Brain Abscess Caused by
            <i>Streptococcus pyogenes</i>
            in a Previously Healthy Child

Dehority, Walter; Uchiyama, Satoshi; Khosravi, Arya; Nizet, Victor

doi:10.1128/jcm.01724-06

Cited by 12 publications

(8 citation statements)

References 12 publications

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“…Intracranial infections caused by S. pyogenes are unusual and nearly always associated with significant meningitis or a contiguous focus. 1-3 Crum 4 and Dehority et al 5 reported a 22-year-old male and a 17-month-old female, respectively, with S. pyogenes brain abscesses following otitis media.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus pyogenes subdural empyema not detected by computed tomography

Viola

Montoya

Arnold

2009

International Journal of Infectious Diseases

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A previously healthy 5-year-old boy presented with a non-specific febrile illness and seizures. Streptococcus pyogenes was identified in his blood culture. The spinal fluid revealed minimal pleocytosis and an axial computed tomography (CT) scan of the head was normal. Ongoing symptoms prompted a magnetic resonance imaging, which revealed a subdural empyema. Our patient diverges from the few previously reported S. pyogenes intracranial infections in that there was neither an adjacent infection nor a bacterial meningitis. In addition, we discuss the few studies addressing the sensitivity of CT for the diagnosis of bacterial intracranial infections.

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Section: Discussionmentioning

confidence: 99%

Streptococcus pyogenes subdural empyema not detected by computed tomography

Viola

Montoya

Arnold

2009

International Journal of Infectious Diseases

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“…There have been five cases reported in the literature regarding brain abscess caused by Streptococcus pyogenes and all had a better prognosis than those caused by the more common CNS pathogens. None of the reported cases had a history of penetrating injury to the cranium 10,11,14,17,21) . We believe that penetrating skull injury has a high risk regarding development of an intracranial abscess.…”

Section: Discussionmentioning

confidence: 99%

“…Med-based search. Two had otitis media while three had no predisposing factors or trauma 10,11,14,17,21) . Our case is the first reported brain abscess caused by penetrating skull injury.…”

Section: Discussionmentioning

confidence: 99%

“…It has rarely been reported as a cause of brain abscess. There have been five reported cases in terms of PubMed-based search but no reported case of brain abscess caused by Streptococcus pyogenes as a result of penetrating skull injury 2,10,11,14,17). Brain abscesses may occur due to different etiologies including a lung abscess in adults, congenital heart disease in children, immunocompromised patients, pulmonary arteriovenous fistulas, bacterial endocarditis, gastrointestinal infections, septic embolization, contiguous spreading such as purulent sinusitis, middle-ear and mastoid air sinus infection 2,6,7,9,12,15,19) .…”

Section: Introductionmentioning

confidence: 99%

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Rapid Development of Brain Abscess Caused by Streptococcus Pyogenes Following Penetrating Skull Injury via the Ethmoidal Sinus and Lamina Cribrosa

Gülşen

Gerilmez

Serhat

et al. 2010

J Korean Neurosurg Soc

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Objective : Streptococcus pyogenes is a beta-hemolytic bacterium that belongs to Lancefield serogroup A, also known as group A streptococci (GAS). There have been five reported case in terms of PubMed-based search but no reported case of brain abscess caused by Streptococcus pyogenes as a result of penetrating skull injury. We present a patient who suffered from penetrating skull injury that resulted in a brain abscess caused by Streptococcus pyogenes. Methods : The patient was a 12-year-old boy who fell down from his bicycle while cycling and ran into a tree. A wooden stick penetrated his skin below the right lower eyelid and advanced to the cranium. He lost consciousness on the fifth day of the incident and his body temperature was measured as 40˚C. While being admitted to our hospital, a cranial computed tomography revealed a frontal cystic mass with a perilesional hypodense zone of edema. There was no capsule formation around the lesion after intravenous contrast injection. Paranasal CT showed a bone defect located between the ethmoidal sinus and lamina cribrosa. Results : Bifrontal craniotomy was performed. The abscess located at the left frontal lobe was drained and the bone defect was repaired. Conclusion : Any penetrating lesion showing a connection between the lamina cribrosa and ethmoidal sinus may result in brain abscess caused by Streptococcus pyogenes. These patients should be treated urgently to repair the defect and drain the abscess with appropriate antibiotic therapy started due to the fulminant course of the brain abscess caused by this microorganism. KEY WORDS :Brain abscess˙ Skull base repairing˙ Penetrating head injury˙ Streptococcus pyogenes˙ Surgical evacuation.

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“…Abscess formation at other sites occurs rarely. Cases of abscesses with S. pyogenes in the brain (6,7,9,17), in the epidural space (10,16), in the mediastinum (5), in the lung (8), in the spleen (4), in the retroperitoneum (11), in the pericolic tissue (15), in muscular tissue (1,3,18), and in periprosthetic breast tissue (14) have been reported. Considering how common S. pyogenes infections are, abscess formation at sites other than those around the tonsils is distinctly uncommon.…”

Section: S Pyogenes or Group A Streptococcusmentioning

confidence: 99%

Axillary Abscess Complicated by Venous Thrombosis: Identification ofStreptococcus pyogenesby 16S PCR

et al. 2010

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We report a case of an axillary abscess with Streptococcus pyogenes complicated by venous thrombosis. Bacterial etiology and typing were obtained by PCR and sequencing of the 16S rRNA and M-protein genes from abscess material. The bacterium was of serotype M41, and serology indicated that it had expressed procoagulant factors. CASE REPORTA 62-year-old woman presented at our department with a 7-day history of fever, chills, and nausea. She was previously healthy, apart from having atopic eczema, and she worked as a technician in a microbiology department handling bacterial specimens. For some months, she had experienced pain in the left part of her thoracic wall, which she related to repetitive movements. Two days prior to admission, she started to feel pain in her left axilla. On the day of admission, she had vomited and suffered from diarrhea. At admission, she had a temperature of 39.5°C. The routine physical examination was normal, except for a slight tenderness upon palpation of the left axilla. There were no signs of erysipelas, lymphangitis, or enlarged lymph nodes in the axilla. Laboratory investigation revealed a white blood cell count of 18 ϫ 10 9 /liter (the neutrophil count was 17 ϫ 10 9 /liter), a C-reactive protein (CRP) level of 53 mg/liter, and normal renal and liver function test results. Coagulation test results were within normal limits, with a PT(INR) [prothrombin time (international normalized ratio)] of 1.1, an aPTT (activated partial thromboplastin time) of 36 s, and a platelet count of 329 ϫ 10 9 /liter. After two aerobic and two anaerobic blood cultures (BacT/Alert; bioMérieux, Durham, NC) and a urinary culture were obtained, the patient was sent home and told to return if she got worse. No antibiotics were prescribed. Blood cultures turned out negative.Seven days later, the patient returned with persistent axillary pain and intermittent chills and was hospitalized. Her body temperature fluctuated between 38.0°C and 39.9°C in the following days. Her white blood cell count was 21 ϫ 10 9 /liter (her neutrophil count was 19 ϫ 10 9 /liter), and her CRP level was 393 mg/liter. Upon examination of the axillary region, pain was provoked by palpation but no enlarged lymph nodes or suspected abscesses were felt and no signs of arthritis were noted. Treatment with cefuroxime and clindamycin was instituted due to suspicion of a soft-tissue infection in the axillary region. A plain X-ray of the shoulder showed degenerative changes in the acromio-clavicular joint, and ultrasonographic examination of the axilla was normal, with no signs of edema in the musculature or in the subcutaneous layer and no signs of abscess. A slight improvement occurred over the following days. Renewed blood cultures taken at the time of admission turned out negative. On the 6th day after admission, a swelling of the left arm developed and venous flebography confirmed the presence of a venous thrombosis in the axillary vein. Coagulation tests were done and showed a PT(INR) of 1.1, an aPTT of 40 s, and a platelet count of 430 ...

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Brain Abscess Caused by Streptococcus pyogenes in a Previously Healthy Child

Cited by 12 publications

References 12 publications

Streptococcus pyogenes subdural empyema not detected by computed tomography

Streptococcus pyogenes subdural empyema not detected by computed tomography

Rapid Development of Brain Abscess Caused by Streptococcus Pyogenes Following Penetrating Skull Injury via the Ethmoidal Sinus and Lamina Cribrosa

Axillary Abscess Complicated by Venous Thrombosis: Identification ofStreptococcus pyogenesby 16S PCR

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