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Brain abscess caused by Streptococcus intermedius: two case reports
M Yamamoto1, T Fukushima, S Ohshiro
1Department of Neurosurgery, Fukuoka University School of Medicine, Japan.
Background:
Although Streptococcus intermedius has been recognized as an important pathogen for abscess formation outside the central nervous System, the Streptococcus milleri group, of which it is a member, has not been recognized as a specific pathogen for brain abscess, often thought to be caused by Streptococcus viridans, which includes other streptococcal species.
Case Description:
Two cases of brain abscess in the left frontal lobe caused by S. intermedius, which responded well to antimicrobial treatment combined with needle aspiration, are presented. In the first patient, the predisposing disease was paranasal sinusitis of the frontal and ethmoid sinuses. In the second patient, the source of the pathogen was not detected despite extensive examination. The patients underwent aspiration of pus under ultrasound guidance in the first patient, and via a computed tomography-guided stereotactic procedure in the second patient. They subsequently received appropriate antimicrobial therapy against S. intermedius isolated from the pus culture. Both patients were discharged without any neurological deficits.
Conclusion:
It is important to recognize S. intermedius as a pathogen of brain abscess, and to be aware of its predisposing factors, i.e., mucosal disturbance and liver abscess.
Insights
Streptococcus intermedius is an emerging cause of brain abscess, often linked to sinusitis. Prompt diagnosis and treatment with antibiotics and aspiration lead to good outcomes in patients with S. intermedius brain abscess.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Streptococcus intermedius, part of the Streptococcus milleri group, is a known pathogen for abscesses.
- The Streptococcus milleri group is often overlooked as a cause of brain abscess, with Streptococcus viridans being the commonly suspected pathogen.
Observation:
- Two cases of left frontal lobe brain abscess caused by Streptococcus intermedius are presented.
- Predisposing factors included paranasal sinusitis in one patient; the source was undetected in the other.
- Both patients were successfully treated with antimicrobial therapy and needle aspiration (ultrasound-guided or CT-guided stereotactic).
Findings:
- Streptococcus intermedius was successfully identified as the causative agent in both brain abscess cases.
- Effective treatment involved a combination of antimicrobial therapy and surgical aspiration.
- Patients recovered without neurological deficits, highlighting the treatability of these infections.
Implications:
- Clinicians should consider Streptococcus intermedius as a potential pathogen in brain abscess cases.
- Recognizing predisposing factors like mucosal disturbances and liver abscesses is crucial for early diagnosis.
- This study underscores the importance of accurate pathogen identification and tailored treatment for brain abscess management.