1 case of brain abscesses caused by austere.

Brain abscesses caused by Eikenella Corrodens are a rare clinical disease that makes clinical diagnosis and treatment difficult.
children due to lack of expression ability, check body signs are not typical, easy to miss diagnosis, misdiagnosis, causing adverse consequences.
in July-September 2018, the neurosurgery of Ningxia Hui Autonomous Region People's Hospital admitted a case of brain abscess caused by rodentaication, reported below.
1. Medical records summary of the sick child, male, 1 year old 7 months;
admission: T37.0C, right upper eyelid bamboo spout, right eyelid bruising swelling.
Auxiliary Inspection: WBC7.35 x 109/L, NEU3.13 x 109/L, NEUT%60.3%, RBC3.83 x 1012/L, HB98g/L MCV77.5fL, MCH25.6pg, TP55.6g/L, PA89mg/L, ALB37.5g/L, GLO18.1g/L.
eye ct show: foreign body from the upper eye piercing the base of the skull pierced into the right frontal lobe brain tissue, brain tissue a small amount of bleeding (Figure 1A).
the ct indication of the head: the right frontal lobe brain bruise bleeding (Figure 1B), the volume and the front (Figure 1A) compared to no significant change.
slowly remove the bamboo stick (due to the bamboo sign accidental lyb pollution did not send cutting-edge culture), review the head CT did not see foreign body residue, cerebral hemorrhage than before no increase (Figure 1C).
intravenous lysanosis is used for anti-infection treatment.
6d review of the brain CT after admission to hospital prompted brain haemorrhage absorption. After
admission, the temperature fluctuations of children with 13 to 17d diseases fluctuated at 37.0 to 37.5 degrees C, WBC 9.76 x 109/L, NEU4.82 x 109/L, LYM4.08 x 109/L, NEUT%49.4%, reviewed the head CT suspected of the formation of cerebral abscess, recommended to improve the head MRI.
because the disease can not cooperate with MRI examination, improve the cranial brain-enhanced CT show brain abscess formation (Figure 1D).
perfected calcitonin, hypersensitivity C reaction protein are normal.
asked for pediatric consultation to switch to vancomycin and merobinan anti-infection treatment. After
admission to the hospital 24d patients develop fever, body temperature 39.0 degrees C, WBC 17.16 x 109/L, NEU13.76 x 109/L, LYM2.49 x 109/L, NEUT%80.2%, review of the head-enhanced CT-indicated pus cavity increased.
in the nerve navigation assisted by the downstream brain abscess puncture drainage, pus samplesent for examination, placed a double cavity drainage tube, continuous drainage tube flushing the pus cavity. after
1d drainage tube did not see liquid lead, review the head CT show pus cavity closed, remove the drainage tube, drainage tube tip to send bacteria culture.
a review of the head CT showed changes after the drainage of brain abscesses (Figure 1E). The body temperature of the
postoperative patient fluctuated from 37.0 to 38.5 degrees C, WBC 12.32 x 109/L, NEU7.08 x 109/L, LYM4.67 x 109/L, NEUT%75.4%.
the results of pus culture showed the rodent aiken bacteria, the drainage tube tip culture did not grow bacteria, according to the drug-sensitive results adjusted antibiotics for cephalosporine sodium and merobinan anti-infection treatment.
the body temperature and blood of the sick child gradually returned to normal.
2 weeks after surgery, the body temperature of the sick child again increased to 38.8 degrees C, WBC 9.62 x 109/L, NEU5.07 x 109/L, LYM3.60 x 109/L, NEUT %52.7%, review of the head-enhanced CT encephalitis, double frontal fomorrhium lesions reduced (Figure 1F).
considered the brain abscess ventricular dispersal during surgery, continued to use the current anti-infection treatment plan, and dynamically reviewed the head-enhanced CT.
8 weeks after surgery to review the head-enhanced CT show intracranial infection has been absorbed completely (Figure 1G), the patient improved discharge.
3 months after the outpatient review of the head-enhanced MRI returns intracranial infection absorption completely and softens the formation of the lesions (Figure 1H).
Figure 1 Neuronavigation assisted by puncture drainage surgery to treat brain abscess before and after the operation imaging examination.
1A eye socket CT shows intracranial foreign body; 1B head CT show a small amount of bleeding after removal of bamboo stick; 1C ct show bleeding absorption; 1D-enhanced CT shows brain abscess formation; 1E drainage enhances CT; 1F-enhanced CT show ventricular strengthening; 1G-enhanced CT show CT show Anti-infection after inflammation absorption; 1H after 3 months to enhance MRI to show infection absorption completely and soften the stove formation 2. Discuss the rodentaaisis is a gram-negative and sexual anaerobic bacteria, and for the germ bacteria, high nutritional requirements, cultivation difficulties, easy to miss, miss.
are usually found in the mouth, respiratory tract, digestive tract and urinary tract.
it is a conditional pathogenic bacteria, due to weak toxicity often mixed with other bacteria infection.
but the disease is often the only cause of meningitis, brain abscess, and pus under the epidural caused by rodenta.
only a single case of brain pus in the cultivation of rodent aiken bacteria case reports, more reported abroad.
drug sensitivity results show editing against penicillin G, third-generation cephalosporins, amoxicillinkravilic acid and fluoroquinolones, and resistance to klinmycin and methazole.
early brain abscess, in the absence of the etiological basis, should be based on the cause of intracranial infection, the choice of covering the common pathogenic bacteria of intracranial infection broad-spectrum antibiotics, covering anaerobic bacteria, usually with methazole.
the bacteria is both anaerobic but resistant to methazole.
abscess once the package is limited, if there are surgical indications, active surgical intervention is necessary. The surgical methods of
brain abscess are divided into craniofacial excisectomy and perforation under nerve navigation.
the former is applicable to shallow parts, non-functional areas, multi-room, abscesses accompanied by foreign bodies, with the advantages of completeremoval of lesions, low recurrence and so on, but the damage of tissue is serious, trauma is large, high surgical risk.
the latter is applicable to deep, functional area, multiple abscesses, with small trauma, accurate positioning, simple operation and other advantages, but with easy to lead to abscess burst into the ventricle, abscess wall residue, high recurrence rate risk.
a domestic study showed that neuronavigation under the puncture drainage surgery with open cranial surgery than cure rate is higher, the rate of disease death is lower.
a meta-analysis abroad supports the same view.
the author thinks that the clinical choice of the surgical method of brain abscess should be tailored to specific cases, strictly the indication of surgery, flexible use.
the causes of brain abscess and ventricular itis in this case may be related to the following aspects: (1) early failure to look for pathogenic bacteria for the route of infection.
(2) Because of the effect of the blood-brain barrier, antibiotics can not reach an effective concentration of bacteriobacteria or sterilization at the abscess site.
(3) sick children are in the transition phase from breastfeeding to complementary food, low immunity combined with anemia.
(4) the pus spreads with cerebrospinal fluid during puncture drainage.
the disadvantage of this treatment is that antibiotics are not combined early in the absence of a clear pathogenic bacteria to improve the effectiveness of treatment.
but HITA and so on believe that, due to the role of the blood-brain barrier, intrauterine injection combined intravenous drug use than intravenous drug use is better, especially for patients with abscesss into the ventricle significant effect, can provide a similar case in the future to provide an alternative method.
: The brain abscess caused by rodenta aiken bacteria is a rare clinical case, through this case for the diagnosis and treatment of clinical diseases have a certain reference value and enlightenment significance.
early intracranial infection head enhancement MRI, enhanced CT examination can be diagnosed clearly, there is surgery to adapt to the need for active surgical intervention, the choice of brain abscess surgery needs to be more clinical verification and discussion.
for patients who can not operate and the abscess spread should be based on drug sensitivity results to choose sensitive antibiotics, intravenous combination or intrauterine injection and intravenous application of combination therapy, dynamic review of the head to enhance MRI or enhance CT assessment treatment effect.
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