A rare case of polymicrobial brain abscess involving Actinomyces

Abo-Zed, Abdelrhman; Yassin, Mohamed; Phan, Tung

doi:10.1016/j.radcr.2021.02.042

Cited by 4 publications

(10 citation statements)

References 14 publications

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“… 14 , 15 Actinomyces species are sometimes among the anaerobic pathogens in polymicrobial brain abscesses. 16 , 17 Mycobacterium tuberculosis can cause a brain mass with necrosis. 18 Nocardia species are an important cause of brain abscess in immunocompromised patients.…”

Section: Questions/discussion Pointsmentioning

confidence: 99%

Educational Case: Brain abscess

Bowens

Nichols

2022

Academic Pathology

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Section: Questions/discussion Pointsmentioning

confidence: 99%

Educational Case: Brain abscess

Bowens

Nichols

2022

Academic Pathology

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“…2 Actinomycosis of CNS can present with hemiparesis, focal or generalised seizures, headache and other features of raised intracranial pressure and spaceoccupying effects. [4][5][6][7][8][9] Leucocytosis may be detected on routine investigations. 4 5 9 Other acute phase reactants may be normal or mildly elevated.…”

Section: Discussionmentioning

confidence: 99%

“… 4–9 Leucocytosis may be detected on routine investigations. 4 5 9 Other acute phase reactants may be normal or mildly elevated. 10 Our case remained clinically asymptomatic for prolonged phase and his laboratory work-up did not reveal any significant change.…”

Section: Discussionmentioning

confidence: 99%

“… 3–5 Doxycycline can be given for prolonged periods (6–12 months) following initial course of intravenous antibiotics. 4 8 Metronidazole, trimethoprim-sulfamethoxazole, ceftazidime, aminoglycosides, oxacillin and fluoroquinolones are not active against the bacteria; they can be used as additional agents to cover other aerobes and anaerobes in mixed infections based on the culture and sensitivity reports. 3 Apart from antibiotics, patient may require symptomatic management such as antiepileptics for prolonged periods.…”

Section: Discussionmentioning

confidence: 99%

“… 3 Apart from antibiotics, patient may require symptomatic management such as antiepileptics for prolonged periods. 4 Course of steroids may be required in tapering doses for control of acute inflammation and seizures. 10 Surgery is reserved for brain abscess, refractory disease and involvement of critical sites.…”

Section: Discussionmentioning

confidence: 99%

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Extensive actinomycosis with intracranial and mediastinal involvement: a therapeutic challenge

et al. 2022

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Central nervous system (CNS) involvement by actinomycosis is rare, seen in 2%–3% cases. It mostly spreads to CNS by haematogenous route from a distant primary site such as oral cavity, lung, abdomen or pelvis. Direct CNS extension can also occur. It mostly presents as brain abscess, meningoencephalitis, actinomycetoma, subdural empyema and epidural abscess. We report one case of extensive actinomycosis having intra and extraparenchymal CNS, spinal canal, retropharyngeal and mediastinal involvement. Due to such widespread extension and involvement of vital areas, complete surgical debulking was not possible. In addition to therapeutic resistance to conventional antibiotics, repetitive negative cultures posed significant difficulty in the case management.

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Brain abscess caused by Actinomyces turicensis in a non-immunocompromised adult patient: a case report and systematic review of the literature

Imeneo,

Rindi,

Di Lorenzo

et al. 2024

BMC Infect Dis

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Background Actinomyces turicensis is rarely responsible of clinically relevant infections in human. Infection is often misdiagnosed as malignancy, tuberculosis, or nocardiosis, therefore delaying the correct identification and treatment. Here we report a case of a 55-year-old immunocompetent adult with brain abscess caused by A. turicensis. A systematic review of A. turicensis infections was performed. Methods A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases MEDLINE, Embase, Web of Science, CINAHL, Clinicaltrials.gov and Canadian Agency for Drugs and Technology in Health (CADTH) were searched for all relevant literature. Results Search identified 47 eligible records, for a total of 67 patients. A. turicensis infection was most frequently reported in the anogenital area (n = 21), causing acute bacterial skin and skin structure infections (ABSSSI) including Fournier’s gangrene (n = 12), pulmonary infections (n = 8), gynecological infections (n = 6), cervicofacial district infections (n = 5), intrabdominal or breast infections (n = 8), urinary tract infections (n = 3), vertebral column infections (n = 2) central nervous system infections (n = 2), endocarditis (n = 1). Infections were mostly presenting as abscesses (n = 36), with or without concomitant bacteremia (n = 7). Fever and local signs of inflammation were present in over 60% of the cases. Treatment usually involved surgical drainage followed by antibiotic therapy (n = 51). Antimicrobial treatments most frequently included amoxicillin (+clavulanate), ampicillin/sulbactam, metronidazole or cephalosporins. Eighty-nine percent of the patients underwent a full recovery. Two fatal cases were reported. Conclusions To the best of our knowledge, we hereby present the first case of a brain abscess caused by A. turicensis and P. mirabilis. Brain involvement by A. turicensis is rare and may result from hematogenous spread or by dissemination of a contiguous infection. The infection might be difficult to diagnose and therefore treatment may be delayed. Nevertheless, the pathogen is often readily treatable. Diagnosis of actinomycosis is challenging and requires prompt microbiological identification. Surgical excision and drainage and antibiotic treatment usually allow for full recovery.

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A rare case of polymicrobial brain abscess involving Actinomyces

Cited by 4 publications

References 14 publications

Educational Case: Brain abscess

Educational Case: Brain abscess

Extensive actinomycosis with intracranial and mediastinal involvement: a therapeutic challenge

Brain abscess caused by Actinomyces turicensis in a non-immunocompromised adult patient: a case report and systematic review of the literature

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