Microbiological Spectrum of Brain Abscess at a Tertiary Care Hospital in South India: 24-Year Data and Review

Abstract

Intracranial abscesses are life-threatening infections that pose a diagnostic challenge not only to the neurosurgeon but also to the microbiologists. Detailed studies documenting the spectrum of infecting agents involved in brain abscesses are limited from India. Materials and Methods. This is a retrospective analysis of 352 samples from 1987 to 2010 analyzed at a tertiary care hospital in South India from 1987 to 2010, to document the changing trends with time. Results. The age of the patients ranged from 2 to 80 years, a larger number of males being affected. Otogenic infections were the most common cause while cryptogenic abscesses were 20%. Gram stain and culture positivity were 78% each. Gram-positive and negative facultative aerobes and obligate anaerobes were also on the rise. Unusual organisms, like Burkholderia pseudomallei, Salmonella typhi, Nocardia species, Cladosporium bantiana, Fonsecaea pedrosoi, Entamoeba histolytica, and Acanthamoeba were also isolated and/or detected from the brain abscesses aspirate or resected tissue. Summary. New and emerging pathogens associated with brain abscess, especially in immunosuppressed individuals, have renewed the necessity of an early detection, and it will be of great value in appropriate management of patients with brain abscess.

Brain Abscess with Anaerobic Gram-Negative Bacilli: Case Series

“…A male predominance for brain abscess has been reported in earlier literature [1][2][3]9,[11][12][13][14]. Brain abscess is reported across all age groups from infancy to elderly.…”

“…Brain abscess accounts for a significant number of patients in the neurosurgical clinic. V Lakshmi et al have reported an incidence of 25% among patients with space occupying lesions [9]. At our tertiary care center, 47 cases of brain abscess are recorded between 2012-15, with an average of 12 cases per year.…”

“…Brain abscess which is considered as a microbiological and neurosurgical emergency is a serious and life threatening infection and can be a diagnostic challenge [9]. Following infection with pyogenic bacteria, localized areas of inflammatory changes in brain parenchyma referred to as cerebritis are seen initially which progress to a suppurative lesion encapsulated in a vascularized membrane [10].…”

Brain abscess due to Streptococcus oralis in an immunocompetent patient

“…CHD with left to right shunts may also predispose to brain abscess. [6] Predisposing condition for viridians streptococcal brain abscess include congestive heart failure, chronic otitis media, head injury with cerebrospinal fluid rhinorrhoea, sinusectomy and craniotomy followed by ventriculoperitoneal shunt placement. [7] Predisposing factors in our case are CHD, but without infective endocarditis and bad oral hygiene.…”

Group G Streptococci in association with brain abscess: a rare occurrence

“…CHD, especially arteriovenous malformations, serves as a focal point for bacteria to settle and become a source of bacteremia [7]. Congenital malformations like patent ductus arteriosus, ventricular septal defect and tetralogy of Fallots allows blood-borne bacteria to bypass the pulmonary capillary bed and reach the brain [8]. The decreased arterial oxygenation and polycythemia in CHD may cause focal areas of ischemia in the brain providing a nidus for bacteria to multiply and form an abscess which could be the probable cause in this case [9].…”