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COMMENTARY
Year : 2012  |  Volume : 4  |  Issue : 6  |  Page : 249

Pyogenic brain abscess


Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India

Date of Web Publication14-Jun-2012

Correspondence Address:
Venkatesh S Madhugiri
Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry-605006
India
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Source of Support: None, Conflict of Interest: None


PMID: 22754874

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How to cite this article:
Madhugiri VS. Pyogenic brain abscess. North Am J Med Sci 2012;4:249

How to cite this URL:
Madhugiri VS. Pyogenic brain abscess. North Am J Med Sci [serial online] 2012 [cited 2019 Nov 15];4:249. Available from: http://www.najms.org/text.asp?2012/4/6/249/97201

In this issue, Drs Somsri Wiwanitkit and Viroj Wiwanitkit present a review of brain abscess in Thailand. The authors reiterate the common etiologic factors for brain abscess, otitis, and cyanotic cardiac anomalies. Sinusitis and trauma are common causes elsewhere in the world. Thailand, according to the authors, continues to grapple with a rising incidence of HIV infection. The incidence of brain abscess in HIV-infected individuals is reported to be 3.2%. It is important to know the bacteriology of brain abscesses in HIV-infected patients in Thailand. Uncommon pathogens, such as fungi, Toxoplasma, and Pseudomonas, may be encountered in patients with HIV infection. [1],[2]

Streptococcus, Staphylococcus, and Proteus are the most commonly documented bacteria in Thailand. All the streptococcal infections seem to have been in the pediatric age group, but the source of cerebral infection is not clear. The source of infection determines the causative organism -if sinusitis or otitis were the source of infection. Streptococcus is the usual cause, in the setting of bacterial endocarditis, Streptococcus viridans or Staphylococcus may be encountered, and Staphylococcus aureus is responsible for most posttraumatic abscesses. [3] 27.4% of brain abscesses are cryptogenic. [4] Bacterial cultures may be negative in 33-45% of patients. [4]

Mortality rates remain as high as 16% for posterior fossa abscess and 10-15% for supratentorial abscess. [4] The mortality rate in Thailand would need to be compared with these rates.

In a large series reported by Nathoo et al., in 2011, 90% of the abscesses were supratentorial. The most common causes were otitis and trauma. The mortality rate was 13.4%. Factors predictive of poor outcome included infarcts, ventriculitis, poor sensorium, hydrocephalus, bilateral or multiple abscesses, HIV co-infection, and so on. [5] Other factors predicting poor outcomes in children include burr hole aspiration as the primary procedure and a volume of >20 mL for cerebral abscesses. [4]

Meliodoisis, amebiasis, and typhoid are uncommon causes of brain abscess elsewhere in the world. The authors are correct to highlight these rare causes of brain abscess.

Despite better sanitation and antimicrobial therapy, brain abscess continues to be an important infection across the world. The reasons, as the authors highlight, could be the increased frequency of travel and the HIV pandemic.

As an initial report from a tropical country, this report adds to the literature on the subject. The major limitation appears to be the data available from the reports recruited for this analysis. This underscores the importance of meticulous record keeping in medical research.

 
  References Top

1.Young JD, McGwire BS. Infliximab and reactivation of cerebral toxoplasmosis. N Engl J Med 2005;353:1530-1.  Back to cited text no. 1
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2.Erdogan E, Cansever T. Pyogenic brain abscess. Neurosurg Focus 2008;24:E2.  Back to cited text no. 2
    
3.Moorthy RK, Rajshekhar V. Management of brain abscess: An overview. Neurosurg Focus 2008;24:E3.  Back to cited text no. 3
    
4.Madhugiri VS, Sastri SB, Srikantha U, Banerjee AD, Somanna S, Devi IB, et al. Focal intradural infections in children: An analysis of management and outcome. Pediatr Neurosurg 2011;47:113-24.  Back to cited text no. 4
    
5.Nathoo N, Nadvi SS, Narotam PK, van Dellen JR. Brain abscess: Management and outcome analysis of a computed tomography era experience with 973 patients. World Neurosurg 2011;75:716-26; discussion 612-7.  Back to cited text no. 5
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This article has been cited by
1 Multiple brain abscesses - Diagnostic dilemma and therapeutic nightmare!
Krishna, K. and Sada, E. and Vikram, A. and Gupta, A.
Journal of Neurosciences in Rural Practice. 2013; 4(2): 234-236
[Pubmed]



 

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