Causative organisms

In the non-immunocompromised host, most brain abscesses are bacterial in origin and are frequently polymicrobial. A wide spectrum of organisms, both aerobic and anaerobic, has been isolated from brain abscesses. Streptococcal species, particularly Streptococcus milled, are the most commonly identified and are found in up to 70% of abscesses. Suppurative infections complicating ear and sinus infections commonly have a mixed flora, which includes Enterobacteriaceae, streptococci (aerobic and anaerobic), Staphylococcus aureus, and Bacteroides spp. Dental sepsis causes infections with a mixed bag of streptococci, Bacteroides spp., and Fusobacterium spp.; pulmonary disease is associated with fusobacteria, other anaerobes, streptococci, and actinomycetes. Patients with congenital heart disease are likely to have anaerobic and microaerophilic streptococci. Staphylococci are found with penetrating head trauma, as are streptococci and Clostridium spp.

The organism implicated in abscesses associated with immunocompromised individuals depends on the type of defect. In those suffering from neutropenia and defects in neutrophil function, gram negative rods and fungi (Aspergillus spp., Candida spp., and Mucoraceae) are most commonly involved. T cell dysfunction predisposes to infection with Listeria monocytogenes, Nocardia asteroides, mycobacteria, Cryptococcus neoformans, and Toxoplasma gondii. In recipients of bone marrow transplants and solid organ transplants 92% of brain abscesses are associated with a single fungal pathogen.148 Aspergillus is most commonly identified followed by Candida. Other fungi are occasionally found.

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