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Microbiology of cerebral abscess: a four-year study in Malaysia
1Department of Medical Microbiology and Immunology, Faculty of Medicine, National University of Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur.
Abstract:
A prospective study was carried out to determine the aetiology of cerebral abscess in relation to the primary source of infections. Seventy-five patients with cerebral abscess were included in the study in the period January 1985 to December 1988. More than half of the patients studied had single lesions and the overall most common sites were in the frontal and parietal regions. Chronic suppurative otitis media, cyanotic congenital heart diseases and meningitis were among the important predisposing conditions in these patients. Approximately 25% of the patients with cerebral abscesses had no documented antecedent infections. Pure cultures were found to be predominant (66.7%) and sterile cultures were obtained from 10 (13.3%) patients. Streptococci were isolated from 23 (30.7%) patients, the commonest species being Streptococcus milleri. Proteus sp, Pseudomonas aeruginosa, Pseudomonas putrifaciens and Bacteroides sp were almost exclusively found in cerebral abscesses secondary to chronic suppurative otitis media; these organisms were found in mixed cultures. Streptococcus milleri, Bacteroides sp and Eikenella corrodens were found in pure cultures in patients with cyanotic congenital heart disease. In patients with ventriculoperitoneal shunts in-situ, Staphylococcus aureus, Staphylococcus epidermidis and diphtheroids were common. Anaerobes were found in 15 (20.0%) patients, the majority in mixed cultures. Culture, as well as gas-liquid chromatographic analysis of volatile fatty acids of cerebral pus, was carried out to enhance the detection of the anaerobes. Based on these findings, an antibiotic regimen consisting of penicillin, chloramphenicol and metronidazole is recommended as an initial therapy while awaiting culture and sensitivity results.
Insights
This study identified common causes of cerebral abscesses, including ear infections and heart conditions. Streptococcus milleri was a frequent pathogen, guiding antibiotic recommendations for brain abscess treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Cerebral abscesses are serious infections requiring understanding of their origins.
- Identifying predisposing conditions is crucial for effective management.
Purpose of the Study:
- To investigate the aetiology of cerebral abscesses.
- To correlate causative organisms with primary infection sources.
- To guide initial antibiotic therapy.
Main Methods:
- Prospective study of 75 patients with cerebral abscesses (1985-1988).
- Analysis of lesion sites, predisposing conditions, and microbial cultures.
- Gas-liquid chromatography used for anaerobic detection.
Main Results:
- Frontal and parietal lobes were common sites; many patients had single lesions.
- Chronic suppurative otitis media, congenital heart disease, and meningitis were key predisposing factors.
- Streptococcus milleri was the most common isolate; anaerobes and specific bacteria were linked to infection sources.
Conclusions:
- Causative agents of cerebral abscess vary with the primary infection site.
- Recommended initial antibiotic regimen: penicillin, chloramphenicol, and metronidazole.
- Early identification of pathogens is vital for successful treatment outcomes.