Streptococcal brain abscess: Analysis of clinical features in 20 patients

BACKGROUND To assess the clinical features and therapeutic outcomes of brai n abscess caused by streptococci. METHODS Twenty patients, 18 males and 2 females, aged 3 to 76 years, collec ted over a 14-year period, have been identified at Kaohsiung Chang Gung Mem orial Hospital. RESULTS Among these 20 patients, 13 had viridans streptococci infection alo ne, one had non-A, non-B, and non-D streptococci infection alone, and the o ther 6 had mixed infections each including streptococci. The locations of a ll the abscesses were supratentorial. Among these patients, 18 had a single abscess and 2 had multiple abscesses. Underlying conditions were common in our patients, including head trauma, heart disease, otopharyngeal infectio n, and medical procedures. Nineteen patients were treated surgically and I was treated with antibiotics alone. Nineteen survived and 1 died, with an o verall mortality rate of 5%. CONCLUSION The clinical presentations and underlying conditions varied acco rding to the different streptococcal species. Streptococcal brain abscesses accounted for 17% of our cases with brain abscesses, and 30% of our strept ococcal infections had polymicrobial infections. Although streptococcal bra in abscesses were commonly associated with otopharyngeal infections or infe ctious endocarditis, they also appeared to be often related to neurosurgica l events or medical procedures in recent years. Based on our study, prognos is is favorable with early diagnosis and prompt treatment. (C) 2001 by Else vier Science Inc.