Ewald C, Kuhn S, Kalff R
Klinik für Neurochirurgie, Klinikum der Friedrich Schiller Universität, Erlanger Allee 101, Jena, Germany.
Neurosurg Rev. 2006 Apr;29(2):163-6; discussion 166-7. doi: 10.1007/s10143-005-0009-1. Epub 2006 Feb 24.
Pyogenic infections of the central nervous system of dental origin are quite uncommon in industrialized countries. We report six cases with intracerebral (n = 4) and intraspinal (n = 2) infections treated in our hospital. The microbial pathogen was successfully isolated in all patients. Fusobacterium nucleatum as well as Streptococcus species were found in three cases. Bacillus species were identified in two patients. Actinomyces was the etiologic agent in one case. All patients suffered from dental pathologies, so that after clinical and radiological exclusion of other sources an oral focus was presumed. Therapeutic management consisted of an operative procedure in order to obtain decompression, as well as evacuation of the pus on the one hand, followed by targeted antibiotics on the other. Clinical improvement was achieved in all patients, with one patient lost to follow-up. On magnetic resonance tomography, the inflammatory changes also disappeared in all cases. We recommend that oral infection with recurrent bacteraemia should always be considered in the pathogenesis of the so-called "cryptic" intracerebral and intraspinal infections.
在工业化国家，牙源性中枢神经系统化脓性感染相当罕见。我们报告了我院治疗的6例脑内（n = 4）和脊髓内（n = 2）感染病例。所有患者均成功分离出微生物病原体。3例患者中发现具核梭杆菌以及链球菌属。2例患者鉴定出芽孢杆菌属。1例患者的病原体为放线菌。所有患者均患有牙病，因此在临床和影像学排除其他感染源后，推测存在口腔感染灶。治疗措施一方面包括手术减压及引流脓液，另一方面使用针对性抗生素。所有患者均临床症状改善，1例患者失访。在磁共振断层扫描中，所有病例的炎症改变也均消失。我们建议，在所谓“隐匿性”脑内和脊髓内感染的发病机制中，应始终考虑口腔感染伴反复菌血症的情况。
