血管链球菌(SAG)是脑脓肿最常见的微生物之一。SAG引起的脑脓肿通常会延迟诊断,因为在一半的病例中血液和脑脊液培养均为阴性。一名68岁男子出现持续发烧,头痛,和myalgias两个星期,并访问了我们的部门。他在没有实验室工作的情况下接受了口服抗生素治疗。虽然检查显示没有局灶性神经症状,一次仔细的采访揭示了前一天几分钟不寻常行为的历史。全身对比增强计算机断层扫描(CT)和头部磁共振成像(MRI)显示靠近双侧心室的两个环增强,这与脑脓肿的诊断是一致的。通过静脉抗菌治疗对较大脓肿进行紧急手术穿刺迅速改善了他的病情,他在第36天出院,没有后遗症。我们回顾性回顾了有关SAG多发性脑脓肿病例的文献,以评估神经系统后遗症的潜在预后因素。对12例病例进行统计分析,包括11例文献综述和当前案例,在有或没有不良预后的组间进行。在年龄的潜在危险因素中,性别,局灶性神经症状,从发病到治疗的持续时间,其他器官的脓肿形成,存在外科引流,血培养呈阳性,只有最初出现的局灶性神经系统症状与不良预后显着相关(无不良预后,1/4例vs预后不良组,8/8例;p=0.01)。应进行仔细的访谈和详细的检查,以评估病因不明的发烧患者发生脑脓肿的可能性。否则,延迟诊断可能会导致不良预后,如死亡或神经后遗症,由于这种疾病的性质,在早期阶段很少有特定的症状。
Streptococcus anginosus group (SAG) is one of the most common microbes of brain abscesses. Brain abscesses caused by SAG have often delayed diagnosis since both blood and cerebrospinal fluid cultures are negative in half of the cases. A 68-year-old man developed persistent fever, headache, and myalgias for two weeks and visited our department. He was treated with oral antibiotics without laboratory work. Although examination showed no focal neurological symptoms, a careful interview revealed a history of unusual behavior for a few minutes on the previous day. Whole body contrast-enhanced computed tomography (CT) and head magnetic resonance imaging (MRI) showed two ring enhancements close to the bilateral ventricles, which were consistent with a diagnosis of the brain abscesses. An emergent surgical puncture for the larger abscess with intravenous antimicrobial therapy quickly improved his condition, and he was discharged on day 36 with no sequelae. We retrospectively reviewed works of literature on cases with multiple brain abscesses by SAG to assess potential prognostic factors for neurological sequelae. Statistical analyses of 12 cases, including 11 cases from the literature review and the current
case, were performed between groups with or without poor prognosis. Among potential risk factors of age, sex, focal neurological symptoms, duration from onset to treatment, abscess formation of other organs, presence of surgical drainage, and positive for blood culture, only focal neurological symptoms at the initial presentation were significantly associated with poor prognosis (no poor prognosis, 1/4 cases vs poor prognosis group, 8/8 cases; p=0.01). Careful interviews and detailed examinations should be conducted to assess the possibility of brain abscesses among patients with fever of unknown etiology. Otherwise, a delayed diagnosis might result in poor prognoses such as death or neurological sequelae due to this disease\'s nature, which has few specific symptoms in the early stages.