Brain abscess in patients with chronic kidney disease: A case-based approach to management in resource-limited settings

Abstract

Fungal, dematiaceous, Cladophialophora, nocardiosis The management of patients with brain abscess poses a significant challenge to clinicians in patients with chronic kidney disease. Obtaining a biopsy sample from the affected area is the mainstay in the diagnosis, but it is often unavailable. In most cases, therapy is guided by clinical findings and imaging alone. We discuss three cases of brain abscess-each with a different scenario and discuss the issues faced in management. The first case was a 32-year-old post-renal transplant male patient with a brain abscess due to dematiaceous fungi and was treated with amphotericin. The second case was a 42-year-old female patient with stage 5 chronic kidney disease on maintenance hemodialysis who presented with a brain abscess due to suspected fungal infection based on imaging findings and was managed with antibiotics and voriconazole. The third case was a 42-year-old post-renal transplant male patient who presented with a brain abscess due to nocardiosis and was managed with cotrimoxazole, meropenem and linezolid. We also summarize the approach to the management of brain abscess in resource-limited settings.

Dematiaceous fungal infections in solid organ transplantation: Systematic review and Bayesian meta‐analysis

“…As a result, we reviewed 228 published reports. We identified and included 149 reports on 201 cases of dematiaceous fungal infections in SOT recipients 21–169 . The majority (134/149; 90%) of included reports scored ≥ 2 of three possible points on our bias assessment (Table S4).…”