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Open Access Highly Accessed Research article

Bacterial brain abscess in patients with nasopharyngeal carcinoma following radiotherapy: microbiology, clinical features and therapeutic outcomes

Peng-Hsiang Fang1, Wei-Che Lin2, Nai-Wen Tsai3, Wen-Neng Chang3, Chi-Ren Huang3, Hsueh-Wen Chang4, Tai-Lin Huang5, Hsin-Ching Lin6, Yu-Jun Lin14, Ben-Chung Cheng45, Ben Yu-Jih Su5, Chia-Te Kung7, Hung-Chen Wang1* and Cheng-Hsien Lu34*

Author Affiliations

1 Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

2 Departments of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

3 Departments of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, 833, Taiwan

4 Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan

5 Departments of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

6 Departments of Otorhinolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

7 Departments of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

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BMC Infectious Diseases 2012, 12:204  doi:10.1186/1471-2334-12-204

Published: 3 September 2012

Abstract

Background

This study aimed to analyze the clinical features, causative pathogens, neuro-imaging findings, and therapeutic outcomes of bacterial brain abscess in patients with nasopharyngeal carcinoma (NPC) following radiotherapy.

Methods

NPC patients with bacterial brain abscess were evaluated. Their clinical data were collected over a 22-year period. For comparison, the clinical features, causative pathogens, neuro-imaging findings, and therapeutic outcomes between NPC and non-NPC patients were analyzed.

Results

NPC accounted for 5.7% (12/210) of the predisposing factors, with Viridans streptococci and Staphylococcus aureus as the two most common causative pathogens. Significant statistical analysis between the two groups (NPC and non-NPC patients) included chronic otitis media (COM) as the underlying disease, post-radiation necrosis by neuro-imaging, and the temporal lobe as the most common site of brain abscesses. The fatality rate in patients with and without NPC was 16.7% and 20.7%, respectively.

Conclusions

NPC patients with bacterial brain abscess frequently have COM as the underlying disease. Neuro-imaging often reveals both post-radiation necrosis and the temporal lobe as the most common site of brain abscesses, the diagnosis of which is not always a straightforward process. Radiation necrosis can mimic brain abscess on neuro-imaging and pose significant diagnostic challenges. Early diagnosis and treatment is essential for survival.

Keywords:
Bacterial brain abscess; Nasopharyngeal carcinoma; Therapeutic outcome