Multiple Brain Abscesses Due to Actinomyces Odontolyticus: A Rare İnfection In a Previously Healthy Child

Actinomyces spp. are commensal gram-positive, non-sporulating, anaerobic bacteria which may cause infections in both immunocompetent patients and in patients with impaired host defenses. Actinomycosis of the central nervous system (CNS) is a rare manifestation affecting between 1-15% of cases with actinomycotic infection. We present a child with multiple brain abscess due to A. odontolyticus.

Case

A 2 ^6/12 years-old male patient with neither previous history of hospitalization or trauma nor family history of early death or serious illness (except prematurity-32 gestation week and twin) was admitted (five and one day ago before admission to our pediatric intensive care unit (PICU)) with complaints of fatigue, vomiting and nasal discharge (no fever). At secondary admission, brain CT and MRI scan were performed because of weakness of the extremities on the left side revealing three brain abscesses in the right hemisphere and a shift to the left hemisphere. He was transferred to our PICU for further treatment. In addition to neurosurgical drainage of the abscess, vancomycin plus ceftriaxone and metronidazole intravenously were initiated. Also decompressive craniectomy was performed. Actinomyces odontolyticus was isolated from the pus obtained during surgery. Since he had lymphopenia (1300/mm³) primary and secondary immunodeficiencies were searched. HIV serology was negative. Serum immunoglobulins, lymphocyte subset analysis, and dihydrorhodamine (DHR) test results were normal. The blood specimen for CH50 was sent, all exons analyzes were performed in terms of genetic defects.

Conclusion: Antimicrobial treatment following neurosurgical evaluation of the CNS abscess resulted in complete neurofunctional recovery. The clinicians should keep in mind that A. odontolyticus may be a causal agent in brain abscesses even in healthy children.