Brain Abscess Caused by Nocardia: Case Report and Literature Review

Nocardia brain abscess is a rare clinical entity, accounting for 2% of all brain abscesses, associated with high morbidity and amortality rate 3 times higher than brain abscesses caused by other bacteria. Proper investigation and treatment, characterized by a longterm antibiotic therapy, play an important role on the outcome of the patient. The authors describe a case of a patient without neurological comorbidities who developed clinical signs of right occipital lobe impairment and seizures, whose investigation demonstrated brain abscess caused by Nocardia spp. The patient was treated surgically followed by antibiotic therapy with a great outcome after 1 year of follow-up.

The accessory gene regulator (agr) controls Staphylococcus aureus virulence in a murine intracranial abscesses model

Background: Intracranial abscesses are associated with high mortality. Staphylococcus aureus is one of the main pathogens that cause intracranial infection. Until now, there is no report to identify the key effectors of S. aureus during the intracranial infection. Methods: The murine intracranial abscesses model induced by S. aureus was constructed. The vital sign and survival rate of mice were observed to evaluate the infection. Histological examination was used to diagnose the pathological alterations of mouse tissues. The sensitivity of S. aureus to whole blood was evaluated by whole-blood killing assay. Results: In murine intracranial abscesses model, it was shown that the mortality caused by the accessory gene regulator (agr) locus deficient strain was significant decreased compared with its parent strain. Moreover, we found that RNAIII, the effector of agr system, was essential for the intracranial infection caused by S. aureus. In the further investigation, it was shown that restoration the expression of α-toxin in agr deficient strain could partially recover the mortality in the murine intracranial abscesses model. Conclusion: Our data suggested that the agr system of S. aureus is an important virulence determinant in the induction and mortality of intracranial abscesses in mice. .

Brain Abscess at the University Hospital of the West Indies

Surgical infections of the central nervous system are still attended by high rates of morbidity and mortality, although substantial progress has been made since the advent of computed tomography (CT) scanning technology. In this retrospective review of 25 surgically treated patients with either brain abscess of subdural empyema at the University Hospital of the West Indies, the majority of patients were male and between the ages of 10 and 30 years with a mean age of 16.9 years. Almost half the patients had a hemiparesis on presentation while 60 percent had fever. Subdural empyema was more common than a localised intracerebral abscess which was most frequently located in the frontal lobe. The most common predisposing factors were sinusitis and congenital heart disease. Streptococci spp and Staphylococci spp were the most frequently isolated organisms. All patients underwent CT scanning and surgical intervention. The mortality rate was 20 percent, and 21 percent of the survivors had late seizures. There must be a high index of clinical suspicion and early referral to specialist centres where neuroradiological investigation and prompt neurosurgical intervention can be carried out to minimise morbidity and mortality.

Treatment of brain abscess

A study of fifty cases of brain abscess is presented, main emphasis being on treatment, morbidity and mortality. Results have been compared with other series

Absceso cerebral en el Instituto Nacional de Salud del Niño

Encontramos 21 pacientes, 52 por ciento varones y 48 por ciento mujeres. El 57 por ciento fueron mayores de 5 años. Los focos primarios más frecuentes fueron la cardiopatía congénita cianótica, ótica y hematógeno, aunque un 43 por ciento no tuvieron foco conocido. Los abscesos fueron múltiples en el 24 por ciento, más frecuentes en los lóbulos parietal y frontal. La presentación clínica más frecuente fue: Hipertensión endocraneana (95 por ciento), compromiso de conciencia (76 por ciento), y fiebre (67 por ciento), notándose mayor predominio de ésta en los menores de 2 años. El cultivo fue positivo en el 50 por ciento de los casos mostrando solo flora aerófila. La TAC demostró ser el medio de diagnóstico por imágenes de elección pues dió la mejor información de la localización, número y naturaleza de la lesión. Los fármacos más frecuentemente utilizados fueron cloramfenicol, penicilina y ceftriaxone, el método quirúrgico más requerido fue el drenaje. Se encuentra un tiempo de enfermedad promedio de 37.1 dias. Las escuelas más frecuentes fueron motoras y sensoriales. La mortalidad fue 38 por ciento, sobretodo en pacientes menores de 2 años, desnutridos, con abscesos multiples, complicaciones y aquellos que se presentaron al ingreso un estado neurológico superior al Grado I de Garfield