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Incidence and prognosis of brain abscess in a defined population: Olmsted County, Minnesota, 1935-1981
A Nicolosi1, W A Hauser, M Musicco
1Department of Epidemiology, Institute of Advanced Biomedical Technologies, National Research Council, Milan, Italy.
Abstract:
The incidence of brain abscess was studied on all cases occurring in residents of Olmsted County, Minn., from 1935 through 1981. Thirty-eight cases (9 cases first diagnosed at autopsy) were identified and followed through the Rochester Olmsted County medical record-linkage system at the Mayo Clinic. The incidence rate was 1.3/100,000 person-years (PY), 1.9 in males and 0.6 in females. Incidence decreased from 2.7 in 1935-44 to 0.9 in 1965-81. Rates were higher in children 5-9 years old (2.4) and after age 60 (2.6 PY). An etiologic agent was identified in 29 cases (76%) with streptococci being the most frequently isolated. Case-fatality ratio was 38% (11/29), stable over time. Concurrent bacterial meningitis was the strongest predictor of death. Neurologic sequelae were observed in 8 (44%) of the 18 surviving patients including epilepsy (5 cases), deafness and motor impairment.
Insights
Brain abscess incidence in Olmsted County, Minnesota, was 1.3 per 100,000 person-years, decreasing over time. Streptococci were common causes, and bacterial meningitis predicted mortality, with significant neurologic sequelae in survivors.
Area of Science:
- Neurology
- Epidemiology
- Infectious Diseases
Background:
- Brain abscess is a serious intracranial infection.
- Understanding its epidemiology is crucial for public health strategies.
- Long-term incidence and outcome data are essential.
Purpose of the Study:
- To determine the incidence and trends of brain abscess in Olmsted County, Minnesota.
- To identify etiologic agents and risk factors.
- To assess case-fatality ratios and neurologic sequelae.
Main Methods:
- Retrospective population-based study.
- Utilized the Rochester Olmsted County medical record-linkage system.
- Reviewed cases from 1935 to 1981, including autopsy diagnoses.
Main Results:
- Overall incidence was 1.3 per 100,000 person-years, higher in males (1.9) and children/elderly.
- Incidence declined from 2.7 (1935-44) to 0.9 (1965-81).
- Streptococci were most common; case-fatality was 38%, with bacterial meningitis as a key predictor of death. 44% of survivors had sequelae.
Conclusions:
- Brain abscess incidence has decreased, but remains a significant concern.
- Prompt diagnosis and treatment are vital, especially considering bacterial meningitis risk.
- Neurologic sequelae are common, impacting long-term patient outcomes.