"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead
Case report
peer-reviewed

Streptococcus Intermedius Brain and Diverticular Abscesses After Dental Manipulation: A Case Report



Abstract

A brain abscess is defined as a focal intracerebral infection consisting of an encapsulated collection of pus, which can be a life-threatening complication of infections, trauma, or surgery. While immunocompromised patients can have a wide array of causative organisms, bacterial species represent the most common etiology in immunocompetent individuals. The incidence of brain abscesses ranges from 0.4 to 0.9 per 100,000, with a high predisposition among immunocompromised patients and in those with disruption of the blood-brain barrier.

The most common causative organisms found were Streptococcus species, particularly S. viridians and S. pneumonia, Enterococcus, and Staphylococcus species, mainly S. aurieus and S. epidermidis. Microorganism can invade the brain through different mechanisms, either directly by contiguous spread and odontogenic infections, which usually cause a single brain abscess, or indirectly through hematogenous spread which can cause multiple brain abscesses. Both surgical and conservative dental procedures contribute to hematogenous spreading of oral microorganisms. Although most of those organisms are eliminated shortly after they gain access to the bloodstream, some can persist and contribute to the pathogenesis of abscesses in the appropriate environment. Odontogenic origins are rarely implicated in the formation of brain abscesses, and oral foci comprise approximately 5% of identified cases. We report a case of brain and diverticular abscesses due to S. intermidius occurring two months after dental extraction. This case highlights the fact that even usual dental workup can result in the development of bacteremia and disseminated abscesses including but not restricted to the brain. Consequently, in addition to identifying the possible source of bacteremia with an extensive history and physical exam, the diagnosis of Streptococcus milleri organisms should prompt the physicians to screen for sites of possible metastatic infection spread.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Case report
peer-reviewed

Streptococcus Intermedius Brain and Diverticular Abscesses After Dental Manipulation: A Case Report


Author Information

Hassan Al Moussawi

Department of Medicine, Staten Island University Hospital, Northwell Health

Medicine, Staten Island University Hospital, Northwell Health

Michael Krzyzak

Medicine, Staten Island University Hospital

Zainab Awada

Department of Medicine, Staten Island University Hospital, Northwell Health

Jean M. Chalhoub Corresponding Author

Department of Medicine, Staten Island University Hospital, Northwell Health


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Streptococcus Intermedius Brain and Diverticular Abscesses After Dental Manipulation: A Case Report


Figures etc.

Share
Case report
peer-reviewed

Streptococcus Intermedius Brain and Diverticular Abscesses After Dental Manipulation: A Case Report

  • Author Information
    Hassan Al Moussawi

    Department of Medicine, Staten Island University Hospital, Northwell Health

    Medicine, Staten Island University Hospital, Northwell Health

    Michael Krzyzak

    Medicine, Staten Island University Hospital

    Zainab Awada

    Department of Medicine, Staten Island University Hospital, Northwell Health

    Jean M. Chalhoub Corresponding Author

    Department of Medicine, Staten Island University Hospital, Northwell Health


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: January 13, 2018

    DOI

    10.7759/cureus.2061

    Cite this article as:

    Al moussawi H, Krzyzak M, Awada Z, et al. (January 13, 2018) Streptococcus Intermedius Brain and Diverticular Abscesses After Dental Manipulation: A Case Report. Cureus 10(1): e2061. doi:10.7759/cureus.2061

    Publication history

    Received by Cureus: December 04, 2017
    Peer review began: December 11, 2017
    Peer review concluded: December 23, 2017
    Published: January 13, 2018

    Copyright

    © Copyright 2018
    Al Moussawi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

A brain abscess is defined as a focal intracerebral infection consisting of an encapsulated collection of pus, which can be a life-threatening complication of infections, trauma, or surgery. While immunocompromised patients can have a wide array of causative organisms, bacterial species represent the most common etiology in immunocompetent individuals. The incidence of brain abscesses ranges from 0.4 to 0.9 per 100,000, with a high predisposition among immunocompromised patients and in those with disruption of the blood-brain barrier.

The most common causative organisms found were Streptococcus species, particularly S. viridians and S. pneumonia, Enterococcus, and Staphylococcus species, mainly S. aurieus and S. epidermidis. Microorganism can invade the brain through different mechanisms, either directly by contiguous spread and odontogenic infections, which usually cause a single brain abscess, or indirectly through hematogenous spread which can cause multiple brain abscesses. Both surgical and conservative dental procedures contribute to hematogenous spreading of oral microorganisms. Although most of those organisms are eliminated shortly after they gain access to the bloodstream, some can persist and contribute to the pathogenesis of abscesses in the appropriate environment. Odontogenic origins are rarely implicated in the formation of brain abscesses, and oral foci comprise approximately 5% of identified cases. We report a case of brain and diverticular abscesses due to S. intermidius occurring two months after dental extraction. This case highlights the fact that even usual dental workup can result in the development of bacteremia and disseminated abscesses including but not restricted to the brain. Consequently, in addition to identifying the possible source of bacteremia with an extensive history and physical exam, the diagnosis of Streptococcus milleri organisms should prompt the physicians to screen for sites of possible metastatic infection spread.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.