Brain Abscess in Children: A Rare but Serious Infection

Abstract

Brain abscess is a rare disease in childhood requiring prompt medical and/or surgical treatment. The objective was to review presentation, management, and outcome of brain abscess in children. We reviewed the clinical and radiological features and outcomes of 18 children (10 females, 8 males), with a median age of 48 months (range 1-182), that presented with brain abscesses and admitted to a tertiary pediatric infectious department between December 2010 and January 2017. One (5.5%) patient underwent craniotomy and 14 (77.7%) had burr hole aspirations. The most common localization was the frontal lobe (33.3%). The survival rate was 94.4%, and long-term neurological sequelae affected 27.7% of the patients. Empiric treatment choices require knowledge of common pathogens and local resistance. The most predominant infections were still upper respiratory infections. Clinicians may treat the children with appropriate choice and duration of antibiotic treatment for upper respiratory tract infections.

Cerebral Abscess with Cranial Hypertension in Young Infants: A Case Report and Systematic Review

“…Corroborating the results described in the present study, Sahbudak et al [29] showed in a retrospective descriptive study carried out in Turkey with 18 children, with a mean age of 48 months with cerebral abscess, among them 22% were less than 1 year old, the most common symptoms on admission were fever, nausea, and vomiting, in addition to 22% having a bulging fontanelle.…”

“…The etiological diagnosis can be obtained through the culture of the abscess pus, acquired by stereotactic biopsy or complete aspiration, instead of an excised craniotomy [16,19,[23][24][25][26][27]. In some cases, neurosurgery is not indicated and therapy should be performed and continued empirically, with monitoring of clinical and radiological improvement [19,24,28,29]. CAS can result from the extension of infection through blood flow from a distant focus (dental, sinus, otological, endocarditis, lung or skin infections) [30,31].…”

“…In the face of neurological involvement, lumbar puncture can be performed for physical-chemical analysis of cerebrospinal fluid (CSF) and subsequent culture for a specific etiology, even if at low risk [16,20,25,29]. It is worth mentioning that the puncture should not be performed routinely and is contraindicated in the case of non-communicating obstructive hydrocephalus and brain dislocation, possible consequences of the mass effect of the CA [41].…”

“…Depending on the characteristics, location, and some abscesses, it is possible to perform a stereotaxic or endoscopic aspiration of the abscess, instead of open surgery (craniotomy with excision) [55]. Studies involving mortality rates are more frequent in patients with lower scores on the Glasgow coma scale, rupture of the intraventricular abscess [5,29] congenital immunosuppression, organ transplantation, tumors being treated with maternal chemotherapy, premature newborns, or malformations [5]. A total recovery rate from infection of about 60-70% is reported in the case of early diagnosis and adequate therapy [20].…”

“…Most authors recommend at least 3 months of prophylaxis if they no longer occur [12]. Clinical sequelae can be found in about 30% of patients and are mainly epilepsy, motor, visual and auditory deficits, and hydrocephalus [29]. Surgically inaccessible lesions, early cerebritis, several small abscesses, and significant medical comorbidities are indicated treatments with only non-surgical methods.…”