Multiple brain abscesses caused by Streptococcus bovis

Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review

OBJECTIVES

To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections.

METHODS

Four cases of S. bovis CNS infections from our institution are presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted.

RESULTS

52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001).

CONCLUSIONS

CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.

Multiple brain abscesses - a rare complication of bronchiectasis

BACKGROUND

Brain abscess can arise as a complication of a variety of infections, trauma or surgery. Bacteria can invade the brain by direct spread or through haematogenous seeding. Brain abscesses are described as a rare complication of bronchiectasis.

CASE DESCRIPTION

A 44 -year -old woman with pulmonary tuberculosis in childhood and with the diagnosis of bilateral extensive bronchiectasis who presented behaviour alterations and later, paresis of the sixth cranial nerve, was diagnosed multiple brain abscesses. The microbiological exams were negative. The study of the primary focus of infection could only identify infected bronchiectasis. Empiric antibiotics and anti- -oedematous treatment were prescribed with progressive clinical improvement. Because of inadequate response she was submitted to surgery. She was discharged with diplopia, without any other neurological alterations.

CONCLUSION

In the present clinical case, the infected bronchiectasis were the only focal infection detected, so in patients with this disease and with new neurological manifestations, infected lesions in the central nervous system should be excluded.

Late infection of a total knee arthroplasty with Streptococcus bovis in association with carcinoma of the large intestine

Infection of a total knee arthroplasty with Streptococcus bovis in a 76-year-old man that led to the diagnosis of a bowel carcinoma is reported. Investigation revealed a malignancy in the ascending colon with extension into the adrenal gland. S bovis in conjunction with colonic neoplasia has been reported in several orthopedic conditions: vertebral osteomyelitis, discitis, lateral neck abscess, and osteomyelitis of the ileum. The relationship of S bovis to endocarditis, meningitis, brain abscesses, and peritonitis has also been well described. However, S bovis is a rare pathogen infecting joint prostheses and should raise the possibility of a gastrointestinal lesion.

Pseudotumour of the lung caused by Mycobacterium malmoense infection in an HIV positive patient

A case of pulmonary Mycobacterium malmoense infection presenting as a pseudotumour of the lung in a severely immunosuppressed HIV infected patient is reported.