ro13-9904 and Brain-Abscess

Salmonella intracranial infection is infrequently encountered in clinical practice. However, with prompt intervention and appropriate antimicrobial therapy, the outcome is usually favourable. A 56-year-old gentleman who worked as an organic fertilizer production supervisor underwent tumour resection for meningioma located at the left frontal temporoparietal region. The surgical procedure went smoothly, and he has prescribed dexamethasone thereafter. He was discharged well. However, a few days after that he developed a fever associated with pus discharged from the surgical wound. A computed tomography (CT) scan of the brain was performed and it revealed an abscess located at the left frontal temporoparietal subdural and subgaleal regions with adjacent cerebritis. Another craniotomy was done to drain the abscess. The bacterial culture of the pus specimen grew Salmonella Enteritidis. The bacterium was susceptible to ciprofloxacin, ceftriaxone, and amoxicillin-clavulanic acid. Clinical improvement was evident after surgical intervention with an additional 6 weeks of ceftriaxone therapy.

Topics: Brain Abscess; Ceftriaxone; Craniotomy; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Salmonella enteritidis; Salmonella Infections

Only 20 cases of abscess formation within a Rathke cleft cyst have been reported.. Case report and review of the English-language literature.. A 64-year-old female was admitted with a 12-mo history of headache and decreased visual acuity and had bilateral papilledema and bitemporal hemianopsia with impairment of visual acuity. Magnetic resonance imaging demonstrated a sellar and suprasellar mass measuring 2×2×2 cm. The lesion was removed using a transsphenoidal approach. The abscess was drained, and gram stain revealed polymorphonuclear cells and gram-positive cocci. The postoperative course was uneventful. Ceftriaxone and metronidazole were continued for 6 wks. The patient also received hydrocortisone and continued thyroid hormone replacement. During a 6-mo follow up, the patient's headaches disappeared, and the bitemporal hemianopsia and impaired visual acuity abated.. Predisposing factors for pituitary abscesses in primary lesions include immunosuppression and pituitary irradiation, surgery, or infarction. Approximately one-third of pituitary abscesses arise within other lesions. The clinical manifestations are non-specific. Magnetic resonance imaging shows a cystic lesion with central low intensity and rim enhancement after administration of contrast. When a pituitary abscess is diagnosed, surgical procedures should be performed promptly via a transsphenoidal (preferably) or transcranial approach.

Topics: Anti-Infective Agents; Brain; Brain Abscess; Ceftriaxone; Central Nervous System Cysts; Debridement; Drainage; Female; Humans; Magnetic Resonance Imaging; Metronidazole; Middle Aged; Pituitary Diseases; Radiography

Aggregatibacter actinomycetemcomitans is considered a major pathogen in localized and generalized aggressive periodontitis. A. actinomycetemcomitans has been found in various extra oral infections and most frequently in endocarditis. We report a patient with multiple brain abscesses due to infection with A. actinomycetemcomitans and review the English language literature related to this subject.. A 42-year-old patient with no underlying medical conditions presented with multiple brain lesions initially thought to be metastatic lesions of a tumour of unknown origin. Findings during drainage and subsequent histopathological conclusions made infection more likely. Culture of drained material remained negative; however, 16S rDNA polymerase chain reaction and sequence analysis on direct material revealed A. actinomycetemcomitans as the causative agent of the infection. The most likely source of infection was the poor dentition of the patient. After repeated drainage of the lesions and antibiotic treatment the patient gradually improved, although cognitive impairment remained.. Our report illustrates that a poor dental condition, notably destructive periodontal disease, can be a risk for life-threatening extra oral disease, and thus contributes to the total inflammatory burden of the body.

Topics: Actinobacillus Infections; Adult; Aggregatibacter actinomycetemcomitans; Anti-Bacterial Agents; Anti-Infective Agents; Biopsy; Brain Abscess; Ceftriaxone; Dental Caries; Drainage; Focal Infection, Dental; Humans; Male; Metronidazole; Periodontal Diseases

Intracranialabscesses are serious, life-threatening infections despite recent advances in diagnosis and treatment. We report the case of a child with metastatic brain abscesses and a chronic, sharp foreign body of the bronchus. Its presentation and endoscopic appearance and the microbiology of the abscesses are detailed. The detection of bacteria of respiratory origin should lead to a search for a bronchopulmonary source of contamination.

Topics: Brain Abscess; Bronchi; Bronchoscopy; Ceftriaxone; Child, Preschool; Contrast Media; Drug Therapy, Combination; Follow-Up Studies; Foreign Bodies; Foreign-Body Reaction; Gram-Positive Bacterial Infections; Humans; Infusions, Intravenous; Male; Metronidazole; Nafcillin; Risk Assessment; Tomography, X-Ray Computed; Treatment Outcome

We present here the challenging case of severe Lemierre syndrome in a healthy woman in her late twenties, whose clinical presentation was characterised by lung abscesses and disseminated systemic abscesses in the brain, the abdomen and the soft-tissues, as a likely consequence of a patent foramen ovale. Blood cultures were positive for

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Female; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Lemierre Syndrome; Meropenem; Metronidazole

Rhinosinusitis-induced brain abscesses are rare but can result in devastating long-term sequalae and mortality; they require a high index of suspicion with early imaging to start early empiric parenteral antibiotic treatment covering aerobes and anaerobes.. Our study was a retrospective analysis on 32 patients who were treated at Oxford University Hospitals for rhinosinusitis-induced brain abscess between February 2013 and June 2020.. Mean age of presentation was 45.83 for adults and 11.14 for children. Subdural collection was the most frequent abscess but 25% of patients had multiple sites of collection; the majority were in the frontal lobe. The most commonly identified pathogens were Streptococcus milleri group and Staphylococcus aureus; 93.75% of the patients were treated with combined Ceftriaxone and Metronidazole for an average of 8 weeks.. In our series most patients received also a prompt and aggressive surgical treatment with combined neurosurgical and ENT procedures in the majority; this was especially important in case of subdural empyema, Streptococcus milleri infection and direct intracranial spread of infection. More than half of the patients were treated with a single surgical procedure. Despite aggressive treatment, one third of patients experienced long-term neurological sequelae; there were no deaths.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Child; Humans; Metronidazole; Retrospective Studies; Review Literature as Topic; Sinusitis; Streptococcal Infections

Cutibacterium (C) acnes, a Gram-positive bacterium that is part of the commensal flora, is increasingly noticed as an opportunistic pathogen in serious infections in both immunocompromised and immunocompetent patients. The indolent character and often difficult identification because of its slow growth contribute to delayed diagnosis or underdiagnosis. This report highlights a unique case of a lung transplant recipient with a C acnes intracerebral abscess, and we recommend including this organism in such differential diagnosis. A 66-year-old woman, 2 years after bilateral lung transplantation for chronic obstructive pulmonary disease, presented with frontal headache, without other complaints, and with normal neurological examination. Magnetic resonance imaging showed an extensive lesion in the right frontal lobe with extensive perilesional edema. Given the broad differential diagnosis, stereotactic brain biopsy was performed and culture became positive for C acnes. She was treated with intravenous ceftriaxone for 8 weeks and per oral clindamycin for 6 months, as well as corticosteroids in tapered dose. There was a rapid favorable clinical and radiographic evolution.

Topics: Aged; Brain Abscess; Ceftriaxone; Female; Gram-Positive Bacterial Infections; Humans; Lung Transplantation; Propionibacterium acnes

We present the case of a patient with a voluminous cerebral abscess caused by Aggregatibacter aphrophilus and Actinomyces meyeri occurring a week post dental scaling. Both these bacteria are rarely involved in brain abscesses, and so far, cases of cerebral actinomyces have mostly been treated surgically and with intravenous (IV) antibiotics for 3-4 months, then put on oral antibiotic therapy with penicillin or amoxicillin for a further 3-12 months. Our patient underwent drainage through craniotomy and was subsequently put on intravenous ceftriaxone for 3 months accompanied by brain imaging control at the end of this period which showed complete regression of the abscess. Following parenteral treatment, no oral antibiotics were given since pharmacokinetic properties do not allow to attain high tissue concentration in the brain. This treatment gave excellent results.

Topics: Actinomycetaceae; Aggregatibacter aphrophilus; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Humans

Lactococcus lactis cremoris is one of the gram positive cocci, not known to be pathogenic in humans. We report a case of brain abscess due to lactococcus lactis in an adolescent. An 18-year male with congenitally corrected transposition of great arteries and dextrocardia was admitted with fever, headache and right-sided numbness. Magnetic resonance imaging revealed a well circumscribed irregular heterogeneous abnormal signal intensity lesion in left temporo-parietal lobe having central area of diffusion restriction and peripheral wall enhancement on post-contrast images. He underwent mini-craniotomy for abscess drainage. Pus culture revealed growth of lactococcus lactis. He was treated with ceftriaxone and remained disability-free on six month follow-up. To our knowledge, this is one of the few reports of brain abscess caused by lactococcus lactis. Key Words: Brain abscess, Lactococcus lactis, Adolescent.

Topics: Adolescent; Brain Abscess; Ceftriaxone; Drainage; Humans; Lactococcus lactis; Magnetic Resonance Imaging; Male

In patients receiving biological therapies, serious infections are a major concern. Infections associated with anti-tumor necrosis factor antibody therapy include tuberculosis, viral, fungal, and bacterial infections. Likewise, severe infections of the upper and lower respiratory tract, lung, skin and soft tissue, urinary tract, gastrointestinal tract, joint, and bone have also been reported previously. However, infections involving the central nervous system are rare, especially an intracranial infection caused by odontogenic infection. To date, only few cases have been reported of this infection. This is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin.. A 39-year-old male with psoriatic arthritis receiving adalimumab treatment came to the emergency department with initial presentation of sudden onset convulsions. He had been receiving adalimumab treatment for 1 month. Two days after the third injection, the patient had an episode of sudden-onset general convulsion for nearly 5 min with the upgazing and general tonic presentation. Magnetic resonance imaging (MRI) showed left frontal lobe brain abscess. Pus culture from the brain abscess detected Streptococcus sanguinis (S. sanguinis), Fusobacterium nucleatum (F. nucleatum), and Parvimonas micra (P. micra).. Brain abscess with odontogenic infection.. The patient received left frontal craniotomy, abscess drainage and systemic empiric antibiotics treatment with vancomycin, cefepime, and metronidazole. Due to drug rash with eosinophilia and systemic symptoms during the treatment, vancomycin and metronidazole were discontinued, and systemic antibiotics were switched to teicoplanin and ceftriaxone.. A brain MRI follow-up performed after 1 month of initial treatment revealed the reduced size of the abscess lesion and minimal oedema. The patient was discharged with stable condition.. To the best of our knowledge, this is the first case of a patient with psoriatic arthritis receiving adalimumab and developing brain abscess of odontogenic origin. Such a rare diagnosis must be kept in mind when patients treated with adalimumab present with sudden-onset convulsions. Careful dental examination should be performed before administration of adalimumab.

Topics: Adalimumab; Adult; Anti-Bacterial Agents; Antirheumatic Agents; Arthritis, Psoriatic; Brain Abscess; Ceftriaxone; Cerebrum; Combined Modality Therapy; Craniotomy; Diagnosis, Differential; Firmicutes; Fusobacterium nucleatum; Humans; Magnetic Resonance Imaging; Male; Periodontitis; Streptococcus; Streptococcus sanguis; Teicoplanin

The infection by Nocardia spp is not common in immunocompetent patients. The empirical antimicrobial treatment directed by anatomical regions does not contemplate the particularities of the germ and the microbiological analysis is necessary for the specific treatment.\ We present the case of a previously healthy and immunocompetent patient, without known risk factors for Nocardia spp. infection, with evidence of involvement of the pulmonary parenchyma and the skin and subsequent development of multiple brain abscesses.. La infección por Nocardia spp. no es común en pacientes inmunocompetentes. El tratamiento antimicrobiano empírico dirigido según las regiones anatómicas, no contempla las particularidades del germen y el análisis microbiológico se hace necesario para el tratamiento específico. A continuación, se presenta el caso de una paciente previamente sana, inmunocompetente y sin factores de riesgo conocidos para la infección por Nocardia spp., con evidencia de compromiso en el parénquima pulmonar y la piel, que posteriormente desarrolló varios abscesos cerebrales.

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Female; Headache; Humans; Immunocompetence; Magnetic Resonance Imaging; Middle Aged; Neuroimaging; Nocardia Infections; Pneumonia, Bacterial; Pulmonary Atelectasis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

The incidence of complications due to acute otitis media (AOM) in childhood has decreased significantly with the use of new antibiotics in recent years. However, acute mastoiditis (AM) is still the most common complication that can lead to further intracranial conditions with high morbidity. Our study aimed to evaluate the clinical characteristics of children with AM and identify possible indicators for further intracranial complications associated with this condition.. Children hospitalized in our clinic with a diagnosis of AM were reviewed. Demographic data, disease-related symptoms, types of complications accompanied by AM, medical/surgical treatments modalities, and culture results were screened. The patients were divided into two groups as those with and without intracranial complications (ICCs). Routine complete blood count tests, biochemical analysis, and C-reactive protein (CRP) level measurement were evaluated and compared between the groups.. Of the 28 AM patients, five (17.9%) had isolated AM. Complications associated with AM included sub-periosteal abscess (28.6%), facial paralysis (25%), meningitis (17.9%), meningitis with sigmoid sinus thrombosis (7.1%), and meningitis with cerebellar abscess (3.6%). Eight patients developed ICCs (28.6%), of whom three had more than one complication. Ceftriaxone was found to be the first-line medical treatment (57.1%). Streptococcus pneumoniae was the most common pathogen isolated from the cultures (42.9%). Three patients (10.7%) were treated non-surgically, eight (28.6%) with myringotomy and ventilation tube (VT) insertion, eight patients (28.6%) with abscess drainage and VT insertion, and nine (32.1%) with cortical mastoidectomy and VT insertion. There was no significant difference between the patients with and without ICCs in terms of complete blood count parameters. The CRP level and the CRP-albumin ratio were significantly higher in patients with ICCs than those without these complications (p < 0.001).. AM remains to be the most common complication of AOM in childhood and can lead to further life-threatening conditions. Additional interventions according to the type of the complication with VT insertion is safe and effective in the management of AM. In patients with AM, it is of great importance to determine whether there is an accompanying ICC. The CRP-albumin ratio is a simple and reliable calculation to detect ICCs in patients with AM.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Blood Cell Count; Brain Abscess; C-Reactive Protein; Ceftriaxone; Child; Child, Preschool; Drainage; Facial Paralysis; Female; Humans; Infant; Male; Mastoidectomy; Mastoiditis; Meningitis; Middle Ear Ventilation; Otitis Media; Serum Albumin; Sinus Thrombosis, Intracranial; Streptococcus pneumoniae

The parasite Entamoeba histolytica is the causal agent of amoebiasis, a worldwide emerging disease. Amebic brain abscess is a form of invasive amebiasis that is both rare and frequently lethal. This condition always begins with the infection of the colon by E. histolytica trophozoites, which subsequently travel through the bloodstream to extraintestinal tissues.. We report a case of a 71-year-old female who reported an altered state of consciousness, disorientation, sleepiness and memory loss. She had no history of hepatic or intestinal amoebiasis. A preliminary diagnosis of colloidal vesicular phase neurocysticercosis was made based on nuclear magnetic resonance imaging (NMRI). A postsurgery immunofluorescence study was positive for the 140 kDa fibronectin receptor of E. histolytica, although a serum analysis by ELISA was negative for IgG antibodies against this parasite. A specific E. histolytica 128 bp rRNA gene was identified by PCR in biopsy tissue. The final diagnosis was cerebral amoebiasis. The patient underwent neurosurgery to eliminate amoebic abscesses and was then given a regimen of metronidazole, ceftriaxone and dexamethasone for 4 weeks after the neurosurgery. However, a rapid decline in her condition led to death.. The present case of an individual with a rare form of cerebral amoebiasis highlights the importance of performing immunofluorescence, NMRI and PCR if a patient has brain abscess and a poorly defined diagnosis. Moreover, the administration of corticosteroids to such patients can often lead to a rapid decline in their condition.

Topics: Aged; Animals; Brain Abscess; Ceftriaxone; Central Nervous System Parasitic Infections; Combined Modality Therapy; Dexamethasone; DNA, Protozoan; Drug Therapy, Combination; Entamoeba histolytica; Entamoebiasis; Fatal Outcome; Female; Humans; Metronidazole; Neurosurgical Procedures; Serologic Tests

Aggregatibacter aphrophilus and Beta haemolytic Streptococci Lancefield group F are part of the normal oral flora and are known to cause endocarditis, sinusitis, empyema, meningitis and septic arthritis. They are now emerging as a cause of brain abscess particularly in patients with congenital heart diseases. We report a case of a 10-year-old boy with Tetralogy of Fallot (TOF), who presented with fever, headache and drowsiness. Culture yielded the growth of Aggregatibacter aphrophilus and Beta hemolytic streptococci Lancefield group F. He became clinically stable after treatment with ceftriaxone.

Topics: Aggregatibacter aphrophilus; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Child; Coinfection; Craniotomy; Culture Techniques; Humans; Male; Pasteurellaceae Infections; Streptococcal Infections; Streptococcus milleri Group; Tetralogy of Fallot; Tomography, X-Ray Computed

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Cefuroxime; Craniotomy; Drainage; Humans; Hydrocephalus; Infant; Male; Megalencephaly; Paresis; Recovery of Function; Staphylococcal Infections; Tomography, X-Ray Computed

Brain abscesses are well-known to neurologic surgeons with well-recognized presentations, which include seizures, neurologic deficit, and headache. Rare symptoms may lead to a delay in diagnosis, which can be life threatening in the setting of a brain abscess.. We present the case of a 46-year-old male with intractable hiccups found to have an abscess of the right basal ganglia. The brain abscess was treated by frameless stereotactic-guided aspiration. The patient's hiccups improved after surgical aspiration and medical management.. A comprehensive literature review confirmed brain abscess as a rare cause of intractable hiccups. In addition, there are few reports of lesions of the basal ganglia causing intractable hiccups. Aspiration and medical therapy resulted in resolution of the hiccups. Knowledge of the hiccup reflex arc and unusual presentation of basal ganglia lesions may shorten time to diagnosis.

Topics: Anti-Infective Agents; Basal Ganglia; Brain Abscess; Ceftriaxone; Central Nervous System Bacterial Infections; Haemophilus Infections; Haemophilus parainfluenzae; Hiccup; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Middle Aged; Treatment Outcome

Topics: Adult; Aggregatibacter aphrophilus; Animals; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Dogs; Humans; Male; Metronidazole; Pets; Zoonoses

Pituitary abscess is an uncommon pituitary lesion. Its clinical diagnosis can be difficult to distinguish from other pituitary lesions. This pathology is characterised by vague symptoms of headaches, generalised tiredness and hypopituitarism manifestations. A history of recent meningitis, paranasal sinusitis or head surgery can be a suggestive of the source of infection.A 20-year-old man was admitted to neurosurgery department with complain of headache, fatigue, polyuria, polydipsia, blurred vision and sexual dysfunction. MRI of the head revealed a suprasellar mass that was centrally hyperintense lesion on T2-weighted images with peripheral hypointensity and isointense centrally on T1 images with peripheral hyperintensity images. Treatment of this lesion pituitary abscess was surgical drainage of the pituitary area through a trans-sphenoidal approach and broad spectrum antibiotic therapy with ceftriaxone, metronidazole and vancomycin for 6 weeks. The patient continues to have pituitary insufficiency and treated with oral hydrocortisone.Although pituitary abscess is a rare condition, it should always be kept in mind when evaluating a patient with hypopituitarism. After the diagnosis, the surgery and antibiotics should be commenced rapidly. The outcome is usually good with proper treatment.

Topics: Anti-Bacterial Agents; Antiprotozoal Agents; Brain Abscess; Ceftriaxone; Diagnosis, Differential; Humans; Hydrocortisone; Hypopituitarism; Magnetic Resonance Imaging; Male; Metronidazole; Pituitary Diseases; Pituitary Gland; Treatment Outcome; Vancomycin; Young Adult

Topics: Anti-Infective Agents; Brain; Brain Abscess; Ceftriaxone; Child; Craniotomy; Female; Fever; Humans; Metronidazole; Tomography, X-Ray Computed; Treatment Outcome; Vancomycin

Topics: Abscess; Aged, 80 and over; Amikacin; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Eye Infections, Bacterial; Humans; Magnetic Resonance Imaging; Male; Microbial Sensitivity Tests; Native Hawaiian or Other Pacific Islander; Nocardia; Nocardia Infections; Retinal Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Vitrectomy

Topics: Brain Abscess; Ceftriaxone; Cerebellum; Child, Preschool; Coinfection; Dermoid Cyst; Drainage; Female; Floxacillin; Humans; Magnetic Resonance Imaging; Staphylococcal Infections; Staphylococcus; Teicoplanin; Treatment Outcome; Vancomycin

The aim of this report was to describe the occurrence of a bacterial brain abscess in a healthy individual, without any predisposing condition.. A thirteen-year old boy was admitted to the Department of Neurosurgery after the onset of vomiting, headache and dizziness. A neurological deficit was detected during the physical examination so urgent magnetic resonance imaging of the brain was performed, revealing an intrahemispheric, right positioned solitary expansive mass with ring enhancement. Purulent material was obtained during osteoplastic craniotomy with total extirpation of the brain abscess. Aggregatibacter aphrophilus and Bacteroides uniformis were isolated. The patient's general condition improved and the neurological deficit subsided as a result of the prompt recognition and treatment of this life threatening condition.. To achieve a favourable clinical outcome, prompt recognition and surgical treatment of a brain abscess are of primary importance,followed by administration of appropriate antimicrobial therapy. To our best knowledge, this is the first report of this combination of microorganisms as the cause of a brain abscess.

Topics: Adolescent; Aggregatibacter aphrophilus; Anti-Bacterial Agents; Bacteroides; Bacteroides Infections; Brain Abscess; Cefixime; Ceftriaxone; Coinfection; Craniotomy; Drainage; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Pasteurellaceae Infections

Hoigne's syndrome is characterized by the development of acute clinical manifestations which are mainly psycho-sensorial. Classically, these features immediately follow the injection of procaine penicillin G.. We report a 59-year-old man who presented with psycho-organic manifestations that occurred just after the intravenous injection of ceftriaxone; to our knowledge, this is the first case of Hoigne's syndrome reported after an injection of this antibiotic.. The pathophysiologic basis of this syndrome is still unknown. It is important to keep in mind its clinical characteristics, which may mimic immuno-allergic symptoms. It should be differentiated from anaphylactic manifestations because Hoigne's syndrome allows the continuation of the treatment.

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Hypersensitivity; Humans; Injections, Intravenous; Male; Middle Aged; Syndrome

Topics: Aged; Anti-Infective Agents; Anticonvulsants; Brain Abscess; Ceftriaxone; Craniotomy; Drainage; Epilepsy; Epilepsy, Tonic-Clonic; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Metronidazole; Paresis; Phenytoin; Streptococcal Infections; Tomography, X-Ray Computed; Viridans Streptococci

Solitary brainstem abscesses are rare and they are usually associated with other infections. They are severe conditions with high morbidity and mortality. The surgical options are stereotactic aspiration and microsurgical drainage. Systemic antibiotic therapy is used for more than six weeks.. We present the case of a young man with a solitary abscess at the pons, without other systemic infections. The patient was treated by means of microsurgical drainage and antibiotic therapy for three weeks. His postoperative recovery was good.. A microsurgical approach may be considered to be an important option for large abscesses that are multiloculated, close to the surface or contain thick fluid. Complete emptying of the purulent accumulation may diminish the required duration of antibiotic therapy.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Brain Stem; Ceftriaxone; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Microsurgery; Oxacillin; Suction; Time Factors

Staphylococcus lugdunensis is a coagulase-negative staphylococcus with aggressive and rapidly progressive infectious behavior. This organism has emerged as an important pathogen implicated in both community-acquired and nosocomial infections, including meningitis, brain abscess, catheter-related bacteremia, and ventriculoperitoneal shunt infection.. We report the first known case of Staphylococcus lugdunensis intracranial abscess in a pediatric hydranencephalic patient, caused by a ventriculoperitoneal shunt-related infection. Further magnetic resonance imaging (MRI) confirmed a large abscess within the cranium that demonstrated multiple loculations. The patient received externalization of the right occipital ventricular catheter with evacuation of the brain abscess. Medical management included one week of intrathecal antibiotic treatment, and she was discharged on long-term intravenous rifampin and vancomycin, leading to cure of the infection.. This case suggests that if Staphylococcus lugdunensis is identified, a virulent and prolonged clinical course with the production of destructive lesions, similar to those with S. aureus, should be expected. A course of antibiotic therapy and aggressive management that may include surgical treatment will be needed.

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Child, Preschool; Female; Humans; Hydranencephaly; Injections, Spinal; Neurosurgical Procedures; Rifampin; Staphylococcal Infections; Staphylococcus lugdunensis; Vancomycin; Ventriculoperitoneal Shunt

Topics: Acute Disease; Administration, Inhalation; Adult; Asthma; Brain Abscess; Ceftriaxone; Cocaine-Related Disorders; Diagnosis, Differential; Drainage; Drug Therapy, Combination; Female; Headache; Humans; Magnetic Resonance Imaging; Meningitis, Escherichia coli; Nasal Septal Perforation; Photophobia; Pituitary Diseases; Pituitary Neoplasms; Vancomycin

Proteus vulgaris is only rarely the cause of multiple septic metastases. We describe multiple brain abscesses due to P. vulgaris in an immunocompetent patient successfully treated by antibiotic therapy and colonectomy.

Topics: Anti-Bacterial Agents; Antiphospholipid Syndrome; Bacteremia; Brain; Brain Abscess; Ceftriaxone; Community-Acquired Infections; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Ofloxacin; Physical Examination; Proteus Infections; Proteus vulgaris; Tomography, X-Ray Computed

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Frontal Lobe; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Metronidazole; Middle Aged; Streptococcal Infections; Streptococcus constellatus; Visual Acuity; Vitrectomy

The brainstem is an uncommon site for a brain abscess. It accounts for less than 4% of all posterior cranial fossa abscesses, and less than 1% of all intracranial abscesses. The pons is the most common site for these abscesses. The aim of the present report was to describe the case of a Brazilian Amazon man with a brainstem abscess (BSA) managed with combined surgical drainage and systemic antibiotic therapy. This case reinforces the importance of an early suspicion of BSA in patients with unexplained fever and neurologic deficits, especially sixth and seventh cranial nerve lesions, to minimize permanent damage.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Central Nervous System Bacterial Infections; Humans; Male; Metronidazole; Oxacillin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Brain Abscess; Bronchi; Ceftriaxone; Child, Preschool; Contrast Media; Drug Therapy, Combination; Follow-Up Studies; Foreign Bodies; Fusobacterium; Humans; Male; Metronidazole; Parietal Lobe; Radiography, Thoracic; Streptococcus; Temporal Lobe; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vancomycin

Topics: Adult; Brain Abscess; Ceftriaxone; Chronic Disease; Combined Modality Therapy; Contrast Media; Drainage; Follow-Up Studies; Frontal Sinusitis; Humans; Magnetic Resonance Imaging; Male; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome

Intracranial dermoid cysts are congenital benign neoplasms. Hydrocephalus and abscess as the principal manifestations of the posterior fossa dermoid cyst are rare. We present a case of obstructive hydrocephalus and abscess induced by an adjacent dermoid cyst with occipital dermal sinus.. A 2-year-old girl presented with headache and vomiting. Physical examination showed nothing abnormal except for a small subcutaneous nodule above the occipital protuberance with a small skin opening. She had no neurological deficits. Neuroradiological studies including CT and MRI showed a cyst located in the posterior fossa. The cyst in the posterior fossa with occipital dermal sinus was diagnosed. She was treated by radical excision of the occipital cyst through a suboccipital approach, and was followed up.. Histopathologic examination suggested a dermoid cyst with an abscess. Bacterial investigation revealed Staphylococcus epidermidis, and appropriate systemic antibiotic therapy was given. The child recovered and a 2-year follow-up was uneventful.. Posterior fossa dermoid cyst should be considered in all children with occipital skin lesions, especially dermal sinus. CT and MRI scan are helpful in the diagnosis of the lesion. Neurosurgical treatment of the lesion should be planned early to prevent infections such as abscess and meningitis.

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Child, Preschool; Dermoid Cyst; Female; Humans; Hydrocephalus; Infratentorial Neoplasms; Magnetic Resonance Imaging; Spina Bifida Occulta; Staphylococcal Infections; Staphylococcus epidermidis; Tomography, X-Ray Computed

Topics: Adult; Amoxicillin; Anti-Infective Agents; Brain Abscess; Ceftriaxone; Humans; Male; Metronidazole; Telangiectasia, Hereditary Hemorrhagic

Streptococcus acidominimus resembles Streptococcus viridans, but they can now be differentiated by phenotypic studies. Only a single previous case of pneumonia, pericarditis, and meningitis has been reported.. We recently encountered a patient with brain abscess from which S acidominimus was isolated after initially being recorded as S viridans. Because 49% of all S viridans isolated from abscesses are resistant to beta-lactam antimicrobials, speciation is important as well as in vitro sensitivity testing. Streptococcus acidominimus is ordinarily sensitive to beta-lactams, and the use of ceftriaxone for 6 weeks successfully resulted in cure of the brain abscess.. The use of speciation in treatment of S viridans should improve clinical outcomes.

Topics: Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Humans; Male; Middle Aged; Streptococcal Infections

Nocardiosis has become a significant opportunistic infection over the last two decades as the number of immunocompromised individuals has grown worldwide. We present two patients with nocardial brain abscess. The first patient was a 39-year-old woman with systemic lupus erythematosus. A left temporoparietal abscess was detected and aspirated through a burr-hole. Nocardia farcinica infection was diagnosed. The patient had an accompanying pulmonary infection and was thus treated with imipenem and amikacine for 3 weeks. She received oral minocycline for 1 year. The second patient was a 43-year-old man who was being treated with corticosteroids for glomerulonephritis. He was diagnosed with a ring-enhancing multiloculated abscess in the left cerebellar hemisphere, with an additional two small supratentorial lesions and triventricular hydrocephalus. Gross total excision of the cerebellar abscess was performed via a left suboccipital craniectomy. Culture revealed Nocardia asteroides, and the patient was successfully treated with intravenous ceftriaxone, then oral trimethoprime-sulfamethoxazole for 1 year. The clinical course, radiological findings, and management of nocardial brain abscess are discussed in light of the relevant literature, and current clinical management is reviewed through examination of the cases presented here.

Topics: Adult; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Female; Humans; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Male; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Patients with End-stage Renal Disease being immunocompromised; are prone to a variety of infections, sometimes, rare ones, more than the general population. This fact should alert the physicians to be more vigilant and have a broader scope when considering the etiology of infections in such patients. We report the case of a 65-year-old man who had a very stormy hospital stay secondary to cerebral nocardiosis with multiple brain abscesses, prolonged unconsciousness and neurological deficits. However, the patient was treated successfully, surgically and chemotherapeutically. He was discharged home in a good condition.

Topics: Aged; Amikacin; Brain Abscess; Brain Diseases; Brain Edema; Ceftriaxone; Humans; Kidney Failure, Chronic; Male; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Unconsciousness; Vancomycin

We report multiple and diffuse supratentorial and infratentorial brain abscesses in a ten months old girl with D- transposition of great arteries. The child was managed medically with intravenous antibiotics for 4 weeks. Her fever settled, however, weakness of right half of the body persisted despite remarkable improvement. Multiple abscesses (about 40 in number), in a child less than 2 years age, associated neutrophilia with toxic granulations and successful therapy with antibiotics alone makes this an unusual case.

Topics: Brain Abscess; Ceftriaxone; Female; Humans; Infant; Metronidazole; Tomography, X-Ray Computed; Transposition of Great Vessels

Predisposing factors, antimicrobial susceptibility patterns, treatment and outcome were analysed for nine consecutive patients with nocardiosis. Predisposing factors were identified in six (67%) of the nine patients. Clinical syndromes of nocardial infection were pulmonary infection (three patients), cerebral infection (five patients) and disseminated infection (one patient). The predominant (60%) species was Nocardia farcinica rather than the Nocardia asteroides complex. Treatment was started empirically, modified according to the antimicrobial susceptibility pattern, and then continued for 6-12 months. Overall mortality was 33%, with death being caused by the Nocardia infection in two cases.

Topics: Adult; Amikacin; Anti-Bacterial Agents; Brain Abscess; Causality; Ceftriaxone; Fatal Outcome; Female; Hospitals, Teaching; Humans; Imipenem; Lung Diseases; Male; Microbial Sensitivity Tests; Nocardia; Nocardia Infections; Retrospective Studies; Turkey

We report a case of a large intracerebral CSF collection formed along the course of the catheter of an ommaya-type reservoir (Medtronic 12 mm), implanted in a patient suffered from cryptococcal meningitis in the frame of CLL. This collection was at first diagnosed as intracerebral abscess but emergency craniotomy proves clear CSF collection with no signs of infection. We describe the case and we discuss the issue of CSF pressure pathophysiology and changes in flow dynamics, to patients with cryptococcal meningitis.

Topics: Acyclovir; Aged; Amphotericin B; Anti-Infective Agents; Brain Abscess; Ceftriaxone; Cerebrospinal Fluid; Cerebrospinal Fluid Pressure; Diagnosis, Differential; Drainage; Fluconazole; Humans; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Metronidazole; Spinal Puncture; Teicoplanin

This is the second report of a Citrobacter-associated brain abscess in an adult and the first report of its association with an intradural tumor. Excluding those associated with trauma, neurosurgical procedures, and proximity to the skull base, only seven other cases of abscesses associated with intracranial tumors have been published. Five of seven tumor-associated abscesses with a microbiological diagnosis involved gram-negative bacteria, a finding that may indicate a predilection of these microorganisms for intracranial tumors.. A 78-year-old female patient presented with a 6-month history of confusion and personality changes. Her medical history included paroxysmal atrial fibrillation and a 10-day course of high-dose dexamethasone but no other predisposing conditions for sepsis. She was afebrile, had no focal neurological deficits, and had no systemic abnormalities on examination. Computed tomographic imaging revealed a noncalcified, homogeneously enhancing, 3-cm-diameter, extra-axial tumor associated with the right anterior falx cerebri. The tumor did not extend to the skull base.. At craniotomy, 10 to 20 ml of thick pus was found around the posteroinferior surface of the tumor. On extended culture, this material demonstrated Citrobacter koseri growth, which was effectively treated with ceftriaxone followed by meropenem and one repeated abscess aspiration. No systemic source of the infection was found.. The characteristic endothelial invasiveness of Citrobacter and related gram-negative bacteria may predispose to the formation of abscesses in association with intracranial tumors.

Topics: Aged; Brain Abscess; Ceftriaxone; Citrobacter koseri; Craniotomy; Enterobacteriaceae Infections; Female; Frontal Bone; Humans; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Meropenem; Thienamycins

Diagnostic laboratories increasingly offer bacterial identification to the species level. The 17 nocardia species known to date differ in their clinical presentation, antibiotic resistance patterns and geographic distribution. The discovery of a new species with pathogenicity for humans calls for the characterization of its clinical and epidemiological properties.. Nocardia isolated from multifocal brain abscesses of an immunocompromised patient were further identified by the analysis of their cellular fatty acids and sequencing of the 16S ribosomal DNA. Quantitative antibiotic resistance testing was performed with E-tests.. The 16S ribosomal DNA analysis showed a 99 % homology to Nocardia cyriacigeorgici. This is the first report of this species as an invasive human pathogen. N. cyriacigeorgici was found susceptible for meropenem, amikacin, ceftriaxon and cotrimoxazole. The combination of surgical drainage and antibiotic treatment for 13 months was curative.. N. cyriacigeorgici has the potential to cause invasive infections at least in immunocompromised patients. Comparing clinical and in vitro characteristics with N. asteroides, the main causative agent of nocardial infections in Europe, we found no clinically relevant differences.

Topics: Amikacin; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; DNA, Ribosomal; Drainage; Humans; Immunocompromised Host; Male; Meropenem; Microbial Sensitivity Tests; Middle Aged; Nocardia; Nocardia Infections; RNA, Ribosomal, 16S; Sequence Homology, Nucleic Acid; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Current estimates of the mortality associated with brain abscesses range from 0-24%, with neurological sequellae in 30-55% of survivors. Although the incidence of brain abscess appears to be increasing, likely due to an increase in the population of immunosuppressed patients, the condition is still sufficiently uncommon to make human clinical trials of therapy problematic. An animal model to study the efficacy of new treatment regimens, specifically, new antimicrobial agents is therefore necessary. This study uses a well-defined experimental paradigm as an inexpensive method of inducing and studying the efficacy of antibiotics in brain abscess. The rat model of brain abscess/cerebritis developed at this institution was used to determine the relative efficacy of trovafloxacin as compared to ceftriaxone in animals infected with Staphylococcus aureus. S. aureus ( approximately 10(5) CFU in 1 microliter) was injected with a Hamilton syringe, very slowly, over the course of 70 minutes after a two mm burr hole was created with a spherical carbide drill just posterior to the coronal suture and four mm lateral to the midline. Eighteen hours later treatment was begun; every 8 hours the rats were dosed with subcutaneous ceftriaxone (n = 10), trovafloxacin (n = 11) or 0.9% sterile pyogen-free saline (n = 10). After four days of treatment the brains were removed and sectioned with a scalpel. The entire injected hemisphere was homogenized and quantitative cultures performed. The mean +/- SEM log(10) colony forming units/ml S. aureus recovered from homogenized brain were as follows: controls 6.10 +/- 0.28; ceftriaxone 3.43 +/- 0.33; trovafloxacin 3.65 +/- 0.3. There was no significant difference in bacterial clearance between ceftriaxone versus trovafloxacin (p = 0.39). Trovafloxacin or other quinolones may provide a viable alternative to intravenous antibiotics in patients with brain abscess/cerebritis.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Area Under Curve; Brain Abscess; Ceftriaxone; Disease Models, Animal; Female; Fluoroquinolones; Half-Life; Injections, Subcutaneous; Microbial Sensitivity Tests; Naphthyridines; Rats; Rats, Wistar; Staphylococcal Infections; Staphylococcus aureus

Multiple brain abscesses are serious neurological problems with high mortality and disabling morbidity. The frequency is rising as a result of AIDS and the increasing number of immunocompromised patients.. A 59-year-old woman developed signs and symptoms of diffuse brain dysfunction including fever and neck stiffness. A brain CT scan demonstrated nine contrast-enhancing ring-shaped lesions. Analysis of the cerebrospinal fluid using PCR-technique revealed DNA of Fusobacterium nucleatum. Conservative treatment with antibiotics was successful. The patient recovered with only mild cognitive deficits.. The experience of our patient and the review of the literature indicate that multiple brain abscesses due to Fusobacterium nucleatum are rare. The most probable source is oral infection.. Multiple brain abscesses may be caused by Fusobacterium nucleatum. Cerebrospinal fluid analysis using PCR technique is helpful with diagnosis. Conservative management can be successful.

Topics: Anti-Bacterial Agents; Brain Abscess; Brain Edema; Ceftriaxone; Cytidine Diphosphate; Dexamethasone; Drug Therapy, Combination; Female; Fusobacterium Infections; Fusobacterium nucleatum; Glucocorticoids; Humans; Metronidazole; Middle Aged; Tomography, X-Ray Computed

A 44-month-old boy with chronic granulomatous disease has been suffering from fever and skin rash for 7 days prior to admission. The blood culture obtained on admission revealed Salmonella enterica subspecies houtenae. He received intravenous ceftriaxone therapy during his hospital stay and oral cefixime after discharge. Unfortunately, the same symptoms recurred 2 weeks after discontinuing cefixime and the culture from the aspirate of a skin nodule yielded the same microorganism again. He received intravenous ceftriaxone therapy after readmission and became afebrile 3 days later. However, focal seizure was noted on the 14th day of hospitalization. Brain magnetic resonance imaging revealed multiple brain abscesses, and electroencephalogram showed epileptiform activity. The intravenous antimicrobial agents were continued for a total of 84 days and interferon-gamma was administered as adjunctive therapy. Finally, he recovered from brain abscesses without any neurologic sequel. It is suggested that an extended course of antimicrobial treatment is necessary for chronic granulomatous disease with pyogenic infection because of the defective intracellular killing ability.

Topics: Anti-Bacterial Agents; Bacteremia; Brain Abscess; Ceftazidime; Ceftriaxone; Child, Preschool; Drug Therapy, Combination; Electroencephalography; Exanthema; Granulomatous Disease, Chronic; Humans; Interferon-gamma; Magnetic Resonance Imaging; Male; Salmonella enterica; Salmonella Infections; Seizures

A 48-y-old woman with an acute Group A streptococcal brain abscess is described. The abscess enlarged rapidly with neurological deterioration and required open drainage and excision. The patient was treated with antibiotics for 6 weeks and recovered completely. Group A streptococcus is a rare cause of brain abscess in the antibiotic era and may require urgent neurosurgical intervention.

Topics: Brain Abscess; Ceftriaxone; Cephalosporins; Drug Therapy, Combination; Female; Humans; Middle Aged; Penicillins; Streptococcal Infections; Streptococcus pyogenes

Nocardia is a serious opportunistic infection in renal transplant recipients and nocardial brain abscess in these patients has a high mortality. In addition to antimicrobial therapy, treatment usually involves craniotomy and excision of the abscess. We describe a renal transplant recipient maintained on cyclosporine and prednisone developing Nocardia Asteroides brain abscess. After stereotactic aspiration of the abscess, successful treatment was achieved by triple therapy with trimethoprim sulfamethoxazole (TMP/SMX), ceftriaxone and amikacin. The allograft function remained stable. Long-term prophylaxis with TMP/SMX is necessary to prevent the relapse of nocardia.

Topics: Amikacin; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Opportunistic Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

A 68-year old patient presented with increasing right-sided weakness, dysarthria, pyrexia and a deteriorating general condition. CT and MRI showed about 20 round hyperdense lesions with peripheral enhancement of contrast material up to 1.5 cm in diameter. Antibiotic triple-therapy using ceftriaxone, gentamycin and metronidazole for 39 days and followed by antibiotic double-therapy using ceftriaxone and metronidazole for a further 22 days resulted in a radiologically proven reduction of the abscesses to very small remnants which disappeared completely during the follow-up period of two years. Simultaneously the general condition of the patient improved significantly. Repeated attempts at isolation of bacteria, fungi, protozoa and parasites from a subdural empyema failed. The histological examination of an abscess, which was entirely removed on occipital craniotomy, showed a structure resembling actinomycosis.

Topics: Actinomycosis; Aged; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Gentamicins; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Tomography, X-Ray Computed; Treatment Outcome

We present a case of cerebral nocardiosis in a patient with AIDS. Space-occupying lesions were identified using magnetic resonance imaging (MRI) and white cell scanning. Nocardia asteroides was isolated from blood cultures. The patient's response to treatment with amikacin, imipenem and ceftriaxone was followed clinically and radiologically. When he died 6 months later, N. asteroides was isolated at post-mortem from a cerebral abscess. Although cerebral infections associated with the infiltration of neutrophils are rare in patients with AIDS, this case demonstrates that indium-labelled neutrophils can be used to identify a brain abscess and monitor its response to antimicrobial therapy.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amikacin; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Cephalosporins; Drug Therapy, Combination; Humans; Imipenem; Magnetic Resonance Imaging; Male; Nocardia asteroides; Nocardia Infections; Radionuclide Imaging; Thienamycins

The first-line treatment for brain abscesses is still a much-debated argument. Recently, stereotactic aspiration of these lesions has gained ground as a valid alternative to the traditional medical and/or surgical therapeutical treatments. From 1991 to 1995, 9 patients affected by intracranial abscesses were surgically treated by stereotactic puncture of the lesion and drainage of pus, using the Kelly-Goerss stereotactic system. Multiple abscesses were present in one case. Specific antibiotic therapy was used in the post-operative stage, when possible. One death occurred four weeks after surgery for acute ischemia of the brain stem. Follow-up CT demonstrated gradual resolution of the abscesses in all the cases and a successful return to normal daily life in all the surviving patients. In one case, recurrence of the abscess occurred two months after resolution: a successful result was obtained by steroids and broad-spectrum antibiotic therapy alone. Possible advantages of this technique are discussed and compared with the traditional routes. The literature concerning this argument is reviewed.

Topics: Adolescent; Adult; Aged; Brain Abscess; Catheterization, Peripheral; Ceftriaxone; Cephalosporins; Drainage; Drug Therapy, Combination; Follow-Up Studies; Gentamicins; Humans; Male; Middle Aged; Netilmicin; Phenobarbital; Postoperative Care; Recurrence; Stereotaxic Techniques; Tomography, X-Ray Computed; Treatment Outcome

We present a case of pefloxacin-induced arthropathy in a 15-year-old patient with brain abscess. Six joints were involved, of which the right elbow joint was most severely affected. Magnetic resonance imaging of the right elbow revealed joint effusion, and bone scintigraphy showed increased tracer uptake which was still present in the follow-up bone scans.

Topics: Adolescent; Anti-Infective Agents; Arthropathy, Neurogenic; Brain Abscess; Ceftriaxone; Cephalosporins; Humans; Magnetic Resonance Imaging; Male; Metronidazole; Pefloxacin

We report the case of an 85-year-old female patient who suffered from disseminated Nocardia asteroides infection complicated by a cerebral abscess. Treatment with amikacin for 2 weeks and ceftriaxone for 6 weeks led to complete recovery, and there was no recurrence of disease over a follow-up period of 12 months after therapy. The use of ceftriaxone in combination with amikacin might significantly shorten the duration of treatment for patients with disseminated nocardiosis. This combination of antibiotics merits further investigation with use of a larger sample of patients.

Topics: Aged; Aged, 80 and over; Amikacin; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Female; Humans; Nocardia asteroides; Nocardia Infections

A case of unilateral hydrocephalus due to an abscess in the ipsilateral choroid plexuses, and revealed by intracranial hypertension is reported. Treatment with ceftriaxone, metronidazol and thiophenicol was clinically and radiographically successful, without surgery 3 weeks later. Management and mechanisms are discussed.

Topics: Adult; Brain Abscess; Ceftriaxone; Choroid Plexus; Drug Therapy, Combination; Humans; Hydrocephalus; Male; Metronidazole; Thiamphenicol; Tomography, X-Ray Computed

Topics: Acquired Immunodeficiency Syndrome; Adult; Brain Abscess; Ceftriaxone; Humans; Male; Minocycline; Nocardia asteroides; Nocardia Infections

Three groups of patients with single hemispheric brain abscesses or subdural empyemas, from 1 to 5 cm large, with similar initial prognosis, have been treated either by medical treatment alone (20), aspiration (21), or excision (15). Differences in survival were not found, but medical treatment alone was better for long term sequelae. Surgical procedures (either aspiration or excision) were better for both isolation of the organism and the hospital stay before discharge. In spite of good results, it is unwise to conclude too strongly in favour of no surgical treatment as this study was not randomised.

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Brain Abscess; Cause of Death; Ceftriaxone; Combined Modality Therapy; Empyema, Subdural; Female; Humans; Male; Metronidazole; Pefloxacin; Postoperative Complications; Suction; Trimethoprim, Sulfamethoxazole Drug Combination

Study of the penetration of ceftriaxone into the brain of patients who underwent surgery for cerebral tumors. Seventeen patients received 2 g of ceftriaxone intravenously 2 h to 13 h before blood and brain samples were taken. Ceftriaxone levels in serum and in non tumoral cerebral tissue were determined by the agar well diffusion technique. Hemoglobin concentration was measured in cerebral samples in order to subtract ceftriaxone due to blood contamination. True ceftriaxone levels in cerebral tissue ranged from 0.3 to 12 mcg/g, mean 1.63 mcg/g. The ceftriaxone level ratio in brain and serum was low, mean about 2%, but cerebral ceftriaxone concentrations would be sufficient to inhibit more than 75% of bacteria isolated in recent cerebral abscesses. These results allow to do further therapeutic studies of ceftriaxone in cerebral abscesses due to identified and susceptible bacteria or in random treatment in association with antibiotics directed on anaerobic organisms and resistant hospital strains.

Topics: Adult; Aged; Biological Transport; Brain Abscess; Brain Neoplasms; Ceftriaxone; Female; Humans; Male; Middle Aged

Topics: Brain Abscess; Ceftriaxone; Cephalosporins; Female; Humans; Infant; Infant, Newborn; Male; Meningitis; Moxalactam; Salmonella enteritidis; Salmonella Infections; Salmonella typhimurium

Topics: Adolescent; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Meningitis

Ceftriaxone is an investigational cephalosporin with a half-life of five to eight hours. In an uncontrolled study, we evaluated its efficacy and safety in 30 pediatric and 12 young adult patients with serious bacterial infections. This agent was administered to children at a dosage of 50 to 75 mg/kg/day intravenously in two divided doses. Those with CNS infections received 100 mg/kg/day. In adults, the dosage was 1 g either once or twice daily. The diseases we treated included pneumonia (17), sepsis (eight), ventriculoperitoneal shunt infections (three), osteomyelitis (three), brain abscess (two), peritonitis (two), and miscellaneous (seven). Clinical cures were achieved in all cases, although one child with cystic fibrosis and Pseudomonas pneumonia had persistent colonization in his sputum. No serious side effects were observed. Although not the agent of choice for many of these pathogens, ceftriaxone appears to represent an important alternative to therapy.

Topics: Bacteria; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Child; Child, Preschool; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Osteomyelitis; Pneumonia

Forty-three children (ten neonates, 15 infants and 18 older children) were treated with single daily doses of ceftriaxone (50 to 100 mg/kg) intravenously or intramuscularly for serious bacterial infections. The infections included meningitis (31 patients), brain abscesses (four patients), septicaemia (three patients), pleuro-pneumonia (two patients), septic arthritis and soft tissue phlegmona (three patients). No other antibacterial agents were used except in four patients with brain abscesses, in whom ceftriaxone was combined with ornidazole. The overall bacteriological cure rate was 98%, and sterilisation of the cerebrospinal fluid occurred in 27 of 28 patients (96%) with proven bacterial meningitis. Two patients died, three survived with severe neurological sequelae; one neonate required partial gut resection. A complete clinical cure was achieved in the remaining 37 patients. Only one treatment failure was directly related to the drug therapy. The only side effect noted were sterilisation of the gut with overgrowth of Candida albicans in 35% of neonates and infants, an prolonged fever in 13% of all patients. Ceftriaxone given in a 24-hourly regimen is convenient and highly effective in serious bacterial infections in children and is without significant toxicity.

Topics: Adolescent; Arthritis, Infectious; Bacterial Infections; Brain Abscess; Cefotaxime; Ceftriaxone; Cellulitis; Child; Child, Preschool; Drug Evaluation; Humans; Infant; Infant, Newborn; Meningitis; Pleuropneumonia; Sepsis