Faculty Collaboration Database

Streptococcus milleri: an organism for head and neck infections and abscess. Arch Otolaryngol Head Neck Surg 2001 Jun;127(6):650-4

Date

06/19/2001

Pubmed ID

11405863

DOI

10.1001/archotol.127.6.650

Scopus ID

2-s2.0-0034905105 (requires institutional sign-in at Scopus site)   82 Citations

Abstract

BACKGROUND: Streptococcus milleri, a commensal organism, has the potential to cause significant morbidity. There is a paucity of published data regarding this organism in the head and neck.

OBJECTIVES: To identify and assess the presentation, treatment, and outcomes 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 patients with cultures positive for S milleri group (SMG) bacteria. Retrospective 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 region. Sites of origin included the paranasal sinuses, dental, facial soft tissues, deep neck spaces, peritonsillar region, and a tracheostomy site. The paranasal sinuses were the most common site in 37% (6/16). Streptococcus milleri was the only isolate in 69% (11) of the infections. Significant local extension occurred in 56% (9/16) of the patients and included the orbit, skull base, cranium, and deep neck spaces. All patients had surgical drainage and 15 also received intravenous antibiotic treatment. One complication of osteomyelitis of the frontal bone occurred with resolution after surgical debridement and intravenous antibiotic treatment.

CONCLUSIONS: Streptococcus milleri can be an aggressive pathogen in the head and neck with a propensity for abscess formation and local extension of the infection in a pediatric population. Surgical drainage with antibiotics is generally successful in management of the condition. However, emerging penicillin resistance and the ability for local extension require suspicion of incomplete treatment if clinical symptoms persist.

Author List

Han JK, Kerschner JE

Author

Joseph E. Kerschner MD Provost, Executive Vice President, Dean, Professor in the School of Medicine Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Abscess
Adolescent
Child
Child, Preschool
Female
Head
Humans
Male
Microbial Sensitivity Tests
Neck
Otorhinolaryngologic Diseases
Retrospective Studies
Soft Tissue Infections