Cerebral abscess

Discussion:

The patient went on to have a craniotomy and aspiration of the fluid center (pus) and partial debridement of the thick capsule which was adherent to the dura. 

Histology

MICROSCOPIC DESCRIPTION: The sections show fragments of necrotic inflammatory debris consistent with the contents of an abscess. This is delimited by acutely inflamed vascular granulation tissue and more peripheral edematous and gliotic brain parenchyma. Colonies of Gram positive cocci are identified in the necrotic debris. The features are of bacterial abscess. No evidence of tumor is seen.

FINAL DIAGNOSIS: Bacterial abscess; Gram positive cocci identified.

Microbiology

Calcofluor White Stain: No fungal elements detected

GRAM STAIN

  • Leukocytes +++
  • Gram positive cocci +++
  • Gram negative bacilli +

CULTURE: Streptococcus anginosus group (milleri group) +++

SENSITIVITIES

  • Ceftriaxone S
  • Penicillin S
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