidity and mortality.Keywords: otogenic brain abscess; pediatric brain abscess; tubercular abscess.

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Sinogenic intracranial complications

The Journal of Laryngology & Otology ◽

10.1017/s0022215100131731 ◽

1995 ◽

Vol 109 (10) ◽

pp. 945-950 ◽

Cited By ~ 72

Author(s):

Bharath Singh ◽

James Van Dellen ◽

Shanil Ramjettan ◽

Tejprakash J. Maharaj

Keyword(s):

Ct Scan ◽

Brain Abscess ◽

Primary Care Physicians ◽

Primary Source ◽

Subdural Empyema ◽

Mortality And Morbidity ◽

Source Of Infection ◽

Threatening Condition ◽

Intracranial Complications ◽

Serious Disease

AbstractTwo hundred and nineteen patients, with intracranial complications of sinusitis, are presented. Sinusitis is still a life-threatening condition and if neglected, or mismanaged, can lead to intracranial complications that result in a high mortality and morbidity.Twenty-two patients had meningitis, 127 subdural empyema, 38 brain abscess, 15 combined brain abscess and subdural empyema and 17 extradural empyema. The diagnosis of intracranial abscess and sinusitis was made with the aid of a CT scan, and that of meningitis on cerebrospinal fluid microscopy, chemistry and culture. The most frequent presenting signs were fever (68 per cent) and headache (54 per cent). The most common localizing neurological sign was hemiparesis (35.5 per cent). Orbital inflammation was present in 41.5 per cent of patients.Treatment entailed immediate, appropriate, intravenous antibiotic therapy and prompt surgery, performed within 12 hours of admission. In patients with meningitis, the surgery entailed surgery of the sinus disease only. In patients with subdural empyema, brain abscess and extradural empyema, evacuation of the primary source of infection by the radical frontoethmoidectomy approach, immediately after drainage of the intracranial collection of pus, was carried out.There were 35 deaths (16 per cent). The highest mortality rate was recorded in patients with meningitis (45 per cent) followed by brain abscess (19 per cent) and subdural empyema (11 per cent). Despite advances in medicine, i.e. antibiotics and CT scan for early and accurate diagnosis, the mortality from sinogenic intracranial complications has remained significant. This can only be eliminated through education. This paper emphasizes to younger generations of otolaryngologists and primary care physicians that sinusitis is a serious disease and there is no place for delay or complacency when managing such patients.

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Analysis of the treatment of 12 consecutive cases of brain abscess

Journal of Neurosurgery ◽

10.3171/jns.1972.37.2.0182 ◽

1972 ◽

Vol 37 (2) ◽

pp. 182-184 ◽

Cited By ~ 8

Author(s):

Zacharias Kapsalakis ◽

Helen C. Askitopoulou ◽

Athanasios Gregoriades

Keyword(s):

Mortality Rate ◽

Brain Abscess ◽

Primary Source ◽

Simultaneous Treatment ◽

Content Type ◽

Brain Scans ◽

Source Of Infection ◽

Focus Of Infection ◽

Symptoms And Signs ◽

Fine Print

✓ An analysis of 12 consecutive cases of brain abscess is reported. In nine patients a distant focus of infection was identified in the middle ear, the cranial sinuses, the lungs, the pleura, the tonsils, or the skull. The most frequent early symptoms and signs were headache, vomiting, papilledema, focal neurological abnormalities, and pyrexia. Angiography, electroencephalography, and brain scans were abnormal in all cases in which they were obtained. Therapy was based on early diagnosis with accurate location, aspiration or excision of the abscess, use of chloramphenicol instead of penicillin, use of steroids, the accomplishment of simultaneous treatment of the primary source of infection, and reevaluation of the patient some time after discharge. The mortality rate was 8% and the morbidity 8%; the six patients with postoperative epilepsy have returned to normal life.

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Severe Sepsis Attributable to Community-Associated Methicillin-Resistant Staphylococcus aureus: An Emerging Fatal Problem

The American Surgeon ◽

10.1177/000313480707300709 ◽

2007 ◽

Vol 73 (7) ◽

pp. 684-687 ◽

Cited By ~ 8

Author(s):

Eric T. Castaldo ◽

Edmund Y. Yang

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Soft Tissues ◽

Hospital Admissions ◽

Primary Source ◽

Necrotizing Pneumonia ◽

Inclusion Criteria ◽

Methicillin Resistant ◽

Cardiorespiratory Failure ◽

Source Of Infection

We observed a number of cases of sepsis from bacteremia in children from community-associated methicillin-resistant Staphylococcus aureus (MRSA), which led us to study its patterns of infection and outcome. A retrospective review identifying children admitted to our institution with blood culture-proven community-associated MRSA sepsis over a 2-year period was performed. The inclusion criteria were younger than 19 years old, two or more blood cultures for MRSA within 48 hours of admission, evidence of systemic inflammatory response syndrome, and no prior hospital admissions within 6 months. Eight patients were included; seven required mechanical ventilation. Vasopressors were required in seven patients. Four patients required extra-corporeal membrane oxygenation. Four patients had culture-proven septic arthritis or thrombophlebitis and three of these patients developed bilateral necrotizing pneumonia. Bilateral necrotizing pneumonia was identified in the other four patients, but the primary source of infection was never identified. The overall intact neurologic survival was 50 per cent. Children with severe community-associated MRSA sepsis can rapidly progress to cardiorespiratory failure. Mortality appears to be high, and children may benefit from a search of their soft tissues and joints to identify the source of infection to prevent embolic dissemination.

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Streptococcus salivarius endogenous endophthalmitis

BMJ Case Reports ◽

10.1136/bcr-2020-239299 ◽

2021 ◽

Vol 14 (2) ◽

pp. e239299

Author(s):

Carl-Joe Mehanna ◽

Lea Kallassi ◽

Ahmad M Mansour ◽

Rola N Hamam

Keyword(s):

Opportunistic Infections ◽

External Source ◽

Endogenous Endophthalmitis ◽

Streptococcus Salivarius ◽

Source Of Infection ◽

Transcatheter Aortic Valve ◽

History Of ◽

Atypical Presentations ◽

High Index Of Suspicion ◽

Valve Implantation

We describe a case of endogenous endophthalmitis in an elderly man caused by Streptococcus salivarius. An 88-year-old male patient with diabetes with iron deficiency anaemia and history of transcatheter aortic valve implantation presented with an insidious clinical picture of atraumatic endophthalmitis. No internal or external source could be identified. Diagnostic and therapeutic vitrectomy revealed papillomacular abscess and vitreous fluids grew S. salivarius. Despite lack of an identifiable source of infection, a high index of suspicion for atypical presentations is required in patients with multiple comorbidities that could weaken their immune system towards opportunistic infections. Early detection, microbiological evaluation and prompt treatment are critical to avoid disastrous outcomes. While S. salivarius has been implicated in cases of exogenous endophthalmitis, this is the first reported case of endogenous endophthalmitis due to S. salivarius.

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Proteogenomic Discovery of Neoantigens Facilitates Personalized Multi-antigen Targeted T cell Immunotherapy for Brain Tumors

10.1101/2021.08.13.456263 ◽

2021 ◽

Author(s):

Samuel Rivero-Hinojosa ◽

Melanie Grant ◽

Aswini Panigrahi ◽

Huizhen Zhang ◽

Veronika Caisova ◽

...

Keyword(s):

T Cell ◽

Brain Tumors ◽

Safety Margin ◽

Primary Source ◽

Pediatric Brain Tumor ◽

Cell Therapies ◽

Cell Immunotherapy ◽

Pediatric Brain ◽

T Cell Immunotherapy

ABSTRACTNeoantigen discovery in pediatric brain tumors is hampered by their low mutational burden and scant tissue availability. We developed a low-input proteogenomic approach combining tumor DNA/RNA sequencing and mass spectrometry proteomics to identify tumor-restricted (neoantigen) peptides arising from multiple genomic aberrations to generate a highly target-specific, autologous, personalized T cell immunotherapy. Our data indicate that novel splice junctions are the primary source of neoantigens in medulloblastoma, a common pediatric brain tumor. Proteogenomically identified tumor-specific peptides are immunogenic and generate MHC II-based T cell responses. Moreover, polyclonal and polyfunctional T cells specific for tumor-specific peptides effectively eliminated tumor cells in vitro. Targeting novel tumor-specific antigens obviates the issue of central immune tolerance while potentially providing a safety margin favoring combination with other immune-activating therapies. These findings demonstrate the proteogenomic discovery of immunogenic tumor-specific peptides and lay the groundwork for personalized targeted T cell therapies for children with brain tumors.

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