Brain abscess in Honduras: a five-year clinical and epidemiological study at Hospital Escuela

Brain abscess is a focal, life-threatening infection of the central nervous system associated with high morbidity and mortality, remaining scarcely studied in low-income settings. This study describes the clinical and epidemiological profile of patients with brain abscess at Hospital Escuela, Honduras (2018-2023), including treatment patterns and in-hospital outcomes.

A retrospective descriptive case series was conducted at a tertiary referral hospital. Thirteen medical records were identified through ICD-10 coding (G06.0-G06.2). With diagnoses confirmed by radiological, microbiological, or documented clinical-team criteria. Analyzed variables included demographics, predisposing conditions, neuroanatomical location, number and estimated volume of abscesses, neuroimaging modality, microbiological findings, empirical and pathogen-directed antibiotic regimens, intensive care admission, and modified Rankin Scale at discharge. Descriptive statistics (frequencies and proportions with 95% confidence intervals by the Wilson method) were used. The study followed the STROBE reporting guidelines.

Of 13 patients, 61.5% were male, and 53.8% were pediatric (≤15 years; range 8-14 years). All abscesses were supratentorial (100%; 95% CI: 77.0-100.0%), with parietal and occipital lobes each affected in 30.8% of cases. Traumatic brain injury was the most frequent individual predisposing condition (23.1%; all three cases pediatric). Etiologic identification at any level was achieved in 30.8% of cases; direct microbiological confirmation from cerebrospinal fluid was available in one case. Identified organisms included Streptococcus spp. and uncommon opportunistic pathogens (Burkholderia pseudomallei, Cryptococcus neoformans, Staphylococcus spp., and Nocardia spp.). Neurological status at admission was preserved in 84.6% (GCS 13-15). All patients were managed exclusively with intravenous antimicrobial therapy; no patient underwent neurosurgical drainage. In-hospital mortality was 0, and 46.2% of patients were discharged with no significant disability (mRS 0-1), 30.8% with slight disability (mRS 2), and 23.1% with moderate disability (mRS 3).

This first institutional clinical-epidemiological characterization of brain abscess in Honduras demonstrates a pediatric-skewed cohort, a low etiologic identification rate, and a management pattern characterized by exclusive medical therapy. Survival was universal, but substantial neurological morbidity persisted at discharge. The findings should be interpreted as descriptive of a single national referral center and provide baseline data for future multicenter research in Central America.