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.

Automated Brain Tumor Diagnosis Using Deep Residual U-Net Segmentation Model

Automated segmentation and classification of biomedical images act as a vital part of the diagnosis of brain tumors(BT).A primary tumor brain analysis suggests a quicker response from treatment that utilizes for improving patient survival rate.The location and classification of BTs from huge medicinal images database,obtained from routine medical tasks with manual processes are a higher cost together in effort and time.An automatic recognition,place,and classifier process was desired and useful.This study introduces anAutomatedDeepResidualU-Net Segmentation with Classification model(ADRU-SCM)for Brain Tumor Diagnosis.The presentedADRUSCM model majorly focuses on the segmentation and classification of BT.To accomplish this,the presented ADRU-SCM model involves wiener filtering(WF)based preprocessing to eradicate the noise that exists in it.In addition,the ADRU-SCM model follows deep residual U-Net segmentation model to determine the affected brain regions.Moreover,VGG-19 model is exploited as a feature extractor.Finally,tunicate swarm optimization(TSO)with gated recurrent unit(GRU)model is applied as a classification model and the TSO algorithm effectually tunes theGRUhyperparameters.The performance validation of the ADRU-SCM model was tested utilizing FigShare dataset and the outcomes pointed out the better performance of the ADRU-SCM approach on recent approaches.

Computer-Aided Diagnosis Model Using Machine Learning for Brain Tumor Detection and Classification

The Brain Tumor(BT)is created by an uncontrollable rise of anomalous cells in brain tissue,and it consists of 2 types of cancers they are malignant and benign tumors.The benevolent BT does not affect the neighbouring healthy and normal tissue;however,the malignant could affect the adjacent brain tissues,which results in death.Initial recognition of BT is highly significant to protecting the patient’s life.Generally,the BT can be identified through the magnetic resonance imaging(MRI)scanning technique.But the radiotherapists are not offering effective tumor segmentation in MRI images because of the position and unequal shape of the tumor in the brain.Recently,ML has prevailed against standard image processing techniques.Several studies denote the superiority of machine learning(ML)techniques over standard techniques.Therefore,this study develops novel brain tumor detection and classification model using met heuristic optimization with machine learning(BTDC-MOML)model.To accomplish the detection of brain tumor effectively,a Computer-Aided Design(CAD)model using Machine Learning(ML)technique is proposed in this research manuscript.Initially,the input image pre-processing is performed using Gaborfiltering(GF)based noise removal,contrast enhancement,and skull stripping.Next,mayfly optimization with the Kapur’s thresholding based segmentation process takes place.For feature extraction proposes,local diagonal extreme patterns(LDEP)are exploited.At last,the Extreme Gradient Boosting(XGBoost)model can be used for the BT classification process.The accuracy analysis is performed in terms of Learning accuracy,and the validation accuracy is performed to determine the efficiency of the proposed research work.The experimental validation of the proposed model demonstrates its promising performance over other existing methods.

Privacy Preserved Brain Disorder Diagnosis Using Federated Learning

Federated learning has recently attracted significant attention as a cutting-edge technology that enables Artificial Intelligence(AI)algorithms to utilize global learning across the data of numerous individuals while safeguarding user data privacy.Recent advanced healthcare technologies have enabled the early diagnosis of various cognitive ailments like Parkinson’s.Adequate user data is frequently used to train machine learning models for healthcare systems to track the health status of patients.The healthcare industry faces two significant challenges:security and privacy issues and the personalization of cloud-trained AI models.This paper proposes a Deep Neural Network(DNN)based approach embedded in a federated learning framework to detect and diagnose brain disorders.We extracted the data from the database of Kay Elemetrics voice disordered and divided the data into two windows to create training models for two clients,each with different data.To lessen the over-fitting aspect,every client reviewed the outcomes in three rounds.The proposed model identifies brain disorders without jeopardizing privacy and security.The results reveal that the global model achieves an accuracy of 82.82%for detecting brain disorders while preserving privacy.

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.

Diagnosis of upper gastrointestinal perforation complicated with fistula formation and subphrenic abscess by contrast-enhanced ultrasound:A case report

BACKGROUND Gastrointestinal perforation complicated by subphrenic abscess is a surgical emergency.Its diagnosis relies mainly on X-ray or computed tomography(CT),while the value of ultrasound,especially contrast-enhanced ultrasound(CEUS),has been underestimated.CASE SUMMARY A 37-year-old man presented with fever and edema of the lower extremities for 10 d.He had a history of laparoscopic repair of gastroduodenal perforation 6 mo prior.His first-time intravenous CEUS indicated a diagnosis of subphrenic abscess.He received antibiotic therapy and ultrasound-guided percutaneous drainage of the abscess.However,second-time intravenous CEUS revealed an unsatisfactory therapeutic effect.Intracavitary CEUS was proposed,and this examination detected communication between the abscess and the stomach.Upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess was diagnosed with the help of CEUS.Abdominal CT and esophagogastroduodenoscopy confirmed the diagnosis.The patient recovered after the perforation was repaired by surgery.CONCLUSION Intravenous and intracavitary CEUS provides helpful information for the diagnosis of upper gastrointestinal perforation complicated by fistula formation and subphrenic abscess.

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.

Differential diagnosis of a vanishing brain space occupying lesion in a child

We describe clinical, diagnostic features and follow up of a patient with a vanishing brain lesion. A 14-yearold child admitted to the department of Neurology at September 2009 with a history of subacute onset of fever, anorexia, vomiting, blurring of vision and right hemiparesis since one month. Magnetic resonance imaging(MRI) of the brain revealed presence of intraaxial large mass(25 mm × 19 mm) in the left temporal lobe and the brainstem which showed hypointense signal in T1 W and hyperintense signals in T2 W and fluid attenuated inversion recovery(FLAIR) images and homogenously enhanced with gadolinium(Gd). It was surrounded by vasogenic edema with mass effect. Intravenous antibiotics, mannitol(2 g/12 h per 2 d) and dexamethasone(8 mg/12 h) were given to relief manifestations of increased intracranial pressure. Whole craniospinal radiotherapy(brain = 4000 CGy/20 settings per 4 wk; Spinal = 2600/13 settings per 3 wk) was given based on the high suspicion of neoplastic lesion(lymphoma or glioma). Marked clinical improvement(up to complete recovery) occurred within 15 d. Tapering of the steroid dose was done over the next 4 mo. Follow up with MRI after 3 mo showed small lesion in the left antero-medial temporal region with hypointense signal in T1 W and hyperintense signals in T2 W and FLAIR images but did not enhance with Gd. At August 2012, the patient developed recurrent generalized epilepsy. His electroencephalography showed the presence of left temporal focus of epileptic activity. MRI showed the same lesion as described in the follow up. The diffusion weighted images were normal. The seizures frequency was decreased with carbamazepine therapy(300 mg/12 h). At October 2014, single voxel proton(1H) MR spectroscopy(MRS) showedreduced N-acetyl-aspartate(NAA)/creatine(Cr), choline(Cho)/Cr, NAA/Cho ratios consistent with absence of a neoplasm and highly suggested presence of gliosis. A solitary brain mass in a child poses a considerable diagnostic difficulty. MRS provided valuable diagnostic differentiation between tumor and pseudotumor lesions.

Pyogenic liver abscess in children: Diagnosis and treatment at the teaching hospital Gabriel Touré, Bamako, Mali

Purpose: To determine diagnostic and therapeutic problems of pyogenic liver abscess in our hospital. Method and material: We conducted a retrospective study from January 2006 to December 2010 of all children aged from 0 - 15 years admitted and treated for pyogenic liver abscesses. Amoebic liver abscesses and other hepatobiliary disorders were not considered. Results: Pyogenic abscesses accounted for 50 cases. The mean age of patients at presentation was 2.4 ± 0.78 years (range from 6 months to 15 years). Sex ratio was 2.8 for boys. Abdominal pain was the primary reason for consultation in 27 cases (54%). Fever has been noted in 42 patients (84%) and the patient general state was altered in 13 patients (26%). Escherishia coli was the most frequent bacteria found at pus. The pus was sterile in 25 cases (50%). The ultrasonographic percutaneous drainage was performed in 33 patients (66%), open surgery in 6 (12%) and antibiotics alone in 11 others (22%). The short outcomes were simple in 36 patients (72%) while pain and fever persisted in 12 others (24%). Two patients (4%) died from sepsis soon after the operating room. Improving the frequency of early diagnosis will depend on education of clinicians about the need for clinical suspicion aided by ultrasound.

Delayed diagnosis of ascending colon mucinous adenocarcinoma with local abscess as primary manifestation: Report of three cases

BACKGROUND Colorectal mucinous adenocarcinoma is a distinct subtype of colorectal adenocarcinoma that is not sensitive to chemotherapy and radiotherapy,and its prognosis is worse than that of nonmucinous adenocarcinoma.Early diagnosis and aggressive surgical treatment may be the key to improving the prognosis of patients.Ascending colon mucinous adenocarcinoma with the primary manifestation of a local abscess caused by non-intestinal perforation has never been reported.Moreover,since the lumen of the ascending colon is large,and early stage ascending colon cancer lacks typical clinical manifestations,the diagnosis may be delayed easily.We herein report three cases of delayed diagnosis of colorectal mucinous adenocarcinoma.CASE SUMMARY We present three patients(two females and one male)with mucinous ascending colon mucinous adenocarcinoma with the primary manifestation of a local abscess(the right area of the lumbar spine,right groin,and lower right abdomen)caused by non-intestinal perforation.At the initial clinical visit,the common causes of those abscesses,including spinal tuberculosis and urinary tract infection,were excluded.The treatment of the abscess was through an incision and drainage.However,the source of the abscess was not made clear,which led to an abscess recurrence and a delayed diagnosis of colorectal mucinous adenocarcinoma.After the patients were referred to our hospital,a definitive diagnosis of ascending colon mucinous adenocarcinoma was made with the help of tumor markers and colonoscopic findings.Because of the delayed diagnosis of the disease,two patients(case 1 and case 2)missed the chance of surgery due to disease progression and died in a short follow-up period.Only case 3 underwent radical surgery for the tumor in the right colon and partial abdominal wall resection and achieved a better prognosis.CONCLUSION Abscesses in the right area of the lumbar spine,right groin,or right lower quadrant caused by non-intestinal perforation as the primary clinical manifestation of ascending colon mucinous adenocarcinoma are extremely rare.Mucinous adenocarcinoma of the ascending colon may be one of the causes of such abscesses.Performing colonoscopy as soon as possible is of great significance in the diagnosis and treatment of the disease.

Diagnosis and treatment of prostate abscess:Report of 6 cases

Objective:Toimprove the diagnosis and treatment of prostate abscess by summing up experience of 6 cases of prostatic abscess.Methods:From May 2014 to October 2019,6 cases of prostatic abscess were diagnosed by means of clinical manifestations combined with digital rectal examination(DRE),ultrasound and computed tomography(CT).Five cases were performed transurethral incision and drainage for prostatic abscess,and 1 case underwent ultrasound-guided perineal drainage.Results:The symptoms of the 6 patients disappeared after drainage and recovered well without recurrence.Conclusions:The clinical manifestations combined with DRE,ultrasonography and CT are beneficial to the diagnosis of prostatic abscess.Both transurethral incision and drainage and ultrasound-guided perineal drainage are effective way to treat prostate abscess.

Spinal Epidural Abscess: When a Fast Diagnosis Is Necessary

A 61 years old man with fatty liver disease and history of recent urinary infection was admitted to the Department of Internal Medicine for severe back pain and fever. The blood culture exams were positive for methicillin-resistant Staphylococcus aureus and later the cervical spine MRI showed an anterior epidural abscess associated with medullary compression. The patient was kept under antibiotic therapy and a decompressive surgery was required. Spinal epidural abscess presentation can be subtle with its presenting complaints ranging in severity from nonspecific back pain to marked weakness. This case report highlights the importance of an early diagnosis in order to avoid a devastating outcome.

Strategies to avoid a missed diagnosis of co-occurring concussion in post-acute patients having a spinal cord injury

Research scientists and clinicians should be aware that missed diagnoses of mild-moderate traumatic brain injuries in post-acute patients having spinal cord injuries may approach 60-74% with certain risk factors, potentially causing clinical consequences for patients, and confounding the results of clinical research studies. Factors leading to a missed diagnosis may include acute trauma-related life-threatening issues, sedation/intubation, subtle neuropathology on neuroimaging, failure to collect Glasgow Coma Scale scores or duration of posttraumatic amnesia, or lack of validity of this information, and overlap in neuro-cognitive symptoms with emotional responses to spinal cord injuries. Strategies for avoiding a missed diagnosis of mild-moderate traumatic brain injuries in patients having a spinal cord injuries are highlighted in this perspective.

Scalp block for brain abscess drainage in a patient with uncorrected tetralogy of Fallot

We report a case of an 11-year-old boy with diagnosed but uncorrected tetralogy of Fallot presented to us for brain abscess drainage. The child was managed successfully with scalp block with sedation.

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.

DIFFERENTIAL DIAGNOSIS IN THE INTRACRANIAL DISEASES: PROTON MAGNETIC RESONANCE S PECTROSCOPY STUDY

Objective To investigate th e value of proton magnetic resonance spectroscopy ( 1H-MRS) on diagnosis a nd differential diagnosis of the intracranial diseases by the MRS results of 52 patients. Methods 12 patients with benign glioma, 16 patients with malignant glioma, 10 patients with meningioma, 8 patients with virus encephalitis, and 6 patients with cerebral infarction underwent MRS in th e lesion region. We measured the area within the spectra of N-acetyl-aspartate (NAA), creatine/phosphocreatine (Cr), choline compounds (Cho), and lactate (Lac ). Results The spectra of meningiomas were characterized by abs ence of NAA. The spectra of gliomas were characterized by the decrease of NAA an d Cr, but the increase of Cho. The ratio of Cho to Cr was 2.25±1.21 in benign g liomas, while the ratio of Cho to Cr was 4.65±2.21 in malignant gliomas. The sp ectra of virus encephalitis appeared the decrease of NAA and the normality of Cr , with the 1.25±0.21 ratio of Cho/Cr. The apparent Lac wave could be seen in al l cerebral infarctions. Conclusion The value of 1H-MRS plays a significant role in the diagnosis and differential diagnosis of gliomas, mening iomas, virus encephalitis, and cerebral infarctions.

Sonographic Diagnosis of Acute Hematogenous Osteomyelitis in the Early Stage

This article presents sonographic diagnosis of acute hematogenous osteomyelitis in early stage.24 clildren with clinically suspected acute hematogtnous osteomyelits were detected to have subptrosteal abscesses by ultrasond during four to fourteen days after onset.The mean length and anteroposterior distance of the subperiosteal abscesses were 86.4 mm and 10.7 mm,respectively.Of 24 cases of subperiosteal atscesses,aspiration performed under ultrasound guidance revealed purulent fluid in al and 23 were verified surgically.The results obtained indicate that ultrasound can be used it diagnosis of actue hematogerous osteomyelitis in the early stage.the earliest case was diagrosed by ultrasound 4 days afttr onset.By use of ultrasound, differentiation diagnosis of acute hematogenous osteomyelitis from other diseases such as cellulitis,soff tissue abscess,acutt septic arthritis and maignant bone tumors is also discussed.