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Background Brain abscess caused by atypical pathogens presents significant diagnostic and therapeutic challenges. The unusual clinical presentations, coupled with incomplete or inaccurate patient histories, often result in misdiagnosis and inappropriate treatment. Case presentation We report a case of a retained intracranial bamboo foreign body resulting in a brain abscess. A female adolescent presented with a newly developed mass on the eyelid. Medical imaging identified a foreign body that had penetrated the frontal lobes via the transorbital route, leading to the formation of a brain abscess. The foreign body was successfully removed through transnasal endoscopy. Inflamed tissue adherent to the foreign body was cultured and analyzed using metagenomic next-generation sequencing (mNGS), which identified Clostridium celerecrescens as the causative pathogen. The patient fully recovered after surgical debridement and two weeks of antibiotic therapy. Conclusions Infections caused by C. celerecrescens are exceedingly rare in clinical practice. This case highlights the bacterium’s ability to adhere to a bamboo foreign body, leading to the formation of a rare brain abscess. mNGS proves to be a valuable diagnostic tool for identifying uncommon infectious agents.

Background Data on critically ill patients with spontaneous empyema or brain abscess are limited. The aim was to evaluate clinical presentations, factors, and microbiological findings associated with the outcome in patients treated in a Neurocritical Care Unit. Methods In this retrospective study, we analyzed 45 out of 101 screened patients with spontaneous epidural or subdural empyema and/or brain abscess treated at a tertiary care center between January 2012 and December 2019. Patients with postoperative infections or spinal abscess were excluded. Medical records were reviewed for baseline characteristics, origin of infection, laboratory and microbiology findings, and treatment characteristics. The outcome was determined using the Glasgow outcome scale extended (GOSE). Results Favorable outcome (GOSE 5–8) was achieved in 38 of 45 patients (84%). Four patients died (9%), three remained severely disabled (7%). Unfavorable outcome was associated with a decreased level of consciousness at admission (Glasgow coma scale < 9) (43% versus 3%; p  = 0.009), need of vasopressors (71% versus 11%; p  = 0.002), sepsis (43% versus 8%; p  = 0.013), higher age (65.1 ± 15.7 versus 46.9 ± 17.5 years; p  = 0.014), shorter time between symptoms onset and ICU admission (5 ± 2.4 days versus 11.6 ± 16.8 days; p  = 0.013), and higher median C-reactive protein (CRP) serum levels (206 mg/l, range 15–259 mg/l versus 17.5 mg/l, range 3.3–72.7 mg/l; p  = 0.036). With antibiotics adapted according to culture sensitivities in the first 2 weeks, neuroimaging revealed a progression of empyema or abscess in 45% of the cases. Conclusion Favorable outcome can be achieved in a considerable proportion of an intensive care population with spontaneous empyema or brain abscess. Sepsis and more frequent need for vasopressors, associated with unfavorable outcome, indicate a fulminant course of a not only cerebral but systemic infection. Change of antibiotic therapy according to microbiological findings in the first 2 weeks should be exercised with great caution.

Brain abscesses (BA) are focal parenchymal infections that remain life-threatening conditions. Polymicrobial BAs (PBAs) are complex coinfections of bacteria or bacterial and nonbacterial pathogens such as fungi or parasites, with diagnostic and therapeutic challenges. In this article, we comprehensively review the prevalence, pathogenesis, clinical manifestations, and microbiological, histopathological, and radiological features of PBAs, as well as treatment and prognosis. While PBAs and monomicrobial BAs have some similarities such as nonspecific clinical presentations, PBAs are more complex in their pathogenesis, pathological, and imaging presentations. The diagnostic challenges of PBAs include nonspecific imaging features at early stages and difficulties in identification of some pathogens by routine techniques without the use of molecular analysis. Imaging of late-stage PBAs demonstrates increased heterogeneity within lesions, which corresponds to variable histopathological features depending on the dominant pathogen-induced changes in different areas. This heterogeneity is particularly marked in cases of coinfections with nonbacterial pathogens such as Toxoplasma gondii. Therapeutic challenges in the management of PBAs include initial medical therapy for possibly underrecognized coinfections prior to identification of multiple pathogens and subsequent broad-spectrum antimicrobial therapy to eradicate identified pathogens. PBAs deserve more awareness to facilitate prompt and appropriate treatment.

Pulmonary arteriovenous malformations (PAVMs) are structurally abnormal vascular communications that provide a continuous right-to-left shunt between pulmonary arteries and veins. Their importance stems from the risks they pose (>1 in 4 patients will have a paradoxical embolic stroke, abscess or myocardial infarction while life-threatening haemorrhage affects 1 in 100 women in pregnancy), opportunities for risk prevention, surprisingly high prevalence and under-appreciation, thus representing a challenging condition for practising healthcare professionals. The driver for the current Clinical Statement was the plethora of new data since previous hereditary haemorrhagic telangiectasia (HHT) guidelines generated in 2006 and a systematic Cochrane Review for PAVM embolisation in 2011. The British Thoracic Society (BTS) identified key areas in which there is now evidence to drive a change in practice. Due to the paucity of data in children, this Statement focused on adults over 16 years. The Statement spans the management of PAVMs already known to be present (interventional and medical), screening and diagnosis (for PAVMs and HHT) and follow-up of patients following a first diagnosis, intervention or negative screen for PAVMs. The Good Practice Points (in bold) were generated for a target audience of general respiratory, medical and specialist clinicians and were approved by the BTS Standards of Care Committee, before formal peer review and public consultation. The Statement spans embolisation treatment, accessory medical management and issues related to the likelihood of underlying HHT.

Background The aim of this study was to investigate the clinical presentation, imaging features, and outcome of patients diagnosed with brain abscess and treated by stereotactic aspiration. Methods We retrospectively analyzed the medical data of all consecutive patients diagnosed with brain abscess who underwent stereotactic aspiration in our department from 2015 to 2022. The demographic characteristics, clinical presentation, radiological data, microbial aetiology, and outcome were collected and analyzed using t-test or χ 2 tests. Results Overall, 120 patients were identified. The mean age was 49.7 years (range: 5–81); 59.2% were male. Seventy-nine patients (65.8%) had comorbidities, of which cardiovascular diseases was the most common. Most of the abscesses were solitary frontal or temporal lesions. A microbiological diagnosis was secured in 70 (58.3%) of cases, among which the majority were of the Streptococcus spp. Outcome was favorable in 107 (89.2%) of cases. The mortality rate during the initial hospital stay was 2.5%. A total of 10 individuals (8.3%) presented with preoperative delirium or coma, which was associated with an inferior clinical outcome compared to those who exhibited clear consciousness. ( p  = 0.01). Conclusions Stereotactic aspiration was a safe intervention with a low incidence of complications. The combination of stereotactic aspiration and antibiotic therapy was an effective treatment strategy for brain abscess. Patients who underwent stereotactic aspiration while in a state of disturbance of consciousness demonstrated a poorer outcome compared to those who were conscious. Clinical trial number Not applicable.

Despite advances in diagnostic techniques and treatment, brain abscess remains a challenging clinical problem with substantial case fatality rates. Delays in diagnosis and treatment can result in a poor outcome. This review summarizes current approaches to effective treatment. Despite advances in imaging techniques, laboratory diagnostics, surgical interventions, and antimicrobial treatment, brain abscess remains a challenging clinical problem with substantial case fatality rates. Brain abscess can be caused by bacteria, mycobacteria, fungi, or parasites (protozoa and helminths), and the reported incidence ranges from 0.4 to 0.9 cases per 100,000 population. 1 , 2 Rates are increased in immunosuppressed patients. 3 Pathogenesis and Epidemiology In most patients, brain abscess results from predisposing factors, such as underlying disease (e.g., infection with the human immunodeficiency virus [HIV]), a history of treatment with immunosuppressive drugs, disruption of the natural protective barriers surrounding the brain (e.g., due . . .

Nocardiosis has a predilection for affecting the lungs or occurs as a disseminated disease. Cerebral involvement resulting in multiple brain abscesses is rarely reported in 2% of cases. A 30-year-old woman diagnosed with immunocompromised state six months back presented with headache, multiple episodes of seizures, and progressive right hemiparesis for the past three months. She was initially treated with antibiotics, but in view of non-improvement, an early burr-hole aspiration of the abscess resulted in the correct diagnosis. She was then subsequently treated with antimicrobial therapy and surgical excision of the abscess, resulting in significant improvement. Follow-up at four-month duration showed significant improvement with complete resolution of all clinical features. Patients with multiple cerebral nocardial abscesses may require combined treatment with antimicrobial therapy and surgical excision to improve the mortality and prognosis. An early burr-hole-guided aspiration results in faster etiological diagnosis and prompt targeted approach.

Background Intracranial abscess (IA) is a rare disorder in childhood. Clinical manifestations of brain abscess include headache, fever, and focal neurological deficits. This study aimed to examine the demographic, clinical, laboratory, and imaging findings in children with IA. Methods Children admitted to the pediatric infection service with a diagnosis of IA between 2011 and 2022 were included in the study. Abscesses were divided into two groups: infratentorial and supratentorial. Demographic characteristics of the patients, complaints, MRI findings, and follow-up data were recorded and compared between the two groups. Results The study included a total of 23 patients, 9 (39.1%) of whom were male, with a mean age at diagnosis of 79.3 ± 65.4 months. The most common complaints were headache (39.1%), fever (91.3%), focal neurological deficits (60.9%), seizures, loss of consciousness (26.1%), and meningitis findings (60.9%). The most frequent etiology was post-operative procedures (30.4%), followed by a history of meningomyelocele (13%), and congenital heart disease (8.7%). On MRI, 68.7% of the supratentorial abscesses were multiple and commonly localized in the frontal and parietal regions. Treatment included ceftriaxone (82.6%), vancomycin (65.2%), meropenem (43.5%), metronidazole (34.8%), and linezolid (17.4%). The median hospitalization duration for patients was 32 days (range: 14–150). Of the patients, 34.8% were hospitalized and followed in the intensive care unit, and neurosurgery performed surgical interventions in 60.9% of cases, with evacuation in 21.7% of cases. In cultures, the causative agent was identified on average within 4 ± 1.3 days. Recurrence of abscess occurred in three (13%) cases, and 13% of cases had residual sequelae. Conclusions Intracranial abscess is a rare infectious disease that can result in long-term neurological deficits requiring extended follow-up and treatment. A correct and effective approach also positively impacts the prognosis of patients.

PurposeTo describe the presentation and management of bacterial brain abscess and subdural empyema in adults treated at two tertiary centers. In addition, to identify factors that may predict a poor clinical outcome.MethodsA retrospective analysis of data obtained from clinical records was performed, followed by multivariate regression analysis of patient and treatment-related factors.Results113 patients were included with a median age of 53 years and a male preponderance. At presentation symptoms were variable, 28% had a focal neurological deficit, and 39% had a reduced Glasgow coma scale (GCS). Brain abscesses most frequently affected the frontal, temporal, and parietal lobes while 36% had a subdural empyema. An underlying cause was identified in 76%; a contiguous ear or sinus infection (43%), recent surgery or trauma (18%) and haematogenous spread (15%). A microbiological diagnosis was confirmed in 86%, with streptococci, staphylococci, and anaerobes most frequently isolated. Treatment involved complex, prolonged antibiotic therapy (> 6 weeks in 84%) combined with neurosurgical drainage (91%) and source control surgery (34%). Mortality was 5% with 31% suffering long-term disability and 64% achieving a good clinical outcome. A reduced GCS, focal neurological deficit, and seizures at presentation were independently associated with an unfavorable clinical outcome (death or disability).ConclusionsComplex surgical and antimicrobial treatment achieves a good outcome in the majority of patients with bacterial brain abscess and subdural empyema. Factors present at diagnosis can help to predict those likely to suffer adverse outcomes. Research to determine optimal surgical and antibiotic management would be valuable.

Objectives Pituitary abscess (PA) accounts for only 0.3–0.5% of sellar masses, and the lack of specific clinical symptoms makes diagnosing PA difficult without a surgical biopsy. In clinical practice, PA is often mistaken for cystic pituitary adenoma, craniopharyngioma, and Rathke’s cyst. Thus, this study aims to investigate challenges in diagnosing PA and evaluate the importance of combining intraoperative surgery with postoperative antibiotic treatment. Methods We conducted a retrospective analysis of 19 patients diagnosed with PA through histopathology. All patients underwent transsphenoidal surgery (TSS) for pituitary adenomas after undergoing comprehensive preoperative evaluations, including routine tests, endocrine assay, and imaging examination. Furthermore, we compared different treatments for pituitary abscess (PA) to determine the most effective approach for achieving a favorable prognosis. Results The most prevalent symptom of PA was headache, especially in the frontal–temporal and vertex regions, ranging from mild to moderate severity. Hypopituitarism-related symptoms were also frequently observed, including hypaphrodisia, cold sensitivity, fatigue, weight loss, polyuria, and amenorrhea. Twelve patients exhibited abnormalities in endocrinology examinations. Diagnosing PA correctly is challenging. In our study, none of the patients were correctly diagnosed with PA prior to surgery, and many sellar lesions were misdiagnosed. The favorable prognosis was largely attributed to surgical intervention and active postoperative antibiotic therapy. Conclusions Given the lack of clarity in preoperative diagnosis, typical intraoperative findings and effective antibiotics treatment are more indicative of the correct diagnosis than other tests. In terms of therapy, optimal surgical intervention and active postoperative antibiotic treatment contribute to resolving the challenges posed by PA.