Bacterial brain abscess in patients with nasopharyngeal carcinoma following radiotherapy: microbiology, clinical features and therapeutic outcomes

Abstract

BackgroundThis study aimed to analyze the clinical features, causative pathogens, neuro-imaging findings, and therapeutic outcomes of bacterial brain abscess in patients with nasopharyngeal carcinoma (NPC) following radiotherapy.MethodsNPC patients with bacterial brain abscess were evaluated. Their clinical data were collected over a 22-year period. For comparison, the clinical features, causative pathogens, neuro-imaging findings, and therapeutic outcomes between NPC and non-NPC patients were analyzed.ResultsNPC accounted for 5.7% (12/210) of the predisposing factors, with Viridans streptococci and Staphylococcus aureus as the two most common causative pathogens. Significant statistical analysis between the two groups (NPC and non-NPC patients) included chronic otitis media (COM) as the underlying disease, post-radiation necrosis by neuro-imaging, and the temporal lobe as the most common site of brain abscesses. The fatality rate in patients with and without NPC was 16.7% and 20.7%, respectively.ConclusionsNPC patients with bacterial brain abscess frequently have COM as the underlying disease. Neuro-imaging often reveals both post-radiation necrosis and the temporal lobe as the most common site of brain abscesses, the diagnosis of which is not always a straightforward process. Radiation necrosis can mimic brain abscess on neuro-imaging and pose significant diagnostic challenges. Early diagnosis and treatment is essential for survival.

Parafalcine Subdural Empyema in a Woman with Recurrent Acute Otitis Media

“…In our patient, a defective CNS barrier owing to previous radiotherapy for NPC may have given the microorganism(s) easy access to the intracranial space. This hypothesis is supported by one study that found a high concurrence of bacterial brain abscess and chronic otitis media in NPC patients following radiotherapy [6].…”

Subdural empyema complicated with intracranial hemorrhage in a postradiotherapy nasopharyngeal carcinoma patient: A case report and review of literature

“…Although extensive studies of central nervous system (CNS) infection have been performed in postradiotherapy NPC patients, subdural empyema is very rare, and only one case has been previously described in detail[ 3 - 5 ]. This previous study demonstrated that postradiotherapy NPC patients are prone to CNS infection for the following reasons.…”

A Case of Misplaced Permacath Dialysis Catheter

“…Misplaced central lines in all these locations have been reported and have not usually resulted in serious consequences except in the case of pericardiophrenic vein. Misplacement of the large dialysis catheter in these locations has been reported [5,6] and can have dangerous consequences such as hemothorax, pneumothorax, hemopericardium, cardiac tamponade etc. Even though entry of catheter into a planned vein can be ensured using ultrasound, its subsequent passage cannot be controlled.…”