Document Detail

Posttraumatic gas-containing brain abscess caused by Clostridium perfringens with unique simultaneous fungal suppuration by Myceliophthora thermophila: case report.
MedLine Citation:
PMID:  8938783     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE AND IMPORTANCE: Gas-containing brain abscesses are rare, and the vast majority are caused by Clostridium perfringens. Significant simultaneous fungal infection in a bacterial abscess is even rarer. We present such a case and review the literature. CLINICAL PRESENTATION: A 21-month-old male patient sustained a penetrating head injury in a barnyard, developed a gas-containing left parietal brain abscess, and presented with high fever, galeal swelling, and seizure. INTERVENTION: The patient initially underwent debridement of his wound and then repeated aspirations. The initial cultures revealed pure growth of Clostridium perfringens. Despite appropriate antibiotic therapy, serial neuroimaging did not demonstrate a decrease in the size of the cavity. An excision had to be undertaken 6 weeks after the injury. The culture from the excised specimen revealed an unexpected growth of a saprophytic and opportunistic fungus, Myceliophthora thermophila. Antifungal treatment consisting of the administration of liposomal amphotericin B and itraconazole was then performed. The child was well and neurologically intact 6 months after the excision. CONCLUSION: Our review revealed 38 cases of clostridial brain abscess in the literature. Despite the reputation of the organism, the outcome with clostridial brain abscesses was relatively benign. The main characteristics of clostridial brain abscesses are highlighted, with reference to their optimal treatment. Our review also revealed that fungal infection after a penetrating head injury is extremely rare and often fatal. Our case seems to be the first in the medical literature with growth of M. thermophila as a causative agent for intracranial suppuration.
I H Tekkök; M J Higgins; E C Ventureyra
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  39     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  1996 Dec 
Date Detail:
Created Date:  1997-03-04     Completed Date:  1997-03-04     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1247-51     Citation Subset:  IM    
Division of Neurosurgery, Children's Hospital of Eastern Ontario, University of Ottawa Faculty of Medicine, Canada.
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MeSH Terms
Amphotericin B / therapeutic use
Anti-Bacterial Agents / therapeutic use
Antifungal Agents / therapeutic use
Brain Abscess / etiology*,  metabolism*,  surgery
Craniocerebral Trauma / complications*
Gas Gangrene / etiology*
Itraconazole / therapeutic use
Mycoses / etiology*
Tomography, X-Ray Computed
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Antifungal Agents; 1397-89-3/Amphotericin B; 84625-61-6/Itraconazole

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