Clinicomycological overview of brain abscess in a tertiary care center: A 38 year retrospection: Fungal brain abscess.

Kruthika P, Prabhu Raj, Shumyla Jabeen, Nandeesh Bn, Veenakumari Hb, Narasinga Rao Kvl, Sandhya M, Ganesh Maher, Binukumar B, Nagarathna Chandrashekar

Journal de mycologie medicale 2021 Dec

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Brain abscesses (BA) form approximately 8% of intracranial masses in developing and 1-2% in western countries. Fungal BA (FBA) are aggressive and represent a catastrophic manifestation compared to protozoan and bacterial BA. Diagnosis of FBA is rare and usually done postmortem. The present retrospective study analyses the clinico-mycological aspects of FBA presented to our neurosurgical services over a period of 38 years, from January 1979 to April 2017. Patients diagnosed as definitive cases of FBA were included in the study. Clinico- demographic and microbiological data were collected from medical records. BA pus was examined for fungal etiology using standard microbiological procedures. During the period of 38 years out of total 2,916 brain abscesses, 29 cases of FBA were diagnosed with an overall incidence rate of 0.99% per year. Cladophialophora bantiana (44%) was the most predominant isolate followed by Aspergillus spp and others. Male preponderance was seen with a male:female ratio of 4.8:1. There was no predilection for any age group. Headache, limb weakness and fever were the most common presentations. Amphotericin B was given in 44.8% of cases. Craniotomy with excision (48.2%) was the predominant surgical management. Outcome was fatal in 62% of the cases. Neurotropic C. bantiana is the predominant isolate causing fungal brain abscess. The incidence and trends of fungi causing brain abscess do not show significant change. Young immunocompetent outdoor working males were predominantly susceptible to fungal infection. Advance in the diagnostic modalities show promising in diagnosis of FBA. High index of suspicion with early diagnosis, prompt antifungal therapy and aggressive surgical management is required as FBA are associated with high mortality rate. Copyright © 2021 SFMM. Published by Elsevier Masson SAS. All rights reserved.

Citation

Kruthika P, Prabhu Raj, Shumyla Jabeen, Nandeesh Bn, Veenakumari Hb, Narasinga Rao Kvl, Sandhya M, Ganesh Maher, Binukumar B, Nagarathna Chandrashekar. Clinicomycological overview of brain abscess in a tertiary care center: A 38 year retrospection: Fungal brain abscess. Journal de mycologie medicale. 2021 Dec;31(4):101156