Streptococcus pyogenes’e Bağlı İnfantil İntraparankimal Beyin Apsesi
Year 2024,
Volume: 12 Issue: 3, 83 - 87, 29.10.2024
Meltem Kıymaz
,
Gülsüm Alkan
,
Büşra Özyalvaç
,
Ayşe Gül Yücel
,
Mehmet Öztürk
,
Saime Sündüs Uygun
,
Murat Konak
,
Derya Karaoğlu Gündoğdu
,
Melike Emiroğlu
Abstract
Giriş
A grubu beta hemolitik streptokoklar (AGBHS) tonsillofarenjitin en sık bakteriyel etkenidir, farenjit ve impetigo gibi noninvaziv hastalıklardan, daha ağır seyirli invaziv enfeksiyonlara neden olabilmektedir. İnvaziv hastalık insidansı yılda 1-3/100.000’tür, morbidite ve mortalite oranı yüksektir. AGBHS’lar nadiren beyin apselerine yol açabilir.
Olgu
Ateş, irritabilite ve fokal nöbet ile başvuran 40 günlük hastanın akut faz reaktanları yüksek bulundu. Transfontanel ultrasonografisinde meninkslerde kalınlık, eko ve kanlanma artışı izlendi. Beyin MR ve difüzyon MR’da sağ serebral hemisferde, parietooksipital parankimde kalın duvarlı, diffüzyon ağırlıklı görüntülerde diffüzyon kısıtlılığı bulunan, apse saptandı. Beyin omurilik sıvısı (BOS) polimeraz zincir reaksiyonu testinde S. pyogenes saptanırken, BOS kültüründe S. pyogenes üredi. Ampirik başlanan meropenem, vankomisin, metronidazol kültür antibiyogram sonrası sefotaksim ve vankomisin olarak 8 haftaya tamamlandı. Nöbetleri geriledi, kontrol beyin görüntülemesinde iyileşme izlendi. Sol alt ekstremite hareketlerinde kısıtlılık kalan hasta fizik tedavi ve rehabilitasyon önerileri ile taburcu edildi.
Sonuç
Akut tonsillofarenjit etkeni olan AGBHS’lar nadiren mortalitesi ve morbiditesi yüksek olan invaziv hastalığa yol açabilmektedir.
References
- 1. Kaplan LE, Krugman S. Streptococcal infections group A. In: Krugman S, Katz LS, Gershon AA, Wilfert MC, editors. Infectious diseases of children. 9th edition St. Louis, Missouri: Mosby;1992. p. 483-94.
- 2. Kızılyıldırım, S. İnvaziv A grubu streptokok enfeksiyonlarından sorumlu suşlarda emm ve süperantijen genotiplerinin dağılımı, klinik korelasyonu ve filogenetik ilişkilerinin tespiti. [Doktora tezi]. Adana: Çukurova Üniversitesi, Sağlık Bilimleri Enstitüsü, 2017.
- 3. Committee on infectious diseases, American Academy of Pediatrics. Group A streptococcal infections. In: Peter G, editors. Red book report of the committeee on infectious diseases. 24th edition, 1997:483-94.
- 4. Todd J. Streptococcal infections. In: Nelson WE, Behrman RE, Kliegman RM, Arvin AM, editors. Nelson Textbook of Pediatrics 15th ed. Philadelphia: WB Saunders; 1996:750-4.
- 5. Mameli C, Genoni T, Madia C et al. Brain abscess in pediatric age: a review. Childs Nerv Syst. 2019;35(7):1117-28.
- 6. Shachor-Meyouhas Y, Bar-Joseph G, Guilburd JN et al. Brain abscess in children - epidemiology, predisposing factors and management in the modern medicine era. Acta Paediatr 2010; 99(8):1163-7.
- 7. Laleoğlu P, Erbaş İ, Özdem Alataş Ş et al. “İnvaziv Grup A Streptokok Tanılı Çocuk Olguların Klinik Seyir ve Sonuçlarının Değerlendirilmesi," 16. Çocuk Enfeksiyon Hastalıkları ve Bağışıklama Kongresi, Antalya, Türkiye, pp.1, 2023.
- 8. Hutton D, Kameda-Smith M, Afshari FT et al. Intracranial invasive group A streptococcus: a neurosurgical emergency in children. J Neurosurg Pediatr. 2023;32(4):478-87.
- 9. de Almeida Torres RS, Fedalto LE, de Almeida Torres RF et al. Group A streptococcus meningitis in children. Pediatr Infect Dis J. 2013;32(2):110-4.
- 10. Annagür A, Altunhan H, Ertugrul S, et al. A rare cause of neonatal meningitis: Group A streptecocci. Dicle Tip Dergisi. 2013;40(1):118-20.
- 11. Gezercan Y, Çavuş G, Ökten Aİ et al. Çocukluk çağı beyin abseleri: tek merkez deneyimi. Cukurova Medical Journal, 2017;42(3):427-35.
- 12. Auvichayapat, N., Auvichayapat, P., & Aungwarawong, S. Brain abscess in infants and children: a retrospective study of 107 patients in northeast Thailand. J Med Assoc Thai. 2007;90(8): 1601.
- 13. Sheehan JP, Jane JA, Ray DK et al. Brain abscess in children. Neurosurg Focus. 2008; 24(6):E6.
- 14. Demirören K, Gülşen İ, Ece İ et al. Çocuklarda intrakraniyal apse. Van Tıp Dergisi. 2015;22(2):67-72.
- 15. Shetty AK, Frankel LR, Maldonado Y, et al. Group A streptococcal meningitis: report of a case and review of literature since 1976. Pediatr Emerg Care. 2001;17:430-4.
- 16. Akar A, & Kuyucu N. Üç yaşından küçük çocuklarda A Grubu Β-Hemolitik Streptokok tonsillofarenjiti sıklığı. Mersin Üniversitesi Sağlık Bilimleri Dergisi. 2018;11(3):332-5.
- 17. Tamer İ, Fenercioğlu A, Dabak R. İstanbul Kartal bölgesinde Okul Öncesi Çocuklarda Asemptomatik A Grubu Beta Hemolitik Streptokok Taşıyıcılığı. Türk Aile Hek Derg. 2008;12:203-6.
- 18. Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and Streptococcal carriage in children: a meta-analysis. Pediatrics. 2010;126:e557-64.
- 19. Shahzad K, Hamid MH, Khan MA et al. Brain abscess in children. J Coll Physicians Surg Pak. 2005;15(10):609-11.
- 20. Özsürekci Y, Kara A, Cengiz AB et al. Brain abscess in childhood: a 28-year experience. Turk J Pediatr. 2012;54(2):144.
- 21. Kanu OO, Ojo O, Esezobor C et al. Pediatric brain abscess - etiology, management challenges and outcome in Lagos Nigeria. Surg Neurol Int. 2021;8(12):592.
- 22. Miniar T, Amel BA, Khalil S et al. Pyogenic brain abscess in children: a Tunisian multi-center experience. Afr Health Sci. 2018;18(3):560-8.
- 23. Stevens DL. Invasive group A streptococcus infections. Clin Infect Dis 1992;14:2-13.
- 24. Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection. Pediatr Infect Dis J. 1999;18:1096-100.
- 25. Stevens DL. Invasive group A streptococcal infection and toxic shock syndrome: Treatment and prevention. In: Edwards MS, Wessels MR, Hall KK, editors. Available from: https://www.uptodate.com/contents/invasive-group-a-streptococcal-infection-and-toxic-shock-syndrome-treatment-and-prevention? (Accessed date: 02.22.2023).
- 26. Stevens DL, Kaplan SL. Invasive group A streptococcal infections in children. In: Edwards MS, Armsby C, editors Available from: https:// www.uptodate.com/contents/invasive-group-a-streptococcal-infections-in-children? (Accessed date: 02.22.2023).
- 27. UpToDate. Linezolid: Drug information. Available from: https://www. uptodate.com/contents/linezolid-drug-information? (Accessed date: 02.25.2023).
- 28. Kara Y. A case of pediatric brain abscess secondary to rhinosinusitis. J Contemp Med. 2024;14(4):213-14.
- 29. Lundy P, Kaufman C, Garcia D et al. Intracranial subdural empyemas and epidural abscesses in children. J Neurosurg Pediatr. 2019:24(1);14-21
Infantile Intraparenchymal Brain Abscess due to Streptococcus pyogenes
Year 2024,
Volume: 12 Issue: 3, 83 - 87, 29.10.2024
Meltem Kıymaz
,
Gülsüm Alkan
,
Büşra Özyalvaç
,
Ayşe Gül Yücel
,
Mehmet Öztürk
,
Saime Sündüs Uygun
,
Murat Konak
,
Derya Karaoğlu Gündoğdu
,
Melike Emiroğlu
Abstract
Introduction
Group A ß-hemolytic streptococcus (GABHS) are the most common bacterial cause of tonsillitis, and can cause noninvasive diseases such as pharyngitis and impetigo, as well as more severe invasive diseases. The incidence of invasive disease is 1-3/100,000 per year, and the morbidity and mortality rate is high. GABHS is rarely lead to brain abscesses.
Case Report
Acute phase reactants were found to be high in a 40-day-old patient who presented with fever, irritability and focal seizures. Acute phase reactants were high. Transfontanel ultrasonography showed increased thickness, echo and blood supply in the meninges. Brain magnetic resonance imaging (MRI) and diffusion MRI revealed a thick-walled abscess in the right cerebral hemisphere and parietooccipital parenchyma with diffusion restriction on diffusion-weighted images. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) test revealed S. pyogenes,and S. pyogenes grown in CSF culture. Initially, meropenem, vancomycin, metronidazole antibiotherapy was applied. Treatment was revised to cefotaxime and vancomycin after culture antibiogram and was completed for 8 weeks. Seizures regressed. Control brain imaging showed improvement. Restriction in left lower extremity movements remained. Physical therapy and rehabilitation was recommended and he was discharged.
Conclusion
GABHS, which is the causative agent of acute tonsillitis, rarely causes invasive disease which has high mortality and morbidity.
References
- 1. Kaplan LE, Krugman S. Streptococcal infections group A. In: Krugman S, Katz LS, Gershon AA, Wilfert MC, editors. Infectious diseases of children. 9th edition St. Louis, Missouri: Mosby;1992. p. 483-94.
- 2. Kızılyıldırım, S. İnvaziv A grubu streptokok enfeksiyonlarından sorumlu suşlarda emm ve süperantijen genotiplerinin dağılımı, klinik korelasyonu ve filogenetik ilişkilerinin tespiti. [Doktora tezi]. Adana: Çukurova Üniversitesi, Sağlık Bilimleri Enstitüsü, 2017.
- 3. Committee on infectious diseases, American Academy of Pediatrics. Group A streptococcal infections. In: Peter G, editors. Red book report of the committeee on infectious diseases. 24th edition, 1997:483-94.
- 4. Todd J. Streptococcal infections. In: Nelson WE, Behrman RE, Kliegman RM, Arvin AM, editors. Nelson Textbook of Pediatrics 15th ed. Philadelphia: WB Saunders; 1996:750-4.
- 5. Mameli C, Genoni T, Madia C et al. Brain abscess in pediatric age: a review. Childs Nerv Syst. 2019;35(7):1117-28.
- 6. Shachor-Meyouhas Y, Bar-Joseph G, Guilburd JN et al. Brain abscess in children - epidemiology, predisposing factors and management in the modern medicine era. Acta Paediatr 2010; 99(8):1163-7.
- 7. Laleoğlu P, Erbaş İ, Özdem Alataş Ş et al. “İnvaziv Grup A Streptokok Tanılı Çocuk Olguların Klinik Seyir ve Sonuçlarının Değerlendirilmesi," 16. Çocuk Enfeksiyon Hastalıkları ve Bağışıklama Kongresi, Antalya, Türkiye, pp.1, 2023.
- 8. Hutton D, Kameda-Smith M, Afshari FT et al. Intracranial invasive group A streptococcus: a neurosurgical emergency in children. J Neurosurg Pediatr. 2023;32(4):478-87.
- 9. de Almeida Torres RS, Fedalto LE, de Almeida Torres RF et al. Group A streptococcus meningitis in children. Pediatr Infect Dis J. 2013;32(2):110-4.
- 10. Annagür A, Altunhan H, Ertugrul S, et al. A rare cause of neonatal meningitis: Group A streptecocci. Dicle Tip Dergisi. 2013;40(1):118-20.
- 11. Gezercan Y, Çavuş G, Ökten Aİ et al. Çocukluk çağı beyin abseleri: tek merkez deneyimi. Cukurova Medical Journal, 2017;42(3):427-35.
- 12. Auvichayapat, N., Auvichayapat, P., & Aungwarawong, S. Brain abscess in infants and children: a retrospective study of 107 patients in northeast Thailand. J Med Assoc Thai. 2007;90(8): 1601.
- 13. Sheehan JP, Jane JA, Ray DK et al. Brain abscess in children. Neurosurg Focus. 2008; 24(6):E6.
- 14. Demirören K, Gülşen İ, Ece İ et al. Çocuklarda intrakraniyal apse. Van Tıp Dergisi. 2015;22(2):67-72.
- 15. Shetty AK, Frankel LR, Maldonado Y, et al. Group A streptococcal meningitis: report of a case and review of literature since 1976. Pediatr Emerg Care. 2001;17:430-4.
- 16. Akar A, & Kuyucu N. Üç yaşından küçük çocuklarda A Grubu Β-Hemolitik Streptokok tonsillofarenjiti sıklığı. Mersin Üniversitesi Sağlık Bilimleri Dergisi. 2018;11(3):332-5.
- 17. Tamer İ, Fenercioğlu A, Dabak R. İstanbul Kartal bölgesinde Okul Öncesi Çocuklarda Asemptomatik A Grubu Beta Hemolitik Streptokok Taşıyıcılığı. Türk Aile Hek Derg. 2008;12:203-6.
- 18. Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and Streptococcal carriage in children: a meta-analysis. Pediatrics. 2010;126:e557-64.
- 19. Shahzad K, Hamid MH, Khan MA et al. Brain abscess in children. J Coll Physicians Surg Pak. 2005;15(10):609-11.
- 20. Özsürekci Y, Kara A, Cengiz AB et al. Brain abscess in childhood: a 28-year experience. Turk J Pediatr. 2012;54(2):144.
- 21. Kanu OO, Ojo O, Esezobor C et al. Pediatric brain abscess - etiology, management challenges and outcome in Lagos Nigeria. Surg Neurol Int. 2021;8(12):592.
- 22. Miniar T, Amel BA, Khalil S et al. Pyogenic brain abscess in children: a Tunisian multi-center experience. Afr Health Sci. 2018;18(3):560-8.
- 23. Stevens DL. Invasive group A streptococcus infections. Clin Infect Dis 1992;14:2-13.
- 24. Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection. Pediatr Infect Dis J. 1999;18:1096-100.
- 25. Stevens DL. Invasive group A streptococcal infection and toxic shock syndrome: Treatment and prevention. In: Edwards MS, Wessels MR, Hall KK, editors. Available from: https://www.uptodate.com/contents/invasive-group-a-streptococcal-infection-and-toxic-shock-syndrome-treatment-and-prevention? (Accessed date: 02.22.2023).
- 26. Stevens DL, Kaplan SL. Invasive group A streptococcal infections in children. In: Edwards MS, Armsby C, editors Available from: https:// www.uptodate.com/contents/invasive-group-a-streptococcal-infections-in-children? (Accessed date: 02.22.2023).
- 27. UpToDate. Linezolid: Drug information. Available from: https://www. uptodate.com/contents/linezolid-drug-information? (Accessed date: 02.25.2023).
- 28. Kara Y. A case of pediatric brain abscess secondary to rhinosinusitis. J Contemp Med. 2024;14(4):213-14.
- 29. Lundy P, Kaufman C, Garcia D et al. Intracranial subdural empyemas and epidural abscesses in children. J Neurosurg Pediatr. 2019:24(1);14-21