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Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 900-901
Intraparenchymal temporal lobe abscess caused by group F streptococci


1 Department of Microbiology, PSG Institute of Medical Science and Research, Peelamedu, Coimbatore, Tamil Nadu, India
2 Department of Neurosurgery, PSG Institute of Medical Science and Research, Peelamedu, Coimbatore, Tamil Nadu, India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Appalaraju B, Mathews AA, Thomas M, Rajkumar P R. Intraparenchymal temporal lobe abscess caused by group F streptococci. Indian J Pathol Microbiol 2010;53:900-1

How to cite this URL:
Appalaraju B, Mathews AA, Thomas M, Rajkumar P R. Intraparenchymal temporal lobe abscess caused by group F streptococci. Indian J Pathol Microbiol [serial online] 2010 [cited 2020 Nov 28];53:900-1. Available from: https://www.ijpmonline.org/text.asp?2010/53/4/900/72057


Sir,

The group F streptococci are gram-positive, facultative anaerobic cocci that naturally inhabit the genitourinary tract. Group F streptococci are known for their propensity to cause tissue abscesses. [1] Brain abscess, a serious life-threatening infection of brain parenchyma, results from spread of infection from contiguous nonneuronal tissue, hematogenous seeding, or a direct introduction into the brain. Predisposing factors identified include congenital heart disease, infections of the middle ear, mastoid, paranasal sinuses, orbit, face, and scalp, and cranial infections. [2]

A 67-year-old male patient presented with ear discharge, inability to walk, fever, and slurring of speech for 15 days. No history of vomiting, headache, photophobia or visual disturbances, convulsions, nystagmus, or any other relevant symptoms or of diabetes or hypertension was revealed. The patient was not immunocompromised either. There was no other relevant history. On examination, he was febrile with temperature of 39°C, and had dysphasia and hemiparesis. His blood pressure was 110/70 mm of Hg. His chest and abdomen examination was within normal limits. No other abnormality was detected. Computerized tomography (CT) scan revealed a hypodense area on the left side with ring enhancement [Figure 1]. Diagnosis was made as intraparenchymal left temporal lobe abscess with left mastoiditis. Craniotomy was done and the drained pus sample was sent for culture and sensitivity. Gram-stained smear showed plenty of pus cells and gram-positive cocci in chains. The samples inoculated on blood agar, chocolate agar, thioglycollate broth and macconkey agar yielded b-hemolytic colonies on blood agar upon incubation at 37°C. Gram stain of the colony revealed gram-positive cocci in chains. The isolate was bacitracin resistant and CAMP test negative. Upon serogrouping with Strep Test kit (Plasma Tec, UK), the isolate was found to be group F streptococci. The anaerobic culture of the sample yielded no growth. The patient was earlier treated with cebanex, amikacin, and metrogyl which were later changed to levofloxacin based on the sensitivity report. The organism was sensitive to clindamycin, erythromycin, levofloxacin, and cotrimoxazole and resistant to penicillin. Ear swab and blood culture were sterile. Inclusion criteria of bacterial brain abscess were (i) characteristic computerized tomography (CT) and/or magnetic resonance imaging (MRI) findings; (ii) evidence of brain abscess seen during surgery or histopathological examination; and (iii) classical clinical manifestations including headache, fever, localized neurological signs, and/or consciousness disturbance. [2] The patient's condition fulfilled all the three criteria. The patient's condition improved after drainage and antibiotics.
Figure 1: CT scan shows the hypodense area on the left side with ring enhancement

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Brain abscess is an important neurological disease with high mortality and morbidity. Streptococcus viridans is the most common causative organism of bacterial brain abscess. Other causes include gram-positive bacteria such as staphylococcus and Mycobacterium tuberculosis and gram-negative bacteria such as Proteus, Pseudomonas, etc. Certain fungi such as Candida, Aspergillus, and Cryptococcus were also isolated from few cases. Beta-hemolytic streptococci rarely cause brain abscess which include Streptococcus pyogenes. Here we are reporting a rare case of group F streptococci causing brain abscess.

There are many reports of temporal lobe cerebral abscess following chronic suppurative otitis media. [3] In this case the patient gave a history of ear discharge but no pathogen was isolated from the discharge. Whether the group F streptococci isolated from the abscess have come from the ear can only be speculated upon. Group F streptococcus has been documented as a pathogen in dental abscess, meningitis, liver abscess, and wound infection especially after appendicectomy, peritonitis. Group F streptococci have also been isolated from Bartholin's abscess and intramedullary abscess [4],[5] and bacteremia cases. [1]

In this case, the patient condition improved but had hemiparesis as the sequela of cerebral abscess. The patient was on treatment with antibiotics and physiotherapy for more than a month after surgery. The rupture of abscess into ventricles or subarachnoid space is a fatal complication. Fortunately in our patient, timely surgical intervention prevented such complications.

 
   References Top

1.Libertin CR, Hermans PE, Washington JA 2 nd . Beta hemolytic Group F streptococcal bacteremia: A study and review of literature. Rev Infect Dis 1985;7:498-500.   Back to cited text no. 1
    
2.Lu CH, Chang WN, Lin YC, Tsai NW, Liliang PC, Su TM, et al. Bacterial brain abscess: Microbiological features, epidemiological trends and therapeutic outcomes. QJM 2002;95:501-9.  Back to cited text no. 2
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3.Kangsanarak J, Navacharoen N, Fooanant S, Ruckphaopunt K. Intracranial complications of suppurative otitis media: 13-years experience. Am J Otol 1995;16:104-9.  Back to cited text no. 3
[PUBMED]    
4.DeAngelo AJ, Dooley DP, Skidmore PJ, Kopecky CT. Group F streptococcal bacteremia complicating a Bartholin's abscess. Infect Dis Obstet Gynecol 2001;9:55-7.   Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Vora YA, Raad II, McCutcheon IE. Intramedullary abscess from group F Streptococcus. Surg Infect (Larchmt) 2004;5:200-4.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
Anila A Mathews
Department of Microbiology, PSG Institute of Medical Science and Research, Peelamedu, Coimbatore - 641 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72057

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