Brain Abscess
General Principles
- Brain abscess in the immunocompetent host is usually bacterial in origin and the result of spread from a contiguous focus (mastoiditis, sinusitis, dental infection), septic emboli from endocarditis, bacteremia, trauma, or surgery.
- Infection is often polymicrobial, with viridans streptococci, S. aureus, and anaerobes being the most common pathogens; staphylococci and gram-negative bacilli predominate after surgery. Streptococcus anginosus is especially associated with abscess formation. In immunocompromised hosts, etiologies include invasive fungal infection, Nocardia, and TB; in HIV-infected patients, toxoplasmosis is a leading consideration.1
Diagnosis
- Diagnosis is radiographic, with ring-enhancing lesions seen on MRI or CT scan.
- A microbiologic etiology should be determined by aspiration, biopsy, or surgery.
Treatment
- Empiric therapy should cover the most likely pathogens based on the primary infection site. A third-generation cephalosporin (ceftriaxone) combined with metronidazole and vancomycin is started in immunocompetent hosts and narrowed when culture data are available. Use cefepime or ceftazidime instead of ceftriaxone after neurosurgical procedures or head trauma.
- Neurosurgical consultation is imperative for drainage; cultures must be sent to enable pathogen-directed therapy, as a prolonged course of antibiotic therapy is often needed.
- Follow-up imaging to assess improvement determines length of therapy.
References
- Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014;82(9):806-813. [PMID:24477107]
Outline
- Chapter 14: Treatment of Infectious Diseases
- Principles of Therapy
- Toxin-Mediated Infections
- Toxic Shock Syndrome
- Skin, Soft-Tissue, and Bone Infections
- Purulent Skin and Soft-Tissue Infections (Furuncles, Carbuncles, Abscesses)
- Nonpurulent Skin and Soft-Tissue Infections (Erysipelas and Cellulitis)
- Complicated Skin and Soft-Tissue Infections
- Infected Decubitus Ulcers and Limb-Threatening Diabetic Foot Ulcers
- Necrotizing Fasciitis
- Anaerobic Myonecrosis (Gas Gangrene)
- Osteomyelitis
- Central Nervous System Infections
- Meningitis
- Encephalitis
- Brain Abscess
- Neurocysticercosis
- Bloodstream Infections and Catheter-Related Bloodstream Infections
- Cardiovascular Infections
- Upper Respiratory Tract Infections
- Lower Respiratory Tract Infections
- Gastrointestinal and Abdominal Infections
- Genitourinary Infections
- Fungal and Atypical Organisms
- Tick-Borne Infections
- Mosquito-Borne Infections
- Zoonoses
- Bite Wounds
- Health Care-Associated Infections
- Bioterrorism and Emerging Infections
© Wolters Kluwer Health Lippincott Williams & Wilkins
Brain Abscess is a sample topic from the Washington Manual of Medical Therapeutics.
To view other topics, please log in or purchase a subscription.
The Washington Manual is an award-winning, complete mobile solution for nurses and students. Look up information on diseases, tests, and procedures; then consult the database with 5,000+ drugs or refer to 65,000+ dictionary terms. Complete Product Information.
Citation
Bhat, Pavat, et al., editors. "Brain Abscess." Washington Manual of Medical Therapeutics, 35th ed., Wolters Kluwer Health, 2016. Washington Manual Redesign, www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602577/all/Brain_Abscess.
Brain Abscess. In: Bhat PP, Dretler AA, Gdowski MM, et al, eds. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602577/all/Brain_Abscess. Accessed January 31, 2023.
Brain Abscess. (2016). In Bhat, P., Dretler, A., Gdowski, M., Ramgopal, R., & Williams, D. (Eds.), Washington Manual of Medical Therapeutics (35th ed.). Wolters Kluwer Health. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602577/all/Brain_Abscess
Brain Abscess [Internet]. In: Bhat PP, Dretler AA, Gdowski MM, Ramgopal RR, Williams DD, editors. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. [cited 2023 January 31]. Available from: https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602577/all/Brain_Abscess.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Brain Abscess
ID - 602577
ED - Williams,Dominique,
ED - Bhat,Pavat,
ED - Dretler,Alexandra,
ED - Gdowski,Mark,
ED - Ramgopal,Rajeev,
BT - Washington Manual of Medical Therapeutics
UR - https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602577/all/Brain_Abscess
PB - Wolters Kluwer Health
ET - 35
DB - Washington Manual Redesign
DP - Unbound Medicine
ER -