1/40. brain abscess caused by streptococcus intermedius: two case reports.BACKGROUND: Although streptococcus intermedius has been recognized as an important pathogen for abscess formation outside the central nervous system, the streptococcus milleri group, of which it is a member, has not been recognized as a specific pathogen for brain abscess, often thought to be caused by Streptococcus viridans, which includes other streptococcal species. CASE DESCRIPTION: Two cases of brain abscess in the left frontal lobe caused by S. intermedius, which responded well to antimicrobial treatment combined with needle aspiration, are presented. In the first patient, the predisposing disease was paranasal sinusitis of the frontal and ethmoid sinuses. In the second patient, the source of the pathogen was not detected despite extensive examination. The patients underwent aspiration of pus under ultrasound guidance in the first patient, and via a computed tomography-guided stereotactic procedure in the second patient. They subsequently received appropriate antimicrobial therapy against S. intermedius isolated from the pus culture. Both patients were discharged without any neurological deficits. CONCLUSION: It is important to recognize S. intermedius as a pathogen of brain abscess, and to be aware of its predisposing factors, i.e., mucosal disturbance and liver abscess.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
2/40. Fungus-like hyphochytrids associated with human disease.We report two cases, with liver and brain abscess, respectively, where fungus-like organisms belonging to the Hyphochytriomycota were found at the site of inflammation together with peptococcus in the first and cysticercus cellulosae in the second case. This is the first time these groups of organisms have been reported in human material. The role of hyphochytrids in human pathology remained uncertain as they were found together with already known human pathogens.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
3/40. Brain abscesses associated with pulmonary arteriovenous malformations.We present three patients with brain abscesses who also had pulmonary arteriovenous malformations (AVMs). All patients had hereditary haemorrhagic telangiectasia (Osler's disease). It is probable that the lung AVMs contributed to the development of the brain abscesses by allowing bacteria easier access to the systemic circulation through a right to left pulmonary vascular shunt, bypassing the filtering action of the pulmonary capillaries. In addition, one patient required a period of postoperative ventilation using PEEP, which may have exacerbated the shunt through the lung AVM and led to difficulty in weaning her from the ventilator.- - - - - - - - - - ranking = 9.1938903061224keywords = circulation (Clic here for more details about this article) |
4/40. brain stem abscess treated surgically. Wtih special note upon the employment of thorium dioxide.A 10-year-old girl, with congenital heart disease, harboring a brain stem abscess, was recently treated at the UCLA Hospital. Needle aspirations of the abscess was performed through a posterior occipital craniectomy, and thorium dioxide (Thorotrast) was placed within the abscess cavity as a marker. Postoperatively, the patient improved temporarily but died 18 days later. autopsy examination included radioactive analysis of brain and liver tissue. Radioautographs were superimposed on H&E preparations of the abscess wall to localize the extent of activity of the thorium dioxide. The unusual occurrence of this abscess in a young patient, clinically diagnosed and treated by operation, provided a rare opportunity to assess the problem of the surgical accessibility of brain stem abscess as well as to reevaluate a role for thorium dioxide as a marker for intracranial purulent collections.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
5/40. Novel presentation and approach to management of hepatopulmonary syndrome with use of antimicrobial agents.A 44-year-old man with hepatitis c-associated liver cirrhosis, cyanosis, digital clubbing, and platypnea presented with left-side hemiplegia found to be due to a brain abscess. hepatopulmonary syndrome was diagnosed after demonstration of the presence of a massive intrapulmonary shunt. Although the anomalous vascular channel never was defined anatomically, follow-up studies confirmed the presence of a functional shunt. culture of a sample from the abscess yielded streptococcus intermedius. It was hypothesized that the patient's pulmonary vascular pathology was due, in large part, to chronic elevated levels of nitric oxide (a potent vasodilator thought to be generated by endotoxin absorbed from the gut). Treatment with oral norfloxacin was initiated on the basis of data that this antibiotic reduces endotoxemia and concomitant nitric oxide production in patients with cirrhosis. Four months after initiation of treatment, the patient's hypoxia had resolved.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
6/40. Cerebral abscess and thrombophilia in pregnancy. A case report.BACKGROUND: Cerebral abscess in pregnancy is a rare event, with the etiology not well described. We present such a case in association with genetic thrombophilia. CASE: A 36-year-old primigravida with a prior history of bilateral popliteal vein thrombosis and pulmonary embolism presented in early gestation with right hemiparesis, aphasia, disseminated intravascular coagulation and a space-occupying lesion in the left temporal lobe. Stereotactic biopsy confirmed the presence of an abscess. The patient also had a homozygous methylene tetrahydrofolate reductase mutation (C677T), protein s deficiency and lupus anticoagulant, all of which possibly contributed to the thrombosis, infarct, infection and abscess. She was successfully treated with low-molecular-weight heparin and antibiotics and had a term vaginal delivery. CONCLUSION: Recently genetic thrombophilia was reported in association with various complications of pregnancy, but it has never before been described as occurring with a cerebral abscess.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
7/40. Endogenous pseudallescheria boydii endophthalmitis in a patient with ring-enhancing brain lesions.A 46-year-old man, status post liver transplantation and taking immunosuppressive medications, was admitted after suffering a generalized seizure. magnetic resonance imaging of the brain revealed two ring-enhancing lesions and treatment was begun for presumed toxoplasmic encephalitis. He was already receiving amphotericin b for a skin lesion suspected to be caused by candidiasis. One day after the seizure, he complained of photophobia in the left eye. Intraocular inflammation and a small infiltrate in the macula were seen. Vision deteriorated over the next three days. Vitreous tap and injection of amphotericin b and vancomycin were performed, but the intraocular inflammation continued to increase. On day 15, a vitrectomy was performed. The vitreous specimen ultimately grew pseudallescheria boydii. The patient died on hospital day 30 from complications of the brain abscesses. pseudallescheria boydii should be considered in the differential diagnosis of endophthalmitis, especially in patients with immunosuppression, serious medical disease, or ring-enhancing brain lesions.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
8/40. bacillus cereus brain abscesses occurring in a severely neutropenic patient: successful treatment with antimicrobial agents, granulocyte colony-stimulating factor and surgical drainage.Multiple brain and liver abscesses developed immediately after bacillus cereus bacteremia in a neutropenic patient with acute lymphoblastic leukemia. After even 8 weeks of antimicrobial chemotherapy together with administration of granulocyte colony-stimulating factor, every infectious process disappeared but the patient's headache has still persisted. Because the wall of one brain abscess became thin and was in danger of rupturing into the ventricle, surgical drainage was performed, resulting in disappearance of headache and resolution of brain abscess. The present case indicates that a combined medical and surgical approach is mandatory to treat patients with brain abscesses.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
9/40. An unusual case of neonatal brain abscess following klebsiella pneumoniae septicemia.A case of solitary brain abscess in a term neonate caused by Kiebsiella pneumoniae is described. K. pneumoniae, although a common cause of neonatal septicemia, is rarely implicated as an etiological agent for cerebral abscess in this age-group. The interest of this case lies in the rarity of the causative organism and atypical features. In the absence of predisposing factors in the neonate, we suspect that the infection was transmitted vertically from the mother before or at the time of delivery since there was evidence of asymtomatic urinary tract infection in the antenatal period.- - - - - - - - - - ranking = 1keywords = liver (Clic here for more details about this article) |
10/40. The multiple brain abscesses associated with congenital pulmonary arteriovenous malformations: a case report.In this report, we describe a case of multiple brain abscesses associated with diffuse congenital pulmonary arteriovenous malformations (PAVM). Although the cases of brain abscesses associated with congenital PAVM are very rare, the brain abscess could be an initial clinical manifestation in asymptomatic PAVM as in the case presented in this report. PAVM may contribute to the development of a brain abscess by allowing easy bacterial access to systemic circulation through the right-to-left pulmonary vascular shunt, bypassing the filtering effect of the pulmonary capillaries. Hence, this association should be considered in cases with brain abscesses of undetermined etiologic factors.- - - - - - - - - - ranking = 9.1938903061224keywords = circulation (Clic here for more details about this article) |
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