Multi-regional abscesses caused by streptococcus milleri following acupuncture

We report a case of multiregional abscesses following acupuncture. A 56-year-old female who had received acupuncture to treat lower back pain, subsequently develops lumbar septic arthritis, epidural abscess, bilateral iliopsoas, and subcutaneous abscesses. Streptococcus milleri was isolated from the peripheral blood, subcutaneous tissue and psoas abscess. Surgical drainage of the subcutaneous abscess, CT guided drainage of the intraabdominal abscess and intravenous ceftriaxone resulted in a good clinical recovery, resolution of the infection, and prevention of complications. The case is discussed in detail, and pertinent review of literature is included. Streptococcus milleri naturally occurs as normal flora of the mouth, nasopharynx, gastrointestinal tract, and vagina. They were first described by Dr O Guthof in 1956 in honour of Dr WD Miller, an oral microbiologist. They are generally sensitive to penicillins, cephalosporins, vancomycin, and clindamycin. They are resistant to bacitracin, and sulphonamides. Infections caused by streptococcus milleri include oral infections, deep abscesses in liver, brain, spinal cord, and lung. They rarely occur in the pericardium, pleura, surgical wounds, endocarditis, and can cause bacteremia in both immunocompromised and immunocompetent hoste[l]. We present a case of a 56-year-old female who developed lumbar septic arthritis, epidural abscess, bilateral iliopsoas, and subcutaneous abscesses due to streptococcus milleri infection after receiving lower back and gluteal acupuncture for relief of musculoskeletal back pain. To the best of our knowledge, this is the first reported case in the literature

Effect of a single-use toothbrush on plaque microflora.

Aim: To study and compare the microbial flora of dental plaque after the use of a self-contaminated toothbrush and that of a single-use toothbrush. Materials and Methods: The study group included 40 young volunteers from Yenepoya Dental College, who were free from any systemic or oral disease. In these subjects, plaque samples were collected after 1 month use of a self-contaminated toothbrush. Each subject was given a set of 30 new toothbrushes and a toothpaste tube and instructed to use one toothbrush everyday and discard it after use. The plaque samples were collected on a weekly interval and cultured on Mitis Salivarius agar. The colonies were identified and speciated and their count was recorded. Results: Streptococcus mitis, S. mutans, S. sanguis, S. milleri and Candida were recovered from the samples. A highly significant decrease in their numbers was found after the use of a single-use toothbrush (P value 0.001). Conclusions : As a contaminated toothbrush can reintroduce microorganisms into the oral cavity, it may be a sound practice to change the toothbrush as frequently as possible.

Magnetic resonance spectroscopy in the diagnosis and etiological definition of brain bacterial abscesses

We report two patients with bacterial brain abscesses whose etiological diagnosis was correctly proposed by association of diffusion weighted images (DWI) and magnetic resonance spectroscopy (MRS) with conventional MRI. Both patients presented ring enhancing lesions with evidences of restricted diffusion. On MRS, the abscess caused by aerobic bacteria presented lactate and aminoacids peaks and the abscess caused by anaerobic facultative bacteria showed also acetate and succinate peaks. These results are in agreement with an unique previous study that related MRS pattern with bacterial etiology. Conventional MRI, associated with DWI and MRS is effective in diagnosing bacterial abscess and promising in exploring its etiology.

Apresentamos dois pacientes com abscessos bacterianos cerebrais cujos diagnósticos etiológicos foram corretamente auxiliados pela associação de difusão e espectroscopia à ressonância magnética convencional. Ambos apresentavam lesões com captação anelar de contraste e evidências de restrição à difusão de moléculas de água. Na espectroscopia, o abscesso causado por bactéria aeróbia apresentou picos de lactato e aminoácidos, enquanto o abscesso causado por bactéria anaeróbia facultativa mostrou, além destes, picos de acetato e succinato. Tais resultados concordam com um único estudo prévio que relacionou o padrão de espectroscopia nos abscessos com sua etiologia bacteriana. A ressonância magnética convencional, associada à difusão e à espectroscopia é uma técnica eficiente no diagnóstico de abscessos bacterianos e promissora em explorar suas etiologias.

Streptococcus milleri group bacteraemia in North Yorkshire, England (1989-2000).

BACKGROUND & OBJECTIVES: Though carriage and local infection with organisms of the Streptococcus milleri group (SMG) are regular in clinical practice, bacteraemia is infrequent in man. The objective of the present study was to give an account of our experience with the SMG bacteraemia over a period of 12 yr in North Yorkshire. METHODS: The laboratory and clinical records of all clinically significant cases of SMG bacteraemia in our district general hospital catchment (combined population 260,000) were reviewed for the 12 yr period from 1989 to 2000. Viable isolates were recovered, species identified, and minimum inhibitory concentration (MIC) determined. RESULTS: Twenty nine episodes of infection gave an annual incidence of 0.93 cases per 100,000 population. Infections included abscess, pneumonia, septic arthritis, genital and urinary tract infections, endocarditis and diffuse septicaemia. Patient ages ranged from 18 to 90 yr but most patients were elderly, 82 per cent had evident predisposing conditions and mortality rate was 10 per cent. Species determination of the 22 isolates showed S. anginosus (64%), S. constellatus (27%) and S. intermedius (9%). Nearly all isolates were non-haemolytic and Lancefield grouping showed carriage of the F antigen (in 41%), C (14%) and no detected group (45%). Most of the isolates were susceptible to the antimicrobials tested. INTERPRETATION & CONCLUSION: Bacteraemia with SMG organisms was infrequent, often opportunistic and featured a low overall mortality rate. Intra-abdominal sepsis was the local feature in 16 (55%) of the patients and 9 (31%) of the total patient group showed abscess or empyema. There was a low rate of antibiotic resistance in these organisms from bloodstream infection.