Moffitt AM report PEARLS: strep anginosus, brain abscesses

**FIRST, A PEARL FROM YESTERDAY’S AM REPORT: A clue to diagnosing lymphoma is new alcohol intolerance (alcohol-related pain at lymph node sites)! A one-page case is attached.

Intern report PEARLS: strep anginosus, brain abscesses

**PEARL: when you uncover strep anginosus (a strep viridans spp), look for abscesses!! Treatment is abscess drainage and prolonged abx.

 

Approach to brain abscesses:

  • Causes: 1. direct spread (from oral cavity, sinuses), 2. hematogenous seeding (eg from endocarditis or bacteremia), or 3. trauma (including recent surgery)
    • Subacute/chronic otitis media and mastoiditis à inferior temporal lobe, cerebellum
    • Frontal/ethmoid sinuses, dental infections à frontal lobes
    • Hematogenous: often multiple abscesses
  • Micro: Usually will give a clue to the primary source of infection. Can think of it as monomicrobial or polymicrobial, depending on the cause.
    • Think about immune status: immunocompromised hosts (HIV/AIDs, neutropenic, on immunosuppression) are also at risk of TB, fungal, parasitic infections
  • Dx: suggestive MRI/CT findings, CT-guided aspiration or surgery.
    • **If focal s/sx, or imaging c/f mass effect, LP is contraindicated!
  • Check out the attached NEJM review article on brain abscesses for more!

Evernote link: https://www.evernote.com/shard/s34/sh/bb91c872-b167-40a7-9301-600bdc1026a8/26f155693a8492a1dbb992a11bfccba3

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