Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
BMC Neurol. 2024 Nov 18;24(1):449. doi: 10.1186/s12883-024-03953-0.
Infectious brain abscesses and granulomas, characterized by localized collections of pus or inflammatory tissue within the brain parenchyma, pose significant clinical challenges due to their potentially life-threatening nature and complex management requirements.
This cross-sectional study investigated patients diagnosed with infectious brain abscesses and granulomas from March 1, 2012, to October 22, 2021, in Mashhad, Iran. Data were collected from adult patients admitted to the two primary referral centers for community-acquired neuroinfections and neuroinflammations. Demographic information, clinical features, laboratory and neuroimaging characteristics, and clinical outcomes were analyzed.
A total of 110 episodes were identified in 106 patients, with a median age of 45 years (IQR 30-56.3) and 62.7% male. Predisposing conditions included immunocompromised states (27.5%), preceding otitis/mastoiditis (16.2%), sinusitis (13.3%), and pulmonary infections (17.2%). The most common clinical manifestations were headache (57.3%), fever (49.1%), altered consciousness (44.4%), and seizures (31.8%). Neuroimaging revealed that brain lesions were solitary in 51% and multiple in 48% of episodes. Surgical intervention was performed in 46.4% of cases. The in-hospital mortality rate was 24.5%, with significant associations found between mortality and factors such as age, altered consciousness, multiple brain lesions, and cerebellum and brainstem involvement. The median length of hospital stay was 28 days (IQR 16-46.5).
Our study underscores challenges in diagnosing and treating brain abscesses and granulomas, with high mortality rates (24.5%) despite advanced techniques. Age, altered consciousness, and lesion characteristics predict death. Addressing changing microbial patterns and improving diagnostics are vital for better outcomes, especially in low- and middle-income countries.
感染性脑脓肿和肉芽肿是一种严重的临床疾病，其特征为脑实质内局限性脓液或炎症组织的积聚，由于其潜在的致命性和复杂的管理需求，给临床带来了重大挑战。
本研究采用回顾性病例系列研究方法，纳入了 2012 年 3 月 1 日至 2021 年 10 月 22 日期间在伊朗马什哈德的两家社区获得性神经感染和神经炎症的主要转诊中心确诊为感染性脑脓肿和肉芽肿的患者。收集患者的人口统计学信息、临床特征、实验室和神经影像学特征以及临床结局等数据。
本研究共纳入 106 例患者的 110 例次感染性脑脓肿和肉芽肿，患者的中位年龄为 45 岁（IQR 30-56.3），其中 62.7%为男性。易患因素包括免疫抑制状态（27.5%）、中耳炎/乳突炎（16.2%）、鼻窦炎（13.3%）和肺部感染（17.2%）。最常见的临床表现为头痛（57.3%）、发热（49.1%）、意识改变（44.4%）和癫痫发作（31.8%）。神经影像学显示，51%的病例为单发脑病变，48%的病例为多发病变。46.4%的病例接受了手术干预。住院期间死亡率为 24.5%，死亡率与年龄、意识改变、多发病变以及小脑和脑干受累等因素显著相关。中位住院时间为 28 天（IQR 16-46.5）。
尽管采用了先进的技术，但感染性脑脓肿和肉芽肿的诊断和治疗仍然面临挑战，死亡率较高（24.5%）。年龄、意识改变和病变特征是死亡的预测因素。改变微生物模式和改善诊断技术对于改善预后至关重要，特别是在中低收入国家。
