The Significance of Streptococcus anginosus Group in Intracranial Complications of Pediatric Rhinosinusitis

JAMA Otolaryngology - Head and Neck Surgery (Impact Factor: 1.79). 02/2013; 139(2):157-60. DOI: 10.1001/jamaoto.2013.1369
Source: PubMed


OBJECTIVE To assess the significance of the Streptococcus anginosus group in intracranial complications of pediatric patients with rhinosinusitis. DESIGN Retrospective cohort study. SETTING Tertiary pediatric hospital. PATIENTS A 20-year review of medical records identified patients with intracranial complications resulting from rhinosinusitis. In the 50 cases identified, S anginosus was the most commonly implicated bacterial pathogen in 14 (28%). Documented data included demographics, cultured bacteria, immune status, sinuses involved, type of intracranial complication, otolaryngologic surgical and neurosurgical intervention, type and duration of antibiotics used, and resulting neurologic deficits. Complications and outcomes of cases of S anginosus group-associated rhinosinusitis were compared with those of other bacteria. MAIN OUTCOME MEASURES The severity and outcomes of intracranial complications of pediatric rhinosinusitis due to S anginosus group bacteria compared with other bacteria. RESULTS Infection caused by the S anginosus group resulted in more severe intracranial complications (P = .001). In addition, patients with S anginosus group-associated infections were more likely to require neurosurgical intervention (P < .001) and develop long-term neurologic deficits (P = .02). Intravenous antibiotics were administered for a longer duration (P < .001) for S anginosus group-associated infections. CONCLUSIONS Rhinosinusitis associated with the S anginosus group should be considered a more serious infection relative to those caused by other pathogens. Streptococcus anginosus group bacteria are significantly more likely than other bacteria to cause more severe intracranial complications and neurologic deficits and to require neurosurgical intervention. A low threshold for intervention should be used for infection caused by this pathogen.

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    ABSTRACT: Streptococcus anginosus and the closely related species Streptococus constellatus and Streptococcus intermedius, are primarily commensals of the mucosa. The true pathogenic potential of this group has been under recognized for a long time caused by difficulties in correct species identification as well as the commensal nature of these species. During recent years, streptococci of the S. anginosus group are increasingly found as relevant microbial pathogens in abscesses and blood cultures and play a pathogenic role in cystic fibrosis. Several international studies showed a surprisingly high frequency of infections caused by the S. anginosus group. Recent studies and a genome-wide comparative analysis suggested the presence of multiple putative virulence factors that are well-known from other streptococcal species. However, very little is known about the molecular basis of pathogenicity in these bacteria. This review summarizes our current knowledge of pathogenicity factors and their regulation in S. anginosus. This article is protected by copyright. All rights reserved.
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