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Kiking Ritarwan
Definition
Brain abscess is a focal intracerebral infection that begin as a localized area of cerebritis and develops into a collection of pus surrounded by a weil-vascularized capsule. Abscess of the brain has been known for over 200 years, and surgical treatment started with MacEwen in 1893 [published: pyogenic infective disease of the Brain].
Parenchymal brain infection can arise from hematogenous delivery of infected material, which often results in multiple abscess. Especially at risk are patients with congenital heart disease or valve infection. Pathogenesis: abscess begin with local cerebritis, causing necrosis and surronding edema. Epidemiology: 0,3 1,3 per 100.000 / tahun Male to female ratio of 2:1 to 3:1
Distingushing characteristics
Ear inf: temporal lobe abscess, sinus inf: frontal lobe abscess, mastoid inf: cerebellar abscess
Multiple abscess
Gunshot wounds are the most common head trauma assc. With abscess
Drug abuser
Common etiologic factors Microorgnism involved Aerobes Anaerob Streptococci, Streptococci Middle ear,paranasal Staph aureus Bacteriodes sinus, or mastoid infection
Metastatic embolic from lung, pulmonary abscess, bronchietasis, or chronic empyema
Staph aureus, Klebsiela S.Pneumoniae Streptococci, Fusobacteria
streptococci
Staph aureus
Neuropatologi (4 stages)
1. Early cerebritis ( days 1-3) infection of the brain with surronding white matter edema. 2. Late cerebritis ( days 4-9) The core of the cerebritis becomes necrotic and enlarges and capsular fibroblasts begin to form. 3. Early capsule formation ( days10-13) The capsule is well developed, with proliferation of fibroblasts, a surronding astrocytic proliferation, and edema 4. Late capsule formation (days 14 or more). A mature, thick capsule surronds the central cavity containing debris and PMN cells. There is usually marked cerebral edema in the surronding brain tissue in the presence of a mature abscess.
Head Ct San
A. Multiple brain abscesses associated with bacterial endocarditis (Staphylococcus aureus) in a 55-year-old man. The large abscess in the left hemisphere shows a characteristic ring enhancement. B. Contrastenhanced CT scan 4 months after institution of antibiotic treatment. The abscesses have resolved.
11
Lung
S. pneumoniae
Metronidazole 7.5 mg IV every 6 h + Cefepime 2 gr IV every 6 h or meropenem 2gr IV every 8 h Same as above
AB treatment
Teeth, mouth Anaerobic streptococci, Eikenella, Prevotella, Actinomyces Metro 7,5 mg/kg IV every 12 h + PNC G 4million units IV every 4 h or ceftizoxime 3 gr IV every 6 h Cefepime 2 gr IV every 8 h, or Nafcillin or oxacillin 2 g IV every 4 h
Staphiloc