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Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses

Received: 24 December 2021     Accepted: 11 January 2022     Published: 17 January 2022
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Abstract

Neonatal Brain abscess is a rare sever neonatal infection requiring careful medical and neurosurgical intervention strategies to reduce morbidity and mortality rates. Gram-negative bacterial agents are the most common pathogens involved in brain abscesses of neonates. The use of wide spectrum antibiotics in combination with neurosurgical drainage of abscesses larger than 2.5 cm is the mainstay of treatment. Colistin is a polymyxin antibiotic used to treat bacterial infections caused by susceptible gram-negative bacteria but with a limited penetration in blood brain barrier. However, there is limited data on using intraventricular Colistin in neonatal intracranial infections. A 12-day-old male neonate with multiple brain abscesses in frontal and parietal lobes is presented. The abscesses were successfully managed with a combination of intravenous antimicrobial agents, intraventricular Colistin and concurrent administration of Interferon-ɣ. Subsequently, he developed ventriculomegaly which was successfully managed by endoscopic third ventriculostomy. He had an acceptable neurologic outcome. Due to reduced penetration of colistin in blood brain barrier, use of intraventricular Colistin in combination with its intravenous form can be beneficial in management of neonatal brain abscesses. Concurrent administration of Interferon-ɣ may improve the treatment process and outcome given that reduced secretion of this agent by neonatal T lymphocytes may contribute to a partial immunodeficiency state at this period of life.

Published in American Journal of Pediatrics (Volume 8, Issue 1)
DOI 10.11648/j.ajp.20220801.14
Page(s) 14-16
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Brain Abscess, Cerebral Ventriculomegaly, Colistin, Interferon Gamma

References
[1] Sheehan, J. P., et al., Brain abscess in children. Neurosurgical focus, 2008. 24 (6): p. E6.
[2] Oliveira, R. S., et al., Brain abscess in a neonate: an unusual presentation. Child's Nervous System, 2007. 23 (2): p. 139-142.
[3] Tsutsumi, S., et al., A case of neonatal cerebellar abscess. Child's Nervous System, 2003. 19 (9): p. 683-685.
[4] Sundaram, V., et al., Klebsiella pneumoniae brain abscess in neonates: a report of 2 cases. Journal of child neurology, 2010. 25 (3): p. 379-382.
[5] Qureshi, U. A., et al., Klebsiella brain abscess in a neonate. Archives of Disease in Childhood-Fetal and Neonatal Edition, 2011. 96 (1): p. F19-F19.
[6] Parthasarathy, A., Textbook of pediatric infectious diseases. 2013: JP Medical Ltd.
[7] Frazier, J. L., E. S. Ahn, and G. I. Jallo, Management of brain abscesses in children. Neurosurgical focus, 2008. 24 (6): p. E8.
[8] Hussain, K., et al., Neurodevelopment Outcome of Neonates Treated With Intraventricular Colistin for Ventriculitis Caused by Multiple Drug-Resistant Pathogens—A Case Series. Frontiers in Pediatrics, 2021. 8: p. 843.
[9] Biswas, B., et al., Neonatal brain abscess due to extended-spectrum beta-lactamase producing Klebsiella pneumoniae. Journal of clinical and diagnostic research: JCDR, 2014. 8 (11): p. PD01.
[10] Singh, A., et al., Neonatal brain abscess: Clinical report and review of Indian cases. Journal of Clinical Neonatology, 2016. 5 (3): p. 213.
[11] Tekgündüz, K. S., et al., Intraventricular colistin use in a premature infant with cerebral abscess and ventriculitis. Journal of Clinical Neonatology, 2015. 4 (2): p. 132.
[12] Ziaka, M., et al., Combined intravenous and intraventricular administration of colistin methanesulfonate in critically ill patients with central nervous system infection. Antimicrobial agents and chemotherapy, 2013. 57 (4): p. 1938-1940.
[13] Alaoui, S., et al. Intraventricular colistin use in neonatal meningitis caused by Acinetobacter baumanii. in Annales francaises d'anesthesie et de reanimation. 2011.
[14] Wilson, C., et al., Decreased production of interferon-gamma by human neonatal cells. Intrinsic and regulatory deficiencies. The Journal of clinical investigation, 1986. 77 (3): p. 860-867.
[15] Mitchell, A. E., K. Scanlon, and N. Carbonetti, Role of Interferon-γ in promoting disease severity in neonatal Bordetella pertussis infection. 2018, Am Assoc Immnol.
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  • APA Style

    Farhad Abolhasan Choobdar, Zahra Soltani, Alireza Nateghian, Vahid Heidari. (2022). Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses. American Journal of Pediatrics, 8(1), 14-16. https://doi.org/10.11648/j.ajp.20220801.14

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    ACS Style

    Farhad Abolhasan Choobdar; Zahra Soltani; Alireza Nateghian; Vahid Heidari. Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses. Am. J. Pediatr. 2022, 8(1), 14-16. doi: 10.11648/j.ajp.20220801.14

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    AMA Style

    Farhad Abolhasan Choobdar, Zahra Soltani, Alireza Nateghian, Vahid Heidari. Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses. Am J Pediatr. 2022;8(1):14-16. doi: 10.11648/j.ajp.20220801.14

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  • @article{10.11648/j.ajp.20220801.14,
      author = {Farhad Abolhasan Choobdar and Zahra Soltani and Alireza Nateghian and Vahid Heidari},
      title = {Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses},
      journal = {American Journal of Pediatrics},
      volume = {8},
      number = {1},
      pages = {14-16},
      doi = {10.11648/j.ajp.20220801.14},
      url = {https://doi.org/10.11648/j.ajp.20220801.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20220801.14},
      abstract = {Neonatal Brain abscess is a rare sever neonatal infection requiring careful medical and neurosurgical intervention strategies to reduce morbidity and mortality rates. Gram-negative bacterial agents are the most common pathogens involved in brain abscesses of neonates. The use of wide spectrum antibiotics in combination with neurosurgical drainage of abscesses larger than 2.5 cm is the mainstay of treatment. Colistin is a polymyxin antibiotic used to treat bacterial infections caused by susceptible gram-negative bacteria but with a limited penetration in blood brain barrier. However, there is limited data on using intraventricular Colistin in neonatal intracranial infections. A 12-day-old male neonate with multiple brain abscesses in frontal and parietal lobes is presented. The abscesses were successfully managed with a combination of intravenous antimicrobial agents, intraventricular Colistin and concurrent administration of Interferon-ɣ. Subsequently, he developed ventriculomegaly which was successfully managed by endoscopic third ventriculostomy. He had an acceptable neurologic outcome. Due to reduced penetration of colistin in blood brain barrier, use of intraventricular Colistin in combination with its intravenous form can be beneficial in management of neonatal brain abscesses. Concurrent administration of Interferon-ɣ may improve the treatment process and outcome given that reduced secretion of this agent by neonatal T lymphocytes may contribute to a partial immunodeficiency state at this period of life.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Intra Ventricular Colistin in Neonatal Brain Abscess Management: A Case of Multiple Brain Abscesses
    AU  - Farhad Abolhasan Choobdar
    AU  - Zahra Soltani
    AU  - Alireza Nateghian
    AU  - Vahid Heidari
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    DO  - 10.11648/j.ajp.20220801.14
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 14
    EP  - 16
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20220801.14
    AB  - Neonatal Brain abscess is a rare sever neonatal infection requiring careful medical and neurosurgical intervention strategies to reduce morbidity and mortality rates. Gram-negative bacterial agents are the most common pathogens involved in brain abscesses of neonates. The use of wide spectrum antibiotics in combination with neurosurgical drainage of abscesses larger than 2.5 cm is the mainstay of treatment. Colistin is a polymyxin antibiotic used to treat bacterial infections caused by susceptible gram-negative bacteria but with a limited penetration in blood brain barrier. However, there is limited data on using intraventricular Colistin in neonatal intracranial infections. A 12-day-old male neonate with multiple brain abscesses in frontal and parietal lobes is presented. The abscesses were successfully managed with a combination of intravenous antimicrobial agents, intraventricular Colistin and concurrent administration of Interferon-ɣ. Subsequently, he developed ventriculomegaly which was successfully managed by endoscopic third ventriculostomy. He had an acceptable neurologic outcome. Due to reduced penetration of colistin in blood brain barrier, use of intraventricular Colistin in combination with its intravenous form can be beneficial in management of neonatal brain abscesses. Concurrent administration of Interferon-ɣ may improve the treatment process and outcome given that reduced secretion of this agent by neonatal T lymphocytes may contribute to a partial immunodeficiency state at this period of life.
    VL  - 8
    IS  - 1
    ER  - 

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Author Information
  • Department of Neonatal Intensive Care, Ali Asghar Children’s Hospital, Iran University of Medical Sciences, Tehran, Iran

  • Department of Paediatrics, Fatemeh Zahra Hospital, Iran University of Medical Sciences, Robat Karim, Iran

  • Department of Paediatric Infectious Disease, Ali Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran

  • Department of Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

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