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ABSTRACT The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3 rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient's treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41 st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68 th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case.
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Resumen Introducción: Los abscesos cerebrales son una urgencia neurológica grave con alto riesgo de déficit neurológico permanente. Son patologías raras en la edad pediátrica, con una incidencia anual de 0.5 por 100,000 niños. Se han realizado pocos estudios de abscesos cerebrales de origen odontogénico y la mayoría de los pacientes son adultos con patología dental de base. Eikenella corrodens es un cocobacilo gramnegativo anaerobio facultativo de crecimiento fastidioso, que forma parte de la biota de la cavidad oral, pero es un patógeno frecuente en infecciones de cabeza y cuello, así como en infecciones dentales. Caso clínico: Paciente de sexo masculino de 16 años, previamente sano, que presentó cefalea de 2 meses de evolución acompañada de náuseas y vómitos. Antecedente de extracción del cuarto molar superior derecho 4 meses antes, sin uso de profilaxis antibiótica. La resonancia magnética de cráneo mostró una lesión compatible con absceso cerebral. Se realizó drenaje por punción guiada por estereotaxia, del que se aisló E. corrodens. El paciente completó un tratamiento con ceftriaxona y metronidazol por vía intravenosa durante 4 semanas y ampicilina-sulbactam por vía oral por 2 semanas más. Conclusiones: Los abscesos cerebrales de origen odontogénico causados por E. corrodens en la edad pediátrica son muy raros. Actualmente, el uso de antibióticos profilácticos en procedimientos dentales es controversial, ya que se ha documentado el aumento de la resistencia microbiana por su uso indiscriminado. La optimización de los estudios diagnósticos y el tratamiento multidisciplinario han mejorado el pronóstico de los pacientes con absceso cerebral.
Abstract Background: Brain abscesses are a serious neurological emergency with a high risk of permanent neurological deficit. The pathology is a rare in the pediatric age: the annual incidence is 0.5 per 100,000 children. There are a few studies of brain abscesses of oral origin mostly in adult patients with an underlying dental pathology. Eikenella corrodens, a slow-growing, Gram negative, facultatively anaerobic rod-bacillus, is part of the oral cavity biota, and common as a pathogen in head, neck, and dental infections. Case report: A previously healthy 16-year-old male presented a headache of 2 months of evolution accompanied by nausea and vomiting. Four months earlier, the fourth upper right molar was extracted, with no antibiotic prophylactic treatment. Magnetic resonance imaging of the skull showed a lesion compatible with brain abscess. Stereotaxy-guided puncture drainage was performed, isolating E. corrodens. The treatment was with ceftriaxone and metronidazole intravenously for four weeks and ampicillin sulbactam orally for two more weeks. Conclusions: Brain abscesses of odontogenic origin by E. corrodens in the pediatric age are very rare. Currently, the use of prophylactic antibiotics in dental procedures is controversial because the indiscriminate use increases antimicrobial resistance. The optimization of diagnostic studies and multidisciplinary treatment has improved the prognosis of patients with brain abscesses.
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The current paper reports on a case of subdural empyema secondary to frontal sinusitis in an otherwise healthy child. Sinusitis is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of pediatric sinusitis is rarely seen today; however, complications (e.g., cavernous sinus thrombosis, orbital infection, meningitis, and subdural empyema) are potentially life threatening. A 15-year-old right-handed male presented with a 3-day history of fever, headache, and left-sided palsy. Computed tomography revealed right-sided subdural empyema with right frontal sinusitis and maxillary sinusitis. A postoperative inpatient neurological consultation was requested 2 months post-surgery due to motor function deficits. The results suggested that early and accurate diagnosis of subdural empyema leads to prompt treatment and a favorable outcome for the patient.
Subject(s)
Adolescent , Child , Humans , Male , Anti-Bacterial Agents , Brain Abscess , Cavernous Sinus Thrombosis , Central Nervous System , Diagnosis , Empyema, Subdural , Fever , Frontal Sinus , Frontal Sinusitis , Headache , Inpatients , Maxillary Sinus , Maxillary Sinusitis , Meningitis , Orbit , Paralysis , SinusitisABSTRACT
Purpose: Brain abscesses often present an aetiological dilemma. Microscopy is insensitive and culture techniques are time consuming. Hence, a new rapid technique in vitro Proton Magnetic Resonance Spectroscopy ( 1 HMRS) was evaluated for its usefulness in the identification of aetiology of brain abscesses. Materials and Methods: A total of 39 pus specimens from brain abscesses were subjected to in vitro 1 HMRS. These pus specimens were also processed by conventional culture methods. The spectral patterns generated by in vitro 1 HMRS were further correlated with culture results. Results: Pus specimens which showed the presence of anaerobes on culture revealed the presence of multiplet at 0.9 ppm (100%), lactate-lipid at 1.3 ppm (100%), acetate at 1.92 ppm (100%) and succinate at 2.4 ppm (75%). Pus specimens that revealed the presence of facultative anaerobes on culture showed a pattern B, i.e., the presence of lactate-lipid at 1.3 ppm (100%), acetate at 1.92 ppm (88.88%) along with the multiplet at 0.9 ppm (100%). Pattern C was seen in aerobic infection which showed the presence of lactate-lipid at 1.3 ppm (100%) along with the multiplet at 0.9 ppm. Pus from two tuberculous abscesses showed the complete absence of multiplet at 0.9 ppm. Conclusions: We observed in this study that it was possible to differentiate bacterial and tuberculous brain abscesses using in vitro 1 HMRS. Further, it was also possible to distinguish between aerobic and anaerobic brain abscesses on the basis of spectral patterns. In vitro 1 HMRS of fungal and actinomycotic brain abscess are also presented for its unusual spectra.
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La paracoccidioidomicosis es una micosis sistémica, endémica de áreas tropicales y subtropicales de América Central y del Sur, causada por un hongo dimorfo denominado Paracoccidioides brasiliensis. El compromiso del sistema nervioso central es una rara complicación de la forma diseminada crónica de la enfermedad y puede comprometer el cerebro, el cerebelo, el tronco cerebral y la médula espinal. La forma clínica más común de la neuroparacoccidioidomicosis es el granuloma o absceso cerebral y, con menos frecuencia, la meningoencefalitis crónica. Se presenta un paciente con diagnóstico de paracoccidioidomicosis diseminada crónica con múltiples lesiones cerebrales compatibles con abscesos. La biopsia estereotáxica seguida del estudio histopatológico y microbiológico del material obtenido de las lesiones permitió observar las levaduras redondeadas con los brotes característicos de Paracoccidioides brasiliensis.
Paracoccidioidomycosis is an endemic systemic disease in subtropical areas of Central and South America caused by a dimorphic fungus Paracoccidioides brasiliensis. Central nervous system involvement is a rare complication of the chronic disseminated disease that can affect the brain, cerebellum, brainstem and the spinal cord. The most frequent clinical form of neuroparacoccidiodomycosis is the cerebral abscess; with less frequency, the disease presents as a diffuse chronic meningoencephalitis. Here we present a patient with diagnosis of disseminated paracoccidioidomycosis and multiple cerebral lesions compatible with abscesses. Stereotactic biopsy followed by the microbiological and histopathological examination of the smears showed the characteristic yeast cells that confirmed the diagnosis of neuroparacoccidioidomycosis.
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Five cases of nocardial infection of central nervous system were reported. All patients were immunocompromised hosts due to corticosteroid and cytotoxic drugs therapy for underlying disease. Two cases showed disseminated infection. The imagings of brain abscess were presented.
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Cerebral paragonimiasis, occurring as an extrapulmonary infestation, is one of the important intracranial lesions in Korea. We have experienced a case of multiple huge brain abscesses caused by cerebral paragonimiasis. The patient, 17 year old boy, had chief complaints of headache and vomiting followed by mental deterioration. Neurologically, the patient presented mental change, papilledema, left abducense palsy and right hemiparesis. The treatment included the closed drainage followed by total removal of abscess capsules which was confirmed histopathologically. This paper is concerned with the description of the clinical features of cerebral paragonimiasis and review of literatures.