Brain Abscess Associated with Polymicrobial Infection after
Brain abscesses, infections within the brain parenchyma, can arise as complications of various conditions including infections, trauma, and surgery. However, brain abscesses due to polymicrobial organisms have rarely been reported in children.

A 9-year-old girl with congenital cyanotic heart disease (CCHD), congenital cataract, scoliosis, and mental retardation had fever, nausea, and vomiting for two days. At three days after symptom onset, she developed right hemiparesis and was admitted to our institution. She had fallen while putting a recorder in her mouth and suffered intraoral trauma 14 days before the admission. She was previously diagnosed with complex CCHD, including atrioventricular septal defect, hypoplastic left ventricle, coarctation of the aorta, and patent ductus arteriosus. She had undergone pulmonary artery banding and ligation of the patent ductus arteriosus at one month of age and bidirectional Glenn operation at four years of age.

On physical examination, she was conscious but drowsy with symmetrical and equally reacting pupils, mild hypertonia, brisk muscle stretch reflexes, and extensor plantar response on the right side. Neurological examination did not reveal any meningeal signs. Laboratory examination revealed the following: white blood cell count, 8200 cells/μL with 67.6% neutrophils; hemoglobin, 16.9 g/dL and platelet count, 19.2 × 104/μL Inflammatory biomarkers were slightly elevated: C-reactive protein, 0.84 mg/dL ; procalcitonin, 0.07 ng/mL; and lactate dehydrogenase, 267 U/L .

Contrast-enhanced computerized tomography revealed a ring-enhanced lesion with perilesional edema on the posterior limb of internal capsule in the left cerebral hemisphere, with a midline shift. Magnetic resonance imaging also demonstrated a ring-enhancing lesion with a large amount of adjacent edema and mass effect. Diffusion-weighted magnetic resonance imaging revealed a markedly hyperintense lesion with a low apparent diffusion coefficient and

The patient underwent emergency drainage under craniotomy, and 1 mL white purulent material was aspirated. Based on the clinical and imaging findings, the patient was diagnosed with a brain abscess and simultaneously administered meropenem and vancomycin as initial empiric antibiotics. S. intermedius, P. micra, and F. nucleatum, which are part of the normal flora in the oral cavity, were isolated from the abscess.

Echo scan of the internal jugular vein and heart did not show the presence of thrombosis. The minimum inhibitory concentrations of the isolates are presented in Table 1. On the basis of these data, the antibiotics were changed from meropenem to ceftriaxone on day 26. Additionally, glycerol and the Kampo medicine goreisan were administered to improve the brain edema. Over the ensuing days, right hemiplegia improved to baseline and the patient was discharged after eight weeks of intravenous antimicrobial therapy, which comprised three weeks of intravenous meropenem and five weeks of intravenous ceftriaxone.

Soure :