Gram stain to the rescue: a case report of cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent 24-year-old

Background Fungal brain abscesses in immunocompetent patients are exceedingly rare. Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis, a dematiaceous mold. Radiological presentation can mimic other disease states, with diagnosis through surgical aspiration and growth of melanized fungi in culture. Exposure is often unknown, with delayed presentation and diagnosis. Case presentation We present a case of cerebral phaeohyphomycosis in a 24-year-old with no underlying conditions or risk factors for disease. He developed upper respiratory symptoms, fevers, and headaches over the course of 2 months. On admission, he underwent brain MRI which demonstrated three parietotemporal rim-enhancing lesions. Stereotactic aspiration revealed a dematiaceous mold on staining and the patient was treated with liposomal amphotericin B, 5-flucytosine, and posaconazole prior to culture confirmation. He ultimately required surgical excision of the brain abscesses and prolonged course of antifungal therapy, with clinical improvement. Conclusions Culture remains the gold standard for diagnosis of infection. Distinct microbiologic findings can aid in identification and guide antimicrobial therapy. While little guidance exists on treatment, patients have had favorable outcomes with surgery and combination antifungal therapy. In improving awareness, clinicians may accurately diagnose disease and initiate appropriate therapy in a more timely manner.

Cerebral Abscess Caused by Listeria monocytogenes: Case Report and Literature Review

Background Listeria monocytogenes is an opportunistic gram-positive, facultative intracellular bacterium that causes invasive diseases mostly in pregnant women and immunosuppressed patients. Despite the predilection toward the central nervous system (CNS), it usually causes meningitis and meningoencephalitis, whereas brain abscesses are very uncommon. Case presentation We describe the case of a 69-year-old homeless patient with a brain abscess due to L. monocytogenes who was successfully treated surgically by a guided stereotactic aspiration and antibiotic therapy with ampicillin and gentamicin. Our patient was discharged after 4 weeks of therapy without neurologic deficits. Additionally, we provide a review of the literature of brain abscesses caused by L. monocytogenes. Conclusions This case highlights the need to drain cerebral abscesses and culture pus to correctly treat patients with antibiotics, especially given the high mortality rate of this infectious entity.

Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques: A Review

Intracerebral hemorrhage (ICH) continues to have high morbidity and mortality. Improving ICH outcomes likely requires rapid removal of blood from the parenchyma and restraining edema formation while also limiting further neuronal damage due to the surgical intervention. Minimally invasive surgery (MIS) approaches promise to provide these benefits and have become alluring options for management of ICH. This review describes six MIS techniques for ICH evacuation including craniopuncture, stereotactic aspiration with thrombolysis, endoport-mediated evacuation, endoscope-assisted evacuation, adjunctive aspiration devices, and the surgiscope. The efficacy of each modality is discussed based on current literature. The largest clinical trials have yet to demonstrate definitive effects of MIS intervention on mortality and functional outcomes for ICH. Thus, there is a significant need for further innovation for ICH treatment. Multiple ongoing trials promise to better clarify the potential of the newer, non-thrombolytic MIS techniques.

CLINICO-EPIDEMIOLOGICAL PROFILE OF BRAIN ABSCESS- A SINGLE CENTER STUDY

INTRODUCTION: The overall incidence of bacterial brain abscess has remained relatively constant despite improved treatment of underlying systemic infections and development of more effective antibiotics. The systemic antibiotics are generally given for 6-8 weeks. The Choice of surgery varies from stereotactic aspiration /open surgical method including twist drill aspiration, burr hole aspiration with or without drainage, small craniectomy with aspiration and drainage to craniotomy and excision of abscess. The purpose of this article is to share authors’ experience regarding clinico epidemiological profile of brain abscess. MATERIAL AND METHODS: Total 30 patients with brain abscess who presented to the Department of Neurosurgery, PGIMER Dr. RML Hospital Delhi, from November 2016 to April 2018 analyzed for clinical, epidemiological, microbiological profile of brain abscess patients along with modes of treatment and their outcome. RESULTS: Total 30 patients of Brain Abscess were evaluated with males outnumbering females. Predominated symptoms were fever (96.7%), headache (83.3%) and nausea and vomiting (40%). The chronic suppurative otitis media (CSOM) was predominately underlying factor in 18 patients i.e. (60%) and commonest organism isolated was streptococcus pneumonia (66.6%) followed by streptococcus Milleri (33.33%). The length of hospital stay was longer in aspiration group {21.2 days (SD ± 4.1)} compared to excision group {13 days (SD ± 1.1)}. Total 20 (66.7%) patients survived, 2 (6.7%) patients died and 8 (26.7%) were lost to follow up. CONCLUSION: Majority of time there is an underlying factor for brain abscess. The treatment of brain abscess involves both medical and surgical modalities. Third generation cephalosporins and metronidazole are the most commonly used antimicrobial agents in the treatment of brain abscesses. The length of hospital stay in excision group was less as compared to medical group and aspiration group.