Clinical characteristics and course of primary brain abscess

Lange, Nicole; Berndt, Maria; Jörger, Ann-Kathrin; Wagner, Arthur; Wantia, Nina; Lummel, Nina; Ryang, Yu‐Mi; Meyer, Bernhard; Gempt, Jens

doi:10.1007/s00701-018-3633-6

Cited by 32 publications

(30 citation statements)

References 32 publications

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“…Comorbidities, including diabetes mellitus, tumor, liver cirrhosis, and granulocytopenia, were noted in 24.56% of the patients in our study. Other comorbidities, including human immunode ciency virus infection, autoimmune disease, and immunosuppressive therapy, were reported in a previous study [13]. However, none of our patients had these comorbidities, and diabetes mellitus was the most common comorbidity observed in this study.…”

Section: Discussionsupporting

confidence: 47%

Clinical Characteristics and Outcome of Primary Brain Abscess: a Retrospective Analysis

Huang

et al. 2021

Preprint

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Background: Patients with primary brain abscess often present with atypical symptoms, and the outcome is varied. We investigated the demographic, laboratory, and neuroimaging features of patients with brain abscess at our hospital and identified factors associated with their outcome.Methods: We retrospectively collected the data of patients diagnosed with primary brain abscess at our hospital between January 2011 and December 2020. Their clinical characteristics, predisposing factors, laboratory and neuroimaging findings, treatment, and outcome were analyzed. Results: Of the 57 patients diagnosed with primary abscess, 51 (89.47%) were older than 40 years and 42 (73.68%) were male. Only eight patients (14.04%) showed the classical triad of headache, fever, and focal neurological deficit. Fourteen patients (24.56%) had comorbidities, of which diabetes mellitus was the most common. Positive pus cultures were obtained in 46.15% of the patients, and gram-negative enteric bacteria were found in 33.33% of them, with Klebsiella pneumoniae being the most frequently observed. Surgical treatment, most commonly in the form of stereotactic drainage, was received by 54.39% of the patients. Good outcomes were achieved in 75.44% of the patients. Multivariate logistic regression analysis showed that patients with headache were more likely to have a poor outcome (odds ratio 6.010, 95% confidence interval 1.114–32.407, p = 0.037).Conclusions: Male patients and those older than 40 years were more susceptible to brain abscess than female patients and those younger than 40 years, respectively. Only a few patients showed the classical triad of clinical symptoms. Diabetes mellitus was the most common comorbidity. Positive pus culture results were uncommon, with gram-negative enteric bacteria, especially Klebsiella pneumoniae, being the main organisms found. Most patients had a good outcome, and the presence of headache may influence the outcome.

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Section: Discussionsupporting

confidence: 47%

Clinical Characteristics and Outcome of Primary Brain Abscess: a Retrospective Analysis

Huang

et al. 2021

Preprint

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“…During the same period, we analyzed all patients with primary brain abscesses treated in our center. In that collective, 23% died during the follow-up period [21]. This underlines an infection with fungi as a still very severe condition, even though log-rank test could not show a significant difference due to the small sample size.…”

Section: Discussionmentioning

confidence: 75%

“…Thereby, brain involvement was only found in 3% of all patients with aspergillosis, and in 20% and up to 42% within the subgroups of previously diagnosed tumor disease, or patients with acute leukemia and hematopoietic stem cell transplantation [4,19,28,40]. Brain involvement most commonly results in brain abscess formation, occasionally accompanied by cerebral infarction due to septic embolisms, or associated mycotic aneurysms [5,17,18,21,25,28]. Prognosis of cerebral aspergillosis is poor.…”

Section: Introductionmentioning

confidence: 99%

Fungal brain infection—no longer a death sentence

et al. 2020

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The aim of this case series was to provide a modern cohort of patients with cerebral aspergillosis and show the effectiveness of modern treatment concepts. In a 10-year period from January 2009 to January 2019, we identified 10 patients (6 male, 4 female) who received surgery or frameless stereotactic drainage of a cerebral aspergilloma at our center. Patients’ and disease characteristics were recorded. The median age was 65 (range 45 to 83). We conducted 133 cranial surgeries in 100 patients due to cerebral brain abscess (BA) during that time, which leads to a percentage of 10% of aspergilloma within BAs in our patient sample. We performed 3.1 surgeries per patient followed by antifungal treatment for 6 months (= median) according to the microbiological findings. Regarding comorbidities, the mean Charlson comorbidity index (CCI) at the time of admission was 5, representing an estimated 10-year survival of 21%. Six (60%) of 10 patients showed conditions of immunosuppression, one suffered endocarditis after replacement of aortic valves. Four patients showed associated frontobasal bone destruction, mycotic aneurysms, or thromboses. The mean duration of hospital stay was 37 days. Mortality was much lower than in literature. Sixty percent of the patients died during the follow-up period. The outcome of the two immunocompetent patients was more favorable. Cerebral aspergillosis is a rare, but still life-threatening, condition, which predominantly occurs in immunosuppressive conditions. Due to radical surgical and antifungal therapy for several months, mortality can be reduced dramatically.

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“…Staphylococcus, Streptococcus, Clostridium, and Enterobactericeae are seen in patients with open head trauma. 4,22,25 Fungal infections, Toxoplasma, Staphylococcus species, Streptococcus species, and Pseudomonas are frequently observed in immunocompromised patients and after organ transplantation, chemotherapy, and steroid usage. 4,20,25 Streptococcus anginosus is a commensal microbe of the mucosae of the oral cavity, gastrointestinal tract, and urogenital tract and is rarely found in brain abscess materials or immunocompetent patients.…”

Section: Discussionmentioning

confidence: 99%

Intracranial infections: lessons learned from 52 surgically treated cases

Kural¹,

Kırmızıgöz²,

Ezgü³

et al. 2019

Neurosurgical Focus

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OBJECTIVEIntracranial infections are serious and life-threatening health problems. They may present as subdural empyemas or intracerebral abscesses. Surgical drainage and subsequent antibiotic treatment is the main technique for a satisfactory clinical outcome. The aims of this study were to present a 10-year intracranial infection series and discuss the surgical characteristics in the light of literature.METHODSFifty-two patients with intracranial infection underwent surgical treatment between 2008 and 2018. Eleven patients were female and 41 patients were male. The mean age was 40.46 years (range 10–75 years). Eighteen patients had intracerebral abscesses, and 34 had subdural empyemas. All patients underwent surgical treatment as well as an antibiotic regimen.RESULTSNo etiological agent was isolated in 29 (56%) cases. Bacterial agents were detected in 20 cases, while fungi were observed in 3 cases. Staphylococci species were the most common agents and were isolated in 8 (15%) cases. Endoscopic aspiration was performed in 3 cases, while surgical drainage and capsule resection via craniotomy was performed in 49 cases. An associated intracranial tumor was diagnosed in 2 patients with brain abscesses. Four (8%) patients died despite surgical and medical treatments.CONCLUSIONSSurgical treatment via craniotomy is an older method, but it is still the best to treat the intracranial infections not only for decompression of the brain but also to attain an accurate diagnosis. The abscess wall should always be histologically examined after surgery to rule out any intracranial tumor.

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Clinical characteristics and course of primary brain abscess

Cited by 32 publications

References 32 publications

Clinical Characteristics and Outcome of Primary Brain Abscess: a Retrospective Analysis

Clinical Characteristics and Outcome of Primary Brain Abscess: a Retrospective Analysis

Fungal brain infection—no longer a death sentence

Intracranial infections: lessons learned from 52 surgically treated cases

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