Retrospective analysis of brain abscess in 183 patients

Wu, Shenglian; Wei, Yi-ting; Yu, Xiaobo; Peng, Yucong; He, Pingyou; Xu, Hangzhe; Qian, Cong; Chen, Gao

doi:10.1097/md.0000000000017670

Cited by 21 publications

(22 citation statements)

References 21 publications

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“…e use of craniotomy for the treatment of abscess has significantly decreased while minimally invasive or image-guided aspiration techniques are now preferred as first surgical choice for abscesses. [32,42] Outcome in this study was unfavorable in 16% with a mortality rate of 9% [Table 2]. e deaths were due to delayed presentation, diagnosis, and intervention often attributable to poverty and ignorance.…”

Section: Discussionmentioning

confidence: 86%

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

Kanu

Ojo

Esezobor

et al. 2021

Surgical Neurology International

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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.

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Section: Discussionmentioning

confidence: 86%

“…The use of craniotomy for the treatment of abscess has significantly decreased while minimally invasive or image-guided aspiration techniques are now preferred as first surgical choice for abscesses. [ 32 , 42 ]…”

Section: Discussionmentioning

confidence: 99%

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

Kanu

Ojo

Esezobor

et al. 2021

Surgical Neurology International

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“…Maximum abscess diameter was higher in patients who underwent a second procedure which may explain the recurrence of abscess formation in the rst place. Wu et al assured in their study that the surgical method plays a crucial role in predicting postsurgical complications and reoperation (6), they found that reoperation was more likely to be needed in patients who underwent aspiration, and that excision yields better clinical outcomes and more complications. In addition, due to the wide variety in the causative aetiological agents of brain abscesses, all patients need an empirical therapy and are recommended to undergo adjunctive systemic antibiotics management especially in cases of local and remote infections (1,7,17).…”

Section: Discussionmentioning

confidence: 99%

“…For centuries, brain abscesses had high morbidity and mortality rates which dramatically decreased with advances of culturing methods, neuroimaging, neurosurgical techniques, and antibiotic treatments, resulting in an earlier diagnosis, accurate localization and better management (3,4). However, it still threatens public health with an incidence of 0.4-0.9% worldwide, 1-2% in western countries and 8% of intracranial insults in developing countries (5,6).…”

Section: Introductionmentioning

confidence: 99%

An in depth look into intracranial Abscesses and Empyemas: a 10-year experience in a single institute.

Jarrar

Barbarawi

Daoud

et al. 2021

Preprint

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Background As the incidence of intracranial infections increase due to diagnostic procedures improvement, more real-life data is needed to reach a more solid informed management approach. This study aims to describe and analyse clinical features of intracranial abscesses patients treated at a tertiary hospital in North Jordan during a 10-year period. Methods We retrospectively identified 37 patients treated at King Abdullah University Hospital (KAUH) from 2011 to 2020 in Irbid, North Jordan. Treatment consisted of either aspiration, open craniotomy excision (OCE) or conservative therapy. Extracted variables included demographic data such (age, gender), clinical presentation, lab findings, radiological findings as well as management plan. Retrieved data was compared between the patients who underwent a single operation and those who underwent reoperation after the initial procedure. Results Thirty-seven patients with 55 intracerebral abscesses were identified, 29 of whom had intraparenchymal brain abscesses, 4 patients had epidural empyema, and 4 had subdural empyema. The mean age was 28.8 (± 20.7) years, with a male predominance (78.4%). Sixteen patients underwent open craniotomy excision (OCE), 14 patients were treated by aspiration and 7 patients were treated conservatively. When comparing the single operation and the reoperation groups, there was no statistically significant difference across variables. Conclusion Our study presents valuable insight from a tertiary hospital in north Jordan on intracranial abscesses and empyemas. Our findings confirm that good recovery can be established after aspiration or OCE in the majority of patients. Similar results were obtained when comparing the SOP and the ROP groups.

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“…A cerebral abscess (CA) is an infection in the cerebral parenchyma that can arise as a complication of a variety of pathological conditions such as surgery, trauma, and as a result of other primary infections [1]. Most of the time, the clinical symptoms of brain abscess are related to intracranial hypertension (ICH), which is generally associated with secondary brain conditions in children, resulting in high morbidity and mortality, varying between 13% to 20% [2]. Brain abscesses are serious conditions, uncommon in the pediatric population, but of great clinical importance due to significant long-term mortality, demonstrating a prevalence of 0.4% to 0.9% for every 1000 people on a global scale [3].…”

Section: Introductionmentioning

confidence: 99%

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

Marqui

Lima

Baptista

et al. 2021

MedNEXT

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Objective: To report a Central Nervous System infection evolving with brain abscess and to address aspects of the treatment of the disease. Results: even with advances in treatment and diagnosis, the pathology has a high mortality. However, the best prognosis is noticed when there is a suspicion through the clinic, neuroradiological images readily available, antimicrobial therapy against commonly encountered agents, and surgical drainage procedures. One study, which combined antibiotic therapy and surgery to drain the abscess, in most of the cases, studied, demonstrated a mortality rate of 12%, and another study, a 42% mortality rate when using antibiotic therapy alone. Another reference suggests the use of antibiotic therapy alone in less severe cases with less neurological impairment. Neurological clinical sequelae can be found in up to 30% of cases. The time of antibiotic therapy still needs to be debated, as well as the surgical indication for drainage. Final Considerations: Pediatric brain abscess is an uncommon disease, still with high morbidity and mortality. Surgical drainage or excision of pediatric abscesses remains the basis of treatment both to relieve the mass effect and to provide a microbiological diagnosis. The literature demonstrates that broad-spectrum antibiotics and access to CT and MRI images decrease the rates of morbidity and mortality. It is concluded that the therapeutic approach involves the administration of broad-spectrum intravenous antibiotics and surgical drainage in more complex cases.

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Retrospective analysis of brain abscess in 183 patients

Cited by 21 publications

References 21 publications

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

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

An in depth look into intracranial Abscesses and Empyemas: a 10-year experience in a single institute.

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

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