Thesis (M.Sc.(O.T.), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Studies of patients presenting with brain abscess (BA) and Empyema are not routinely focused on occupational therapy (OT). There is a paucity of literature on deficits other than hemiplegia. Aims of this study were to determine the relationship between BA, Empyema, motor and other deficits and whether an OT intervention protocol is needed. Record review was used to establish clinical presentation trends. Hemiplegia was the most common motor deficit and the majority scored below the norm on the Beery- Buktenika Developmental Test of Visual Motor Integration (VMI). Patients with Brain Abscess generally had more significant deficits than those with Empyema for both motor and process deficits. Part B followed up a small sample (n=8) which indicated clinical improvement on the VMI test with the score on the supplemental test of motor coordination remaining a concern. Occupational Therapy is recommended to address these issues based on the Occupational Therapy Practice Framework-II.

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Objectives: Report a novel case of new-onset type 1 diabetes in a pediatric patient presenting with DKA and concurrent Streptococcus intermedius brain abscess. Case presentation: The following case report is that of a previously healthy 12 year-old girl presenting with new-onset type 1 diabetes with mild diabetic ketoacidosis and subsequently found to have a brain abscess. Over the course of her hospital stay, she developed seizures and was found to have a 1.3 × 1.0 × 1.2 cm right frontal parasagittal mass culture-positive for S. intermedius. Neurologic symptoms were unmasked once insulin treatment was initiated and ketosis improved, supporting the relationship between therapeutic ketosis and the management of medication-refractory epilepsy. Conclusions: This case both supports the relationship between therapeutic ketosis and the management of medication-refractory epilepsy and highlights the need to carefully consider comorbid conditions in patients with DKA and new onset neurological symptoms.

Proton magnetic resonance spectroscopy has been widely applied to the diagnosis of brain diseases. In the meanwhile, the classification of brain abscesses plays an important role on the accurate prognosis in clinics. Recently, the interest in using proton MRS to classify pyogenic brain abscesses has been arising because of its non-invasive property and good accuracy in detecting metabolites. The brain abscess can be classified by means of the metabolites observed in the MR spectra, which may thus benefit the accuracy of the brain abscess diagnosis clinically. However, the interpretation of MR spectra by experienced radiologists can be also very subjective and therefore results in the variation of diagnosis. In this study, we investigate the potential possibility of using Principal Component Analysis (PCA) to classify the short TE MR spectra in more objective way.

Magnetic Resonance Imaging (MRI) can obtain the tissues of in vivo non-invasively. Proton MR Spectroscopy uses the resonance principle to collect the signals of proton and transforms them to spectrums. It provides information of metabolites in patient¡¦s brain for doctors to observe the change of pathology. Observing the metabolites of brain abscess patients is most important process in clinical diagnosis and treatment. Then, doctors use different spectrums of echo time (TE) to enhance the accuracy in the diagnosis. In our study, we use independent component analysis (ICA) to analyze MR spectroscopy. After analyzing, the independent components represent the elements which compose the input data. Then, we use the projection which is mentioned by Ssu-Ying Lu¡¦s Thesis to help us observe the relationship between independent components and spectrums of patients. We also discuss the result of spectrums with using ICA and PCA and discover some questions (whether it need to do scale normalization before inputting data or not, the result of scale normalization doesn¡¦t expect, and the peak in some independent components confuse us by locating in indistinct place) to discuss and to find possible reason after experiments.

Objectives: Intracranial subdural empyema (ICSDE) can be a devastating condition, with a sequelae ranging from epilepsy, focal deficits to death. Factors affecting the outcome in subdural empyema range from level of consciousness, the extend of subdural pus at the time of diagnosis and the type of surgical procedure performed. Previous studies have conflicting results of unfavourable prognostic factors associated with ICSDE. The outcome of this condition at Steve Biko Academic Hospital (SBAH) is reported, as well as factors influencing the outcome. Methods: A retrospective analysis of all the patients admitted at neurosurgery unit of SBAH during 2006 – 2010 period with confirmed subdural empyema on brain CT scan and at surgery. Data sheet was used to collect all clinical information from patients’ records. Glasgow Outcome Scale and Henk W. Mauser grading were used to report on the outcome. Results: A total of 34 patients (20 males and 14 females) with mean age of 16.1 years were admitted with a diagnosis of ICSDE. The common presenting features were headache (58.8%), fever and seizures (47.0% each). Over 61% of patients had hemiplegia at presentation. CT scan confirmed subdural collections with 70.6% over the convexity, 23.5% at the convexity and parafalx and only 5.9% had bilateral collections. Complicated paranasal sinusitis was the origin of infection in 82.3%, followed by meningitis with 8.8%. Burr hole washout was done in 52.9% of patients, while 38.2% had burr holes with drains in situ and 8.8% had craniotomy to evacuate the subdural pus. All the patients were given empiric triple antibiotic therapy. Streptococci species were the most cultured organisms in the 19 (56.0%) patients who had positive cultures, however 15 (44.0%) patients had negative cultures. Resistance to penicillin was noted in 5.0% of cases only. Sixty-five percent of patients had good outcome with no seizures nor neurological deficits. The overall mortality was 15.0% in this study, with none from patients who had craniotomy. Conclusion: Clinical presenting features and organisms cultured seems to be the same internationally, particularly those due to complicated sinusitis. Empiric triple antibiotic therapy of 3rd generation cephalosporin plus vancomycin plus metronidazole is still relevant at SBAH. Factors associated with favourable outcome were ages between 11 and 20 years, and craniotomy as the surgical procedure of choice. / Dissertation (MMEd)--University of Pretoria, 2013. / Neurology / Unrestricted

Les abcès cérébraux sont des infections potentiellement mortelles, entraînant souvent des séquelles graves. La prise en charge médicale en reste empirique en raison d’un manque de connaissance approfondie des microorganismes responsables de cette condition. Dans la plupart des laboratoires microbiologiques, le diagnostic d’abcès cérébral est basé sur la culture du pus recueilli chirurgicalement. Malheureusement, cette procédure a de nombreuses limites et ne permet l’identification que d’une petite partie de la population microbienne en cause. L’amplification par PCR et le séquençage du gène codant la fraction 16S de l’ADN ribosomal ont récemment été utilisées pour surmonter les limites de la culture, et ont été démontré leur efficacité dans la documentation des infections bactériennes. Malheureusement, cette procédure présente un degré de discrimination limité en cas d’infection polymicrobienne. Des études métagénomiques de flores complexes de l’homme, basées sur une combinaison de PCR, clonage et séquençage des produits de PCR se sont avérées utiles pour évaluer la diversité bactérienne des flores dentaires, vaginales et intestinales. Nous avons appliqué cette technique à des échantillons d’abcès cérébral pour étudier la flore associée à cette maladie. Dans une première étape, nous avons réalisé une enquête en utilisant la culture et les techniques moléculaires. Le but de cette étude était d’analyser et d’évaluer les bactéries de la flore responsable des abcès cérébraux, en comparant la culture à trois techniques moléculaires basées sur le gène 16S rDNA, incluant le séquençage direct, le clonage suivi de séquençage par méthode de Sanger, et le séquençage direct des produits de PCR par pyroséquençage. Cette enquête a déterminé que la variété des espèces bactériennes associée aux abcès cérébraux est beaucoup plus grande que précédemment décrite, et inclut de nombreuses bactéries anaérobies et des bactéries incultivables de la flore buccale. Cette étude préliminaire a identifié 49 agents bactériens différents, et a permis l’identification de 27 bactéries jamais détectées auparavant dans des abcès du cérébraux, dont 15 n’avaient jamais été cultivées. Un tel nombre d’espèces bactériennes impliquées dans les abcès cérébraux a motivé l’étude de 51 nouveaux spécimens dans le but de décrire plus en détail la flore associée aux abcès cérébraux en fonction de leurs étiologies. Ainsi, nous avons effectué une analyse métagénomique, basé sur le gène 16S rDNA, de 51 patients ayant développé un abcès cérébral. Notre stratégie a été beaucoup plus discriminatoire et a permis à l’identification d’un plus grand nombre de bactéries que la culture et l’amplification et le séquençage direct de l’ANRr 16S. La combinaison des données de 71 patients (20 de la première étude et 51 de la deuxième étude) a permis l’identification de plusieurs associations à l’aide de la méthode de data mining.En outre, notre étude a permis l’identification de deux nouvelles bactéries, la première étant une nouvelle espèce de genre Staphylococcus (Staphylococcus massiliensis) et la seconde étant une bactérie anaérobie qui représente une nouvelle espèce dans un nouveau genre au sein du phylum des Bacteroidetes (Phocaeicola abscesses). En outre, nous avons décrit deux cas inhabituels d’abcès du cerveau, à Mycoplasma hominis après curetage utérin, et à Nocardia carnea chez un greffé rénal. Malgré les limites inhérentes à la procédure de clonage, nos résultats suggèrent que le clonage et le séquençage de gène DNAr 16S est une méthode très performante pour identifier les agents bactériens associés aux abcès cérébraux. / Brain abscess is a life-threatening infection with frequent serious sequelae. The medical management remains empirical due to a lack of comprehensive knowledge of the microorganisms responsible for this condition. In most microbiology laboratories the diagnosis of brain abscess is based on culture from pus collected surgically. Unfortunately, this procedure has many limitations and reveals only a small portion of the true microbial population. PCR-amplified 16S rDNA sequencing has recently been used to overcome the limitations of culture-based bacterial detection in brain abscess pus, and it was demonstrated to be effective in the documentation of monomicrobial infections. Unfortunately, this procedure failed to discriminate among polymicrobial floras.Metagenomic studies of complex human floras using a combination of 16S rDNA PCR and cloning-sequencing of PCR products proved useful to evaluate the bacterial diversity of dental, vaginal and intestinal floras. Thus, we applied this technique to brain abscess samples to study the flora associated with this condition. In a first step, we performed an investigation using culture and molecular techniques. The purpose of this investigation was to analyze and evaluate the bacterial flora responsible for brain abscess by comparing standard culture technique to three techniques using 16S rDNA amplification, that is, direct sequencing, multiple sequencing following cloning, and multiple sequencing via high throughput pyrosequencing. This investigation has determined that the variety of brain abscess-associated bacterial species is much larger than previously reported, and it includes many anaerobes and uncultured bacteria from the oral cavity flora. This preliminary study identified 49 distinct brain abscess bacterial agents, and enabled the identification of 27 bacteria never detected before in brain abscess, 15 of which were uncultured.Such a high number of bacterial species involved in brain abscess prompted the study of 51 new specimens in an effort to describe further the flora associated with brain abscesses and their etiologies. Thus, we performed a 16S rDNA-based metagenomic analysis of cerebral abscesses from 51 patients. Our strategy was significantly more discriminatory and enabled the identification of greater number of bacterial taxa, than culture and conventional 16S rDNA PCR/sequencing, respectively. The combination of data from 71 patients (20 from the first study and 51 from the second study) enabled the identification of several associations using the data mining analysis. Also, these studies permitted the identification of two novel bacteria, the first being a novel Staphylococcus species (Staphylococcus massiliensis) and the second being a novel anaerobic bacterium that represents a novel species in a new genus within the phylum Bacteroidetes (Phocaeicola abscesses). In addition, we reported tow unusual cases of brain abscess, the first case was a Mycoplasma hominis brain abscess following uterus curettage and the second case was a Nocardia carnea infection in a kidney transplant recipient patient.Despite limitations inherent to the cloning procedure, our results suggest that cloning and sequencing of PCR-amplified 16S rDNA is a highly valuable method to identify bacterial agents of brain abscesses.