Risk of mortality, epilepsy higher in youths with brain abscess

Children and young adults with brain abscess have a higher risk of mortality for up to 5 years, according to a study, which notes new-onset epilepsy in 28 percent of survivors and its persisting risk several years following infection.

Nationwide, population-based medical registries were used to identify all individuals aged <20 years who were hospitalized with first-time diagnosis of brain abscess in Denmark from 1982 to 2016. The authors also included a comparison cohort matched for age, sex and residence, as well as siblings of all study participants.

Cumulative incidence curves of mortality and new-onset epilepsy were then constructed. Finally, Cox regression was used to estimate hazard rate ratios (HRRs) with 95 percent confidence intervals (CIs).

Overall, the population comprised 155 brain abscess patients and 1,550 population controls, with median follow-up times of 15 years (interquartile range [IQR], 6–25) and 16 years (IQR, 11–26). The most common predisposing conditions for brain abscess were ear–nose–throat infections (22 percent) and congenital heart disease (13 percent).

Overall mortality stood at 14 percent (21/155) in brain abscess patients compared with just 1 percent (20/1,550) in population controls. The corresponding HRRs were 150 (95 percent CI, 19.8–1,116) after 1 year of observation, 24.6 (95 percent CI, 4.78–127) after 2–5 years, and 0.66 (95 percent CI, 0.09–4.98) after 6–30 years.

New-onset epilepsy occurred in 28 percent of 30-day brain abscess survivors compared with 1 percent in controls, yielding an HRR of 29.6 (95 percent CI, 14.4–60.8) adjusted for previous head trauma, stroke, and cancer. In analyses of sibling cohorts, family-related factors failed to explain the observed increased risks of death or epilepsy among brain abscess patients.