Friday, February 17, 2017

Why does cyanotic heart disease predispose to brain abscess?

Ever wondered why cyanotic heart disease predisposes to brain abscesses?

Cyanotic heart disease allows blood to flow from the right side of the heart to the left side without passing the lungs. You see, the lungs is like a filter. Bacteria in the bloodstream are normally filtered through the pulmonary circulation, where they are be removed by phagocytosis.

Also, hypoxaemia, metabolic acidosis and increased blood viscosity from compensatory polycythemia from the cyanotic heart disease results in low perfusion areas (microinfarcts) in the brain. It's like a perfect little space for bacteria to grow. Microinfarcts provide a milieu where seeded microorganism can sustain growth and multiply to form abscess.

Interesting, isn't it?

Extra facts:
1. Anaerobic streptococci like Streptococcus milleri is the most common organism isolated from the abscess in patients with cyanotic heart disease.
2. Because most of these patients present only with headache, the threshold for performing a CT scan in a patient with cyanotic heart disease should be low.


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