Yamamoto M, Fukushima T, Ohshiro S, Go Y, Tsugu H, Kono K, Tomonaga M
Department of Neurosurgery, Fukuoka University School of Medicine, Japan.
Surg Neurol. 1999 Feb;51(2):219-22. doi: 10.1016/s0090-3019(97)00505-3.
Although Streptococcus intermedius has been recognized as an important pathogen for abscess formation outside the central nervous System, the Streptococcus milleri group, of which it is a member, has not been recognized as a specific pathogen for brain abscess, often thought to be caused by Streptococcus viridans, which includes other streptococcal species.
Two cases of brain abscess in the left frontal lobe caused by S. intermedius, which responded well to antimicrobial treatment combined with needle aspiration, are presented. In the first patient, the predisposing disease was paranasal sinusitis of the frontal and ethmoid sinuses. In the second patient, the source of the pathogen was not detected despite extensive examination. The patients underwent aspiration of pus under ultrasound guidance in the first patient, and via a computed tomography-guided stereotactic procedure in the second patient. They subsequently received appropriate antimicrobial therapy against S. intermedius isolated from the pus culture. Both patients were discharged without any neurological deficits.
It is important to recognize S. intermedius as a pathogen of brain abscess, and to be aware of its predisposing factors, i.e., mucosal disturbance and liver abscess.
尽管中间型链球菌已被公认为中枢神经系统外脓肿形成的重要病原体，但其所属的米勒链球菌组尚未被视为脑脓肿的特定病原体，脑脓肿通常被认为是由包括其他链球菌种类的草绿色链球菌引起的。
本文介绍了两例由中间型链球菌引起的左侧额叶脑脓肿病例，经抗菌治疗联合穿刺抽吸后效果良好。第一例患者的诱发疾病为额窦和筛窦的鼻窦炎。第二例患者尽管进行了广泛检查，但未检测到病原体来源。第一例患者在超声引导下进行了脓液抽吸，第二例患者通过计算机断层扫描引导的立体定向手术进行了抽吸。随后，他们接受了针对从脓液培养物中分离出的中间型链球菌的适当抗菌治疗。两名患者均出院，无任何神经功能缺损。
认识到中间型链球菌是脑脓肿的病原体，并了解其诱发因素，即黏膜紊乱和肝脓肿，非常重要。
