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Hirnabszesse nach extrakraniellen Infektionen im Kopf-Hals-Bereich

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Abstract

20 Patienten mit Hirnabszessen in Folge primärer Infektionen des Mittelohres (12 Fälle), der Mundhöhle (7 Fälle) und der Stirnhöhle (1 Fall) werden vorgestellt.

In 17 Fällen (85%) wurde eine neurochirurgische Intervention notwendig. In acht dieser Fälle wurde eine operative Sanierung des infektiösen Fokus durchgeführt (6 Antro- bzw. Mastoidektomien, 2 Zahnextraktionen). Bei einem von 3 Patienten, die nicht neurochirurgisch behandelt wurden, wurde eine Mastoidektomie durchgeführt. Die mikrobiologische Diagnostik konnte bei 9 Patienten den Erreger sichern. Bei 8 Patienten war das gewonnene Abszessmaterial steril. 19 Patienten wurden erfolgreich behandelt, einer starb an den Folgen des Hirnabszesses. Es ergaben sich keine prognostischen Unterschiede bei den untersuchten Faktoren wie Geschlecht, Alter, Symptomdauer vor Diagnose, klinischem Bild, Größe des Abszesses und Art der Behandlung.

Die Frühdiagnose ermöglicht mit höherer Wahrscheinlichkeit die Isolation des infektiösen Agens auf dem Boden der ersten klinischen Zeichen (Zephalgie, Fieber, Bewusstseinsänderungen, fokale neurologische Defizite, epileptische Anfälle).

Abstract

The authors report on 20 immunocompetent patients with brain abscess after 12 cases of middle ear , seven tooth and a single frontal sinus infection.

The clinical aspects, hematochemical and microbiological data, the role of imaging diagnostics (CT, MR) and the type of treatment are analysed.

Neurosurgery was performed on 17 patients (85%), eight of whom subsequently underwent evacuation of the primary source of infection (four mastoidectomies, two timpanoplasties, two tooth extractions). Mastoidectomy was eventually carried out on one of the three patients who did not undergo neurosurgery. Microbiological diagnosis was possible in nine patients through culture examination: Proteus mirabilis in three cases, Peptostreptococcus sp. in two, Micrococcus varians, Proteus vulgaris, Streptococcus sanguis and Streptococcus viridans not typed in single cases. The pus was sterile in eight patients (47.1% of those operated).

An association of two antimicrobial agents was used in 18 patients, while in two cases monotherapy was preferred, based on the isolated bacteria. Treatment lasted on average 38 days. The most frequently used therapy regimen (75%) was the association of a beta-lactam drug with chloramphenicol or metronidazole.

Therapy was successful in 19/20 patients; one patient died. There was no significant difference in prognostic terms with regard to sex, age, duration of symptoms prior to diagnosis, clinical picture at onset, number and size of abscesses or type of treatment. Recognising the first clinical signs and symptoms (headache, fever, alterations in consciousness, focal neurological deficit, epileptic seizures) is extremely important for prompt diagnosis of brain abscess.

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Authors and Affiliations

  1. V. le Umbria 6, , 30019 Chioggia, Venezia, Italien

    P. Boscolo Rizzo

  2. Regionalkrankenhaus Treviso, HNO-Klinik—Universität Padua, Italien

    C. Marchiori, P. Boscolo Rizzo, M. Levorato & M. C. Da Mosto

  3. , HNO-Universitätsklinik Heidelberg

    A. Dietz

  4. Regionalkrankenhaus Treviso, Hygieneinstitut—Universität Padua, Italien

    E. Tonon & A. Vaglia

  5. , Neurologische Universitätsklinik Heidelberg

    U. Meyding-Lamadé

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  1. C. Marchiori
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  2. E. Tonon
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  6. M. Levorato
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Correspondence to P. Boscolo Rizzo.

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Marchiori, C., Tonon, E., Boscolo Rizzo, P. et al. Hirnabszesse nach extrakraniellen Infektionen im Kopf-Hals-Bereich. HNO 51, 813–822 (2003). https://doi.org/10.1007/s00106-003-0827-9

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