Tuberculous brain abscess: clinical presentation, pathophysiology and treatment (in children)

Abstract

Treatment options include simple puncture, continuous drainage, fractional drainage, repeated aspiration through a burr hole, stereotactic aspiration and total excision of the abscess. Total excision usually becomes necessary in multilocular noncommunicating and thick-walled abscesses. Antitubercular therapy is the mainstay of management. The development of fulminant tubercular meningitis is sometimes problematic following surgical excision of TBA, as seen in one of our four operated cases. Mortality is reported to be high despite progress in treatment, while five of the six children treated by us responded well to the treatment.

Brain abscess: surgical experiences of 162 cases

“…[15,16] Cultures for acid-fast bacilli and fungi should be conducted in all cases as occasionally, intracranial tuberculosis as well as fungal infections can present as an abscess. [17][18][19][20] In our series, majority of the culture failed to show positive bacterial growth. More than one-third of otogenic and metastatic abscesses are polymicrobial (aerobic and/or anaerobic).…”

“…Furthermore, in patients with an otogenic brain abscess, the disease in the middle ear can also be surgically treated at the same sitting or soon thereafter. [18] This also reduces the likelihood of recurrence of the abscess. Abscess resulting from fistulous communication, example, trauma and congenital dermal sinus, require excision of infected granulation tissue and closure of the fistula.…”

Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects

“…Tuberculous brain abscess develops either from parenchymal tubercular granulomas or via the spread of tuberculous foci from the meninges and is characterized by an encapsulated collection of pus containing viable bacilli without evidence of the classic tubercular granuloma and must be distinguished from granuloma with central caseation and liquefaction mimicking pus (108). Brain abscesses can arise as solitary or multiple lesions (241).…”

“…Brain abscesses can arise as solitary or multiple lesions (241). Grossly and radiographically, a tuberculous brain abscess has a much thicker abscess wall than a pyogenic brain abscess (108). Histopathological findings suggest that the inflammatory reaction in the abscess wall is predominantly vascular granulation tissue containing acute and chronic inflammatory cells and bacilli in the pus or abscess wall (241).…”

Aparición paradójica de tuberculomas encefálicos durante el tratamiento de tuberculosis en pacientes inmunocompetentes.

“…En su interior, pueden contener áreas necróticas compuestas de material caseoso, ocasionalmente espeso y purulento, en el cual se pueden demostrar los bacilos tuberculosos (2), como se describió en el caso 1. Se deben diferenciar de los abscesos tuberculosos los cuales están formados por una colección encapsulada de pus que contiene bacilos tuberculosos viables (4)(5)(6). No obstante, algunos autores consideran a los tuberculomas y a los abscesos tuberculosos como variantes histológicas del mismo proceso patológico (5,7).…”