Brain abscess in children (original) (raw)
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Brain abscess in children with Cyanotic Congenital Heart Disease- clinical presentation and outcome
2018
BACKGROUND : Brain abscess is a serious life threatening infection of brain parenchyma. Cyanotic congenital hearth disease is important predisposing factor for brain abscess. OBJECTIVE: This study was conducted to evaluate the clinical profile and outcome of children with brain abscess and underlying Cyanotic congenital hearth disease . MATERIALS & METHODS: The study was carried out at The Department of Paediatric Cardiology, Hayatabad Medical Complex, Peshawar. This study was conducted from June 2015 to May 2016. All children presenting with brain abscess and having an underlying Cyanotic congenital hearth disease were prospectively entered into this study. Data was collected on a written Performa and later on shifted to and analysed by SSPS 18 program. RESULTS: Thirty children with underlying Cyanotic congenital hearth disease were confirmed to have a brain abscess during this period. There were 22 (73%) males and 8 (27%) females. Majority (22 pts-73%) were in the age group 6 to 1...
Recurrent Brain Abscess in a Child With Cyanotic Congenital Heart Disease
Cureus
Brain abscesses are rare but life-threatening conditions associated with morbidity and mortality. They are encountered in unoperated and partially treated cyanotic congenital heart diseases. Our patient is a diagnosed case of transposition of great arteries with a ventricular septal defect. She had recurrent abscesses for which a combination of antimicrobial therapy and surgical excision was performed. Surgical excision carries a great risk of rupture of abscess into the ventricular system and is associated with poorer outcomes. The outcome of brain abscess primarily depends on Glasgow Coma Score (GCS) at the time of admission and ventricular extension of the abscess. Fortunately, our patient showed good results without any apparent neurological sequelae. Early diagnosis of the brain abscess and timely administration of antibiotics help in a good outcome.
Paediatrica Indonesiana, 2018
Background Brain abscess is a severe infection of brain parenchyma, which occurs in 25-46% of cases of uncorrected cyanotic (CHD). Low arterial oxygen saturation is the main risk factor for brain abscess in children with cyanotic CHD, however, the arterial oxygen saturation test is invasive and not routinely done in our setting. Objective To evaluate low peripheral oxygen saturation as a risk factor for brain abscess in children with cyanotic CHD. Methods We conducted a matched, case-control study at Sardjito Hospital, Yogyakarta, for children aged less than 18 years with cyanotic CHD, from 2010-2016. Case subjects were children with brain abscess complications. The control group had only cyanotic CHD, and were matched for age and sex to the case group. During hospitalization due to the brain abscess complication in the case group, data regarding peripheral oxygen saturation, polycythemia, pneumonia, sepsis, dental caries and restricted pulmonary blood flow were collected and compared between both groups. Results During the study period, 18 children with cyanotic CHD had brain abscesses. This group was compared to the control group of 36 children. Bivariate analysis revealed that the lowest level of peripheral oxygen saturation (OR 0.92; 95%CI 0.85 to 0.98; P=0.02) and dental caries (OR 3.3; 95%CI 1.01 to 11.18; P=0.04) were significant risk factors for brain abscess. However, in the multivariate analysis, the only statistically significant risk factor associated with brain abscess was the lowest level of peripheral oxygen saturation (OR 0.92; 95%CI 0.86 to 0.99; P=0.04). Conclusion Low peripheral oxygen saturation is a significant risk factor for brain abscess development in children with cyanotic CHD. A decrease of 1% peripheral oxygen saturation may increase the risk of brain abscess by 8%.
Bangladesh Heart Journal, 2016
Introduction: Brain abscess is a complication of congenital cyanotic heart disease with or without shunt anomaly. It is more common in children. Here, we delineated a case of 19-year-old young Bangladeshi-Bengali male who presenting with brain abscess, an unusual presentation of cyanotic complex congenital heart disease. This case report focuses not only on the unusual presentation of congenital heart disease but also emphasizes the importance of early recognition of neurological complication for referal management.
Forgotten? Not Yet. Cardiogenic Brain Abscess in Children: A Case Series–Based Review
World Neurosurgery, 2017
Brain abscess is a significant cause of morbidity in patients with uncorrected or partially palliated congenital cyanotic heart disease (CCHD). Unfortunately, in the developing world, the majority of the patients with CCHD remain either uncorrected or partially palliated. Furthermore, a risk of this feared complication also exists even among those undergoing staged corrective operations in the interval in between operations. There have been no recent articles in the literature on surgical outcomes of management of cardiogenic brain abscess in children. Objective: To describe the clinical and demographic profile of patients with cardiogenic cerebral abscess and to highlight the fact that uncorrected or palliated CCHD continue to be at risk for brain abscess. Material and methods: Retrospective analysis of 26 children (age below 19 years) being managed for CCHD who were diagnosed with cerebral abscess managed surgically (26/ 39 of cerebral abscess in children), at AIMS, Kochi, India from December 2000 to January of 2014 was done. Details of variables were retrospectively collected included demographics, modes of presentation, diagnosis, location of abscess, details of the underlying heart disease, management of the cerebral abscess and the outcome of the management. Results: Mean age for all 26 patients was 7.19 years, with a wide range of 1.5 years to 19 years. There were 16 males and 10 females. 10 of the 26 patients (38%) required reaspiration after the initial surgery. On follow up, all the patients improved symptomatically and were cured for the cerebral abscess.
Brain abscess in an adult with uncorrected TOF - A case report
2018
One of the most common cyanotic congenital heart diseases in children is Tetralogy of Fallot (ToF). It occurs in 3 out of every 10,000 live births and accounts for up to one-tenth of all congenital cardiac lesions.2 The patients with cyanotic congenital heart disease are prone to develop cerebral abscess incidence being 4-6%.3 Tetralogy of Fallot is the most common cyanotic congenital heart disease accounting for 13-70% of all brain abscess cases.1,4 Most of them are located in the supratentorial compartment and are most common in 4 to7 years of age.5 The incidence of cerebral abscess in patients with Tetralogy of Fallot is due to the fact that microorganisms in blood, instead of passing through pulmonary circulation and undergoing phagocytosis, passes from right to left heart through the shunt and gains access to cerebral circulation. The prognosis of a cardiogenic abscess is worse than that of other brain abscesses, and mortality rates have ranged from 27.5% to 71%.6 Management op...
2021
Background Cardiogenic brain abscess (CBA) is the commonest noncardiac cause of morbidity and mortality in cyanotic heart disease (CHD). The clinical diagnosis of a CBA is often delayed due to its nonspecific presentations and the scarce availability of computed tomography (CT) imaging in resource-restricted settings. We attempted to identify parameters that reliably point to the diagnosis of a CBA in patients with Tetralogy of Fallot (TOF). Methods From among 150 children with TOF treated at a tertiary care institute over a 15-year period from 2001 to 2016, 30 consecutive patients with CBAs and 85 age- and sex-matched controls without CBAs were included in this retrospective case–control study. Demographic and clinical features, laboratory investigations, and baseline echocardiographic findings were analyzed for possible correlations with the presence of a CBA. Statistical Analysis Variables demonstrating significant bivariate correlations with the presence of a CBA were further...
Emergency Department Presentation and Outcome of Children With Cyanotic Congenital Heart Diseases
Cureus, 2021
This study aimed to assess the outcome and see the spectrum of presenting symptoms of children with cyanotic congenital heart diseases (CHDs) admitted through the emergency department in Lady Reading Hospital (LRH) in Peshawar, Pakistan. Materials and methods This cross-sectional study included 104 children with cyanotic CHD admitted through the emergency department in the pediatric cardiology unit of LRH from February 2019 to January 2020. Diagnosis of cyanotic CHD was confirmed through two-dimensional echocardiography. Patients were treated according to standard protocols for their presenting symptoms. The data were analyzed using Statistical Package for the Social Sciences (SPSS), version 20.0 (IBM Corp., Armonk, NY) and frequencies were expressed as percentages. Results The study included 65 male cases (62.5%) and 39 female cases (37.5%), and participant ages ranged from 10 days to 15 years (mean, 2.7 ± 3.4 years). Of 104 patients, 70 presented with cyanotic spells (84.5%), 53 with fever (10.7%), 28 with respiratory distress (26.5%), 11 with loose stools (10.5%), 10 with hemiplegia (9.6%), and eight with seizures (7.6%). Pneumonia was a precipitating factor in 13 patients (12.5%), infective endocarditis in 12 patients (11%), gastroenteritis in 11 (11%), brain abscess and cerebrovascular accidents in seven patients each (6% each), meningitis in six patients (6%), and tuberculous pericardial effusion in one patient (<1%). The primary CHD was tetralogy of Fallot (TOF) in 52 patients, tricuspid atresia in 14 patients, pulmonary atresia in 13 patients, double outlet right ventricle in 10 patients, transposition of great arteries (TGA) in seven patients, and total anomalous pulmonary venous return (TAPVR), truncus arteriosus, congenitally corrected TGA, and critical pulmonary stenosis in two patients each. Twenty-six patients received treatment of the acute problem and instructions for follow-up monitoring. Twelve patients died during their hospital stay, and three left against medical advice. Fifteen patients received patent ductus arteriosus stenting, and six received right ventricular outflow tract stenting. One patient received a Blalock-Taussig (BT) shunt stent, and one received a left pulmonary artery stent. Two patients received a balloon pulmonary valvotomy, and one received pericardial effusion drainage. Eleven patients received surgical correction of TOF, 11 received surgical correction for BT shunt, four received surgical correction for brain abscess drainage, and two received TAPVR repair. Conclusion TOF was the most common cyanotic heart disease in our study. Cyanotic spells or increased cyanosis was the most common presenting concern. Cyanotic CHDs present with variable extracardiac signs and symptoms in emergencies. Appropriate assessment, immediate management of the acute problem, and timely intervention or surgical management result in good outcomes.
Brain abscess in childhood-long-term experiences
European Journal of Pediatrics, 1991
A retrospective evaluation was performed on 28 cases of paediatric brain abscess (male:female ratio 2.5:1; mean age 9.4 years; range 2.8-16 years) diagnosed between 1967 and 1987. In 46%, congenital cyanotic heart disease was identified as a predisposing factor, likewise sinusitis, otitis media or mastoiditis in 29% and immunodeficiency in 11%. Pathogenesis remained unclear in 14%. Initial symptoms and signs were predominantly nonspecific; loss of consciousness occurred in 32% of cases, neurological deficit and seizures each in 25%. Since the availability of CT, both diagnostic delay after hospital admission and mortality were substantially reduced: mean delay from 8.4 to 3.0 days, and mortality from 23% to 0%. Seventeen patients (61%) had follow up examinations 9.6 years (mean) after the acute illness (range 1-21 years). Neurological sequelae were diagnosed in 35% of cases, epilepsy in 29%, epileptic potentials during EEG in 12%, and CNS scars in 50%. Psychological testing revealed no statistically significant differences compared to normal populations. CNS scars, and epilepsy and/or epileptic potentials were more common after excision (7 patients) when compared to patients treated by aspiration and/or antibiotics alone (21 patients). It is concluded that excision of brain abscess should be avoided whenever possible. Therapy of choice consists of the administration of adequate antibiotics with or without CT-guided needle aspirations.
Endocardial Abscesses in Children: Case Report and Review of the Literature
Clin Infect Dis, 1999
The rarity of perivalvular abscesses arising as a complication of bacterial endocarditis in the pediatric population limits its recognition and awareness of its often malignant course. The diagnosis depends on a combination of clinical criteria, including persistent fever and bacteremia, the presence of an atrioventricular block and persistent embolic phenomenon, and transthoracic or transesophageal echocardiographic confirmation. Because of the infrequency of perivalvular abscesses in children, there is no consensus on a treatment strategy. Early detection and intervention with antibiotics and surgical debridement are recommended to decrease the morbidity and mortality associated with this disease. A case of a 14-year-old boy with an aortic root abscess is presented, along with review of other cases reported in the last 20 years in children in relation to risk factors, clinical features, diagnosis, therapy, and mortality.