Brain abscess in Korean children: A 15-year single center study

Abstract

PurposeA brain abscess is a serious disease of the central nerve system. We conducted this study to summarize the clinical manifestations and outcomes of brain abscesses.MethodsA retrospective chart review of pediatric patients diagnosed with brain abscesses from November 1994 to June 2009 was performed at Samsung Medical Center, Seoul, Korea.ResultsTwenty-five patients were included in this study. On average, 1.67 cases per year were identified and the median age was 4.3 years. The common presenting clinical manifestations were fever (18/25, 72%), seizure (12/25, 48%), altered mental status (11/25, 44%), and signs of increased intracranial pressure (9/25, 36%). A total of 14 (56%) patients had underlying illnesses, with congenital heart disease (8/25, 32%) as the most common cause. Predisposing factors were identified in 15 patients (60%). The common predisposing factors were otogenic infection (3/25, 12%) and penetrating head trauma (3/25, 12%). Causative organisms were identified in 64% of patients (16/25). The causative agents were S. intermedius (n=3), S. aureus (n=3), S. pneumoniae (n=1), Group B streptococcus (n=2), E. coli (n=1), P. aeruginosa (n=1), and suspected fungal infection (n=5). Seven patients received medical treatment only while the other 18 patients also required surgical intervention. The overall fatality rate was 16% and 20% of patients had neurologic sequelae. There was no statistical association between outcomes and the factors studied.ConclusionAlthough uncommon, a brain abscess is a serious disease. A high level of suspicion is very important for early diagnosis and to prevent serious consequences.

Evaluation of short term neurological outcomes in children diagnosed with brain abscesses

“…In the presence of right-left shunting, microorganisms that entered the systemic circulation cannot be cleared within the alveoli (14,16). The rate of CCHD was 6.5% in our study cohort, being far below the previous pediatric reports (6,15,20). This may reflect the success of prophylactic antibiotic therapy for infective endocarditis in the risk group as well as the improvements in the operative repair of CCHD (5,16).…”

Clinical and Microbiologic Features Guiding Treatment Recommendations for Brain Abscesses in Children

“…There was neurological deficit in 35.3% at 6 months after diagnosis, comparable with rates of 16-35% in recent studies. 4,5,27 Numerous factors were analyzed, and only age younger than 5 years and a Glasgow Coma Scale score ≤8 at presentation were significant risk factors. Whereas this is consistent with previous studies in children, other factors such as meningitis were not associated with poor outcome.…”

Pyogenic brain abscess caused by Serratia marcescens in a Brazilian premature neonate

“…It affects more men than women and the majority of cases occur between the second and fourth decade of life 19,20 . Most patients have a demonstrable infectious source leading to the intracranial suppuration and chronic otitis media has been found as the main source of microorganism in most cases and streptococci seems to be the most common agent isolated from cultures of the purulent material obtained during surgical drainage 1,5,6,16,26 . However, brain abscess in premature neonates is a rare condition and few reports exist in English literature pointing Serratia marcescens as the causative agent 4,14,21 .…”

“…The most frequently identified organism is Streptococcus spp. in most international series 5,16,26 . However, brain abscess has been rarely described in preterm newborns and few reports exist on English medical literature pointing Serratia marcescens as the causative agent on those high-risk pediatric patients 4,14,21 .…”