Clinical Characteristics and Outcome Analysis of 94 Children With Brain Abscess in Beijing: A Single-center Retrospective Study

Abstract

Background: There are limit studies about pediatric brain abscess in China. The aim of this study was to analyze clinical characteristics and outcomes of pediatric brain abscess in recent years in China. Methods: The clinical information of children with brain abscess hospitalized in Beijing Children’s Hospital between January 1, 2007 and December 31, 2016 were retrospectively reviewed. Results: Ninety-four children were enrolled in this study. A Streptococcus milleri group (13.8%) was identified as the most common causative organisms, followed by Staphylococcus aureus (6.4%). The overall mortality was 21.6%, with 50.0% of deaths happening in the first week after diagnosis. Long-term outcomes of 74 patients were assessed with Glasgow Outcome Scale–Extended Pediatric Reversion: 50 patients with a score of 1–2 (favorable outcome) and 24 patients with a score of 3–8 (unfavorable outcome). Patients with multiple abscesses (P = 0.029) and intraventricular rupture of brain abscess/hydrocephalus (P = 0.024) had higher risk of unfavorable outcomes. Conclusions: Brain abscess is a serious disease with high mortality in children; more aggressive treatments should be considered in the first week of diagnosis because of high risk of death, and for patients with multiple brain abscesses and intraventricular rupture of brain abscess/hydrocephalus because of their higher risk of unfavorable.

Factors Associated with Mortality in Children with Congenital Heart Disease and Cerebral Abscess

“…In this study, we found that the mortality rate of cerebral abscess patients with a history of CHD is 38.3%. This finding is superior to the prior study in China which the overall mortality was 21.6%, with 50.0% of deaths happening in the 1 st week after diagnosis [10]. Another study in Pakistan also shows that the mortality rate is lower than ours, with only 7.5% of prevalence [11].…”

Encephalitis and Brain Abscess

“…107,112 The presence of intraventricular rupture is strongly associated with in-hospital mortality; the majority of adult and pediatric patients with ventricular rupture die. 109,126 In-hospital outcomes from brain abscess have improved over the past several decades, likely attributable to better general medical care, more widespread and earlier adoption of neuroimaging, improved microbial diagnostics (in particular, culture of anaerobic bacteria), adoption of minimally invasive neurosurgical procedures, and increased effectiveness of CNS penetrating antimicrobial agents. A 2020 population-based study in Denmark found that the crude 30-day mortality rate decreased almost threefold from the 1980s to the 2010s (from 18% to 7%).…”

“…The concurrent presence of systemic illness (eg, pneumonia, sepsis) portends poorer prognosis 107,112 . The presence of intraventricular rupture is strongly associated with in-hospital mortality; the majority of adult and pediatric patients with ventricular rupture die 109,126 …”

“…108 Among survivors, neurologic sequelae including focal neurologic deficits and epilepsy have been reported in up to 40% of individuals. 126,127 In one 2020 study in which the median follow-up was greater than 7 years, new-onset epilepsy occurred in 32% of survivors of brain abscess compared with 2% of matched controls. 128 Notably, however, robust data on functional and neuropsychological outcomes after brain abscess are lacking.…”

Brain abscess in immunocompetent patients: recent findings

“…Recent studies highlight how the clinical diagnosis of brain abscesses can be challenging, especially in pediatric patients [9][10][11][12]. Symptoms at presentation are nonspecific and may include a combination of headache (for 49-97% of patients), mental status changes (28-91%), fever (32-79%), focal neurologic deficit (20-66%), and/or seizures (13-35%).…”