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Case 2 developed infection had a median survival of 30 months
A 22-year-old man underwent a brain MRI because of whereas patients without postoperative infection had
seizures. The MRI revealed a 5 cm × 3.2 cm × 4.3 cm a median survival of 15 months. The difference was
left frontal lesion. The lesion had a heterogeneous cystic statistical significant. In 5 cases there was a surgical
and solid appearance that enhanced after gadolinium abscess, in 3 cases abscess and wound infection and in
administration. The patient underwent surgical 2 cases surgical wound and bone flap infection required
resection, and gross total excision was performed. surgical revision. In 6/10 cases Staphylococcus aureus
Histological examination revealed the presence of an was isolated. In the present study, the patient with
[2]
astrocytoma Grade II. Postoperative radiation treatment glioblastoma had an overall survival of 42 months. In
was administered. On follow-up MRI 7 years later a a previous study in our institute, the median survival
lesion suspicious for tumor recurrence was noted. The of patients with glioblastoma was 15.5 months.
[8]
patient was re-operated, and the histology revealed the Bowles et al. also reported 4 cases of malignant brain
presence of an anaplastic oligoastrocytoma. The patient tumors with prolonged survival after postoperative
received TMZ-based chemotherapy. Nevertheless, infection. In those cases, Enterobacter aerogenes was
28 months later the patient had uncontrolled seizures. isolated. The authors suggested that in addition to the
Brain MRI demonstrated a lesion suspicious of tumor bacteria direct oncolytic effect, an immune adjuvant
recurrence. Brain SPECT with 99m Tc-tetrofosmin responses to tumor suppression might play a role.
[4]
was positive for recurrent disease. The patient was Nevertheless, Bohman et al. did not find a survival
re-operated. A new recurrence was noted 23 months advantage in 18 patients with postoperative infection
later, and the patient re-operated, carmustine after glioblastoma resection out of 382 patients included
wafers were placed around the resection cavity. in their study. [9]
Postoperatively, the patient had fever and discharge
from the wound. Brain CT showed findings consistent Regarding experimental data, a recent study showed
with infection and there was contrast enhancement. that intracerebrally implanted heat-inactivated
The patient was re-operated, and craniectomy was staphylococcal epitopes mixed with 9L gliosarcoma
performed. Cerebrospinal fluid cultures showed cells in Wistar rats, resulted in significant prolong
the presence of Staphylococcus epidermidis (CoNS) survival than controls. In one case there was complete
resistant to penicillin, oxacillin, erythromycin and regression of an already grown mass. [10] William Coley,
clindamycin. After proper antibiotic treatment, the a pioneer in immunotherapy, was the first injecting a
patient improved. The patient did not show any sign of mixture of live streptococcus bacilli and subsequently
the tumor reappearance for 37 months until recurrence heat-killed Streptococcus into tumors and managed
was noted. Two months later he died. The overall to induce remission of inoperable sarcomas. [11] This
survival was 14 years.
vaccine was also successful in cases of melanoma
DISCUSSION and lymphomas. [12] According to Coley, the induction
of fever was a key element. [12] The inflammation
cascade induced by bacteria and the presence of
High-grade gliomas are the most common brain tumors
in adults and are highly malignant. Treatment includes factors such as interferon-alpha, tumor necrosis
[2]
surgery, postoperative radiotherapy, and concomitant factor-alpha, interleukin-2, have been considered
and adjuvant chemotherapy. Nevertheless, even as the cause of this effect. [12] Tanaka et al. injected
[2]
receiving the same treatment, the clinical outcome intratumorally an immunopotentiator, Picibanil, in
[1]
of patients varies significantly. Age, 1p19q deletion 13 patients with brain tumors. [13] Picianil was a low
status and isocitrate dehydrogenase (IDH) mutational virulent mutant strain of Lancefield’s Type 111, Group A
status are of prognostic significance. [5,6] Streptococcus pyogenes. The results showed significant
tumor regression in 6/12 patients for whom CT was
A survival benefit for patients that developed performed. [13] More recently, Jeys et al. investigated
postoperative infection in the tumor removal site has the effect of postoperative infection in patients treated
been reported. [3,4] Postoperative infection is generally for osteosarcoma, using endoprosthetic replacement
considered when wound and/or bone flap infection, and neo-adjuvant chemotherapy. The results showed
cerebral abscess, or meningitis, occur within 2 months that patients who developed an infection had a
[2]
from surgery. Its incidence has been reported to significantly longer survival. Furthermore, infection
range between 0.75% and 2.3% for intracranial was an independent prognostic factor on cox regression
operations. De Bonis et al. studied 197 patients analysis. [14] Ruckdeschel et al. reported improved
[7]
operated for glioblastoma and found 10 cases of survival rates for patients who developed the empyema
postoperative bacterial infection. Patients that after lung cancer compared with noninfected patients. [15]

Neuroimmunol Neuroinflammation | Volume 2 | Issue 1 | January 15, 2015 19