COMMUNITY ACQUIRED METHICILLIN SENSITIVE STAPHYLOCCUS AUREUS CEREBRAL ABSCESS IN A PREVIOUSLY HEALTH GENTLEMAN MIMICKING SIGNS OF CAVERNOUS SINUS THROMBOSIS-A UNIQUE PRESENTATION
AbstractCentral Nervous System (CNS) infections like meningitis and cerebral abscess caused by Staphylococcus aureus are usually seen in patients with neurosurgical interventions or immune compromised patients or patients with cardiac vegetation’s. They are extremely rare in healthy patients. We report a case of a 44 year old Indian gentleman who was perfectly healthy with no known co morbidities, which presented with fever, neck stiffness and altered mental status. He had fulminant staph bacteraemia (as evidenced by persistently positive blood cultures) with meningitis and cerebral abscess. Extensive search was made to find the source of infection, but it was inconclusive. Isolated CNS Methicillin Sensitive Staphylococcus aureus (MSSA) infection in an apparently healthy patient is very rare. This gentleman presented with altered mental status, asymmetrical exophthalmos and multiple cranial nerve palsies. This case highlights the challenge of making early diagnoses of a brain abscess; since it has symptomology mimicking cavernous sinus thrombosis .This is due to the involvement of the cerebellopontine angle and extensive brain oedema and oedema of the retro bulbar tissues.Keywords: Staphylococcus aureus, brain abscess, bacteraemia
Classics in infectious diseases. "On abscesses". Alexander Ogston (1844–1929). Rev Infect Dis 1984;6(1):122-8.
Troidle L, Eisen T, Pacelli L, Finkelstein F. Complications associated with the development of bacteremia with Staphylococcus aureus. Hemodial Int 2007; 11(1):72–5.
Roberts FJ, Smith JA, Wagner KR. Staphylococcus aureus meningitis: 26 years' experience at Vancouver General Hospital. Can Med Assoc J 1983;128(12):1418–20.
Sharma R, Mohandas K, Cooke RP. Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside. Infection 2009;37(1):39–43
Tristan A, Bes M, Meugnier H, Lina G, Bozdogan B, Courvalin P, et al. Global distribution of Panton-Valentine leucocidin-positive methicillin –resistent Staphylococcus aureus,2006. Emerg Infect Dis 2007;13(4):594–600.
Lo BM, Erwin EA. Missed epidural brain abscess after furunculosis. Am J Emerg Med. 2008 May;26(4):522.e3–4.
Naesens R, Ronsyn M, Druwe P, Denis O, Ieven M, Jeurissen A. Central nervous system invasion by community acquired methicillin-resistant Staphylococcus aureus. J Med Microbiol 2009;58(pt 9):1247–51.
Gonzalez C, Roa J, Shabarek N. Community acquired methicillin sensitive Staphylococcus aureus bacteremia,meningitis and brain abscess:A unique presentation. Int J Case Reports 2013;4(1):19–23.
Mylotte JM, McDermott C, Spooner JA. Prospective study of 114 consecutive episodes of staphylococcus aureus bacteremia .Rev Infect Dis 1987;9(5):891–907.
Fowler VG Jr, Olsen MK, Corey GR, Woods CW, Cabell CH, Reller LB, et al. Clinical identifiers of complicated Staphyloccus aureus bacteremia. Arch Intern Med 2003;163(17):2066–72.
Carpenter J, Stapleton S, Holliman R. Retrospective analysis of 49 cases of brain abscess and review of the literature. Eur J Clin Microbiol Infect Dis 2007;26(1):1–11.
Roche M, Humphreys H, Smyth E, Phillips J, Cunney R, McNamara E, et al. A twelve –year review of central nervous system bacterial abscesses;presentation and aetiology. Clin Microbiol Infect 2003;9(8):803–9.