American Journal of Infectious Diseases and Microbiology, 2014, Vol. 2, No. 5, 131-137 Available online at http://pubs.sciepub.com/ajidm/2/5/6 © Science and Education Publishing DOI:10.12691/ajidm-2-5-6 Cerebral Abscess Caused by Streptococcus spp in a Patient with Chronic Suppurative Otitis Media (CSOM) K V Ramana 1,* , K Maheshwar Reddy 2 , Padmawali Palange 1 , B Mohan Rao 1 , Sanjeev D Rao 1 1 Department of Microbiology, Prathima Institute of Medical Sciences, Karimnagar, Telangana, India 2 Department of Microbiology, Chalmeda Anandrao Institute of Medical Sciences, Karimnagar, Telangana, India *Corresponding author: ramana_20021@rediffmail.com Received October 29, 2014; Revised November 09, 2014; Accepted November 12, 2014 Abstract Chronic suppurative otitis media (CSOM) is a clinical condition where a patient suffers from external and middle ear infection caused mostly by bacteria or by fungi resulting in ear discharge. Identification of the causative microorganism and initiation of appropriate antimicrobial chemotherapy is needed in patients suffering from CSOM. Infections of the ear if happen to be chronic in nature have the tendency to leak in to the adjacent areas of the central nervous system causing severe complications. Keywords: Streptococcus spp, chronic suppurative otitis media (CSOM) and cerebral abscess Cite This Article: K V Ramana, K Maheshwar Reddy, Padmawali Palange, B Mohan Rao, and Sanjeev D Rao, “Cerebral Abscess Caused by Streptococcus spp in a Patient with Chronic Suppurative Otitis Media (CSOM).” American Journal of Infectious Diseases and Microbiology, vol. 2, no. 5 (2014): 131-137. doi: 10.12691/ajidm-2-5-6. 1. Introduction Ear infections are among the most common causes necessitating hospital visits usually in the paediatric age population. Infections of the ear may be presenting either as acute or chronic. Otitis media results from the infection mostly due to a pyogenic bacterium or a fungus. The inflammatory process mediated by the infection in the middle ear often spreads in to the endocranium through direct damage of the middle ear bone walls. Etiology of otogenic cerebral abscess is complex that may involve pyogenic aerobic bacteria (Streptococci spp, Staphylococcus aureus, E coli, Klebsiella spp, Pseudomonas spp and others) and anaerobic pathogens (Bacteroides spp, Fusobacterium spp) and fungi (Aspergillus spp and Candida spp) [1,2,3,4,5]. Clinical and microbiological diagnosis of ear infections and the treatment with appropriate antimicrobial agents is necessary to avoid intracranial spread and resultant serious complications. People living in the developing nations are predisposed to frequent infections (skin infections, respiratory tract infections, ear infections) attributed usually to overcrowding, mal nutrition and poor hygiene. We discuss a case of cerebral abscess caused by Streptococcus spp in an immunocompetent adult who complained of chronic ear infection since childhood. 2. Case Presentation A 29-year-old male patient presented to the emergency department of Prathima Institute of Medical Sciences with symptoms of nausea, vomiting, severe head ache, giddiness, difficulty in ingesting food and difficulty in walking. Patient gave history of ear discharge since one month. Patient was apparently healthy one month back. The ear discharge was from the left ear and was whitish in colour and foul smelling. Patient revealed that he had on and off ear infections since childhood. The patient was a non-smoker and occasional alcoholic. There was no history of diabetes mellitus, hypertension, asthma and tuberculosis. Patient was non-reactive for human immunodeficiency virus (HIV), Hepatitis B virus (HBV) and Hepatitis C Virus (HCV). CT scan 5mm slice thick was taken in 128 slices without intravenous catheterization. CT scan of brain revealed evidence of hypo dense lesion with surrounding peri-lesional oedema in left cerebellar region. CT scan also showed evidence of erosion of sigmoid plate with extension of collection of middle ear in to intracranial cavity (Figure 1, Figure 2 and Figure 3). MRI was performed for a better study of brain which confirmed left CSOM with extension in to the left cerebellum with peri-lesional oedema causing compression of pons, 4 th ventricle aqueduct and minimal middle line shift of right side. MRI also showed evidence of T1 hypointense and T2 hyperintense lesion in left mastoidal cells, left external ear and middle ear cavity with extension to lateral part of left cerebellum. Perilesional oedema surrounding left cerebellum and verms causing mass effect in the form of compression of 4 th ventricle aqueduct and pons with a minimal midline shift towards right side was confirmed. Rest of the brain tissue was found normal. Based on the clinical symptoms and results of the imaging studies a diagnosis of otogenic cerebellar abscess was made. Computer guided Aspiration of the abscess pus was performed and was sent for microbiological