Brain Abscess in the Current Decade (2010–2019) in India—A Review

Abstract

Brain abscess outcomes have improved in recent years due to advancements in cranial imaging, microbiological techniques, minimally invasive neurosurgical procedures, and effective antibiotic treatments. However, the incidence of brain abscess remains unchanged in developing countries. We searched PubMed and Google Scholar for references using the key words “brain abscess” and “India” and reviewed both retrospective and prospective studies published in peer-reviewed journals in the current decade to understand the present status. The review shows that the patients’ ages, the predominance of male patients, the symptoms and locations of brain abscesses, and the types of bacteria associated with them have remained unchanged over the past decade. The most common predisposing condition in recent years has been chronic suppurative otitis media with a mortality rate of 7 to 10%. Middle ear infection is often neglected and not treated aggressively in Asian countries. It requires multidisciplinary treatment strategies to address the primary source of infection and better health awareness to prevent the development of brain abscess.

A Common Neurological Presentation With an Unusual Etiology: Dense Hemiplegia Due to Pneumococcal Meningitis

“…Brain abscess is an uncommon life-threatening neurological condition with a high mortality rate of up to 36% [ 4 ]. It typically presents with a triad of fever, headache, and focal deficits.…”

“…Brain abscess, however, is a rare complication of pneumococcal meningitis, and Streptococcus pneumoniae accounts for only 2% of all bacterial brain abscesses [ 10 ]. In fact, out of 2,216 culture-positive brain abscesses reported in India from 2010 to 2019, only Sarmast et al reported the isolation of Streptococcus pneumoniae in 22 of their patients [ 4 ].…”

“…Repeat blood and CSF cultures done after one week were sterile. She was given intravenous vancomycin for six weeks as per guidelines for brain abscess [ 4 ] and had no residual deficits at discharge.…”

Concomitant extradural, subdural, and intraparenchymal abscesses of the brain in a patient with cerebral melioidosis – A case report

“…Other features include meningitis, multiple infarcts, thrombosis, and aneurysm formation all attributable to vascular invasion by fungal elements. [ 10 ] Although viral etiology is rare, it has high mortality. Radiologically, there is negligible literature on viral cerebral abscess, as viral CNS infections has different traits of presentation including encephalitis (Herpes and Rabies virus), leukoencephalopathy (Human Immunodeficiency Virus), ventriculoencephalopathy (Cytomegalovirus), tissue necrosis, and hemorrhagic foci with sequelae of diffuse gliosis and cyst formation [malacia] with calcification (Coxsackie virus).…”

“…Of the micro-organisms affecting the brain, Gram-negative bacilli account for 9–31% of the total infections. [ 10 ] Our case report features CNS melioidosis, caused by Burkholderia pseudomallei , a Gram-negative bacillus endemic to tropical countries. [ 2 ] The rising occurrence of melioidosis in India can be attributed to rising temperatures, humidity, and ultraviolet radiation; the increased prevalence of diabetes mellitus, and immunocompromised status in the population.…”