A Study of 31 Cases with Head and Neck Abscesses

Clinical Significance of the Abscesses Caused by Streptococcus milleri Group

Abstract

A retrospective review of 31 patients diagnosed with head and neck abscesses at Onomichi General Hospital, Hiroshima, between April 2001 and September 2003 was performed. The patient median age was 55 years (age range,17-80 years). There were 18 males and 13 females. We divided the 31 patients into three groups by the sites of abscesses;“peritonsillar lesion”group (n=10),“deep neck”group (n=6) and“other sites”group (n=15). The majority of deteriorated cases belonged to the “deep neck infection”group. There were 27 cases with discharge from infectious sites. The predominant organisms isolated from these 27 specimens were of the Streptococcus milleri group (n=11). Four cases had infections by SMG mixed with anaerobes Five cases had undergone deteriorated course, which had necessitated emergency intratracheal intubations and/or repeated surgical drainages. Three of these were infections by SMG with anaerobes. There was a deteriorated case with gas gangrene unresponsive to repeated surgical drainage and intravenous antibiotic therapy. Finally hyperbaric oxygen therapy improved the condition.
Streptococcus milleri group (SMG) comprises organisms which are common inhabitants of the mouth and gastrointestinal tract. They can be aggressive pathogens and cause abscess formation in various sites of the body, but have rarely been listed as causes of head and neck infections. We describe the clinical features and management of SMG in head and neck infections. It is important to recognize SMG as a pathogen of head and neck infection. In addition, we should be aware that the infectious diseases caused by SMG with anaerobes can deteriorate rapidly.