title: Bacterial brain abscess in patients with nasopharyngeal carcinoma following radiotherapy: microbiology, clinical features and therapeutic outcomes.
abstract: BACKGROUND
  This study aimed to analyze the clinical features, causative pathogens, neuro-imaging findings, and therapeutic outcomes of bacterial brain abscess in patients with nasopharyngeal carcinoma (NPC) following radiotherapy.
  
  
  METHODS
  NPC patients with bacterial brain abscess were evaluated. Their clinical data were collected over a 22-year period. For comparison, the clinical features, causative pathogens, neuro-imaging findings, and therapeutic outcomes between NPC and non-NPC patients were analyzed.
  
  
  RESULTS
  NPC accounted for 5.7% (12/210) of the predisposing factors, with Viridans streptococci and Staphylococcus aureus as the two most common causative pathogens. Significant statistical analysis between the two groups (NPC and non-NPC patients) included chronic otitis media (COM) as the underlying disease, post-radiation necrosis by neuro-imaging, and the temporal lobe as the most common site of brain abscesses. The fatality rate in patients with and without NPC was 16.7% and 20.7%, respectively.
  
  
  CONCLUSIONS
  NPC patients with bacterial brain abscess frequently have COM as the underlying disease. Neuro-imaging often reveals both post-radiation necrosis and the temporal lobe as the most common site of brain abscesses, the diagnosis of which is not always a straightforward process. Radiation necrosis can mimic brain abscess on neuro-imaging and pose significant diagnostic challenges. Early diagnosis and treatment is essential for survival.
authors.affiliation: Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Peng-Hsiang
authors.initials: PH
authors.lastname: Fang
authors.forename: Wei-Che
authors.initials: WC
authors.lastname: Lin
authors.forename: Nai-Wen
authors.initials: NW
authors.lastname: Tsai
authors.forename: Wen-Neng
authors.initials: WN
authors.lastname: Chang
authors.forename: Chi-Ren
authors.initials: CR
authors.lastname: Huang
authors.forename: Hsueh-Wen
authors.initials: HW
authors.lastname: Chang
authors.forename: Tai-Lin
authors.initials: TL
authors.lastname: Huang
authors.forename: Hsin-Ching
authors.initials: HC
authors.lastname: Lin
authors.forename: Yu-Jun
authors.initials: YJ
authors.lastname: Lin
authors.forename: Ben-Chung
authors.initials: BC
authors.lastname: Cheng
authors.forename: Ben Yu-Jih
authors.initials: BY
authors.lastname: Su
authors.forename: Chia-Te
authors.initials: CT
authors.lastname: Kung
authors.forename: Hung-Chen
authors.initials: HC
authors.lastname: Wang
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D001922:Brain Abscess / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000473:pathology; D002277:Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D011859:Radiography; D011878:Radiotherapy / Q000009:adverse effects*; D016896:Treatment Outcome