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Haemophilus aphrophilus and Streptococcus acidominimus in a brain abscess
Case Report
Haemophilus aphrophilus and Streptococcus acidominimus in a Brain Abscess Karen A. Thomas, B.A., M.T.(ASCP) Peter J. Farano, M.D. Microbiology Department The Lower Bucks Hospital Bristol, Pennsylvania 19007 A 55-yr-old afebrile male was seen in the emergency room with a chief complaint of a generalized frontal headache of approximately 3 wk duration. His wife noted a slight change in his mental status and personality. He was referred to a neurologist and admitted 4 d later. Admission laboratory tests were as follows: white blood cell count 13,200/mm3; hemoglobin 14.9 gm/dl; hematocrit 43.6%; platelet count 475,000/rmm3; prothrombin time 12.1 s. A C T scan showed a possible right frontal glioma. His past medical history was significant for chronic bilateral otitis media with a perforated left eardrum. In addition, the patient had dental work done within the past 2 mo. The remainder of the patient's medical history was unremarkable. Intravenous cefazolin therapy was initiated. He was then sent for a craniotomy, at which time a sac containing about 30 ml of greenish-white, foulsmelling material was discovered. The exudate was aspirated and submitted to the laboratory for culture and cytology.
Wanted
In the surgical pathology laboratory, marked acute and chronic inflammation with chronic necrosis and no evidence of malignancy were found. Gram stain revealed heavy white blood cells, heavy gram-positive cocci in chains and heavy gram-negative bacilli. The organisms recovered from the exudate were Haemophilus aphrophilus and Streptococcus acidominimus. The Haemophilus was identified by biochemical reactions using NonFermenter Minitek (Becton-Dickinson Microbiology Systems, Cockeysville, Md.), by lack of growth on MacConkey agar, and a negative catalase reaction. Antimicrobial minimum inhibitory concentrations (ttg/ml) were performed by an independent laboratory and were as follows: penicillin, 0.06; ampicillin, 0.25; ceftriaxone, 0.5. H. aphrophilus has been implicated as a cause of sinusitis, otitis media, meningitis, and soft-tissue and brain abscess (1). The S. acidominimus was identified with the Rapid DMS (Analytab Products, Plainview, N.Y.) by an independent laboratory (2). Antimicrobial minimum inhibitory concentrations (~g/ml) for penicillin, ampicillin, and ceftriaxone were 0.03, 0.25, and ~<0.5, respectively. S. acidominimus, although rarely found in humans, is usually isolated from brain abscesses in the frontal lobe (3). Dental sepsis is most often the route of infection in frontal lobe abscesses caused by this organism (3). Postoperative antimicrobial therapy
consisted of penicillin for 8 d, followed by ceftriaxone after consultation with an infectious-disease specialist. The patient was asymptomatic and free of clinical disease upon discharge 19 d later. Intravenous penicillin was prescribed for 6 wk after discharge. This was arranged through our home care program. This case suggests that a complete and detailed medical history can give valuable insight as to the epidemiology of certain infectious processes. This case study in particular reveals a close correlation between H. aphrophilus and the ear canal and S. acidominimus with dental manipulation. Multiple vectors should always be considered in the diagnosis of clinically complicated cases such as brain abscesses.
References 1. Hand, W. L. 1985. Hemophilus species, p. 1279-1282. In G. L. Mandell, R. G. Douglas, Jr., and J. E. Bennett (ed.), Principles and practice of infectious diseases, 2nd ed. Wiley, New York. 2. Facklam, R. R. and R. B. Carey. 1985. Streptococci and aerococci, p. 154-175. In E. H. Lennette, et al (ed.), Manual of clinical microbiology, 4th ed. American Society for Microbiology, Washington, D.C. 3. Scheld, W. M. and H. R. Winn. 1985. Brain abscess, p. 585-592. In G. L. Mandell, R. G. Douglas, Jr., and J. E. Bennett (ed.), Principles and practice of infectious diseases, 2nd ed. Wiley, New York.
Case Reports
If your laboratory has isolated an uncommon organism, a common organism from an unusual patient site, or an organism that presented a particular diagnostic challenge, why not share the information with your colleagues through the Clinical Microbiology Newsletter. The editors would like to receive interesting case reports from
Clinical Microbiology Newsletter 11:22,1989
our readers for possible publication in the Newsletter. Submitted case reports should contain: a) a brief clinical history summarizing the symptoms and course of the illness; b) a description of how the organism(s) were cultured and differentiated from closely associated organisms; and c) the results of susceptibility tests for the isolate(s).
© 1989 Elsevier Science Publishing Co., Inc.
Send the original typescript and four copies to:
J. G. McRelvic Clinical Microbiology Newsletter Elsevier Science Publishing Co., Inc. 655 Avenue of the Americas New York, New York 10010
0196-4399/89/$0.00 + 02.20
175
Haemophilus aphrophilus and Streptococcus acidominimus in a Brain Abscess Karen A. Thomas, B.A., M.T.(ASCP) Peter J. Farano, M.D. Microbiology Department The Lower Bucks Hospital Bristol, Pennsylvania 19007 A 55-yr-old afebrile male was seen in the emergency room with a chief complaint of a generalized frontal headache of approximately 3 wk duration. His wife noted a slight change in his mental status and personality. He was referred to a neurologist and admitted 4 d later. Admission laboratory tests were as follows: white blood cell count 13,200/mm3; hemoglobin 14.9 gm/dl; hematocrit 43.6%; platelet count 475,000/rmm3; prothrombin time 12.1 s. A C T scan showed a possible right frontal glioma. His past medical history was significant for chronic bilateral otitis media with a perforated left eardrum. In addition, the patient had dental work done within the past 2 mo. The remainder of the patient's medical history was unremarkable. Intravenous cefazolin therapy was initiated. He was then sent for a craniotomy, at which time a sac containing about 30 ml of greenish-white, foulsmelling material was discovered. The exudate was aspirated and submitted to the laboratory for culture and cytology.
Wanted
In the surgical pathology laboratory, marked acute and chronic inflammation with chronic necrosis and no evidence of malignancy were found. Gram stain revealed heavy white blood cells, heavy gram-positive cocci in chains and heavy gram-negative bacilli. The organisms recovered from the exudate were Haemophilus aphrophilus and Streptococcus acidominimus. The Haemophilus was identified by biochemical reactions using NonFermenter Minitek (Becton-Dickinson Microbiology Systems, Cockeysville, Md.), by lack of growth on MacConkey agar, and a negative catalase reaction. Antimicrobial minimum inhibitory concentrations (ttg/ml) were performed by an independent laboratory and were as follows: penicillin, 0.06; ampicillin, 0.25; ceftriaxone, 0.5. H. aphrophilus has been implicated as a cause of sinusitis, otitis media, meningitis, and soft-tissue and brain abscess (1). The S. acidominimus was identified with the Rapid DMS (Analytab Products, Plainview, N.Y.) by an independent laboratory (2). Antimicrobial minimum inhibitory concentrations (~g/ml) for penicillin, ampicillin, and ceftriaxone were 0.03, 0.25, and ~<0.5, respectively. S. acidominimus, although rarely found in humans, is usually isolated from brain abscesses in the frontal lobe (3). Dental sepsis is most often the route of infection in frontal lobe abscesses caused by this organism (3). Postoperative antimicrobial therapy
consisted of penicillin for 8 d, followed by ceftriaxone after consultation with an infectious-disease specialist. The patient was asymptomatic and free of clinical disease upon discharge 19 d later. Intravenous penicillin was prescribed for 6 wk after discharge. This was arranged through our home care program. This case suggests that a complete and detailed medical history can give valuable insight as to the epidemiology of certain infectious processes. This case study in particular reveals a close correlation between H. aphrophilus and the ear canal and S. acidominimus with dental manipulation. Multiple vectors should always be considered in the diagnosis of clinically complicated cases such as brain abscesses.
References 1. Hand, W. L. 1985. Hemophilus species, p. 1279-1282. In G. L. Mandell, R. G. Douglas, Jr., and J. E. Bennett (ed.), Principles and practice of infectious diseases, 2nd ed. Wiley, New York. 2. Facklam, R. R. and R. B. Carey. 1985. Streptococci and aerococci, p. 154-175. In E. H. Lennette, et al (ed.), Manual of clinical microbiology, 4th ed. American Society for Microbiology, Washington, D.C. 3. Scheld, W. M. and H. R. Winn. 1985. Brain abscess, p. 585-592. In G. L. Mandell, R. G. Douglas, Jr., and J. E. Bennett (ed.), Principles and practice of infectious diseases, 2nd ed. Wiley, New York.
Case Reports
If your laboratory has isolated an uncommon organism, a common organism from an unusual patient site, or an organism that presented a particular diagnostic challenge, why not share the information with your colleagues through the Clinical Microbiology Newsletter. The editors would like to receive interesting case reports from
Clinical Microbiology Newsletter 11:22,1989
our readers for possible publication in the Newsletter. Submitted case reports should contain: a) a brief clinical history summarizing the symptoms and course of the illness; b) a description of how the organism(s) were cultured and differentiated from closely associated organisms; and c) the results of susceptibility tests for the isolate(s).
© 1989 Elsevier Science Publishing Co., Inc.
Send the original typescript and four copies to:
J. G. McRelvic Clinical Microbiology Newsletter Elsevier Science Publishing Co., Inc. 655 Avenue of the Americas New York, New York 10010
0196-4399/89/$0.00 + 02.20
175