Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco.
World Neurosurg. 2010 Aug-Sep;74(2-3):346-50. doi: 10.1016/j.wneu.2010.05.029.
Actinomyces spp. are often underestimated as causes of central nervous system infection because they are not looked for routinely and are difficult to detect. We try to determine the optimal management of these problematic intracranial infectious diseases in neurosurgical practice.
Five cases of intracranial suppurations due to Actinomyces spp. treated between December 2007 and February 2009 are reported. The relevant clinicobacteriologic features and treatment outcomes are analyzed.
There were two brain abscesses, two subdural empyemas, and one frontal sinus pyomucocele with intracranial extension. Among them, three cases were previously operated and two patients were previously treated for otorhinolaryngeal infection. All cases were immunocompetent. In addition to Actinomyces sp., three patients had coinfectious bacteria (Pseudomonas aeruginosa, Staphylococcus warneri, and Escherichia coli). Complete resolution of the infection was achieved by means of aggressive surgical treatment and relatively short course of antibiotic therapy with a full recovery.
Actinomycotic focal cerebral infections may occur with greater frequency than previously recognized. Polymicrobial bacteria may be seen. This rare anaerobic organism should be considered in patients with a history of head trauma, previous surgery, or otorhinolaryngeal infection who present with a long duration of neurologic symptoms with or without an accompanying fever. Patients may be candidates for surgical debridement with relative shorter term of antibiotic therapy (ciprofloxacin).
由于常规情况下不会寻找放线菌，且其难以检测，因此放线菌常被低估为中枢神经系统感染的原因。我们试图确定神经外科实践中这些棘手的颅内感染性疾病的最佳治疗方法。
报告了 2007 年 12 月至 2009 年 2 月期间治疗的 5 例放线菌引起的颅内化脓性感染病例。分析了相关的临床细菌学特征和治疗结果。
有 2 例脑脓肿、2 例硬脑膜下积脓和 1 例额窦黏液囊肿伴颅内扩展。其中 3 例曾接受过手术治疗，2 例患者曾因耳鼻喉感染接受过治疗。所有患者的免疫功能均正常。除放线菌外，3 例患者还存在合并感染细菌（铜绿假单胞菌、华纳葡萄球菌和大肠杆菌）。通过积极的手术治疗和相对较短疗程的抗生素治疗，感染完全得到解决，患者完全康复。
放线菌引起的局灶性大脑感染的发生频率可能高于之前的认识。可能存在多种微生物细菌感染。对于有头部外伤、先前手术或耳鼻喉感染史，伴有或不伴有发热、持续时间较长的神经系统症状的患者，应考虑这种罕见的厌氧菌。患者可能适合进行手术清创，抗生素治疗疗程相对较短（环丙沙星）。
