Multiple Brain Abscesses in A Child with Infective Endocarditis
Journal Title: International Journal of Health & Medical Research - Year 2023, Vol 2, Issue 09
Abstract
Background: Infective endocarditis is a lethal infection affecting the endocardium of the heart and the valves.The causes are varied with staphylococcus aureus and streptococcus as the major causative agents.The triad of fever exceeding 38o c,vegetation in the heart and blood culture of the causative agents are the hallmarks of the diagnosis .The disease is known to be affect all ages with the very young age group, those with congenital heart disease and those on cardiac prosthesis as the most vulnerable. Septic emboli from the septic vegetation can spread to the brain, kidney, spleen, and lungs resulting in massive metastatic infections.It therefore has multisystemic manifestations and complications. Though neurological complications are common, brain abcess is known to be rare constituting only 1.0% of neurological complications. Objective: The study aimed at reporting occurrence of both cerebral and cerebellar micro- and macro-abscesses in a 3 year boy with infective endocarditis; a rare occurrence in the literature. Methods: This case report was carried out at University College Hospital Ibadan. Results: The boy presented with fever of 38oc for five weeks, convulsions and altered state of consciousness for ten days..In course of treatment patient however developed irritability and aggressive behaviour, which attracted the use of largactil to which he reacted with extrapyramidal signs and convulsions. Within the week he developed yellowness of the eyes and increase in abdominal girth. Patient had cranial computed tomography (CT) after plain skull X-rays and was referred to University College Hospital Ibadan as a result of the radiologically diagnosed brain abscess seen on CT images. child had grunting respiration with dyspnea, and the respiratory rate was 50/mm. However, the chest was clinically clear. In the cardiovascular system (CVS); the pulse was 140/mm, with moderate volume. The blood pressure (BP) was l60/110 mmHg. The first and second heart sounds were heard with a gallop rhythm. Cranial CT scan showed multiple ring enhancing hypodense lesions with surrounding hypodensity measuring 1cm in diameter and above with only a few measuring less than 1.0cm in both cerebral hemispheres and cerebelli in keeping with multiple cerebral and cerebellar abscesses. An echocardiography showed a brightly echogenic spot attached to the papillary muscle in the left ventricle suggesting vegetation consistent with an infective endocarditis. Retroviral test was negative for both type I and II.Blood culture — was negative, however urine culture yielded klebsiella sp. Serum urea, creatinine, Ca2+ and P04 were all elevated.The abdominal ultrasound scan confirmed the hepatosplenomegaly with decreased echogenicity but both kidneys appeared normal.There was no demonstrable ascitis. The boy was placed on antimicrobials; and had craniotomy for the drainage of the macroabscesses. He improved significantly. His renal and cardiac condition equally improved; he was subsequently discharged to continue treatment in the the paediaric outpatient. The infective endorcarditis still poses enormous challenge in management and the condition calls for multi disciplinary approach. It requires high index of suspicion for early detection; as well deployment of multiple imaging modalities by the cardiologists and radiologists to arrive at a more accurate diagnosis for effective patient management. This may save financial and material resources on part of the patients, care givers, the facility managers and the society at large.
Authors and Affiliations
Rimande U. Joel MBBS, MSc, FWACS, FMCR , Rosethe Rimande-Joel RN, Dip. PON, BEd, PhD , Eyo O. Ekpenyong MBBS, FWACS, Mni3 , Charles Anjorin MBBS, FMCP, FWACP , Peter Teru Yaru, MBBS, FMC Paed , Millicent O. Obajimi MBBS, DMRD, FWACS, FMCR5
Keywords
Related Articles
- EP ID EP731373
- DOI 10.58806/ijhmr.2023.v2i9n08
- Views 60
- Downloads 0
The Influence of Diet and Intake of Macro and Micro Zinc Nutrients on the Incident of Stunting in Toddlers Ages 12-36 Months in Usitasae Village
Short Toddlers (Stunting) is a nutritional status based on the Body Length according to Age (PB/U) index or Body Height according to Age (TB/U) where in the anthropometric standard for assessing children’s nutritional st...
Forensic Psychiatry Analysis and Methods for Assessing The Mental Health of A Serial Killer.
Psychosis is a mental illness that causes an alteration in the notion of reality, where a world of its own is formed in the mind of the psychotic, in other words, he lives in a delirium and suffers hallucinations, hearin...
Chronic Obstructive Pulmonary Disease: How Can It Be Assessed and Managed?
Chronic obstructive pulmonary disease (COPD) is a serious health problem characterized by constriction in the air passages that results from different etiologic factors. The problems of COPD include narrowing of the smal...
Bacterial Resistance to Antibiotics: A Review Article
Antibacterial resistance (ABR) is nowadays considered as a public global health problem, with expected mortality rate of 106 yearly by 2050. ABR happens when pathogenic bacteria are not affected to antibacterial therapy,...
Identification Of Locally Transmitted COVID-19 Spatial Clusters And Hotspots
Background: The coronavirus disease 2019 (COVID-19) is an emerging and rapidly evolving profound pandemic, which causes severe acute respiratory syndrome and results in significant case fatality around the world. We cond...