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Fungal brain abscesses in neonates: Sonographic appearances and corresponding histopathologic findings
M Marcinkowski1, K Bauer, G Stoltenburg-Didinger
1Department of Pediatrics, Freie Universität Berlin, Universitätsklinikum Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany.
Abstract:
Extremely preterm neonates and neonates with predisposing conditions such as congenital or acquired immunodeficiency are at high risk for systemic fungal infection. Abscess formation in the brain is a severe complication that occurs in 70% of neonates with systemic fungal infection. Cerebral sonography can be used to diagnose abscesses in the brain in these patients. We report 2 sonographic presentations of fungal brain abscesses in neonates confirmed by postmortem histopathologic examination. The first patient, an extremely preterm neonate of 23 weeks' gestation with a systemic Candida albicans infection, had multiple small, round, hypoechoic lesions with echogenic rims in both brain hemispheres. The second patient, a term neonate with disseminated aspergillosis and DiGeorge syndrome, had a few large echogenic areas in the right periventricular region. Brain imaging should be considered in the diagnostic workup in neonates with suspected systemic fungal infection. Cerebral involvement can be diagnosed at the bedside with cerebral sonography.
Insights
Neonates with fungal infections are at high risk for brain abscesses. Cerebral sonography can diagnose these fungal brain abscesses, aiding early detection in at-risk infants.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Medical Imaging
Background:
- Extremely preterm neonates and those with immunodeficiency face significant risk of systemic fungal infections.
- Brain abscesses are a severe complication, affecting up to 70% of neonates with systemic fungal infections.
Observation:
- This study reports two cases of fungal brain abscesses in neonates.
- Cerebral sonography revealed distinct imaging patterns for fungal brain abscesses in neonates.
- Case 1: Multiple small, hypoechoic lesions with echogenic rims in an extremely preterm neonate with Candida albicans infection.
- Case 2: Large echogenic areas in the periventricular region of a term neonate with disseminated aspergillosis.
Findings:
- Cerebral sonography effectively visualized fungal brain abscesses in neonates.
- Sonographic findings varied based on the fungal species and extent of infection.
- Postmortem histopathologic examination confirmed the sonographic diagnoses.
Implications:
- Cerebral sonography is a valuable bedside tool for diagnosing fungal brain abscesses in neonates.
- Brain imaging should be considered in the diagnostic workup of neonates with suspected systemic fungal infections.
- Early diagnosis via cerebral sonography can potentially improve outcomes for neonates with fungal brain infections.