Management of brain abscess: Changing trend and experience in Enugu, Nigeria

Background: Intracranial abscess remains a significant health-care problem. Its causes, diagnosis, treatment, and outcome are changing. Aim: This paper reviewed the demography, examined new trends, and compared outcomes with different treatment options. Methodology: Retrospective analysis of intracranial abscesses managed at Memfys Hospital, Enugu (2004­2014) and University of Nigeria Teaching Hospital (2009­2014). Patients were followed up for at least 6 months. All patients had neuroimaging before intervention. Microscopy and culture were performed for the specimens. Intravenous antibiotics were given for 2 weeks before conversion to oral. Results: Seventy-nine parenchymal abscesses (eight cases per year) were managed. Peak age was the second decade of life. Previous head injury (21.5%) and meningitis (16.5%) were the most common predisposing factors. The frontal lobe was most common anatomical location (32%). Only 24% had positive culture result. Three cases were fungal infections. Seventy percent of patients managed with burr hole drainage and 37.5% of craniotomy made complete recovery. Overall, 58% of patients made complete recovery, whereas 19.0% died. Nine percent of cases died before definitive intervention. Among the 24% of patients that presented in coma, 47% died within 6 months. Most important factor influencing mortality was admission level of consciousness. Abscess recurred in 6% of cases. Conclusion: Intraparenchymal abscesses in Enugu were mostly solitary lesions resulting from poorly managed head injury and meningitis. Predisposition from otitis media and systemic diseases has reduced. The proportion of fungal organisms is increasing. A significant proportion of the patients present in coma. Burr hole and aspiration of abscess is less invasive and has very good outcome

Brain abscesses - the Groote Schuur experience; 1993 - 2003

Objective: To review management and outcome of patients with brain abscess treated at Groote Schuur Hospital (GSH) between 1993 and 2003. Patients and methods: Case notes; radiological results and laboratory records were reviewed retrospectively for 121 patients at GSH who underwent a neurosurgical procedure for treatment of a brain abscess between 1993 and 2003. Patients not treated surgically were excluded. Follow-up with serial computed tomography (CT) scans; erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels and the temperature chart were used to determine the duration of parenteral antibiotic treatment and the need for repeat surgical evacuation of pus by either aspiration or excision of the capsule. Results: The mean patient age was 33 years; with a male-to-female ratio of 5:1. Headache; depressed level of consciousness and pyrexia were the commonest presenting symptoms. Other symptoms included seizures and hemiparesis. The frontal lobe was the commonest site (44); the majority of abscesses occurred as a result of infection following trauma. Mastoiditis (21) and sinusitis (8) were the second and third most common causes. Organisms were identified in 81of cases; polymicrobial infections occurred in half of these. Thirty-three different organisms were identified; the majority of which were Gram-positive bacteria. Anaerobes were present in 23; while methicillin-resistant Staphylococcus aureus was identified in 1 patient. Nocardia was seen in 3 patients; 2 of whom were diabetic. The average duration of parenteral antibiotic therapy was 15 and 19 days for excision and aspiration respectively. Accurate ESR records were available in 75of cases; with a positive predictive value in 81; while CRP (in use since 1999) was helpful in 92of cases. Outcome: Sixteen patients (13) died; 12 of whom had been admitted with a Glasgow Coma Score (GCS) of less than 4T/15. Thirteen patients developed epilepsy. On discharge; patients continued to take oral antibiotics for another 4 weeks; at the end of which they were reviewed at the neurosurgery outpatient department.Conclusion: Compared with previous studies from this hospital; mortality and morbidity have been diminishing progressively. GCS at the time of admission remains the most important prognostic factor

Brain abscesses - the Groote Schuur experience; 1993 - 2003 : neurosurgery

Objective. To review management and outcome of patients with brain abscess treated at Groote Schuur Hospital (GSH) between 1993 and 2003. Patients and methods. Case notes; radiological results and laboratory records were reviewed retrospectively for 121 patients at GSH who underwent a neurosurgical procedure for treatment of a brain abscess between 1993 and 2003. Patients not treated surgically were excluded. Follow-up with serial computed tomography (CT) scans; erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels and the temperature chart were used to determine the duration of parenteral antibiotic treatment and the need for repeat surgical evacuation of pus by either aspiration or excision of the capsule. Results. The mean patient age was 33 years; with a male-to-female ratio of 5:1. Headache; depressed level of consciousness and pyrexia were the commonest presenting symptoms. Other symptoms included seizures and hemiparesis. The frontal lobe was the commonest site (44); the majority of abscesses occurred as a result of infection following trauma. Mastoiditis (21) and sinusitis (8) were the second and third most common causes. Organisms were identified in 81of cases; polymicrobial infections occurred in half of these. Thirty-three different organisms were identified; the majority of which were Gram-positive bacteria. Anaerobes were present in 23; while methicillin-resistant Staphylococcus aureus was identified in 1 patient. Nocardia was seen in 3 patients; 2 of whom were diabetic. The average duration of parenteral antibiotic therapy was 15 and 19 days for excision and aspiration respectively. Accurate ESR records were available in 75of cases; with a positive predictive value in 81; while CRP (in use since 1999) was helpful in 92of cases. Outcome. Sixteen patients (13) died; 12 of whom had been admitted with a Glasgow Coma Score (GCS) of less than 4T/15. Thirteen patients developed epilepsy. On discharge; patients continued to take oral antibiotics for another 4 weeks; at the end of which they were reviewed at the neurosurgery outpatient department. Conclusion. Compared with previous studies from this hospital; mortality and morbidity have been diminishing progressively. GCS at the time of admission remains the most important prognostic factor

Antimicrobial Susceptibility Pattern of Bacteria Isolated from Pyogenic Oro-Facial Lesions in Dar es Salaam

The aim of this study was to identify bacterial agents responsible for oro-facial infections in patients referred to Muhimbili Medical Centre in Dar es Salaam and to investigate their sensitivity pattern to the commonly used antibiotics. According to our results the most common agent was S. aureus; which accounted for about one third of all isolates. The other notable agents were Viridans streptococci; Enterococcus faecalis and Klebsiella spp. Most isolates were sensitive to erythromycin; cloxacillin; cotrimoxazole; ampicillin; amoxycillin and penicillin G. None of the antibiotics was effective in combating all infections; underlining the need for routine culture and sensitivity. However; where laboratory facilities are lacking; as may be the case in peripheral clinics; erythromycin; cloxacillin; chloramphenicol and cotrimoxazole could be used for blind treatment. This; however; has to be guided by continuous drug surveillance

Brain abscesses at Mpilo Central Hospital 1982-1988

The results of the management of patients with brain abscesses have been audited. Guidelines are suggested for surgeons working under similar conditions