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

doi:10.1016/j.mycmed.2021.101156

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

J Mycol Med. 2021 Dec;31(4):101156. doi: 10.1016/j.mycmed.2021.101156. Epub 2021 Jul 5.

Authors

Affiliations

¹ Department of Neuromicrobiology, NIMHANS, Bangalore 560029, Karnataka, India.
² Department of Neurosurgery, NIMHANS, Bangalore 560029, Karnataka, India.
³ Department of Neuroimaging and interventional radiology, NIMHANS, Bangalore 560029, Karnataka, India.
⁴ Department of Neuropathology, NIMHANS, Bangalore 560029, Karnataka, India.
⁵ Department of Biostatistics, NIMHANS, Bangalore 560029, Karnataka, India.
⁶ Department of Neuromicrobiology, NIMHANS, Bangalore 560029, Karnataka, India. Electronic address: nagarathnachandrashekar@gmail.com.

PMID: 34280711
DOI: 10.1016/j.mycmed.2021.101156

Abstract

Introduction: 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.

Objectives: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Antifungal therapy; Cladophialaphora bantiana; Fungal brain abscess; Neuroimaging features; Surgical intervention.

MeSH terms

Antifungal Agents / therapeutic use
Brain Abscess* / diagnosis
Brain Abscess* / epidemiology
Female
Humans
Male
Mycoses* / drug therapy
Retrospective Studies
Tertiary Care Centers

Substances

Antifungal Agents