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Published on: June 19, 2012
Legionella in the brain: First culture-confirmed post-surgical abscess case and its successful management
Philippe Lavrard-Meyer1, Piseth Seng2, Fabrice Bartolomei3
1Department of Infectious Diseases, Tropical Medecin and Chronic Infections (MIT-IC), AP-HM, La Timone University Hospital, Marseille, France; Department of Internal Medicine, Sainte-Anne Armed Forces Teaching Hospital, Toulon, France.
Introduction:
Post-neurosurgical brain abscesses are documented in approximately 9% of cases, with causative pathogens often linked to polymicrobial or nosocomial origins.
Case Report:
We report the first case of post-neurosurgical Legionella pneumophila brain abscess in a 55-year-old woman with drug-resistant epilepsy. The abscess developed following stereo-electroencephalography and thermocoagulation procedures, manifesting as hemiparesis and vomiting. Diagnosis was confirmed via 16S rRNA PCR, antigen testing, and Buffered Charcoal Yeast Extract (BCYE) culture. Treatment with targeted antibiotics, including levofloxacin and rifampicin, led to a complete recovery without sequelae. Investigation identified the patient's home water system as the infection source.
Conclusion:
This case highlights the importance of molecular diagnostics and tailored therapy in managing rare brain abscesses.
Insights
This case study details the first reported instance of a Legionella pneumophila brain abscess following neurosurgery. Prompt diagnosis and targeted antibiotic treatment led to complete recovery, emphasizing the need for advanced diagnostics in rare infections.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Post-neurosurgical brain abscesses occur in about 9% of cases.
- Pathogens are often polymicrobial or nosocomial.
Purpose of the Study:
- To report the first case of a post-neurosurgical brain abscess caused by Legionella pneumophila.
- To highlight diagnostic and therapeutic strategies for rare brain abscesses.
Main Methods:
- Diagnosis confirmed by 16S rRNA PCR, antigen testing, and Buffered Charcoal Yeast Extract (BCYE) culture.
- Treatment involved targeted antibiotics: levofloxacin and rifampicin.
- Infection source identified as the patient's home water system.
Main Results:
- Successful treatment of a Legionella pneumophila brain abscess in a patient with drug-resistant epilepsy.
- Complete recovery without sequelae achieved through tailored antibiotic therapy.
- Identification of a domestic water system as the source of infection.
Conclusions:
- This case underscores the significance of molecular diagnostics for identifying rare pathogens.
- Tailored antibiotic therapy is crucial for managing complex brain abscesses.
- Environmental sources should be considered in post-neurosurgical infections.
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