Brain abscess, the path to diagnosis: case report

Authors

  • Ronald Andrés Ganchozo Arévalo ACESS. Ecuador Author
  • Angelo Andy Magallanes Bajaña CS Santa Lucía. Ecuador Author
  • Geovanna Paola Jaramillo Calderón Universidad Católica de Santiago de Guayaquil. Ecuador Author
  • Isis Micaela Zambrano Gilces Hospital General Monte Sinaí. Ecuador Author
  • Karla Andreina Calvas Torres Hospital Julius Doepfner Zamora. Ecuador Author
  • Carlos Roberto Asencio Portugal Hospital del niño Francisco Icaza Bustamante. Ecuador Author

DOI:

https://doi.org/10.56294/sctconf2024725

Keywords:

Brain Abscess, Cerebritis, Intracranial Infection, Magnetic Resonance Imaging, Neuroinfection

Abstract

Brain abscess is a focal infection of the central nervous system (CNS), in which there are areas of localized cerebritis and central necrosis, surrounded by a well vascularized capsule. We present a 19-year-old case, with orobuccal and more recent cutaneous history, which starts with neurological symptoms. He is evaluated with laboratory tests and lumbar puncture without elucidating the etiology. Complementary neuroimaging tests were performed showing supratentorial lesions compatible with brain abscess. A sample was taken and the histopathological result determined infection by Staphylococcus Aureus. The patient was treated with antibiotic therapy, steroids and anticonvulsants with an immediate favorable evolution. He remains in controls. Brain abscess is a life-threatening disease that requires multidisciplinary management to achieve a timely diagnosis and management. Clinical manifestations are usually nonspecific, so the identification of the entity depends on neuroimaging studies and in case of infection, the diagnosis may require biopsy. Finally, treatment associates medical management with antibiotic therapy and neurosurgical intervention for drainage

References

1. Bodilsen J, Pedersen D, Beek D, Brouwer M, Nielsen H. Risk factors for brain abscess: a nationwide, population-based, nested case-control study Clin Infect Dis [Internet]., 71 (4) (2020 Aug 14), pp. 1040-1046

2. Bokhari MR, Mesfin FB. Brain Abscess. 2022 May 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 28722871.

3. Tunkel A. G-BJC Absceso cerebral. Enfermedades Infecciosas Principios y Práctica Mandell. Elsevier Inc, Douglas, Bennett. Madrid (2021), pp. 1248-1261

4. Canales D. William Macewen and the treatment of brain abscesses revisited after one undred years. Department of neurosurgery, University of Tennessee, Memphis, USA. J Neurosurg 1996; 84(1): 133-42.

5. Alvis H, Castellar M, Moscote R. Absceso. Rev Cubana Neurol Neurocir. 2013; 3 (2): 162-171.

6. Molina G, Armijo Y, Mimenza A. Absceso cerebral. Revista Mexicana de Neurociencia.2010; 11(1): 63-70.

7. Sonneville R, Ruimy R, Benzonana N, Riffaud L, Carsin A, Tadié J, et al. Una actualización sobre el absceso cerebral bacteriano en pacientes inmunocompetentes. Clin Microbiol Infect [Internet], 23 (9) (2017), pp. 614-620

8. Vargas L, Alvarado M, Suárez A. Absceso cerebral: diagnóstico, manejo, complicaciones y pronóstico Revista Chilena de Neurocirugía, 44 (1) (2019), pp. 60-68.

9. Carpintero J, Stapleton S., Holliman R. Análisis retrospectivo de 49 casos de absceso cerebral y revisión de la literatura European J Clin Microbiol Infect Dis[Internet], 26 (1) (9 de enero de 2007), pp. 1-11

10. Brouwer M, Coutinho J, Beek D. Clinical characteristics and outcome of brain abscess [Internet]. Neurology., 82 (2014), pp. 806-813

11. Pasternack, M. Approach to the adult with recurrent infections. 2022. UpToDate. [Internet]. Disponible en https://www.uptodate.com/contents/approach-to-the-adult-with-recurrentinfections?search=brain%20abscess&source=search_result&selectedTitle=5%7E150&usage_type=default&display_rank=5#H1

12. Zhang C, Liuhua H, Xiaojun G. A retrospective study on the aetiology, management, and outcome of brain abscess in an 11-year, single-centre study from China. BMC Infect. Dis., 14 (311) (2014), pp. 1-7.

13. Zhang C, Liuhua H, Xiaojun G. A retrospective study on the aetiology, management, and outcome of brain abscess in an 11-year, single-centre study from China. BMC Infect. Dis., 14 (311) (2014), pp. 1-7

14. Pisculli M, Barker F. Postoperative infections of the head and brain. Yoummans and Winn Neurological Surgery (7th ed.), Elsevier Inc, Philadelphia (2017), pp. 319-330.

15. Helweg L, Astradsson A, Richhall H, Erald J, Laursen A, Brennum J. Pyogenic brain abscess, a 15 year survey. BMC Infections Diseases. 2012; 12: 332-342.

16. Suthar R, Sankhyan N (2018) Bacterial infections of the central nervous system. Ind J Pediatr 15: 1-10.

17. Martínez A, et al. Enfermedad que simula un ictus: a propósito de un caso. Rev. Finlay. 2016; 6(1): 73-78.

18. Dorenbeck U, Butz B, Schlaier J, Bretschneider T, Schuierer G, Feuerbach S. Diffusion- weighted echo-planar MRI of the brain with calculate d ADCs :a useful tool in the differential diagnosis of tumor necrosis from abscess?. J Neuroim aging. 2003; 13(4): 330-8.

19. Muhammad Saad Ahmed, Muhammad kashif shazlee, Rahila Usman, Kamran Hamid, Junaid Iqbal, Imaas Hussain, Diagnostic accuracy of diffusion weighted MRI in the diagnosis of brain abscess. Journal of Radiology. 2016; 26(4): 305-311.

20. Brouwer M, Beek D (2017) Epidemiology, diagnosis, and treatment of brain abscesses. Curr Opin Infect Dis 30: 129-134.

21. Enzmann D, Britt R, Obana W, Stuart J, Murphy-Irwin K. Experimental Staphylococcus aureus brain abscess. AJNR Am J Neuroradiol. 1986 May-Jun;7(3):395-402. PMID: 3085444; PMCID: PMC8331336.

22. Zheng Y, Shang W, Peng H, Rao Y, Zhao X, Hu Z, et al. Virulence Determinants Are Required for Brain Abscess Formation Through Staphylococcus aureus Infection and Are Potential Targets of Antivirulence Factor Therapy. Frontiers in Microbiology. 2019; 10: 682.

23. Gahlot T, Kasana D. A cross-sectional study of etiological and sensitivity profiling of meningitis in under-five children. International Journal of Mycobacteriology. 2021; 10: 149–154.

24. Antonello R, Riccardi N. How we deal with Staphylococcus aureus (MSSA, MRSA) central nervous system infections. Front. Biosci. (Schol Ed) 2022, 14(1), 1. https://doi.org/10.31083/j.fbs1401001.

25. Byrne C, Hazlerigg A, Khan W, Smitham P. The role of perioperative care in reducing rates of methicillin resistant Staphylococcus aureus. Journal of Perioperative Practice. 2011; 21: 410–417.

26. Weis S, Kesselmeier M, Davis JS, Morris AM, Lee S, Scherag A, et al. Cefazolina versus penicilinas antiestafilocócicas para el tratamiento de pacientes con bacteriemia por Staphylococcus aureus. Microbiología Clínica e Infección. 2019; 25: 818–827.

27. M. Ortega-Martínez y cols. Abscesos piógenos encefálicos. Nuestra experiencia en 60 casos consecutivos. Neurocirugía. 2006; 17 (2): 23-33.

28. Yepez J, Pérez C, Lambertinez I, Pájaro N, Arrieta D, Hurtado D, et al. Brain Abscess: A Review of the Literature. iMedPub Journals. 2021. Vol.17. No.3:1. doi: 10.3823/1467.

29. Matthijs C. Brouwer, Allan R. Tunkel, Guy M. McKhann II, Diederik van de Beek. Brain Abscess N Engl J Med 2014; 371:447-56.

30. Antonio MDDG, Elizabeth AY, Alberto MA (2010) Absceso cerebral. Revista Mexicana de Neurociencia 11: 63-70.

31. Tunthanathip T, Kanjanapradit K, Sae Heng S, Oearsakul T, Sakarunchai I. (2015) Predictive factors of the outcome and intraventricular ruptura of brain abscess. J Med Assoc Thai 98: 170-180

Downloads

Published

2024-04-30

How to Cite

1.
Ganchozo Arévalo RA, Magallanes Bajaña AA, Jaramillo Calderón GP, Zambrano Gilces IM, Calvas Torres KA, Asencio Portugal CR. Brain abscess, the path to diagnosis: case report. Salud, Ciencia y Tecnología - Serie de Conferencias [Internet]. 2024 Apr. 30 [cited 2025 Jan. 18];3:725. Available from: https://conferencias.ageditor.ar/index.php/sctconf/article/view/1015