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CASE REPORT
Year : 2020  |  Volume : 47  |  Issue : 1  |  Page : 43-44

A case of multiple brain abscesses with unknown sources


1 Department of Medicine, CMOSHMC, Chittagong, Bangladesh
2 Department of Neurosurgery, CMOSHMC, Chittagong, Bangladesh

Date of Submission10-Mar-2020
Date of Acceptance20-Mar-2020
Date of Web Publication23-Jun-2020

Correspondence Address:
Dr. Rajat Sanker Roy Biswas
Department of Medicine, CMOSHMC, Chittagong
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_17_20

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  Abstract 


Brain abscess is a common neurosurgical condition in developing countries like Bangladesh. Usually, it has some etiology. The present case was a 25–year-old male with poor socioeconomic status from a rural area of Chittagong, Bangladesh, and was admitted in our hospital and diagnosed as a case of multiple brain abscesses. He was investigated as per available facility and resources in our hospital, but no sources of abscesses were found. Planning of surgery was done at the 4th day of admission after getting all the reports, but on the 5th day, the patient died and the source and etiology of abscesses were unexplored as no provision of postmortem study is available in our country for such patients.

Keywords: Brain abscess, burr hole, etiology


How to cite this article:
Biswas RS, Ellius MM, Mamun SM. A case of multiple brain abscesses with unknown sources. J Sci Soc 2020;47:43-4

How to cite this URL:
Biswas RS, Ellius MM, Mamun SM. A case of multiple brain abscesses with unknown sources. J Sci Soc [serial online] 2020 [cited 2020 Jul 7];47:43-4. Available from: http://www.jscisociety.com/text.asp?2020/47/1/43/287483




  Introduction Top


A brain abscess can form when fungi or bacteria reach the brain through a wound to the head or infection elsewhere in the body.[1] According to the Children's Hospital of Wisconsin, infections from other parts of the body account for between 20% and 50% of all brain abscess cases. Both heart and lung infections are among the most common causes of brain abscesses, but brain infections can also begin as an ear infection or even an abscessed tooth.[2] However, sometimes, source of infection cannot be detected as like the present case.


  Case Report Top


A 25-year-old male with low socioeconomic status from a rural area of Bangladesh presented with high fever, disorientation, two times convulsions, and vomiting for the last 10 days. He gave no history of such disease previously. On examination, his Glasgow Coma Scale was 9/15, toxic, low blood pressure (90/60), slow pulse (56/min), and rigid neck. He had no cardiac valve problems, dental or sinus problems, and he has no history of aural discharges. Fundoscopy revealed bilateral papilledema. His complete blood count revealed neutrophilic leukocytosis (TC-16,000/cml N-78%), chest X-ray postero-anterior view(PAV) and Echocardiography revealed normal findings and he was HIV screening negative. On computed tomography, multiple brain abscesses on both frontal lobes [Figure 1] were diagnosed on the 3rd day of his admission and intravenous (IV) antibiotics (IV ceftriaxone + IV flucloxacillin + IV metronidazole) were given with other supportive care in the intensive care unit. Plan of surgery was taken, but the patient's condition was deteriorated, he was intubated, and on the 5th day, the patient died. Due to resource-poor setup of our hospital and low economic status of the patient, taking and implementing of decisions were not prompt. Sources of abscesses were not found as postmortem study is not practiced in Bangladesh for other than the medicolegal cases.
Figure 1: Multiple brain abscesses

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  Discussion Top


Brain abscesses occur commonly in developing countries, with an incidence of up to 8% of different neurosurgical conditions. In the developed world, its incidence is of up to 2% of all space-occupying lesions.[1] A brain abscess can form when fungi or bacteria reach the brain through a wound to the head or infection elsewhere in the body.[2] Nearly anyone can get a brain abscess, but certain groups of people are at higher risk than most. Some diseases, disorders, and conditions that raise the risk of brain abscess include a compromised immune system due to HIV or AIDS and cancer. Again other chronic illnesses, congenital heart disease, meningitis, immunosuppressant drugs, such as those used in chemotherapy, chronic sinus or middle ear infections, certain birth defects, such as tetralogy of Fallot allow infections to reach the brain also.[3] A brain abscess is an emergency situation. Pressure due to swelling in the brain can cause reduced blood flow, which can cause permanent brain damage. If the abscess is located deep inside the brain or brain stem, antibiotics are most often prescribed for treatment. Antibiotic medications will also be used to treat any underlying infections. Broad-spectrum antibiotics that kill a variety of different bacteria are the most commonly prescribed, but in some instances, combination therapy is necessary.[4] Surgery is often the inevitable step. Surgery for the removal of an abscess most commonly involves aspiration by burr hole or craniotomy and excision with capsule.[5] In our case, plan of surgery was taken, but in the meantime, the patient was expired though the patient was under empiric broad-spectrum antibiotics and postmortem analysis cannot be done to explore the cause of death as it is not practiced routinely in our country.

Country like Bangladesh needs more infrastructure, trained task force, and health-care facility to deal difficult cases like the present one. Furthermore, there should be some financial support from the government for the poor patients who cannot afford their treatment cost. Furthermore, authority should start to implement the postmortem analysis of patients who expire due to unknown causes or there are some diagnostic dilemmas.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ciurea AV, Stoica F, Vasilescu G, Nuteanu L. Neurosurgical management of brain abscesses in children. Childs Nerv Syst 1999;15:309-17.  Back to cited text no. 1
    
2.
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.  Back to cited text no. 2
    
3.
Cohen JE, Mierez R, Tsai EC. Postcraniotomy gas-containing brain abscess: A neurosurgical emergency. Case report. Surg Neurol 1999;51:568-70.  Back to cited text no. 3
    
4.
Ferreira NP, Otta GM, do Amaral LL, da Rocha AJ. Imaging aspects of pyogenic infections of the central nervous system. Top Magn Reson Imaging 2005;16:145-54.  Back to cited text no. 4
    
5.
Hasdemir MG, Ebeling U. CT-guided stereotactic aspiration and treatment of brain abscesses. An experience with 24 cases. Acta Neurochir (Wien) 1993;125:58-63.  Back to cited text no. 5
    


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