Multiple pyogenic brain abscesses

Abstract

Thirty eight patients with multiple pyogenic brain abscesses constituted 11% of all the brain abscesses treated during a 12 year period. Sixty per cent (23) of the patients were in the first two decades of life, including 9 (24%) infants. The clinical presentation was similar to brain abscess in general. 21 patients had altered "sensorium" at the time of admission. Otogenic brain abscesses were the commonest (26%), followed by those associated with congenital cyanotic heart disease (18%). The abscesses were invariably large in size. The pus was sterile on culture in 11 (29%) patients, while Staphylococcus aureus was the commonest organism grown in 9 (24%) patients. Aspiration of the pus was required as a life saving measure, to control raised intracranial pressure, in 29 (76%) patients. Twelve (32%) of these patients underwent secondary excision of the abscess capsule. The overall mortality was 32% with failure to control intracranial and systemic infection as the major causes of mortality. Level of consciousness at the time of admission was the most significant factor affecting the outcome. Surgery has a definite therapeutic and life saving role in the management of multiple pyogenic brain abscesses. A systematic treatment plan for multiple abscesses is proposed.

Strategies for the management of bacterial brain abscess

“…14 The prognosis is worse for patients with intraventricular rupture, associated meningitis, ependymitis or empyema, an unknown primary source, sterile pus or culture, large abscess, presence of hydrocephalus, metastatic abscess, neonates and infants, multiple deep-seated abscesses, inaccurate diagnosis, and/or congenital cyanotic heart disease. 4,[15][16][17][18][19][20][21] The treatment of brain abscess requires a combination of antimicrobial agents, surgical intervention, and eradication of primary infected foci.…”

Management of brain abscesses in children

“…Neonates and infants have a much worse prognosis, as do those in whom there was an initial error in diagnosis and/or an unknown source of infection. 9,49,61,64,93,97,101,102,111 Conclusions Although brain abscesses arise infrequently in children, the rates of morbidity and mortality in this population are significant. Advances in antibiotic therapy, culturing procedures, and operative techniques, combined with earlier detection made possible through the development of imaging modalities have led to significant progress in the treatment of this disease.…”

Twist Drill Aspiration of Pyogenic Brain Abscesses: Our Experience in 103 Cases

“…If repeated aspirations prove ineffective, most authors, as a rule, use total abscess excision including the capsule. [15][16][17][18][19] One of the drawbacks of aspiration reported in the literature is the high recurrence rate. Recurrence or relapse reported in different series after aspiration using different techniques ranges from 0 to 32%.…”

“…Recurrence or relapse reported in different series after aspiration using different techniques ranges from 0 to 32%. 6,14,15,[18][19][20][21] Factors that have been associated with recurrence after aspiration include inadequate aspiration because of multiloculation, chronic immunosuppression, insufficient antibiotic therapy [22][23][24] and persistence of contiguous source of infection. 22,[25][26][27] Recurrence rate in our study was 1.9%, which was quite low and was due to persistence of contiguous ear infection.…”