BRAIN ABSCESSES IN CHILDREN WITH CANCER

Background. Brain abscesses in pediatric patients are rare events, and the causative organism and prognosis vary with the population under s tudy. Children with cancer seem to be particularly susceptible to the development of brain abscesses because of the immunological changes in duced by cancer and its treatment. We reviewed the records of children who developed a brain abscess during treatment of a malignancy to def ine the clinical characteristics, prognosis, and management of these p atients. Procedure. We performed a retrospective review of the clinica l and laboratory characteristics of all cancer patients younger than a ge 20 years who were admitted to our institution between 1980 and 1996 for a brain abscess. Results. Twelve children were identified. Cancer diagnoses were brain tumor in two, systemic PNET in two, and leukemia in eight. Six patients had multiple abscesses. Eleven received prior chemotherapy. Abscesses were surgically excised or aspirated in seven, and empiric antibiotics were given to the other five. At surgery, Lis teria monocytogenes, Aspergillus fumigatus (3), Fusarium, and Candida lusitanea were cultured. Aspergillus was identified in other locations in four patients. Abscesses were successfully treated in seven patien ts, two of whom received antibiotics only; five patients (42%) died fr om infection. Conclusions. Mortality is high in this immunosuppressed population, in part due to the preponderance of fungal infection. The finding of very rare organisms suggests that drainage and culture shou ld be performed whenever possible; empiric antibiotics that include an antifungal agent may, on occasion, be successful. (C) 1998 Wiley-Liss , Inc.