ABSTRACT
BACKGROUND: The Streptococcus anginosus group (SAG, S. anginosus, S. intermedius and S. constellatus) are often associated with severe disease and abscess formation. In our institution, we observed an apparent increase in frequency of intraorbital and intracranial infections resulting from SAG at Texas Children's Hospital. We undertook a retrospective review to describe the frequency and clinical features of these infections. METHODS: We reviewed the database of the microbiology laboratory at Texas Children's Hospital from 2011 to 2018 for SAG-positive cultures. Cases included were those associated with (1) either otitis media or sinusitis and (2) Pott's puffy tumor, orbital abscesses, mastoiditis, epidural abscesses, subdural empyema, brain parenchymal abscesses or dural enhancement by imaging. The number of overall diagnoses were determined using diagnostic codes and used to estimate the proportion of disease caused by SAG. RESULTS: Ninety-five cases were identified meeting inclusion criteria. The median age of patients was 11.4 years, and 75.8% were previously healthy. S. intermedius was most commonly isolated (80%) followed by S. constellatus (12.6%) and S. anginosus (7.4%); 50.5% of cases were polymicrobial. Among polymicrobial cases, Staphylococcus aureus was most frequently isolated. All patients underwent surgical intervention. 8.4% of patients experienced persistent neurologic deficits. We observed a significant increase in disease incidence during the study period; in addition, the overall proportion of all intracranial infections caused by SAG increased. CONCLUSIONS: Complications of otitis media and sinusitis caused by SAG are associated with substantial morbidity. These infections are becoming increasingly common at our center although the precise reason for this temporal trend is unclear.
Subject(s)
Otitis Media/complications , Otitis Media/epidemiology , Sinusitis/complications , Sinusitis/epidemiology , Streptococcal Infections/complications , Streptococcal Infections/epidemiology , Streptococcus anginosus , Adolescent , Age Factors , Central Nervous System Infections/diagnosis , Central Nervous System Infections/epidemiology , Central Nervous System Infections/etiology , Child , Child, Preschool , Female , Humans , Male , Otitis Media/diagnosis , Otitis Media/microbiology , Pott Puffy Tumor/diagnosis , Pott Puffy Tumor/epidemiology , Pott Puffy Tumor/etiology , Public Health Surveillance , Retrospective Studies , Sinusitis/diagnosis , Sinusitis/microbiology , Streptococcal Infections/diagnosis , Streptococcal Infections/microbiology , Texas/epidemiologyABSTRACT
OBJECTIVES/HYPOTHESIS: Pott's puffy tumor (PPT) is defined as one or more subperiosteal abscesses of the frontal bone based on osteomyelitis. PPT is observed predominantly in the adolescent age group and rarely in adults. Some parameters affecting prognosis and an appropriate surgical approach for antecedent frontal sinusitis have not been elucidated due to the rarity of patients with adult PPT. STUDY DESIGN: Retrospective patient record and literature study. METHODS: Five patients from our cohort and 27 patients identified in a literature search formed the study group. RESULTS: The incidence rate of intracranial complications was lower than in previous reports at 29.0%. There was no correlation between the incidence rate of intracranial complications and each patient's parameters. It was indicated that the department first consulted by the patients was possibly related to the initial diagnosis and the incidence rate of intracranial complications. CONCLUSIONS: Although the incidence rate of major complications is lower than in children and later than in earlier published adult cases, patients are still at high risk of serious intracranial complications. Early diagnosis and adequate treatment may contribute to reducing the incidence rate.
