Streptococcus miller - An organism for head and neck infections and abscess

Background: Streptococcus milleri, a commensal organ ism, has the potential to cause significant morbidity. There is a paucity of published data regar ding this organism in the head and neck. Objectives: To identify and assess the presentation, treatment, and outcome s of pediatric patients affected by this pathogen. Study Design: Review of the Department of Pathology database at Children's Hospital of Wisconsin, Milwaukee, between 1997 and 1999 identified 26 patie nts with cultures positive for S milleri group (SMG) bacteria. Retrospectiv e chart analysis examined the demographic data, site of origin of infection , additional organisms cultured, symptoms, treatments, and complications. Results: Sixteen patients had SMG infections involving the head and neck re gion. Sites of origin included the paranasl sinuses, dental, facial soft ti ssues, deep neck spaces, peritonsillar region, and a tracheostomy site. The paranasal sinuses were the most common site in 37% (6/16). Streptococcus m illeri was the only isolate in 69% (11) of the infections. Significant loca l extension occurred in 56% (9/16) of the patients and included the orbit, skull base, cranium, and deep neck spaces. All patients had surgical draina ge and 15 also received intravenous antibiotic treatment. One complication of osteomyelitis of the frontal bone occurred with resolution after surgica l debridement and intravenous antibiotic treatment. Conclusions: Streptococcus milleri fan be an aggressive pathogen in the hea d and neck with a propensity for abscess formation and local extension of t he infection in a pediatric population Surgical drainage with antibiotics i s generally successful in management of the condition. However, emerging pe nicillin resistance and the ability for local extension require suspicion o f incomplete treatment if clinical symptoms persist.