Johns Hopkins ABX Guide
Brain Abscess
Brain Abscess is a topic covered in the Johns Hopkins ABX Guide.
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PATHOGENS
- In 80-90% of brain abscesses, multiple organisms are recovered by culture (even more with molecular techniques).
- Bacterial:
- Streptococci most common single organisms identified (30-50%), but anaerobic or other aerobic organisms can predominate.
- Gram negatives are more common in infants.
- Early infection = cerebritis, subsequent necrosis and capsule formation → abscess.
- Causes of pyogenic abscess:
- ~25% unknown source (cryptogenic)
- ~50% related to the contiguous spread of infection
- ~25% hematogenous
- Causes of pyogenic abscess:
- Fungal causes include Candida spp., Aspergillus, Zygomycetes.
- Parasitic causes include protozoa and helminths.
- Source or host specifics:
- Paranasal sinusitis: microaerophilic (S. intermedius group) and anaerobic strep, Haemophilus species, Bacteroides spp, Fusobacterium spp, Prevotella spp.
- Otogenic infection: aerobic and anaerobic streptococci, Enterobacteriaceae, Pseudomonas aeruginosa , Prevotella spp, B. fragilis.
- Odontogenic infection: S. viridans and anaerobic streptococci, Bacteroides spp, Fusobacterium spp, Prevotella spp, Actinomyces spp.
- Endocarditis: Staphylococcus aureus, S. viridans, Enterococcus.
- Lung abscess: microaerophilic and anaerobic streptococci, Actinomyces species, Fusobacterium species, Nocardia species, Prevotella.
- Penetrating trauma: Staphylococcus aureus, aerobic streptococci, Clostridium species, Enterobacteriaceae.
- Postoperative: Staphylococcus epidermidis, S. aureus, Enterobacteriaceae, Pseudomonas aeruginosa.
- Right to left shunt (congenital heart disease): microaerophilic and aerobic streptococci.
- Compromised host (AIDS, cancer chemotherapy, chronic steroids, lymphoma): toxoplasmosis, Nocardia, EBV lymphoma, TB, fungal (Aspergillus or other).
- Solid organ transplant patients: fungal causes = up to 90% of brain abscesses.
- Immigrant: cysticercosis, echinococcus, TB (tuberculoma).
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PATHOGENS
- In 80-90% of brain abscesses, multiple organisms are recovered by culture (even more with molecular techniques).
- Bacterial:
- Streptococci most common single organisms identified (30-50%), but anaerobic or other aerobic organisms can predominate.
- Gram negatives are more common in infants.
- Early infection = cerebritis, subsequent necrosis and capsule formation → abscess.
- Causes of pyogenic abscess:
- ~25% unknown source (cryptogenic)
- ~50% related to the contiguous spread of infection
- ~25% hematogenous
- Causes of pyogenic abscess:
- Fungal causes include Candida spp., Aspergillus, Zygomycetes.
- Parasitic causes include protozoa and helminths.
- Source or host specifics:
- Paranasal sinusitis: microaerophilic (S. intermedius group) and anaerobic strep, Haemophilus species, Bacteroides spp, Fusobacterium spp, Prevotella spp.
- Otogenic infection: aerobic and anaerobic streptococci, Enterobacteriaceae, Pseudomonas aeruginosa , Prevotella spp, B. fragilis.
- Odontogenic infection: S. viridans and anaerobic streptococci, Bacteroides spp, Fusobacterium spp, Prevotella spp, Actinomyces spp.
- Endocarditis: Staphylococcus aureus, S. viridans, Enterococcus.
- Lung abscess: microaerophilic and anaerobic streptococci, Actinomyces species, Fusobacterium species, Nocardia species, Prevotella.
- Penetrating trauma: Staphylococcus aureus, aerobic streptococci, Clostridium species, Enterobacteriaceae.
- Postoperative: Staphylococcus epidermidis, S. aureus, Enterobacteriaceae, Pseudomonas aeruginosa.
- Right to left shunt (congenital heart disease): microaerophilic and aerobic streptococci.
- Compromised host (AIDS, cancer chemotherapy, chronic steroids, lymphoma): toxoplasmosis, Nocardia, EBV lymphoma, TB, fungal (Aspergillus or other).
- Solid organ transplant patients: fungal causes = up to 90% of brain abscesses.
- Immigrant: cysticercosis, echinococcus, TB (tuberculoma).
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Last updated: April 3, 2019
Citation
Auwaerter, Paul. "Brain Abscess." Johns Hopkins ABX Guide, The Johns Hopkins University, 2019. Johns Hopkins Guide, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540065/all/Brain_Abscess.
Auwaerter P. Brain Abscess. Johns Hopkins ABX Guide. The Johns Hopkins University; 2019. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540065/all/Brain_Abscess. Accessed August 8, 2020.
Auwaerter, P. (2019). Brain Abscess. In Johns Hopkins ABX Guide. The Johns Hopkins University. Retrieved August 08, 2020, from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540065/all/Brain_Abscess
Auwaerter P. Brain Abscess [Internet]. In: Johns Hopkins ABX Guide. The Johns Hopkins University; 2019. [cited 2020 August 08]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540065/all/Brain_Abscess.
* Article titles in AMA citation format should be in sentence-case
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