Brain abscess of odontogenic origin in children: a systematic review of the literature with emphasis on therapeutic aspects and a new case presentation

Abstract

SUMMARY Brain abscesses (BAs) are rare but life-threatening infections. BAs of an odontogenic origin should always be considered as a possible aetiological factor, especially when other infectious foci are not present. Clinical presentation in children may be ambiguous and pose a difficult differential diagnosis: the identification of causal bacteria can be difficult and odontogenic origin is often a diagnosis of exclusion. The aim of this paper was to systematically review the literature reports with particular emphasis on therapy and propose a diagnostic flowchart for odontogenic brain abscess in children. A systematic literature review was performed on PubMed, Scopus and ISI Web of Science to identify cases of BAs in children and discuss clinical management: only human research articles, published in peer-reviewed English language journals, were included. Among 109 articles, 7 publications were selected for data analysis: clinical data could be extracted for only 8 subjects; different clinical approaches are descripted in the reports, even if therapy should be started as soon as possible to prevent rapid diffusion to the rest of the central nervous system. Due to their rarity and ambiguous clinical presentation in children, BAs of odontogenic origin are difficult to diagnose. A thorough oral-maxillofacial investigation should always be performed to exclude an oral origin.

Brain Abscess Caused by Eikenella corrodens in an Immunocompetent Child: Case Report and Literature Review

“…12 A published systematic review of brain abscesses in children reported that an oral-maxillofacial examination should always be performed to exclude an oral origin. 13 In the case presented here, the history of the patient did not reveal anything specific; therefore, the port of entry of the bacteria could not be determined. Hematogenous spread could be considered as the cause, but the patient had no fever and blood cultures were sterile.…”

“…In addition to the broad antibiotic treatment, incision and drainage of the abscesses were expressed to be more important than antibiotics alone in the management of Eikenella infections. 5 6 7 8 9 10 11 12 13 14 In recent years, although the prognosis has improved significantly with the development of additional diagnostic and therapeutic capabilities, neurological deficits can still be seen despite treatment and some children may need ventriculoperitoneal shunts. However, our patient did not have any neurological deficit after the treatment and the need for a shunt did not develop.…”

Isolated Meningitis and Lacrimal Gland Abscess due to Odontogenic Sinusitis: Case Report

“…According to the review conducted by Moazzam et al regarding intracranial bacterial infections of oral origin, the hematogenous spread appears to be the more important pathophysiological route of spread. Most frequently the central nervous system infection is represented by an abscess (frontal lobe in 31.7 % of cases, parietal lobe in 21.7 % and temporal lobe in 13.7 %) while isolated meningitis resulted to be unusual (5 % of cases) (Moazzam et al, 2015;Lajolo et al, 2019). Moreover, they found that caries with periapical involvement and periodontitis are the oral pathologies most frequently responsible of an intracranial bacterial infection (Ewald et al, 2006;Moazzam et al).…”

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

“…20 Health awareness in terms of ear and oral hygiene may help to reduce the overall incidence of brain abscess. 51,52…”