Rehman Atiq Ur, Rehman Tausif, Ali Rushna
Department of Neurosurgery, King Fahd Specialists Hospital, Al-Qassim, Saudi Arabia.
Cases J. 2009 Aug 25;2:6352. doi: 10.4076/1757-1626-2-6352.
A brain abscess is a focal, intracerebral infection that begins as a localized area of cerebritis and develops into a collection of pus surrounded by a well-vascularized capsule.
An 18 year old male was diagnosed to have culture-negative bilateral subdural empyema, which was drained and the patient was discharged, only to return 3 months later with a left temporo-parietal abscess that was drained and continued to show no growth on cultures and was non-responsive to multiple antibiotics. As a final effort, chloramphenicol therapy was begun and the patient showed immediate improvement and made a relatively uneventful recovery.
Chloramphenicol is an antimicrobial agent used rarely today in the United States because of its associated adverse effects. But the fact remains, that it is a broad-spectrum agent that is highly effective against many gram-positive and gram-negative bacteria, spirochetes, chlamydiae, and rickettsia. Due to its ability to achieve high concentrations in the cerebrospinal fluid we would advise it as second line therapy for culture negative brain abscesses.
脑脓肿是一种局限性脑内感染，最初表现为局限性脑炎区域，随后发展为被血管丰富的包膜包裹的脓腔。
一名18岁男性被诊断为双侧培养阴性的硬脑膜下积脓，经引流后出院，但3个月后因左侧颞顶叶脓肿再次入院。该脓肿经引流后培养仍无细菌生长，且对多种抗生素无反应。作为最后的治疗手段，开始使用氯霉素治疗，患者立即好转并康复过程相对顺利。
氯霉素是一种在美国如今很少使用的抗菌药物，因其有相关不良反应。但事实是，它是一种广谱药物，对许多革兰氏阳性菌、革兰氏阴性菌、螺旋体、衣原体和立克次体都非常有效。由于其能够在脑脊液中达到高浓度，我们建议将其作为培养阴性脑脓肿的二线治疗药物。
