Bilateral Intraorbital Abscesses and Cavernous Sinus Thromboses Secondary to Streptococcus milleri With a Favorable Outcome

Udaondo, Patricia; García-Delpech, S.; Díaz-Llópis, Manuel; Salom, David; García-Pous, Maria; Strottmann, James M.

doi:10.1097/iop.0b013e318182aff7

Cited by 16 publications

(13 citation statements)

References 6 publications

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“…Staphylococcus aureus is the causative agent in more than half of septic CST cases,4 , 12 , 13 most of which arise from sphenoidal and ethmoidal sinus infections 10 , 13. Mixed organisms are usually found in odontogenic sources and these include streptococci (notably of the β haemolytic variety) and anaerobes 8 , 14. Early addition of meropenem and clindamycin was therapeutic for the initial infective focus and CST, and also the septic pulmonary deposits.…”

Section: Discussionmentioning

confidence: 99%

Sudden onset proptosis secondary to cavernous sinus thrombosis from underlying mandibular dental infection

Jones¹,

Arnold

2009

Case Reports

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The present report concerns a patient who presented with a 4-day history of left-sided facial pain arising from a pre-existing dental infection and progressive shortness of breath. The patient had a previous diagnosis of rheumatoid arthritis and was being treated with methotrexate. The rapid development of a right eye proptosis necessitated urgent decompression with a lateral canthotomy and cantholysis. Imaging revealed a left facial abscess, cavernous sinus thrombosis (CST), bilateral internal jugular thrombosis and multiple lung abscesses. Blood cultures yielded Streptococcus constellatus, a member of the Peptostreptococcus family. The patient was admitted to the intensive care unit (ICU) with respiratory failure and septic shock. She was treated with intravenous meropenem and clindamycin, and anticoagulated. Despite early intervention, the patient developed a middle cerebral artery infarct. Over a 3-week period she was gradually weaned from vasopressor and ventilatory support.

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Section: Discussionmentioning

confidence: 99%

Sudden onset proptosis secondary to cavernous sinus thrombosis from underlying mandibular dental infection

Jones¹,

Arnold

2009

Case Reports

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“…Other reported complications of disseminating dental infections include brain abscess (21)(22)(23)(24), septicemia in a patient with multiple myeloma (25), deep neck infection (26,27), mediastinitis (14,(28)(29)(30), necrotizing fasciitis (31)(32)(33), orbital abscess (34)(35)(36), and cervical spondylodiscitis with spinal epidural abscess (37). It has been suggested that some host-related factors may contribute toward increased morbidity and mortality associated with acute dental abscesses, including diabetes, chronic alcohol and tobacco consumption, malnourishment, and the use of illicit substances (26,27,33).…”

Section: Complications Stemming From Acute Apical Abscessesmentioning

confidence: 99%

Microbiology and Treatment of Acute Apical Abscesses

2013

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SUMMARY Acute apical abscess is the most common form of dental abscess and is caused by infection of the root canal of the tooth. It is usually localized intraorally, but in some cases the apical abscess may spread and result in severe complications or even mortality. The reasons why dental root canal infections can become symptomatic and evolve to severe spreading and sometimes life-threatening abscesses remain elusive. Studies using culture and advanced molecular microbiology methods for microbial identification in apical abscesses have demonstrated a multispecies community conspicuously dominated by anaerobic bacteria. Species/phylotypes commonly found in these infections belong to the genera Fusobacterium , Parvimonas , Prevotella , Porphyromonas , Dialister , Streptococcus , and Treponema . Advances in DNA sequencing technologies and computational biology have substantially enhanced the knowledge of the microbiota associated with acute apical abscesses and shed some light on the etiopathogeny of this disease. Species richness and abundance and the resulting network of interactions among community members may affect the collective pathogenicity and contribute to the development of acute infections. Disease modifiers, including transient or permanent host-related factors, may also influence the development and severity of acute abscesses. This review focuses on the current evidence about the etiology and treatment of acute apical abscesses and how the process is influenced by host-related factors and proposes future directions in research, diagnosis, and therapeutic approaches to deal with this disease.

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“…They occur in 1% of orbital and periorbital complications of sinusitis 6. Bilateral intraorbital abscesses are extremely rare, and cases reported are usually associated with virulent pathogens and more serious complications 5,7…”

Section: Discussionmentioning

confidence: 99%

“…Inability to culture organisms is attributed to preceding antibiotic therapy 1,9. The most common pathogen in cases with intracranial complications is Streptococcus milleri 7,8,111.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral intraorbital abscesses with intracranial complications in a young Cameroonian girl: a case report

Abdouramani¹,

Nguefack²,

Dohvoma³

et al. 2012

OPTH

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Background:Intraorbital abscess is a very severe infection with ophthalmologic and neurologic complications that are sometimes life-threatening.Objective:To report the etiologic, clinical, radiologic, and prognostic features of one case of bilateral intraorbital abscesses with intracranial complications.Case report:A 15-year-old Cameroonian girl in a comatose state (11/15 on the Glasgow Coma Scale) with meningeal signs, right hemiplegia, right facial palsy, and bilateral exophthalmia was admitted for meningitis and cerebral abscess secondary to orbital cellulitis. A lumbar tap was carried out, no organisms were seen by Gram stain, and culture was negative due to previous antibiotic therapy. A computed tomography scan showed a left internal capsule infarct and a pansinus opacification. Bilateral superior orbitotomies were performed and the abscess evacuated. Microscopy and culture of surgical material were negative. The patient was discharged 4 weeks after hospital admission with a visual acuity of 0.1 in both eyes, aphasia, and right hemiplegia. Nine months later, there was complete visual recovery (visual acuity 1.0 in both eyes). Anterior and posterior segments were normal on slit-lamp examination. There was no aphasia, but right-sided hemiparesis persisted.Conclusion:The authors emphasize the need for prevention, early diagnosis, and adequate treatment of orbital cellulitis in order to avoid complications.

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Bilateral Intraorbital Abscesses and Cavernous Sinus Thromboses Secondary to Streptococcus milleri With a Favorable Outcome

Cited by 16 publications

References 6 publications

Sudden onset proptosis secondary to cavernous sinus thrombosis from underlying mandibular dental infection

Sudden onset proptosis secondary to cavernous sinus thrombosis from underlying mandibular dental infection

Microbiology and Treatment of Acute Apical Abscesses

Bilateral intraorbital abscesses with intracranial complications in a young Cameroonian girl: a case report

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