A case of otitis media complicated by intracranial infection with Actinomyces turicensis

Abstract

Introduction:Actinomycosis is a granulomatous suppurative infection caused by filamentous Gram-positive anaerobic bacteria from the family Actinomycetaceae. To our knowledge, this is the first reported case of otogenic brain abscess associated with Actinomyces turicensis.Case presentation:We report the case of an immunocompetent 5-year-old boy with recurrent otitis media who re-presented to the emergency department with a 3-week history of otorrhoea, progressive anorexia, vomiting and lethargy. He was admitted with a working diagnosis of otitis media and dehydration, and was treated with intravenous fluids and oral co-trimoxazole. He subsequently developed abnormal posturing with a reduced Glasgow coma score and seizures. Urgent computed tomography revealed a cerebellar abscess with obstructive hydrocephalus for which he underwent urgent neurosurgical intervention. Tissue and aspirate cultures revealed a polymicrobial infection with A. turicensis. The patient has since undergone long-term antibiotic treatment and has made a good recovery.Conclusion:This case demonstrates the successful use of long-term antibiotic therapy and neurosurgical intervention to treat otogenic brain abscess associated with A. turicensis infection. To the best of our knowledge, this is the first such documented case. Our report also provides a timely reminder that, despite a reduced incidence in the developed world, intracranial complications of otitis media continue to occur and a high index of suspicion is required.

Actinomycosis of the Middle Ear in Children: Case Report and Literature Review

“…Four patients (24%) in our review of case reports of middle ear actinomycosis, developed central nervous system complications. Two developed intracranial abscesses, 2,5 1 developed sigmoid sinus thrombosis, 6 and 1 developed meningoencephalitis. 9 Because delayed diagnosis can lead to serious central nervous system complications, clinicians should be aware that actinomycosis could cause recurrent and/or chronic otitis media, even if ear fluid culture does not reveal Actinomyces species.…”

“…We found 16 articles that reported an additional 16 cases of pediatric actinomycosis of the middle ear, published between 1974 and 2021. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The characteristics of the 17 cases, including our patient, are summarized in Table (Supplemental Digital Content 1, http://links.lww.com/ INF/E804). The median age at diagnosis was 9 years (range, 5-14 years), and 10 cases (59%) occurred in males.…”

“…Middle-ear actinomycosis commonly presents with recurrent otitis media. 2,4,5,8,17,20 The infection is indolent, with intermittent otorrhea, resistant to several antibiotics. 11 In general, there are 3 possible routes for Actinomyces to enter the middle ear: the Eustachian tube, the external auditory canal and via hematogenous spread.…”

“…1 To date, only 16 pediatric cases of middle ear and mastoid actinomycosis have been reported in scientific literature published in English. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] We treated Actinomyces otitis media and mastoiditis in a 9-year-old girl, in whom actinomycosis was diagnosed by histology.…”

Actinomycosis of the Middle Ear Mimicking Cholesteatoma: A Case Report and Literature Review

“…It is a saprophytic infection caused by Actinomyces. Actinomyces is a gram-positive, anaerobic, non-acid-fast, filamentous bacterium [ 1 , 2 ]. They are part of the normal flora of the oropharynx, digestive, and genital tracts [ 3 ].…”