Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Brain abscess in Korean children: A 15-year single center study

  • Lee, Cha-Gon (Department of Pediatrics, School of Medicine, Sungkyunkwan University, Samsung Medical Center) ;
  • Kang, Seong-Hun (Department of Pediatrics, School of Medicine, Sungkyunkwan University, Samsung Medical Center) ;
  • Kim, Yae-Jean (Department of Pediatrics, School of Medicine, Sungkyunkwan University, Samsung Medical Center) ;
  • Shin, Hyung-Jin (Department of Neurosurgery, School of Medicine, Sungkyunkwan University, Samsung Medical Center) ;
  • Choi, Hyun-Shin (Department of Pediatrics, School of Medicine, Sungkyunkwan University, Samsung Medical Center) ;
  • Lee, Jee-Hun (Department of Pediatrics, School of Medicine, Sungkyunkwan University, Samsung Medical Center) ;
  • Lee, Mun-Hyang (Department of Pediatrics, School of Medicine, Sungkyunkwan University, Samsung Medical Center)
  • Received : 2009.09.15
  • Accepted : 2009.12.01
  • Published : 2010.05.15
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Abstract

Purpose: A brain abscess is a serious disease of the central nerve system. We conducted this study to summarize the clinical manifestations and outcomes of brain abscesses. Methods: A retrospective chart review of pediatric patients diagnosed with brain abscesses from November 1994 to June 2009 was performed at Samsung Medical Center, Seoul, Korea. Results: Twenty-five patients were included in this study. On average, 1.67 cases per year were identified and the median age was 4.3 years. The common presenting clinical manifestations were fever (18/25, 72%), seizure (12/25, 48%), altered mental status (11/25, 44%), and signs of increased intracranial pressure (9/25, 36%). A total of 14 (56%) patients had underlying illnesses, with congenital heart disease (8/25, 32%) as the most common cause. Predisposing factors were identified in 15 patients (60%). The common predisposing factors were otogenic infection (3/25, 12%) and penetrating head trauma (3/25, 12%). Causative organisms were identified in 64% of patients (16/25). The causative agents were $S$ $intermedius$ (n=3), $S$ $aureus$ (n=3), $S$ $pneumoniae$ (n=1), Group B streptococcus (n=2), $E.$ $coli$ (n=1), $P.$ $aeruginosa$ (n=1), and suspected fungal infection (n=5). Seven patients received medical treatment only while the other 18 patients also required surgical intervention. The overall fatality rate was 16% and 20% of patients had neurologic sequelae. There was no statistical association between outcomes and the factors studied. Conclusion: Although uncommon, a brain abscess is a serious disease. A high level of suspicion is very important for early diagnosis and to prevent serious consequences.

Keywords

References

  1. Tseng JH, Tseng MY. Brain abscess in 142 patients: factors influencing outcome and mortality. Surg Neurol 2006;65:557-62. https://doi.org/10.1016/j.surneu.2005.09.029
  2. Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children's Hospital Boston. Pediatrics 2004;113:1765- 70. https://doi.org/10.1542/peds.113.6.1765
  3. Sato T, Kaneda M, Ichikawa M, Suzuki D, Nakagawa A, Kobayashi R. Current approaches to management of cerebral fungal infection in pediatric patients with hematologic disorders. J Pediatr Hematol Oncol 2008;30:249-53. https://doi.org/10.1097/MPH.0b013e318161aa0c
  4. Sheehan JP, Jane JA, Ray DK, Goodkin HP. Brain abscess in children. Neurosurg Focus 2008;24:E6.
  5. Frazier JL, Ahn ES, Jallo GI. Management of brain abscesses in children. Neurosurg Focus 2008;24:E8.
  6. Saez-Llorens X. Brain abscess in children. Semin Pediatr Infect Dis 2003;14:108-14. https://doi.org/10.1053/spid.2003.127227
  7. Dehority W, Uchiyama S, Khosravi A, Nizet V. Brain abscess caused by Streptococcus pyogenes in a previously healthy child. J Clin Microbiol 2006;44:4613-5. https://doi.org/10.1128/JCM.01724-06
  8. Fuchs H, von Baum H, Meth M, Wellinghausen N, Lindner W, Hummler H. CNS-manifestation of aspergillosis in an extremely lowbirth-weight infant. Eur J Pediatr 2006;165:476-80. https://doi.org/10.1007/s00431-006-0111-6
  9. Chalstrey S, Pfleiderer AG, Moffat DA. Persisting incidence and mortality of sinogenic cerebral abscess: a continuing reflection of late clinical diagnosis. J R Soc Med 1991;84:193-5. https://doi.org/10.1177/014107689108400404
  10. Schliamser SE, Backman K, Norrby SR. Intracranial abscesses in adults: an analysis of 54 consecutive cases. Scand J Infect Dis 1988;20:1-9. https://doi.org/10.3109/00365548809117210
  11. Chun CH, Johnson JD, Hofstetter M, Raff MJ. Brain abscess. A study of 45 consecutive cases. Medicine (Baltimore) 1986;65:415-31. https://doi.org/10.1097/00005792-198611000-00006
  12. Kao PT, Tseng HK, Liu CP, Su SC, Lee CM. Brain abscess: clinical analysis of 53 cases. J Microbiol Immunol Infect 2003;36:129-36.
  13. Barea LM, Tannhauser M, Rotta NT. An epidemiologic study of headache among children and adolescents of southern Brazil. Cephalalgia 1996;16:545-9. https://doi.org/10.1046/j.1468-2982.1996.1608545.x
  14. Kalinowska-Nowak A, Garlicki A, Bociaga-Jasik M. Brain abscessmodern diagnostics and therapeutic treatment. Przegl Epidemiol 2009;63:89-95.
  15. Finkelstein JA, Christiansen CL, Platt R. Fever in pediatric primary care: occurrence, management, and outcomes. Pediatrics 2000;105:260-6.
  16. Seydoux C, Francioli P. Bacterial brain abscesses: factors influencing mortality and sequelae. Clin Infect Dis 1992;15:394-401. https://doi.org/10.1093/clind/15.3.394
  17. Barnes PD, Taylor GA. Imaging of the neonatal central nervous system. Neurosurg Clin N Am 1998;9:17-47.
  18. Tattevin P, Bruneel F, Clair B, Lellouche F, de Broucker T, Chevret S, et al. Bacterial brain abscesses: a retrospective study of 94 patients admitted to an intensive care unit (1980 to 1999). Am J Med 2003;115:143-6. https://doi.org/10.1016/S0002-9343(03)00292-4
  19. Yang SY, Zhao CS. Review of 140 patients with brain abscess. Surg Neurol 1993;39:290-6. https://doi.org/10.1016/0090-3019(93)90008-O
  20. Jansson AK, Enblad P, Sjolin J. Efficacy and safety of cefotaxime in combination with metronidazole for empirical treatment of brain abscess in clinical practice: a retrospective study of 66 consecutive cases. Eur J Clin Microbiol Infect Dis 2004;23:7-14. https://doi.org/10.1007/s10096-003-1055-7
  21. Cavusoglu H, Kaya RA, Turkmenoglu ON, Colak I, Aydin Y. Brain abscess: analysis of results in a series of 51 patients with a combined surgical and medical approach during an 11-year period. Neurosurg Focus 2008;24:E9.
  22. Carpenter J, Stapleton S, Holliman R. Retrospective analysis of 49 cases of brain abscess and review of the literature. Eur J Clin Microbiol Infect Dis 2007;26:1-11. https://doi.org/10.1007/s10096-006-0236-6
  23. Hakan T, Ceran N, Erdem I, Berkman MZ, Goktas P. Bacterial brain abscesses: an evaluation of 96 cases. J Infect 2006;52:359-66. https://doi.org/10.1016/j.jinf.2005.07.019
  24. Lee TJ, Chun JK, Kim KH, Kim KJ, Kim DS. Clinical features of brain abscesses in neonates and children: a single center experience from 1997 to 2006. Korean J Pediatr Infect Dis 2008;15:29-34.
  25. Lee YH, Go CJ. Clinical studies of brain abscess in children. J Korean Neurol Assoc 1985;3:210-6.

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