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 Table of Contents  
CASE REPORTS
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 40-42

Penicillium chrysogenum: A rare cause of cerebral abscess


Department of Microbiology, Armed Forces Medical College, Pune, Maharashtra, India

Date of Submission21-Dec-2021
Date of Decision29-Jul-2022
Date of Acceptance06-Jun-2022
Date of Web Publication19-Sep-2022

Correspondence Address:
Neha Singh
Department of Microbiology, Armed Forces Medical College, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/DYPJ.DYPJ_79_21

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  Abstract 

Brain abscess is a severe intracranial infection with a very high mortality rate and usually secondary to an external infection. Fungal infections are now been increasingly reported especially with Candida sp. We present a case of brain abscess in a 63-year-old woman, which was managed successfully by surgical evacuation and was diagnosed radiologically as a fungal infection and on culture detected to have Penicillium chrysogenum.

Keywords: Brain abscess, fungal infections, Penicillium


How to cite this article:
Singh N, Anand KB, Sondhi A. Penicillium chrysogenum: A rare cause of cerebral abscess. D Y Patil J Health Sci 2022;10:40-2

How to cite this URL:
Singh N, Anand KB, Sondhi A. Penicillium chrysogenum: A rare cause of cerebral abscess. D Y Patil J Health Sci [serial online] 2022 [cited 2022 Oct 6];10:40-2. Available from: http://www.dypatiljhs.com/text.asp?2022/10/1/40/356519




  Introduction Top


Brain abscess is a severe intracranial infection with a prevalence rate of 0.4–0.9 per 100,000 population and a high mortality rate.[1],[2] It usually results from the invasion of an external infection. In recent years, invasive fungal infections have become increasingly common. A number of cases have been reported with rare fungal infections especially in immunocompromised and even in normal patients. We present a case of brain abscess in a 63-year-old woman, which was diagnosed radiologically, and on culture, it was detected to be caused by Penicillium chrysogenum.


  Case Report Top


A 63-year-old woman, a known case of hypertension and type 2 diabetes mellitus with a poor compliance of medications, presented with a history of fever with chills of 8-day duration associated with a history of otalgia and pus discharge from the left ear for which she was on medication by a local practitioner. The patient also gives a history of acute onset headache, giddiness, and vomiting. The patient also noticed facial deviation toward the right side. The patient was brought to emergency department with altered sensorium. On examination, the patient was conscious, well-oriented with vitals within normal limits with no signs of meningitis. The patient had sixth and seventh cranial nerves palsy with rest of the systemic examination normal. Ear nose and throat examination was unremarkable. Non contrast computerized tomography (NCCT) head ill-defined hypodense lesion in the left temporal lobe of 2.9 × 2.8 × 3.2 cm with perilesional vasogenic edema and mass effect and a midline shift of 2 mm [Figure 1]. There is a possibility of intraventricular dermoid and intra-axial mass with lipomatous transformation. Contrast-enhanced magnetic resonance imaging of brain revealed brain abscess in the left temporal lobe, likely fungal. Hematological and biochemical parameters were within normal limits. The patient was managed with a broad spectrum of antibiotics and antifungals with antiedema measures and antiepileptics and steroids. The patient underwent decompressive craniotomy. Intraoperative findings were: 10 mL of thick mucoid pus was drained from temporal region and pus culture indicated [Figure 2]. 10% potassium hydroxide showed a broad aseptate hyphae with acute angle branching. The growth on Sabouraud dextrose agar [Figure 3] at 37°C showed white-colored colonies, cottony in texture with olive gray reverse. Grocott’s methenamine silver prepared from the growth showed aseptate hyphae with acute angle branching. The speciation was done by matrix assisted laser desorption ionization-time of flight, which showed the causative organism to be Penicillium chrysogenum. Repeat NCCT head showed no lesion in temporal region. The patient was managed with a broad spectrum of antibiotics and liposomal amphotericin B. Presently, the clinical condition of the patient improved and has been discharged from the hospital.
Figure 1: Non contrast computerized tomography head revealing hypodense lesion in left temporal lobe with midline shift

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Figure 2: Potassium hydroxide mount revealing broad aseptate hyphae with acute angle branching

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Figure 3: Growth on Sabouraud dextrose agar at 37°C

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  Discussion Top


Brain abscess is a severe, life-threatening intracranial infection with a male-to-female ratio of 1.5:3.4/1.[3],[4] It commonly manifests as headache, fever, and focal cerebral signs. The patient may also suffer from an epileptic attack.[5] Its common sources of infection may be by a direct invasion or through hematogenous routes and may also be cryptogenic. With the advent of the use of antibiotics, the incidence of otitis media is decreasing, and the rates of cryptogenic brain abscess are gradually increasing. A number of cases of fungal brain abscess are also been reported with infection by Candida sp. Our case was detected to have Penicillium chrysogenum, which is the rare cause of cerebral abscess [Figure 4].
Figure 4: Grocott’s methenamine silver showing broad aseptae hyphae with acute angle branching

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The therapies for brain abscess include medication and surgery. Treatment via medication is suitable only during the early suppuration stage, for small abscesses (diameter below 2.5 cm), when no apparent increase in intracranial pressure, or for multiple brain abscesses without apparent space occupation.[6] The surgical approaches for brain abscess include puncture aspiration and stereotactic resection.


  Conclusion Top


Fungal infection is a rare cause of brain abscesses with a very high mortality rate of 70% despite combined surgical and antifungal therapy. A high index of suspicion is required to diagnose the condition, and multimodal treatment is required for the same.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nicolosi A, Hauser WA, Musicco M, Kurland LT Incidence and prognosis of brain abscess in a defined population: Olmsted County, Minnesota, 1935-1981. Neuroepidemiology 1991;10:122-31.  Back to cited text no. 1
    
2.
Helweglarsen J, Astradsson A, Richhall H, Erdal J, Laursen A, Brennum J Pyogenic brain abscess, a 15 year survey. BMC Infect Dis 2012;12:332.  Back to cited text no. 2
    
3.
Lu CH, Chang WN, Lin YC, Tsai NW, Liliang PC, Su TM, et al. Bacterial brain abscess: Microbiological features, epidemiological trends and therapeutic outcomes. QJM 2002;95:501-9.  Back to cited text no. 3
    
4.
Nathoo N, Nadvi SS, Narotam PK, van Dellen JR Brain abscess: Management and outcome analysis of a computed tomography era experience with 973 patients. World Neurosurg 2011;75:716-26.  Back to cited text no. 4
    
5.
Zhang C, Hu L, Wu X, Hu G, Ding X, Lu Y A retrospective study on the aetiology, management, and outcome of brain abscess in an 11-year, single-centre study from China. BMC Infect Dis 2014;14:311.  Back to cited text no. 5
    
6.
Arlotti M, Grossi P, Pea F, Tomei G, Vullo V, De Rosa FG, et al. Consensus document on controversial issues for the treatment of infections of the central nervous system: Bacterial brain abscesses. Int J Infect Dis 2010;14(suppl 4):S79-92.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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