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Pyogenic brain abscess caused by Streptococcus pneumoniae: case report and review
1Division of General Internal Medicine, The Toronto Hospital, University of Toronto, Ontario, Canada.
Abstract:
While Streptococcus pneumoniae is the most common cause of bacterial meningitis in adults, cases of pneumococcal brain abscess have rarely been reported. We describe a case of otogenic brain abscess caused by S. pneumoniae that developed in a patient who was receiving ciprofloxacin for the empirical treatment of otitis media. We also review 23 additional cases of pyogenic brain abscess caused by S. pneumoniae that have previously been reported. The development of a pneumococcal brain abscess was associated with a contiguous intracranial focus of infection in 50% of cases. The majority of patients presented with headache (81%) and focal neurological deficits (86%). However, the classic triad of headache, fever, and focal neurological deficits was present in only 24% of patients. The mortality rate for patients with brain abscess caused by S. pneumoniae was 35%; persistent neurological deficits were documented in 40% of patients who survived.
Insights
Pneumococcal brain abscesses, though rare, can occur in adults, often linked to ear infections. Streptococcus pneumoniae can cause serious brain abscesses with significant mortality and long-term deficits.
Area of Science:
- Neurology
- Infectious Diseases
- Otolaryngology
Background:
- Streptococcus pneumoniae is a leading cause of bacterial meningitis in adults.
- Brain abscesses caused by S. pneumoniae are uncommon but serious infections.
Observation:
- A case of otogenic brain abscess caused by S. pneumoniae is presented in a patient treated with ciprofloxacin for otitis media.
- A review of 23 previously reported cases of pyogenic brain abscess caused by S. pneumoniae is included.
Findings:
- Pneumococcal brain abscesses were associated with contiguous intracranial infection in 50% of cases.
- Headache (81%) and focal neurological deficits (86%) were common presenting symptoms.
- The classic triad of headache, fever, and focal neurological deficits was present in only 24% of patients.
Implications:
- The mortality rate for pneumococcal brain abscess is high at 35%.
- Forty percent of survivors experienced persistent neurological deficits.
- Early recognition and treatment are crucial for improving outcomes in pneumococcal brain abscess.