Skip to main content Skip to main navigation menu Skip to site footer
Articles
Published: 2021-11-04

Cerebral Abscess with Cranial Hypertension in Young Infants: A Case Report and Systematic Review

UNIMAR - Faculty of Medicine, University of Marilia, Marilia, Sao Paulo, Brazil
UNIMAR - Faculty of Medicine, University of Marilia, Marilia, Sao Paulo, Brazil
UNIMAR - Faculty of Medicine, University of Marilia, Marilia, Sao Paulo, Brazil
UNIMAR - Faculty of Medicine, University of Marilia, Marilia, Sao Paulo, Brazil
UNIMAR - Faculty of Medicine, University of Marilia, Marilia, Sao Paulo, Brazil
UNIMAR - Faculty of Medicine, University of Marilia, Marilia, Sao Paulo, Brazil
UNIMAR - Faculty of Medicine, University of Marilia, Marilia, Sao Paulo, Brazil
UNIMAR - Faculty of Medicine, University of Marilia, Marilia, Sao Paulo, Brazil
UNIMAR - Faculty of Medicine, University of Marilia, Marilia, Sao Paulo, Brazil
UNIMAR - Faculty of Medicine, University of Marilia, Marilia, Sao Paulo, Brazil
UNIMAR - Faculty of Medicine, University of Marilia, Marilia, Sao Paulo, Brazil
Cerebral abscess Intracranial hypertension Pediatrics

Abstract

Objective: To report a Central Nervous System infection evolving with brain abscess and to address aspects of the treatment of the disease. Results: even with advances in treatment and diagnosis, the pathology has a high mortality. However, the best prognosis is noticed when there is a suspicion through the clinic, neuroradiological images readily available, antimicrobial therapy against commonly encountered agents, and surgical drainage procedures. One study, which combined antibiotic therapy and surgery to drain the abscess, in most of the cases, studied, demonstrated a mortality rate of 12%, and another study, a 42% mortality rate when using antibiotic therapy alone. Another reference suggests the use of antibiotic therapy alone in less severe cases with less neurological impairment. Neurological clinical sequelae can be found in up to 30% of cases. The time of antibiotic therapy still needs to be debated, as well as the surgical indication for drainage. Final Considerations: Pediatric brain abscess is an uncommon disease, still with high morbidity and mortality. Surgical drainage or excision of pediatric abscesses remains the basis of treatment both to relieve the mass effect and to provide a microbiological diagnosis. The literature demonstrates that broad-spectrum antibiotics and access to CT and MRI images decrease the rates of morbidity and mortality. It is concluded that the therapeutic approach involves the administration of broad-spectrum intravenous antibiotics and surgical drainage in more complex cases.

References

  1. N. Nathoo, S. S. Nadvi, P. K. Narotam, and J. R. van Dellen, “Brain abscess: management and outcome analysis of a computed tomography era experience with 973 patients,” World Neurosurg, vol. 75, no. 5-6, pp. 716–726, 2011.
  2. WU, Shenglian et al. Retrospective analysis of brain abscess in 183 patients: A 10-year survey. Medicine, v. 98, n. 46, 2019. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867766/. Acesso em: 03 de Abril de 2020.
  3. Helweg-Larsen J, et al. Pyogenic brain abscess, a 15 year survey. BMC Infect Dis 2012;12:332.
  4. Cole TS, et al. Pediatric focal intracranial suppuration: a UK single-center experience. Child’s Nervous System 2012; 28: 2109–2114.
  5. Felsenstein S, et al. Clinical and microbiologic features guiding treatment recommendations for brain abscesses in children. Pediatric Infectious Disease Journal 2013; 32: 129–135.
  6. Laulajainen-Hongisto A, et al. Intracranial abscesses over the last four decades; changes in aetiology, diagnostics, treatment and outcome. Infectious Diseases 2016; 48: 310–316.
  7. Gelabert-González M, et al. Management of brain abscess in children. Journal of Paediatrics and Child Health 2008; 44: 731–735.
  8. Fumihiro Ochi , Hisamichi Tauchi, Toyohisa Miyata, Tomozo Moritani, Toshiyuki Chisaka, Junpei Hamada, Kozo Nagai , Minenori Eguchi-Ishimae, and Mariko Eguchi. Brain Abscess Associated with Polymicrobial Infection after Intraoral Laceration: A Pediatric Case Report. Hindawi Case Reports in Pediatrics Volume 2020, Article ID 8304302, 5 pages https://doi.org/10.1155/2020/8304302.
  9. Riley DS, Barber MS, Kienle GS, AronsonJK, von Schoen-Angerer T, Tugwell P, Kiene H, Helfand M, Altman DG, Sox H, Werthmann PG, Moher D, Rison RA, Shamseer L, Koch CA, Sun GH, Hanaway P, Sudak NL, Kaszkin-Bettag M, Carpenter JE, Gagnier JJ. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017 May 18. pii: S0895-4356(17)30037-9. doi: 10.1016/j.jclinepi.2017.04.026.
  10. Mameli, Chiara et al. Brain abscess in pediatric age: a review. Child's Nervous System, p. 1-12, 2019.
  11. Hall, Samuel et al. Paediatric brain abscesses: a single centre experience. British journal of neurosurgery, v. 33, n. 5, p. 550-554, 2019.
  12. Saez-Llorens X MD. Brain Abscess in Children. Seminars in Pediatric Infectious Diseases, v.14, n.2, p.108-114, 2003.
  13. Xiao, Furen et al. Brain abscess: clinical experience and analysis of prognostic factors. Surgical neurology, v. 63, n. 5, p. 442-449, 2005.
  14. Brouwer MC, Coutinho JM, Van De Beek D. Clinical characteristics and outcome of brain abscess. Systematic review and meta-analysis. Neurology. v.82, p.806–813, 2014.
  15. Capua, Tali et al. Group A streptococcal brain abscess in the pediatric population: case series and review of the literature. The Pediatric infectious disease journal, v. 37, n. 10, p. 967-970, 2018.
  16. Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children’s Hospital Boston. Pediatrics. v.113, p.1765–1770, 2004.
  17. Renier, Dominique et al. Brain abscesses in neonates: a study of 30 cases. Journal of neurosurgery, v. 69, n. 6, p. 877-882, 1988.
  18. Gilard, Vianney et al. Brain abscess in children, a two-centre audit: outcomes and controversies. Archives of Disease in Childhood, v. 105, n. 3, p. 288-291, 2020.
  19. Ozsürekci, Yasemin et al. Brain abscess in childhood: a 28-year experience. Turk J Pediatr, v. 54, n. 2, p. 144-149, 2012.
  20. Raffaldi, I. et al. Brain abscesses in children: an Italian multicentre study. Epidemiology & Infection, v. 145, n. 13, p. 2848-2855, 2017.
  21. George, Reena et al. Central nervous system manifestations of HIV infection in children. Pediatric radiology, v. 39, n. 6, p. 575-585, 2009.
  22. Lackner, Herwig et al. Management of brain abscesses in children treated for acute lymphoblastic leukemia. Pediatric Blood & Cancer, v. 52, n. 3, p. 408-411, 2009.
  23. Atiq, Mehnaz et al. Brain abscess in children. The Indian Journal of Pediatrics, v. 73, n. 5, p. 401-404, 2006.
  24. Canpolat, Mehmet et al. Brain abscesses in children: results of 24 children from a reference center in Central Anatolia, Turkey. Journal of child neurology, v. 30, n. 4, p. 458-467, 2015.
  25. Cole, Theresa S. et al. Pediatric focal intracranial suppuration: a UK single-center experience. Child's Nervous System, v. 28, n. 12, p. 2109-2114, 2012.
  26. Gelabert‐González, Miguel et al. Management of brain abscess in children. Journal of paediatrics and child health, v. 44, n. 12, p. 731-735, 2008.
  27. Shachor‐Meyouhas, Y. et al. Brain abscess in children–epidemiology, predisposing factors and management in the modern medicine era. Acta Paediatrica, v. 99, n. 8, p. 1163-1167, 2010.
  28. Jain, Avani et al. Intracranial complications of CSOM in pediatric patients: A persisting problem in developing countries. International Journal of Pediatric Otorhinolaryngology, v. 100, p. 128-131, 2017.
  29. Sahbudak Bal, Z. et al. Brain Abscess in Children: A Rare but Serious Infection. Clinical pediatrics, v. 57, n.5, p. 574–579, 2018.
  30. Go, Cynthia et al. Intracranial complications of acute mastoiditis. International journal of pediatric otorhinolaryngology, v. 52, n. 2, p. 143-148, 2000.
  31. Patel, Neha A. et al. Systematic review and case report: intracranial complications of pediatric sinusitis. International Journal of Pediatric Otorhinolaryngology, v. 86, p. 200-212, 2016.
  32. De Oliveira, Ricardo Santos et al. Brain abscess in a neonate: an unusual presentation. Child's Nervous System, v. 23, n. 2, p. 139-142, 2007.
  33. Schielke E. Bacterial brain abscess. Der bakterielle Hirnabszess. V.66, n.10, p.745-753,1995.
  34. Giugno, Katia M. et al. Tratamento da hipertensão intracraniana. Jornal de Pediatria, v. 79, n. 4, p. 287-296, 2003.
  35. Ochi, Fumihiro et al. Brain Abscess Associated with Polymicrobial Infection after Intraoral Laceration: A Pediatric Case Report. Case Reports in Pediatrics, v. 2020, 2020. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7085370/. Acesso em: 03 de Abril de 2020.
  36. Kahle, K. T., Kulkarni, A. V., Limbrick, D. D., Warf, B. C. Hydrocephalus in children. The Lancet. V.387, n.10020, p.788–799,2016.
  37. Britt, Richard H.; Enzmann, Dieter R.; Yeager, Anne S. Neuropathological and computerized tomographic findings in experimental brain abscess. Journal of neurosurgery, v. 55, n. 4, p. 590-603, 1981.
  38. Brizuela M et al. Absceso cerebral en niños: experiencia en diez años en un hospital pediátrico de alta complejidad. Arch Argent Pediatr. v.115, n.4, p.230–232, 2017.
  39. Foerster, B. R. et al. Intracranial infections: clinical and imaging characteristics. Acta Radiologica, v. 48, n. 8, p. 875-893, 2007.
  40. Haimes, Alison B. et al. MR imaging of brain abscesses. American Journal of Roentgenology, v. 152, n. 5, p. 1073-1085, 1989.
  41. Costerus, Joost M.; BROUWER, Matthijs C.; VAN DE BEEK, Diederik. Technological advances and changing indications for lumbar puncture in neurological disorders. The Lancet Neurology, v. 17, n. 3, p. 268-278, 2018.
  42. Nickerson, Joshua P. et al. Neuroimaging of pediatric intracranial infection—part 2: TORCH, viral, fungal, and parasitic infections. Journal of Neuroimaging, v. 22, n. 2, p. e52-e63, 2012.
  43. Lumbiganon P, Chaikitpinyo A. Antibiotics for brain abscesses in people with cyanotic congenital heart disease. Cochrane Database Syst Rev., v.28, n.3, 2013.
  44. Nau R, Seele J, Djukic M, Eiffert H. Pharmacokinetics and pharmacodynamics of antibiotics in central nervous system infections. Curr Opin Infect Dis. v.31, n.1, p.57–68, 2018.
  45. Shovlin CL, Condliffe R, Donaldson JW, Kiely DG, Wort SJ, on behalf of the British Thoracic Society British Thoracic Society clinical statement on pulmonary arteriovenous malformations. Thorax., v.72, p.1154–1163, 2017.
  46. Sonneville R, Magalhaes E, Meyfroidt G. Central nervous system infections in immunocompromised patients. Curr Opin Crit Care. v.23, n.2, p.128–133, 2017.
  47. Senevirantne RDE S, Navvasivayam P, Perera S, WICKREMASINGHE RS. Microbiology of cerebral abscess at the neurosurgical unit of the National Hospital of Sri Lanka. Ceylon Medical Journal. v.48, n.1, p.14-6, 2003.
  48. Arlotti M et al. Consensus document on controversial ssues for the treatment of infections of the central nervous system: bacterial brain abscesses. Int J Infect Dis. v.14, n.4, p.79-92, 2010.
  49. Brook I. Microbiology and treatment of brain abscess. J Clin Neurosci, v.38, p.8–12, 2017.
  50. Krzysztofiak A, Zangari P, De Luca M, Villani. A brain abscesses: an overview in children. J Pediatr Infect Dis. v.14, p.002– 005, 2017.
  51. Mathisen GE, Johnson JP. Brain abscess. Clin Infect Dis. v.25, p.763-781, 1997.
  52. Skoutelis AT, Gogos CA, Maraziotis TE, et al: Management of brain abscess with sequential intravenous/oral antibiotic therapy. Eur J Clin Microbiol Infect Dis. v.19, p.332-335, 2000.
  53. Cochrane DD. Brain abscess. Pediatr Rev. v.20, p.209-214, 1999.
  54. Shovlin CL, et al., on behalf of the British Thoracic Society. British Thoracic Society clinical statement on pulmonary arteriovenous malformations. Thorax. v.72, p.1154–1163, 2017.
  55. Ratnaike et al. Review of brain abscess surgical treatment -78 years: aspiration versus excision. World Neurosurg. v.76, n.5, p.431–436, 2011.
  56. Ingham HR, Selkon JB: Metronidazole and brain abscess. Lancet. v.2, p.613-614, 1982.
  57. Broggi G, et al. Treatment of deep brain abscesses by stereotactic implantation of an intracavitary device for evacuation and local application of antibiotics. Acta Neurochir (Wien) v.76, p.94-98, 1985.
  58. Zeidman et al. Intraventricular rupture of a purulent brain abscess: Case report. Neurosurgery. v.36, p.189-193, 1995
  59. Quartey GRC, et al. Decadron in the treatment of cerebral abscess. J Neurosurg. v.45, p.301-310, 1976.
  60. Park Hyun-Kyung et al. Treatment with Ultrasound-Guided Aspiration of Intractable Methicillin-Resistant Staphylococcus aureus Brain Abscess in an Extremely Low Birth Weight Infant. Pediatr Neurosurg. v.50, n.4,p.210-215, 2015.
  61. Yakut N, Kadayifci EK, Karaaslan A, Atici S, Akkoc G, Ocal Demir S, et al. Braın abscess due to Streptococcus intermedius secondary to mastoiditis in a child. Springer Plus. 2015;4. doi:10.1186/s40064-015-1608-0.

How to Cite

Marqui, N. A. C., Lima, M. L. de C., Baptista, R. de F. F., Righetti, R. E. V. G., Martins, T. R., Marconato, G. G., Leite, G. C., Viana, K. C., Hauy, B. N., Modaelli, J., & Mendes, A. J. (2021). Cerebral Abscess with Cranial Hypertension in Young Infants: A Case Report and Systematic Review. MedNEXT Journal of Medical and Health Sciences, 2(4). https://doi.org/10.54448/mdnt2141