Cerebral abscesses with odontogenic origin: a population-based cohort study

Abstract

Objectives Recent studies have indicated that cerebral abscess (CA) patients with odontogenic origin are on the rise. However, CA patients are often poorly characterized and with an unknown etiologic background. The purpose of this study is to identify and characterize CA patients that may have an odontogenic origin based on microbiologic, radiographic, and/or clinical findings. Materials and methods This is a population-based cohort study analyzing retrospective and prospective data from CA patients. Radiographic examinations of panoramic radiographs (PRs) or computed tomography (CT) scans were conducted. CA patients characterized with odontogenic origin required the fulfilment of the following criteria on admission: (1) Oral pathologic conditions were the only bacterial infections present, (2) oral microorganisms were isolated in the purulent exudate from the brain, and (3) radiographically and/or clinical recordings of oral pathologic conditions. Results A total of 44 patients could be included in this study of which 25 (57%) were characterized as having CA with a likely odontogenic origin. Type two diabetes (T2D) (p = 0.014) and microorganisms of the Streptococcus anginosus group (SAG) (p < 0.01) were overrepresented in patients with CAs of odontogenic origin. Conclusions Odontogenic infections may cause CAs to a greater extent than previously assumed. T2D was overrepresented among patients with odontogenic CA. When microorganisms of the SAG were isolated from the brain pus, CA patients had a predisposing odontogenic or sinus infection. Clinical relevance The identification of patients with a likely odontogenic CA will contribute to understanding the etiology of the infectious disease and highlighting the importance of preserving oral health.

A Report of Two Cases of Meningoencephalitis Caused by Streptococcus intermedius

“…A recent study revealed that odontogenic CAs frequently have unclear clinical features and an increasing incidence, and that patients diagnosed with diabetes are more likely to develop CA, indicating that maintaining oral health can help reduce the incidence of CA. 6 Multiple abscesses occur in 10% to 15% of CA cases, with a mortality rate ranging from 6% to 24%, and 30% to 56% of patients diagnosed with CA experience permanent neurologic complications. 7 With the advancement of medical technology, the incidence and disability of bacterial meningoencephalitis have significantly decreased.…”

Update and approach to patients with brain abscess

“…Other contributing factors may be increased use of immuno-modulating treatments and advanced neurosurgical procedures with associated risks of infection. Odontogenic infections were frequently reported as a major risk factor for brain abscess in recent studies [3 ▪ ,21,22 ▪ ,23 ▪ ]. Still, a large population-based case-control study found no association between number of dentist consultations or invasive dental procedures and risk of brain abscess [24 ▪ ].…”