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Pediatric brain abscess - etiology, management challenges and outcome in Lagos Nigeria
Okezie Obasi Kanu1, Omotayo Ojo1, Christopher Esezobor2
1Department of Surgery, Division of Neurosurgery, Cardiothoracic Surgical Unit, Lagos State, Nigeria.
Insights
Pediatric brain abscess is a serious condition in children, often requiring antibiotics and surgery. Early diagnosis and intervention are crucial for successful management, especially in resource-limited areas.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Public Health
Background:
- Brain abscess in children is a neurosurgical emergency with potentially severe outcomes.
- Nonspecific symptoms vary by age, abscess characteristics, and infection source.
- Treatment involves antibiotics and often surgical evacuation.
Purpose of the Study:
- To document clinical characteristics and etiological factors of pediatric brain abscess.
- To identify the spectrum of bacteriologic agents involved.
- To analyze challenges and management outcomes in an African city.
Main Methods:
- Retrospective study over 11 years with 89 pediatric patients.
- Data extracted from medical records.
- Results presented using charts and tables.
Main Results:
- Median age was 6.4 years; male-to-female ratio was 1.8:1.
- Common symptoms: headache (80%), fever (78%), hemiparesis (78%).
- 80% received antibiotics with surgical evacuation; 84% had favorable outcomes. Gram-positive organisms were most common.
Conclusions:
- Pediatric brain abscess remains a significant public health challenge, particularly in resource-limited settings.
- Early diagnosis, referral, and intervention are critical for successful management.
- A high index of suspicion is essential for timely treatment.
Background:
Brain abscess in children is a neurosurgical emergency with potentially catastrophic outcome despite the advances made in neuroimaging techniques and antibiotic therapy. Symptoms are nonspecific and may vary with the child's age, location, size, numbers and stage of abscess, and the primary source of infection. Treatment is usually with broad-spectrum antibiotics in combination and surgical evacuation in most cases or antibiotics alone in selected cases with clear-cut indications. This study was to document clinical characteristics, etiological factors, and spectrum of bacteriologic agents responsible for pediatric brain abscess in an African city, the challenges and management outcome over the study period.
Methods:
This was a retrospective study over an 11-year period involving 89 children who presented with brain abscess. Information of interest was extracted from the medical records of each participant. The results from data analysis were presented in charts and tables.
Results:
Eighty-nine children aged 0.85-15.7 years (median age of 6.4 years) met the inclusion criteria. The male-to-female ratio was 1.8:1. Headache (80%), fever (78%), and hemiparesis (78%) were the most common symptoms. Brain imaging deployed was CT scan in 56 (63%), MRI in 9 (10%), and transfontanel ultrasound scan in 24 (27%) children. Seventy-one (80%) children had antibiotics with surgical evacuation while 18 (20%) children received only antibiotics. In 19 (27%) children, the culture of the abscess was negative. In 53 (75%) children, Gram-positive aerobic organisms were isolated. A total of 75 patients (84%) had a favorable outcome.
Conclusion:
Pediatric brain abscess still poses significant public health challenge, especially in resource-limited regions. Successful management of brain abscess requires high index of suspicion for early diagnosis, referral, and intervention.
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