Brain abscesses caused by oral infection

Abstract— Brain abscesses are rare but can be life-threatening infections. Recent progress in microbiological classification and identification has indicated that they are sometimes caused by oral infection and dental treatment. It has been postulated that oral microorganisms may enter the cranium by several pathways: 1) by direct extension, 2) by hematogenous spread, 3) by local lymphatics, and 4) indirectly, by extraoral odontogenic infection. In the direct extension, oral infections spread along the fascial planes. Hematogenous spreading occurs along the facial, angular, ophthalmic, or other veins which lack valves, through the cavernous sinus and into the cranium. Another hematogenous pathway is through the general circulation. Oral bacteria may cause systemic infections, e.g., endocarditis, and then indirectly initiate brain abscess. Microbiota, complications, and the prevention and management of odontogenic brain abscesses are also discussed in this review.     

Orbital abscess as a complication of odontogenic infection. A case report and review of the literature.

Orbital abscess is a rare complication of odontogenic infection. This report describes a case of an orbital abscess in a 42-year-old HIV-seropositive woman who developed this condition as a complication by direct spread via the maxillary sinus of a dento-alveolar abscess of the maxillary first premolar, resulting in the loss of her eye.     

局限性牙源性感染的诊治与预防

牙源性感染是指因牙或牙周围结构破坏引起的牙槽和(或)颌面部感染.局限性牙源性感染经及时、正确处理均可获得良好效果;但若未得到及时、有效治疗,可引起骨髓炎及间隙感染(即播散性感染),重者可发展至海绵窦血栓形成、脑脓肿、纵隔炎而危及生命.文章通过对常见局限性牙源性感染的病因、临床表现、诊断、治疗和预防进行阐述,为口腔全科医...     

Brain abscess from chronic odontogenic cause: report of case

A case of a chronic odontogenic abscess that probably precipitated a frontopatrietal brain abscess by hematogenous spread has been presented. A thorough examination of the patient showed no other source of infection. Peptostreptococcus sp was found as the common pathogen despite 6 days of broad-spectrum antibiotic therapy. This case emphasizes the important role of dentistry in medical diagnosis and treatment implemented in the hospital setting.     

Orbital abscess from an odontogenic infection

An orbital abscess is a rare but serious complication of an odontogenic infection, which can lead to loss of vision or worse. This paper presents a case of orbital abscess secondary to an infection from the upper molar teeth, which extended to the retobulbar and posterosuperior region of the orbit, close to the superior orbital fissure. The infection spreaded to the pterygopalatine and infratemporal fossa and then to the orbit via the inferior orbital fissure. This paper reviews the clinical presentation, differential diagnosis, route of spread, value of serial CT scanning, treatment and possible complications.     

Diagnosis and treatment of the retropharyngeal abscess in adults

While the retropharyngeal space abscess is an extremely rare entity that may arise from odontogenic infections, its potential complications may be fatal. When infection of the retropharyngeal space occurs, urgent surgical and antibiotic therapy is required. A review of the anatomy, symptoms, treatment, diagnostic methods and complications is provided. As well, the successful treatment of a multispace odontogenic infection is discussed as a reminder that the retropharyngeal abscess does exist.     

Frontal lobe abscess of dental origin. Report of a case.

A 52-year-old white man came to our hospital with obscure signs of disease. Multiple laboratory tests, radiographs, and examinations ruled out aseptic meningitis, bacterial endocarditis, cerebral artery aneurysm, and other possibilities. A brain abscess was finally diagnosed. The teeth and their surrounding tissues were implicated as the etiologic factors. The importance of odontogenic sources as potential foci of infection is emphasized. This sequel to odontogenic infection is quite rare, but it can be prevented by removal of chronically carious teeth and periapical pathosis.     

Characterization of Streptococcus constellatus strains recovered from a brain abscess and periodontal pockets in an immunocompromised patient

BACKGROUND: There have been a number of reports of brain abscesses suggesting an odontogenic etiology. However, no efforts have been made to compare brain abscess isolates with isolates from the oral cavity using highly discriminative methods. We report a brain abscess caused by Streptococcus constellatus in an immunocompromised patient where oral infection (periodontitis) was suspected to be implicated. METHODS: The brain abscess and oral isolates were compared by means of one phenotypic and three genetic (restriction fragment length polymorphism [RFLP], ribotyping, and random amplified polymorphic DNA [RAPD]) fingerprinting techniques. RESULTS: The phenotypic method and RFLP showed identical profiles between brain and periodontal isolates, while ribotyping and RAPD showed very close similarity, with only one band difference in one of the three ribotypes and in one of the three polymorphic RAPD. CONCLUSIONS: Gene transfer by genetic recombinational events in the periodontal pocket might have been responsible for the emergence of a strain variant of S. constellatus that had the potential to cause an abscess at a distant site (brain). The importance of odontogenic sources as potential foci of infection for brain abscesses is discussed.     

Suppurative oral candidosis. Review of the literature and report of a case

A case of a dento-alveolar abscess due to a polymicrobial infection with a yeast, Candida guilliermondii and two other oral bacteria are described. A review of the literature has revealed only a single case of an odontogenic abscess due to Candida species and we believe this to be the first report of a dentoalveolar infection where Candida guilliermondii is associated as a co-pathogen.     

Brain Abscess Potentially Resulting from Odontogenic Focus: Report of Three Cases and a Literature Review

Introduction

Odontogenic foci can rarely cause intracranial infection. Hematogenous spread is considered to be the most important pathophysiological mechanism of intracranial infection of odontogenic origin. To investigate the oral origin of intracranial infections, oral surgeons should understand the underlying mechanisms by which oral bacteria spread to the central nervous system. However, there have been very few reports of intracranial infection resulting from odontogenic infection.

Case reports

The authors report the cases of a 64-year-old man, a 68-year-old man, and a 64-year-old woman whose brain abscesses perhaps have arisen from odontogenic foci, because other sources of intracranial infection such as endocarditis and maxillary sinusitis were not found. Bacteriological examination of brain abscess specimens identified Staphylococcus aureus in case 1, Streptococcus constellatus, Fusobacterium nucleatum, and Parvimonas micra in case 2, and Lactobacillus catenaformis, Porphyromonas gingivalis, and F. nucleatum in case 3. All suspected causal teeth had no obvious signs of acute inflammation in all three cases.

Conclusions

Oral surgeons should understand these characteristics of odontogenic brain abscess, in which the potentially causal odontogenic foci often lack acute symptoms. If other origins of infection are not found, it would be better to eliminate the potentially causal odontogenic foci for improvement of oral hygiene, however, the decision making criteria to eliminate suspected causal teeth is needed to be elucidated.

     

Odontogenic orbital abscess: a case report and review of literature

Odontogenic orbital abscess is a rare but well-documented complication of sinusitis and infections spreading from dental apical lesion. We report a case of orbital abscess with periorbital cellulitis, in a 35-year-old man with positive recent dental history of a periapical dental infection arising from the second upper left premolar spread into maxillary sinus. The patient has shown facial edema, ocular pain, ophthalmoplegia, proptosis, and initial visual symptoms. A surgical intervention to drain the abscess and a revision of the dental lesion and maxillary sinus were required. A review of literature is also reported focusing on etiology and treatment options dealing with odontogenic orbital abscess and cellulitis.     

Brain abscess following dental procedures. Case report

There have been a number of reports of brain abscess suggesting an odontogenic etiology after dental treatment procedures or oral infections, but the diagnosis was mainly by exclusion rather than based on evidence. We present a case of a brain abscess due to Strepto-coccus constellatus in a 27-year-old-immunocompetent woman who underwent extraction of the primary molar and eradication of a radicular cyst some weeks before.     

Are dental infections a cause of brain abscess? Case report and review of the literature

Dental pathology and/or treatment have been linked to a small number of brain abscesses as possible sources of infection. A further case is presented, in which a dental site is implicated. A review of the evidence was undertaken. A wide range of dental procedures had been implicated. In some cases the brain isolate was not of dental origin. In many, the diagnosis was one of exclusion. In order to confirm the role of odontogenic infection in the pathogenesis of brain abscess, modern sampling techniques should be used to precisely identify the isolates. The causal organism should be identified in both oral and cranial sites.     

Cavernous sinus thrombosis and blindness as complications of an odontogenic infection: report of a case and review of literature

A case of orbital abscess complicated by unilateral blindness and CST as a result of an odontogenic infection is reported. The patient eventually recovered her sight. This case illustrates how appropriate consultations and prompt interventions are beneficial in giving total care to a critically ill patient.     

A primary canine and an impacted permanent canine with infection potentially induced an intracranial abscess

Intracranial abscess is a rare but life-threatening disease. There have been no reports on intracranial abscess induced by the residual primary tooth and the impacted successive permanent tooth with infection. We report on an interesting case of a 29-year-old man suffering from an epidural abscess, potentially caused by an infection of the residual primary maxillary right canine and the impacted permanent maxillary right canine. The patient recovered completely after prolonged antibiotic treatment and extraction of both of the suspected teeth. Fusobacterium sp. was isolated from the culture of a peripheral blood sample. This case alerts us to realize that the lack of suitable and timely intervention in oral conditions might produce a harmful effect on general health.     

下颌骨颈胸CT连续扫描在牙源性下行坏死性纵隔炎诊治中的意义

目的:探讨下颌骨颈胸CT连续扫描在牙源性下行坏死性纵隔炎(DNM)诊治中的作用.方法:回顾性总结12例牙源性DNM的临床资料,对其临床表现、治疗及CT诊断结果进行分析.结果:10例可见病灶牙及颌骨变化,下颌颈胸CT连续扫描显示感染自颌面向胸部扩散的连续过程,表现为口底、颌下广泛积气、积脓,经颈部间隙达纵隔,3例为上纵隔感染,9例扩散到下后纵隔;8例伴胸腔积脓、肺部感染,2例心包积脓、积气.结论:牙源性下行坏死性纵隔炎发病急、扩散快、病情凶险、死亡率高,值得警惕.早诊断、早治疗是提高治愈的有效方法.颌面颈胸连续CT扫描是判断感染扩散范围、确定引流部位的有力手段.     

Ludwig Angina after First Aid Treatment: Possible Etiologies and Prevention—Case Report

Ludwig angina is a life-threatening type of soft tissue cellulitis involving 3 compartments on the floor of the mouth including the submental, sublingual, and submandibular spaces bilaterally. Prevention, early recognition, and treatment of Ludwig angina are critical because this is a clinical diagnosis with unpredictable progression. This article describes a rare case of Ludwig angina that evolved from an odontogenic infection and the specific microbiology and clinical course and discusses possible etiologies and prevention.     

Retrobulbar abscess: rare complication after repair of an oroantral communication

We present the case of a retrobulbar abscess that developed secondary to the repair of an oroantral communication. Orbital abscesses have been described in relation to odontogenic infections, facial injury, sinusitis, and after dental extractions but, to the best of our knowledge, none has been reported in these circumstances. Retrobulbar abscess is a rare complication, but early clinical and radiological diagnosis, and urgent decompression are vital because it comes with considerable risk of irreversible visual impairment.     

Use of interventional radiology in the management of mediastinitis of odontogenic origin

Descending necrotising mediastinitis is a rare complication of odontogenic infection. The key to diagnosis is to maintain a high index of suspicion when antibiotics and adequate surgical drainage do not lead to resolution of symptoms. Open thoracic operation to drain mediastinal collections is potentially lethal and interventional radiological techniques are thought to reduce mortality. We report the use of interventional radiology in the diagnosis, monitoring and treatment of this condition and illustrate our experience with three case reports.