Infantile Intraparenchymal Brain Abscess due to Streptococcus pyogenes

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.

Keywords

• Streptococcus pyogenes
• brain abscess
• infant
• meningitis
• encephalitis

Streptococcus pyogenes’e Bağlı İnfantil İntraparankimal Beyin Apsesi

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.

Keywords

• Streptococcus pyogenes
• beyin absesi
• infant
• menenjit
• ensefalit

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