Pediatric brain abscess – etiology, management challenges and outcome in Lagos Nigeria

Abstract

Background: Brain abscess in children is a neurosurgical emergency with potentially catastrophic outcome despite the advances made in neuroimaging techniques and antibiotic therapy. Symptoms are nonspecific and may vary with the child’s age, location, size, numbers and stage of abscess, and the primary source of infection. Treatment is usually with broad-spectrum antibiotics in combination and surgical evacuation in most cases or antibiotics alone in selected cases with clear-cut indications. This study was to document clinical characteristics, etiological factors, and spectrum of bacteriologic agents responsible for pediatric brain abscess in an African city, the challenges and management outcome over the study period. Methods: This was a retrospective study over an 11-year period involving 89 children who presented with brain abscess. Information of interest was extracted from the medical records of each participant. The results from data analysis were presented in charts and tables. Results: Eighty-nine children aged 0.85–15.7 years (median age of 6.4 years) met the inclusion criteria. The male-to-female ratio was 1.8:1. Headache (80%), fever (78%), and hemiparesis (78%) were the most common symptoms. Brain imaging deployed was CT scan in 56 (63%), MRI in 9 (10%), and transfontanel ultrasound scan in 24 (27%) children. Seventy-one (80%) children had antibiotics with surgical evacuation while 18 (20%) children received only antibiotics. In 19 (27%) children, the culture of the abscess was negative. In 53 (75%) children, Gram-positive aerobic organisms were isolated. A total of 75 patients (84%) had a favorable outcome. Conclusion: Pediatric brain abscess still poses significant public health challenge, especially in resource-limited regions. Successful management of brain abscess requires high index of suspicion for early diagnosis, referral, and intervention.

Re-Operation Rates after Burr-Hole Aspiration of Brain Abscess

“…9 In another study conducted by Ahmad S et al, significant residual abscesses in 17 (17%) of the patients required re-aspiration. 10 This slightly increased rate of re-aspiration in our study might be a result of the patient's late presentation and poor preoperative health, which prevents the antibiotic from entering the abscess sac while the abscess is in the late capsule stage.…”

“…12 In another study conducted by Ahmad et al, the parietal region was the most frequently affected in 44 patients (44%) followed by the frontal in 33(33%), temporal in 13 (13%), and occipital regions in 10 (10%). 10 This may be attributed to the hematogenous source being the most common route of infection and the internal carotid artery's role in providing 80% of the blood supply to the brain.…”

Contemporary Management of Intracranial Subdural Empyema

“…Percutaneous trans-fontanelle subdural aspiration of intracranial subdural and intra-axial pus has been documented; however, this should be employed with great caution. [ 7 13 15 19 ]…”

“…The causative organisms correlate with the age of the patient and the primary source of infection. [ 19 ] In our series, the positive cultures were from patients who had SDE complicating previous neurosurgical procedures. One yielded methicillin-resistant S. aureus and the other, P. aeruginosa .…”

Brain abscess as an otorhinolaryngological complication

“…The spectrum of causative microorganisms depends on factors such as age, immunocompetence, location, social income, culture, and other essential factors when approaching a patient suspected of having a brain abscess. Several studies since the 20th century have shown that the main microorganisms are Streptococcus, Staphylococcus, and gram-negative enteric bacteria [2,[8][9][10]. The location of the brain abscess can be intracranial or extracranial, such as subdural or epidural, and is essential in eligible treatment, such as antibiotics alone or with neurosurgery [8,9].…”