PDF(Pubmed)
Abstract：
BACKGROUND: Streptococcus intermedius is a member of the S. anginosus group and is part of the normal oral microbiota. It can cause pyogenic infections in various organs, primarily in the head and neck area, including brain abscesses and meningitis. However, ventriculitis due to periodontitis has not been reported previously.
METHODS: A 64-year-old male was admitted to the hospital with a headache, fever and later imbalance, blurred vision, and general slowness. Neurological examination revealed nuchal rigidity and general clumsiness. Meningitis was suspected, and the patient was treated with dexamethasone, ceftriaxone and acyclovir. A brain computer tomography (CT) scan was normal, and cerebrospinal fluid (CSF) Gram staining and bacterial cultures remained negative, so the antibacterial treatment was discontinued. Nine days after admission, the patient\'s condition deteriorated. The antibacterial treatment was restarted, and a brain magnetic resonance imaging revealed ventriculitis. A subsequent CT scan showed hydrocephalus, so a ventriculostomy was performed. In CSF Gram staining, chains of gram-positive cocci were observed. Bacterial cultures remained negative, but a bacterial PCR detected Streptococcus intermedius. An orthopantomography revealed advanced periodontal destruction in several teeth and periapical abscesses, which were subsequently operated on. The patient was discharged in good condition after one month.
CONCLUSIONS: Poor dental health can lead to life-threatening infections in the central nervous system, even in a completely healthy individual. Primary bacterial ventriculitis is a diagnostic challenge, which may result in delayed treatment and increased mortality.
METHODS: A 64-year-old male was admitted to the hospital with a headache, fever and later imbalance, blurred vision, and general slowness. Neurological examination revealed nuchal rigidity and general clumsiness. Meningitis was suspected, and the patient was treated with dexamethasone, ceftriaxone and acyclovir. A brain computer tomography (CT) scan was normal, and cerebrospinal fluid (CSF) Gram staining and bacterial cultures remained negative, so the antibacterial treatment was discontinued. Nine days after admission, the patient\'s condition deteriorated. The antibacterial treatment was restarted, and a brain magnetic resonance imaging revealed ventriculitis. A subsequent CT scan showed hydrocephalus, so a ventriculostomy was performed. In CSF Gram staining, chains of gram-positive cocci were observed. Bacterial cultures remained negative, but a bacterial PCR detected Streptococcus intermedius. An orthopantomography revealed advanced periodontal destruction in several teeth and periapical abscesses, which were subsequently operated on. The patient was discharged in good condition after one month.
CONCLUSIONS: Poor dental health can lead to life-threatening infections in the central nervous system, even in a completely healthy individual. Primary bacterial ventriculitis is a diagnostic challenge, which may result in delayed treatment and increased mortality.
摘要：
背景：中间型链球菌是硬化链球菌群的成员，是正常口腔微生物群的一部分。它可以在各种器官中引起化脓性感染，主要在头部和颈部，包括脑脓肿和脑膜炎.然而,由于牙周炎引起的脑室炎以前没有报道。
方法：一名64岁男性因头痛入院，发烧和后来的失衡，视力模糊,一般的缓慢。神经系统检查显示颈部僵硬和全身笨拙。怀疑是脑膜炎,患者接受了地塞米松治疗，头孢曲松和阿昔洛韦.脑部计算机断层扫描（CT）扫描正常，和脑脊液（CSF）革兰氏染色和细菌培养保持阴性，所以停止了抗菌治疗。入院9天后,病人的病情恶化。抗菌治疗重新开始,脑部磁共振成像显示脑室炎。随后的CT扫描显示脑积水,所以做了脑室造口术.在CSF革兰氏染色中，观察到革兰氏阳性球菌链。细菌培养保持阴性,但是细菌PCR检测到了中间链球菌.端骨造影术显示几颗牙齿和根尖周脓肿的牙周严重破坏，随后进行了手术。一个月后，患者病情良好。
结论：牙齿健康状况不佳可导致中枢神经系统感染危及生命，即使是一个完全健康的人。原发性细菌性脑室炎是一个诊断挑战，这可能导致延迟治疗和增加死亡率。
方法：一名64岁男性因头痛入院，发烧和后来的失衡，视力模糊,一般的缓慢。神经系统检查显示颈部僵硬和全身笨拙。怀疑是脑膜炎,患者接受了地塞米松治疗，头孢曲松和阿昔洛韦.脑部计算机断层扫描（CT）扫描正常，和脑脊液（CSF）革兰氏染色和细菌培养保持阴性，所以停止了抗菌治疗。入院9天后,病人的病情恶化。抗菌治疗重新开始,脑部磁共振成像显示脑室炎。随后的CT扫描显示脑积水,所以做了脑室造口术.在CSF革兰氏染色中，观察到革兰氏阳性球菌链。细菌培养保持阴性,但是细菌PCR检测到了中间链球菌.端骨造影术显示几颗牙齿和根尖周脓肿的牙周严重破坏，随后进行了手术。一个月后，患者病情良好。
结论：牙齿健康状况不佳可导致中枢神经系统感染危及生命，即使是一个完全健康的人。原发性细菌性脑室炎是一个诊断挑战，这可能导致延迟治疗和增加死亡率。
