Clinical Characteristics of Brain Abscess in Cyanotic Congenital Heart Disease in Japan

Abstract

Background and Methods: To delineate the clinical characteristics of brain abscess concomitant with cyanotic congenital heart disease in Japan, a nationwide survey was performed through the network of the Committee for Genetics and Epidemiology of Cardiovascular Diseases in the Japanese Society of Pediatric Cardiology and Cardiac Surgery.
Results: Of ninety reported cases, 75 cases (83％) survived, 6 cases (7％) died, and the remaining 9 had unknown outcome. Forty-five of 83 cases (54％) showed neurologic symptoms such as loss of consciousness, seizure, and palsy. Seventeen of 90 cases (19％) had evidence of preceding symptoms including upper respiratory or gastrointestinal infection. Although dental procedures were performed ahead of brain abscess in eight cases (9％), seven of these cases (88％) were not given prophylactic antibiotic treatment against infective endocarditis. Bacterial organism were identified in the blood or abscess culture in 32 of 42 examined cases (76％) and Streptococcus species were the most frequently found (53％). The level of serum C-reactive protein was less than 1mg/dL in 72％ of patients at the diagnosis. Neurologic sequelae remained in 31 of 75 survived cases (41％) and were significantly common in those who manifested neurologic symptom at the diagnosis (p<0.01).
Conclusion: Lower level of inflammatory response in blood examination was common in patients with brain abscess concomitant with cyanotic congenital heart disease. The antimicrobial prophylaxis of infective endocarditis for dental procedures was suggested to be important to prevent brain abscess. Focal neurologic symptoms at the onset of brain abscess were significantly associated with neurologic sequelae thereafter.