Streptococcus milleri: An Organism for Head and Neck Infections and Abscess | Infectious Diseases | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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1.
Gomez-Garces  JLAlos  JCogollos  R Bacteriologic characteristics and antimicrobial susceptibility of 70 clinically significant isolates of Streptococcus milleri group.  Diagn Microbiol Infect Dis.1994;19:69-73Google Scholar
2.
Koneman  EWAllen  SDJanda  WMSchreckenberger  PCWinn  WC Color Atlas and Textbook of Diagnostic Microbiology. 5th ed. Philadelphia, Pa: JB Lippincott; 1997:577-649.
3.
Whiley  RABeighton  D Emended descriptions and recognition of Streptococcus constellatus, Streptococcus intermedius, and Streptococcus anginosus as distinct species.  Int J Syst Bacteriol.1991;41:1-5.Google Scholar
4.
Jousimies-Somer  HSavolainen  SMakitie  AYlikoski  J Bacteriologic findings in peritonsillar abscesses in young adults.  Clin Infect Dis.1993;16:S292-S298.Google Scholar
5.
Piscitelli  SCShwed  JSchreckenberger  PDanziger  LH Streptococcus milleri group: renewed interest in an elusive pathogen.  Eur J Clin Microbiol Infect Dis.1992;11:491-498.Google Scholar
6.
Gossling  J Occurrence and pathogenicity of the Streptococcus milleri group.  Rev Infect Dis.1988;10:257-285.Google Scholar
7.
Jacobs  JAPietersen  HGStobberingh  EESoeters  PB Bacteremia involving the Streptococcus milleri group: analysis of 19 cases.  Clin Infect Dis.1994;19:704-713.Google Scholar
8.
Whiley  RABeighton  DWinstanley  TGFraser  HYHardie  JM Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus (the Streptococcus milleri group): association with different body sites and clinical infections.  J Clin Microbiol.1992;30:243-244.Google Scholar
9.
Jacobs  JAPietersen  HGStobberingh  EESoeters  PB Streptococcus anginosus, Streptococcus constellatus, and Streptococcus intermedius: clinical relevance, hemolytic, and serologic characteristics.  Am J Clin Pathol.1995;104:547-553.Google Scholar
10.
Singh  KPMorris  ALang  SDRMacCulloch  DMBremner  DA Clinically Significant Streptococcus anginosus (Streptococcus milleri) infections: a review of 186 cases.  N Z Med J.1988;101:813-816.Google Scholar
11.
Poole  PMWilson  G Occurrence and cultural features of Streptococcus milleri in various body sites.  J Clin Pathol.1979;32:764-768.Google Scholar
12.
Murray  HWGross  KCMasur  HRoberts  RB Serious infections caused by Streptococcus milleri Am J Med.1978;64:759-764.Google Scholar
13.
Franklam  RR Physiological differentiation of viridans streptococci.  J Clin Microbiol.1977;5:184-201.Google Scholar
14.
Parker  MTBall  LC Streptococci and aerococci associated with systemic infection in man.  J Med Microbiol.1976;9:275-302.Google Scholar
15.
Poole  PMWilson  G Streptococcus milleri in the appendix.  J Clin Pathol.1977;30:937-942.Google Scholar
16.
Fenton  JESmyth  DAViani  LGWalsh  MA Sinogenic brain abscess.  Am J Rhinol.1999;13:299-302.Google Scholar
17.
Simo  RHartley  CRapado  FZarod  APSanyal  DRothera  MP Microbiology and antibiotic treatment of head and neck abscesses in children.  Clin Otolaryngol.1998;23:164-168.Google Scholar
18.
Hamrick  HJMangum  ME Beta-hemolytic Streptococcus milleri group misidentified as Streptococcus pyogenes on throat culture.  Pediatr Infect Dis J.1999;18:75-76.Google Scholar
19.
Jacobs  JAStobberingh  EE In-vitro antimicrobial susceptibility of the "Streptococcus milleri" group.  J Antimicrob Chemother.1996;37:371-375.Google Scholar
20.
Lima  AJimenez  MLAlarcon  TLopez-Brea  M Five year analysis of antimicrobial susceptibility of the Streptococcus milleri group.  Eur J Clin Microbiol Infect Dis.1999;18:440-444.Google Scholar
21.
Bantar  CCanigia  LFRelloso  SLanza  ABianchini  HSmayevsky  J Species belonging to the Streptococcus milleri group: antimicrobial susceptibility and comparative prevalence in significant clinical specimens.  J Clin Microbiol.1996;34:2020-2022.Google Scholar
22.
Aracil  BGomez-Garces  JLAlos  JI A Study of susceptibility of 100 clinical isolates belonging to the Streptococcus milleri group to 16 cephalosprins.  J Antimicrob Chemother.1999;43:399-402.Google Scholar
Original Article
June 2001

Streptococcus milleri: An Organism for Head and Neck Infections and Abscess

Author Affiliations

From the Department of Otolaryngology and Communications Sciences, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee.

Arch Otolaryngol Head Neck Surg. 2001;127(6):650-654. doi:10.1001/archotol.127.6.650
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.

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