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Brain abscess in children - epidemiology, predisposing factors and management in the modern medicine era
Y Shachor-Meyouhas1, G Bar-Joseph, J N Guilburd
1Pediatric Infectious Diseases Unit, Meyer Children's Hospital, Rambam Health Care Campus and the Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. y_shahor@rambam.health.gov.il
Insights
Pediatric brain abscesses, though rare, often have identifiable risk factors. Early detection through high suspicion and imaging is crucial for good outcomes, with modern medicine leading to low mortality rates.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Brain abscess is a rare but serious condition in children.
- Predisposing factors are identified in the majority of pediatric brain abscess cases.
- Children represent 25% of all brain abscess cases, with a peak incidence in the 4-7 year age group.
Purpose of the Study:
- To characterize pediatric brain abscesses treated at the hospital.
- To identify associated risk factors, common pathogens, and short-term outcomes.
- To evaluate the effectiveness of current treatment strategies.
Main Methods:
- Retrospective cohort study of 27 children (0-18 years) over a 20-year period (1989-2009).
- Analysis of medical records including demographics, symptoms, predisposing factors, laboratory results, imaging, microbiology, treatment, and outcomes.
- Surgical intervention combined with antibiotic therapy was the standard treatment.
Main Results:
- Male predominance (63%); mean age 7.9 years; 52% referred from other hospitals.
- Predisposing factors found in 81%, with sinusitis in 22%; congenital heart disease and otitis were rare.
- Common symptoms included fever (81%) and neurological signs (78%); sterile cultures in 30% of cases.
- Low mortality rate (3.7%) observed with a good overall outcome.
Conclusions:
- Pediatric brain abscess manifestations can be subtle, necessitating a high index of suspicion.
- Early diagnosis through prompt imaging is critical for effective management.
- Identifying predisposing factors may guide early interventions, particularly for congenital heart diseases.
- Modern medical and surgical approaches have significantly reduced mortality.
Aims:
Brain abscess is rare in children. Predisposing factors are found in almost 85% of cases. Overall, 25% of brain abscesses develop in children, mostly in the 4-7 years age group. Our study aimed to characterize children with brain abscesses treated in our hospital, identify risk factors, pathogens and short-term outcome.
Methods:
A retrospective cohort of 20 years period, (1989-2009) included 27 children (0-18 years). Medical records were analysed for age, gender, presenting symptoms and signs, predisposing factors, laboratory tests, imaging, microbiology results, treatment and outcome.
Results:
Of all the children, 63% (17/27) were male patients; mean age was 7.9 years and 52% were referred from other hospitals. Predisposing factors were identified in 81%, congenital heart disease and otitis were rare and sinusitis was found in 22% of the children. Main symptoms and signs included headaches, fever, neurological signs convulsions, (41%, 81%, 78% and 41% respectively). In 30% of cases, cultures were sterile. All patients were operated in addition to antibiotic treatment. Outcome was good with low mortality rate (3.7%).
Conclusions:
Manifestations of brain abscess may be subtle. A high index of suspicion and early imaging are warranted, different predisposing factors may reflect early intervention for congenital heart diseases. Mortality is rare in the modern medicine era.
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