Brain abscesses

Brain abscesses are localized collections of pus within the cranium. These infections are difficult to treat due to the presence of walled-off infections in the brain tissue that are hard for some antibiotics to reach. In addition to appropriate antimicrobial therapy (a discussion of which is beyond the scope of this chapter), surgical debridement is often required as an adjunctive measure. Surgical debridement also may be required in the management of neurosurgical postoperative infections. 

Brain abscess A localized collection of pus inside the brain. 

Suggested Alternatives for Differential Diagnosis California encephalitis, eastern equine encephalitis, West Nile encephalitis, western equine encephalitis, herpes simplex encephalitis, meningitis, brain abscess, carcinomatous meningitis, CNS vasculitis, cerebrovascular disease. 

Adults 50 mg/kg/day in divided doses every 6 hours for typhoid fever and rickettsial infections. Exceptional infections (ie, meningitis, brain abscess) caused by moderately resistant organisms may require dosage up to 100 mg/kg/day to achieve... 

CNS infections - Men ng t s and brain abscess caused by Bacteroides sp. including the B. fragilis group. 

The cephalosporins distribute in satisfactory concentrations to most tissues except the central nervous system. Only cefepime, cefuroxime (Zinacef), cefotaxime (Claforan), ceftriaxone Rocephin), and ceftazidime (Eortaz) achieve therapeutic concentrations in cerebrospinal fluid. Cefotaxime and ceftriaxone are antibiotics of first choice for the empirical treatment of brain abscess and meningitis. 

Unlabeled Uses Treatment of brain abscess, perioperative infections, staphylococcal or streptococcal meningitis... 

Metronidazole is indicated for treatment of anaerobic or mixed intra-abdominal infections, vaginitis (trichomonas infection, bacterial vaginosis), C difficile colitis, and brain abscess. The typical dosage is 500 mg three times daily orally or intravenously (30 mg/kg/d). Vaginitis may respond to a single 2-g dose. A vaginal gel is available for topical use. 

Brain abscess formation was studied experimentally in rats, and treatment with different combinations of hyaluronidase, dexamethasone, and antibiotic has been investigated [128]. Hie results showed (hat combined theraov with antibiotic and hyaluronidase. started the dav before inocula-... 

A. Pnsaoglu, A. YUdizhan, and B. Kandemir. Treatment of experimental brain abscess % Bitccia of combinations of hyuiuronirtaie with antibiotics and dexa-methasone. Acta IVeumcbr, 700 79 (1989). 

Nocardia is an actinomycete that causes pneumonia and brain abscess, particularly in immunosuppressed or debilitated patients. 

Telangiectasias are collections of dilated capillaries that are usually of no clinical significance (Milandre et al. 1987). They may be associated with hereditary hemorrhagic telangiectasia (the Osler-Weber-Rendu syndrome), but this is more likely to be associated with neurological complications from a pulmonary arteriovenous malformation with right-to-left shunting, such as cerebral hypoxia, brain abscess, paradoxical and septic embolism, or from an associated intracranial arteriovenous malformation or aneurysm (McDonald et al. 1998). 

Since penicillin is a substrate for the p-aminohippurate transporters, it is very rapidly cleared from the circulation. In the early days, when penicillin was very expensive, this rapid clearance was a major problem. The urine of patients receiving penicillin therapy was actually collected, and the secreted penicillin recovered. This problem was overcome by the development of probenecid (Figure 2.19b), which inhibits the second step in the above transport process.This results in a very pronounced prolongation of the retention of penicillin in the body. While no longer used routinely, probenecid is still used occasionally if high, stable plasma levels of penicillin are important in the treatment of life-threatening infections, such as brain abscesses. 

Karman J, Chu HH, Co DO, Seroogy CM, Sandor M, Fabry Z (2(X)6) Dendritic cells eunplify T cell-mediated immune responses in the central nervous system. J Immunol 177 7750-7760 Kielian T, Hickey WF (2000) Proinflammatory cytokine, chemokine, and cellular adhesion molecule expression during the acute phase of experimental brain abscess development. Am... 

Uses. The decision to use chloramphenicol for systemic infection is influenced by its rare but serious toxic effects (see below). Its role in meningitis and brain abscess has largely been superseded by broad-spectrum cephalosporins such as cefotaxime and ceftriaxone, but it is a second-line agent for these indications, and for haemophilus epiglottitis in children. Chloramphenicol may be used for salmonella infections (t) hoid fever, salmonella septicaemia) but ciprofloxacin is now preferred. Topical administration is effective for bacterial conjunctivitis. 

A 50-year-old woman, a renal transplant recipient, developed a brain abscess dne to Nocardia otitidisca-viarum after craniotomy and was given meropenem and rifampicin. The dose of tacrolimns had to be increased three-fold to maintain adequate trough concentrations. 

Symptoms of amoebic dysentery are associated with mucosal invasion and ulceration. Mucosal erosion causes diarrhoea, the severity of which increases with the level of invasion and colonization. Symptoms can also be affected by the site of the infection. Peritonitis as a result of perforation has been reported in connection with severe amoebic infection. Extra-intestinal amoebiasis is usually associated with liver infection, causing abscesses and/or enlargement. The abscess appears as a slowly enlarging liver mass and will cause noticeable pain. Jaundice may also occur due to blockage of the bile. Pleural, pulmonary, and pericardial infection results from metastatic spread from the liver, but can also manifest in other parts of the viscera or give rise to a brain abscess. However, these complications are uncommon. 

Chloramphenicol is prescribed to treat meningitis (//. influenzae, S. pneumoniae, and N. meningitides), parathyroid fever, Q fever, Rocky Mountain spotted fever, typhoid fever, typhus infections, brain abscesses, and bacterial septicemia. 

Brain abscess Clear or slightly turbid 20-120 Slight increase... 

Systemic febrile syndromes Cytomegalovirus infection Febrile neutropenia Brain abscess... 

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