Brain abscess caused by Streptococcus anginosus group:Three case reports

BACKGROUND This case series investigated the clinical manifestations,diagnoses,and treatment of cerebral abscesses caused by Streptococcus anginosus.We retrospectively analyzed the clinical characteristics and outcomes of three cases of cerebral abscesses caused by Streptococcus anginosus and conducted a comprehensive review of relevant literature.CASE SUMMARY Case 1 presented with a history of left otitis media and exhibited high fever,confusion,and vomiting as primary symptoms.Postoperative pus culture indicated a brain abscess caused by Streptococcus constellatus infection.Case 2 experienced dizziness for two days as the primary symptom.Postoperative pus culture suggested an intermediate streptococcal brain abscess.Case 3:Enhanced head magnetic resonance imaging(MRI)and diffusion-weighted imaging revealed occupancy of the left temporal lobe,initially suspected to be a metastatic tumor.However,a postoperative pus culture confirmed the presence of a brain abscess caused by Streptococcus anginosus infection.The three cases presented in this case series were all patients with community-acquired brain abscesses resulting from angina caused by Streptococcus group infection.All three patients demonstrated sensitivity to penicillin,ceftriaxone,vancomycin,linezolid,chloramphenicol,and levofloxacin.Successful treatment was achieved through stereotaxic puncture,drainage,and ceftriaxone administration with a six-week course of antibiotics.CONCLUSION Preoperative enhanced head MRI plays a critical role in distinguishing brain tumors from abscesses.Selecting the correct early diagnostic methods for brain abscesses and providing timely intervention are very important.This case series was in accordance with the CARE guidelines.

Cerebral syphilitic gumma misdiagnosed as brain abscess: A case report

BACKGROUND Cerebral syphilitic gumma is a relatively rare clinical disease.Its clinical manifest-ations are non-specific,and the imaging manifestations are similar to other in-tracranial occupying lesions,often misdiagnosed as tumors or abscesses.There are few reports on this disease in the relevant literature.To our knowledge,we have reported the first case of cerebral syphilitic gumma misdiagnosed as a brain abscess.We report this case and provide useful information for clinical doctors on neurosyphilis diseases.CASE SUMMARY We report the case to explore the diagnostic essentials of cerebral syphilitic gumma and attempt to mitigate the rates of misdiagnosis and missed diagnosis by equipping physicians with knowledge of neurosyphilis characteristics.The cli-nical diagnosis and treatment of a patient with cerebral syphilitic gumma were reported.Clinical manifestations,classifications,and diagnostic points were retro-spectively analyzed.The patient was admitted to the hospital with fever and limb weakness.Brain magnetic resonance imaging showed multiple space-occupying lesions and a positive serum Treponema pallidum gelatin agglutination test.The patient was misdiagnosed as having a brain abscess and underwent a craniotomy.A postoperative pathological diagnosis of syphilis gumma was made.The patient improved and was discharged after penicillin anti-syphilis treatment.Follow-up recovery was satisfactory.CONCLUSION Cerebral syphilitic gumma is rare in clinical practice,and it is often misdiagnosed and missed.Clinical diagnosis should be considered in combination with multiple examinations.

Brain abscess from oral microbiota approached by metagenomic next-generation sequencing: A case report and review of literature

BACKGROUND Brain abscess is a serious and potentially fatal disease caused primarily by microbial infection.Although progress has been made in the diagnosis and treatment of brain abscesses,the diagnostic timeliness of pathogens needs to be improved.CASE SUMMARY We report the case of a 54-year-old male with a brain abscess caused by oral bacteria.The patient recovered well after receiving a combination of metagenomic next-generation sequencing(mNGS)-assisted guided medication and surgery.CONCLUSION Therefore,mNGS may be widely applied to identify the pathogenic microor-ganisms of brain abscesses and guide precision medicine.

A Case Report of Methylobacterium radiotolerans Bacteremia and Brain Abscesses

Methylobacterium radiotolerans is a ubiquitous organism found in the environment and is considered an opportunistic pathogen of low virulence in humans.Most human infections from M.radiotolerans have been reported in immunocompromised hosts and have been reported mainly as bloodstream infections related to central venous catheters.We present the first known case of M.radiotolerans as a causative agent of multiple brain abscesses in an immunocompromised host.

Isolated cerebral mucormycosis that looks like stroke and brain abscess:A case report and review of the literature

BACKGROUND Cerebral mucormycosis is an infectious disease of the brain caused by fungi of the order Mucorales.These infections are rarely encountered in clinical practice and are often misdiagnosed as cerebral infarction or brain abscess.Increased mortality due to cerebral mucormycosis is closely related to delayed diagnosis and treatment,both of which present unique challenges for clinicians.CASE SUMMARY Cerebral mucormycosis is generally secondary to sinus disease or other disseminated disease.However,in this retrospective study,we report and analyze a case of isolated cerebral mucormycosis.CONCLUSION The constellation of symptoms including headaches,fever,hemiplegia,and changes in mental status taken together with clinical findings of cerebral infarction and brain abscess should raise the possibility of a brain fungal infection.Early diagnosis and prompt initiation of antifungal therapy along with surgery can improve patient survival.

Brain Abscess after COVID-19: Case Report

As the COVID-19 pandemic progresses, complications and unusual presentations of the disease have been described. Among them, the involvement of distinct parts of the neuroaxis. We report a rare case of brain abscess in elderly after SARS-Cov-2 infection readmitted in our health unit. Patient was treated with ceftriaxone, metronidazole and vancomycin with good clinical and therapeutic response. The satisfactory conduct of the case was only possible by the involvement of a multiprofessional team, which sought early diagnosis, surgical intervention and adequate duration of treatment.

Brain Abscess Surgery Outcome: A Comparison between Craniotomy with Membrane Excision versus Burr Hole Aspiration

Introduction: Brain abscess represents 8% of intracranial masses in developing countries. Despite the advances in neuro-imaging, still, the diagnosis of brain abscess is difficult and may need a biopsy in most cases to verify the diagnosis because may even lead to death. CT scan with contrast is a good tool for diagnosing and localizing brain abscesses in late stages, however, it is difficult to diagnose them in the early stages. The development of MRI helps to more accurately diagnose brain abscess. Surgical management of brain abscesses is either medical or surgical through craniotomy or burr holes. Indications of each are still a point of debate among most neurosurgeons. Methodology: This is a descriptive longitudinal prospective study to compare the outcomes of two surgical procedures used in The National Centre for Neurological Sciences-Khartoum-Sudan (NCNS) from 2012 to 2015, craniotomy and excision of the abscess membrane versus burr hole and aspiration of brain abscess in terms of duration of hospitalization, length of antibiotic use, recurrence rate, number of images needed for follow-up, and the final postoperative early and late outcomes. The data was collected through a designed questionnaire and was then analyzed using SPSS version 20. No significant ethical approval was required for this study. Results: Fifty-four patients were operated on through craniotomy (29/54) and burr hole (25/54). Their ages ranged from 1 year to 53 years with an average presentation at 13 years of age. Most patients presented with fever (23.1%), convulsions (16%), vomiting (16.7%) and headache (15.4%). The mean of illness for both groups was almost 2 months. The majority of patients in this study were having no risk factors (38.9%) while the major risk factors seen were cardiac diseases (14.8%), neurosurgical procedures (13%) and otitis media (11.1%). As most patients presented late, the diagnosis of most was made using CT brain with contrast (83.3%). In most of the patients (85.2%) there were no organisms separated in the culture. 8/54 patients had positive cultures, 7/8 were bacterial and only one (1/8) was fungal. Most patients received antibiotics for 45 days postoperatively in both craniotomy and burr hole groups. When both groups were compared, those operated with craniotomy were found to have a relatively higher length of hospital stay, however, no significant difference was found between both groups. Also, it was found that those operated on with craniotomy had a high cure rate and less recurrence in comparison with burr hole group. Deterioration and death were significantly higher among craniotomy group. Only CT brain was used as the imaging modality of choice for follow-up in both groups for 4 months’ duration and it was noted that complete evacuation was significantly higher among craniotomy group while remnants were higher among burr hole group. Conclusion: Brain abscess is still a challenging condition for neurosurgeons in Sudan. The limited number of Sudanese neurosurgeons, neurosurgical centers and diagnostic facilities contributed to delay in diagnosing brain abscess in most patients. It is important to design a strict protocol and precautions for any neurosurgical operation or bedside procedure to prevent infection and subsequent brain abscess development. CT brain with contrast is a good imaging tool for assessing the size, site and stage of brain abscesses. No significant difference between craniotomy or burr hole for clearance from brain abscess in terms of antibiotic used or duration of hospital stay. However, burr hole aspiration is associated with higher rates of recurrences. On the other hand, craniotomy and excision have relatively higher neurologic morbidity postoperative with expectantly higher post-operative hospitalization but no differences in the final outcome. Therefore, the selection of surgical technique should be individualized in each case based on the abscess site size source patient fitness for surgery and neurosurgeon’s preference.

Rare case of cryptogenic brain abscess caused by Raoultella ornithinolityca

Cerebral abscess is a potentially fatal neurosurgical condition,despite improvements in technology,new antimicrobial agents and modern neurosurgical instruments and techniques.I report the case of a 64-yearold woman,affected by a right frontobasal brain abscess,compressing the homolateral frontal horn of lateral ventricle,with a second mass partially occupying the right orbital cavity.She presented also with inflammatory sinusopathy involving the right maxillary,ethmoid and frontal sinuses.After 14 d of clinical observation and antimicrobial therapy,the patient received a computed tomography scan,which showed growth of the cerebral mass,with a ring of peripheral contrast enhancement and surrounding edema.She promptly underwent neurosurgical treatment and recovered well,except for the sight in her right eye,which remained compromised,as before the operation.This is believed to be the first case of cryptogenic cerebral abscess caused by Raoultella ornithinolityca isolated from the brain,with more than 1-year follow-up.

Perioperative Nursing of a Case of Right Temporal Lobe Brain Abscess Ruptured into the Ventricle

Objective: To explore the perioperative nursing method of brain abscess breaking into the ventricle. Methods: By reviewing the clinical data of 1 case of right temporal lobe brain abscess into the ventricle, the effective nursing methods were summarized. Results: The patient’s condition was advanced quickly, and the diagnosis was treated in time to avoid brain hernia, but the treatment was difficult because of the critical condition. Conclusion: Brain abscess is a very serious intracranial infectious disease. It is of great significance to observe the changes in patients’ condition and take effective nursing measures.

Neonatal Brain Abscess:Case Report of 12 Cases and Literature Review

Objective:To investigate the etiological characteristics,clinical manifestations,and early identification methods of neonatal brain abscess.Methods:The baseline characteristics,clinical manifestations,and laboratory results of 12 neonatal brain abscess cases were retrospectively analyzed.Results:The clinical manifestations were fever,convulsion,and lethargy.A small number of them had respiratory and circulatory failure.The diagnosis made was based on imaging examination.All 12 cases were confirmed by cranial enhanced computed tomography(CT)or magnetic resonance imaging(MRI).Blood cultures of 9 cases were positive,with Escherichia coli in 6 cases,β-hemolytic Streptococcus in 1 case,methicillin-resistant Staphylococcus aureus in 1 case,and Enterococcus faecium in 1 case.However,only 3 of them had positive cerebrospinal fluid(CSF)cultures.All the 12 neonates were treated with antibiotic therapy upon admission,with only 3 cases treated with surgery.Among them,4 recovered and were discharged,while the remaining 8 discontinued their therapy.Conclusion:Escherichia coli is the most common pathogen of neonatal brain abscess in our study.The clinical manifestations of neonatal brain abscess are atypical,and the prognosis is poor.Respiratory and circulatory failure in children with intracranial infection may indicate the presence of brain abscess.For children with suspected brain abscess,cranial enhanced CT or MRI should be performed as soon as possible to make an early diagnosis.The prevention of brain abscess should be prioritized;neonates with sepsis or meningitis should receive prompt and strong antibiotic therapy in an effort to prevent the development of brain abscess.

Coinfection of Streptococcus suis and Nocardia asiatica in the human central nervous system:A case report

BACKGROUND Streptococcus suis(S.suis)is an anthropozoonotic pathogen that shows clinical manifestations of meningitis,septicemia,and arthritis in infected humans.Nocardia is another type of anthropozoonotic bacteria,with clinical manifestations of skin,lung,and brain abscesses in infected humans.Few intracranial infections caused by S.suis or Nocardia have been reported.To the best of our knowledge,no study has reported a patient with simultaneous intracranial infection by S.suis and Nocardia.CASE SUMMARY A 66-year-old male presented at Liaocheng People’s Hospital(Liaocheng,Shandong Province,China)reporting dizziness with nausea and vomiting.Metagenomic next-generation sequencing(m NGS)was performed on cerebrospinal fluid for examination,and the patient was diagnosed with suppurative meningitis caused by S.suis infection.He received anti-infection treatment with penicillin sodium and ceftriaxone.The patient’s condition initially improved but then deteriorated.Further m NGS of cerebrospinal fluid revealed both S.suis and Nocardia.Imaging examination revealed a brain abscess.Furthermore,a mixed infection of S.suis and Nocardia was detected in the patient’s central nervous system.The patient was treated with antibiotics and sulfamethoxazole.He was discharged after his condition improved.CONCLUSION This case shows that the disease can be recurrent in patients with intracranial infection of a rare pathogen.The possibility of mixed infection should also be considered,especially in patients treated with immunosuppressive agents.m NGS of cerebrospinal fluid is a supplement to conventional microbial pathogen identification methods.Patients with unknown pathogen diagnosis,early extensive use of antibiotics and infection with rare pathogens can be diagnosed by the combination of conventional methods and m NGS of cerebrospinal fluid.

Potential otogenic complications caused by cholesteatoma of the contralateral ear in patients with otogenic abscess secondary to middle ear cholesteatoma of one ear:A case report

BACKGROUND Otogenic brain abscess caused by middle ear cholesteatoma is a potentially serious and life-threatening complication in the ear,nose,and throat clinic.The mortality rate associated with otogenic brain abscesses is 8%–26.3%.Recently,in China,the incidence of brain abscess secondary to middle ear cholesteatoma has started to increase due to antibiotic resistance.CASE SUMMARY A 55-year-old male presented hearing loss in the right ear and headache for 1 mo in 2018.Computed tomography(CT) showed an area of low density in the right middle ear and mastoid and auditory ossicle defects and a small amount of soft tissue density in the left middle ear.The parietal wall of the right tympanic cavity and the posterior wall of the mastoid sinus were thin and less continuous.Cranial magnetic resonance imaging revealed an area of low intensity encapsulated by an area of high intensity in the right temporal lobe.We diagnosed him with a brain abscess secondary to middle ear cholesteatoma.He received surgery to drain the abscess followed by a modified radical mastoidectomy.The patient visited our department 3 years later because of intermittent otorrhea in the left ear.CT revealed that the area of the soft tissue density in the left middle ear and mastoid was significantly increased.The posterior wall of the mastoid sinus was destroyed,leaving the left middle ear connecting with the brain.The patient underwent a modified radical mastoidectomy in the left ear CONCLUSION Regular follow-up and timely treatment of contralateral ear disease are vital for the prevention of otogenic complications in patients with otogenic abscesses secondary to middle ear cholesteatoma in the unilateral ear.

Cerebral Abscesses Revealing Pulmonary Arteriovenous Malformations

Pulmonary arteriovenous malformations （AVM） lung is defined by an abnormal communication between pulmonary artery（ies） and vein（s） responsible for a right-left shunt. Congenital forms are most common and usually associated with Rendu-Osler disease （ROD）. Inversely, 15-45% of patients with ROD present lung AVM Nowadays, embolization is preferred to surgical resection in the majority of cases. Except for certain cases where surgery is indicated. This paper shows the role of surgery in AVMs.

Brain abscess:surgical experiences of 162 cases

Aim:Brain abscess still poses a public health challenge in spite of the advent of modern neurosurgical techniques and antibiotics.Here,we present our surgical experiences and ultimate outcome in the management of brain abscess.Methods:Totally,162 patients with proved brain abscess who underwent surgical treatment were included in this study.The prospectively recorded data of surgical management of brain abscess and the ultimate outcome(by Glasgow outcome scale)were studied retrospectively.Results:Total number of cases was 162,of which 113 were acute pyogenic abscess while 49 were chronic abscess.Among the chronic abscess,29 were chronic pyogenic abscess,14 were tubercular,3 aspergillus,and 3 abscesses were in malignant brain metastases.In acute cases,common clinical features were headache,fever,vomiting,focal deficit and seizure.In chronic abscesses,common clinical features were mild to moderate headache and progressive focal deficit.Seventy-three(45.06%)patients had adjacent localized sinus,middle ear or cranial infection.The common predisposing factors included postneurosurgery,postpenetrating injury to brain,chronic suppurative otitis media,and congenital heart disease,infective endocarditis,sinusitis and sub optimum immuno-status.Frontal lobe involved in 30.2%cases,temporal lobe is next to involved.Single time burr hole aspiration in 111(68.5%)cases,two or more times burr hole aspiration were done in 34(21%)cases.Pus culture was negative in 129(79.62%)cases.Total number of death was 22(13.58%)cases.Complete resolution of abscess with complete recovery of preoperative neuro-deficit was seen in 80.86%cases and recovery with major neuro-deficit was observed in 5.55%cases.There is a significant association between Glasgow coma scale(GCS)on admission and mortality in brain abscess.Conclusion:In most of the cases,pus culture did not yield growth of any causative organism.Mortality was not directly related to surgical intervention,but GCS on admission has a significant association with mortality.Early diagnosis,optimum follow-up and timely surgical interventions are the keys in the proper management of brain abscess.

Brain Abscess Caused by Bacillus megaterium in an Adult Patient

Bacillus megaterium, a Gram-positive, aerobic, spore-forming, rod-shaped bacterium, has been found in widely diverse habitats and has been widely used as a source of recombinant protein in the industry. With a cell length of up to 4 lain and a diameter of 1.5 μm, B. megaterium belongs to one of the largest known bacteria.

Nocardial brain abscess in an immunocompetent patient and review of literature

Background:Nocardial brain abscesses are associated with significant morbidity and mortality rates.The optimal management remains unclear.Case presentation:We report a case of 49-year-old woman presented with dizziness,progressive headache for 3 days,accompanied with left arm twitched for twice.The patient underwent a right parietal craniotomy for resection of the lesion.Gross total resection of the lesion was achieved.There were no new neurological deficits post-operatively,and no lesions was demonstrated on Gd-enhanced MRI images at six months follow-up.Conclusions:After review of the literature and experience learned from our case,we suggest that craniotomy and surgical resection of the lesions,instead of aspiration,is a safe,efficacious treatment for the patient with nocardial brain abscesses.Long-term chemotherapy and follow-up is mandatory in all cases.

Neuronavigation combined with nerve electrophysiology in excision of brain abscess: A case report and literature review

A brain abscess is a parenchymal infection,which is a severe intracranial infectious disease. Although the incidence is low,it causes serious inflammation and neurological deficits. The current treatments for brain abscesses are primarily surgical,including abscess resection or puncture and drainage. In recent years,extensive application of neuronavigation and electrophysiological monitoring technology have improved the safety and reliability of neurosurgery. To explore the application and curative effect of neuronavigation combined with neurophysiological techniques in the treatment of brain abscesses,we retrospectively analyzed a female patient who had undergone neurological monitoring and neuronavigation-assisted surgery to remove an abscess in 2015. Diagnosis and treatment are reported.