PDF(Pubmed)
Abstract：
BACKGROUND: Recently, there is increasing evidence that the proportion of odontogenic brain abscesses is greater than previously known. In this study, we aim to differentiate the oral infections as triggers more precisely and to classify them in the clinical setting.
METHODS: For analysis, we conducted a retrospective single center study. We reviewed patients with brain abscesses who have undergone treatment in the University Hospital of Freiburg, Germany in the period between 2000-2021. Inclusion required two main criteria: 1. The brain abscess must not have an other focus than odontogenic. 2. The microbial spectrum identified in the brain abscess must be consistent with an odontogenic origin.
RESULTS: Of 217 brain abscess patients, 26 met the inclusion criteria. 42% (11 patients) suffered from immunosuppressive conditions. Odontogenic foci were diagnosed in 18 cases (69%). Neurologic deficits included vigilance reduction and hemiparesis. Pathogens of the Streptococcus anginosus group were the most frequent causative agent (21 cases, 81%). Metronidazole (54%) and ceftriaxone (42%) were part of the targeted antibiotic therapy. All brain abscesses were surgically treated. Teeth were extracted in 14 of 17 cases for focus control. 18 cases (72%) showed complete or partial resolution of neurologic symptoms and 3 cases were fatal.
CONCLUSIONS: Apparently silent or chronic oral infections are sufficient to cause bacterial colonization of the brain, especially in immunocompromised patients. Therefore, special care should be taken to maintain good oral health. An interdisciplinary management should become a standard to prevent and treat the occurrence of brain abscesses.
METHODS: For analysis, we conducted a retrospective single center study. We reviewed patients with brain abscesses who have undergone treatment in the University Hospital of Freiburg, Germany in the period between 2000-2021. Inclusion required two main criteria: 1. The brain abscess must not have an other focus than odontogenic. 2. The microbial spectrum identified in the brain abscess must be consistent with an odontogenic origin.
RESULTS: Of 217 brain abscess patients, 26 met the inclusion criteria. 42% (11 patients) suffered from immunosuppressive conditions. Odontogenic foci were diagnosed in 18 cases (69%). Neurologic deficits included vigilance reduction and hemiparesis. Pathogens of the Streptococcus anginosus group were the most frequent causative agent (21 cases, 81%). Metronidazole (54%) and ceftriaxone (42%) were part of the targeted antibiotic therapy. All brain abscesses were surgically treated. Teeth were extracted in 14 of 17 cases for focus control. 18 cases (72%) showed complete or partial resolution of neurologic symptoms and 3 cases were fatal.
CONCLUSIONS: Apparently silent or chronic oral infections are sufficient to cause bacterial colonization of the brain, especially in immunocompromised patients. Therefore, special care should be taken to maintain good oral health. An interdisciplinary management should become a standard to prevent and treat the occurrence of brain abscesses.
摘要：
背景：最近，越来越多的证据表明，牙源性脑脓肿的比例高于先前已知的比例。在这项研究中,我们的目标是更精确地区分口腔感染的诱因,并在临床上对其进行分类.
方法：对于分析，我们进行了一项回顾性单中心研究.我们回顾了在弗莱堡大学医院接受治疗的脑脓肿患者，德国在2000年至2021年期间。纳入需要两个主要标准：1。脑脓肿除了牙源性外不得有其他焦点。2.在脑脓肿中鉴定的微生物谱必须与牙源性起源一致。
结果：在217例脑脓肿患者中，26符合纳入标准。42％（11例）患有免疫抑制疾病。诊断为牙源性病灶18例（69％）。神经功能缺损包括警惕性降低和偏瘫。最常见的病原体是血管链球菌组（21例，81%)。甲硝唑（54％）和头孢曲松（42％）是靶向抗生素治疗的一部分。所有脑脓肿均接受手术治疗。17例中有14例拔牙进行病灶控制。18例（72％）表现出完全或部分的神经系统症状，3例死亡。
结论：明显的沉默或慢性口腔感染足以引起大脑的细菌定植，尤其是免疫功能低下的患者。因此,应特别注意保持良好的口腔健康。跨学科管理应成为预防和治疗脑脓肿发生的标准。
方法：对于分析，我们进行了一项回顾性单中心研究.我们回顾了在弗莱堡大学医院接受治疗的脑脓肿患者，德国在2000年至2021年期间。纳入需要两个主要标准：1。脑脓肿除了牙源性外不得有其他焦点。2.在脑脓肿中鉴定的微生物谱必须与牙源性起源一致。
结果：在217例脑脓肿患者中，26符合纳入标准。42％（11例）患有免疫抑制疾病。诊断为牙源性病灶18例（69％）。神经功能缺损包括警惕性降低和偏瘫。最常见的病原体是血管链球菌组（21例，81%)。甲硝唑（54％）和头孢曲松（42％）是靶向抗生素治疗的一部分。所有脑脓肿均接受手术治疗。17例中有14例拔牙进行病灶控制。18例（72％）表现出完全或部分的神经系统症状，3例死亡。
结论：明显的沉默或慢性口腔感染足以引起大脑的细菌定植，尤其是免疫功能低下的患者。因此,应特别注意保持良好的口腔健康。跨学科管理应成为预防和治疗脑脓肿发生的标准。
