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CASE REPORT
Year : 2001  |  Volume : 19  |  Issue : 3  |  Page : 149-150
 

Clostridium ramosum in a case of cerebellar abscess


TN Medical College & Nair Hospital, Mumbai - 400 008, Maharashtra, India

Correspondence Address:
TN Medical College & Nair Hospital, Mumbai - 400 008, Maharashtra, India

 ~ Abstract 

A case of cerebellar abscess due to Clostridium ramosum is reported here. The microbiological workup has been discussed.

How to cite this article:
Set R, Kandian S, Koppikar G V. Clostridium ramosum in a case of cerebellar abscess. Indian J Med Microbiol 2001;19:149-50


How to cite this URL:
Set R, Kandian S, Koppikar G V. Clostridium ramosum in a case of cerebellar abscess. Indian J Med Microbiol [serial online] 2001 [cited 2019 Oct 18];19:149-50. Available from: http://www.ijmm.org/text.asp?2001/19/3/149/8150


Brain abscess accounts for approximately one out of ten thousand general hospital admissions. Cerebellar abscess secondary to otitis media is one of the most serious forms. It remains a significant problem in the developing world specially in children living in poverty. The threat is twofold - first due to spreading infection and second due to the increased intracranial pressure produced by space occupying lesion.
A cerebellar abscess is never primary but secondary to some focus of infection.[1] Streptococci, Pseudomonas species , anaerobic cocci and Bacteroides species are the most common isolates from cases of chronic otitis media and its intracranial complications.[2] We report a case of cerebellar abscess seen at our hospital which yielded Clostridium ramosum.

 ~ Case report Top

A 5 year old boy presented in September 1999 with a history of fever for one and a half months along with irritability and headache for 15 days. Two episodes of general tonic convulsions were reported. He gave a history of bilateral chronic suppurative otitis media for four years for which he was being treated with no response.
On examination, there was no neck stiffness. Ataxia and nystagmus were present. Finger nose test was positive. Ear swab yielded Proteus species on aerobic culture. CSF microscopic examination and culture were negative for microorganisms. Axial CT scan of brain revealed 4.5 x 4.8 x 3 cm hypodense lesion showing peripheral enhancement in the left cerebellar hemisphere with erosion of sigmoid plate. Posterior fossa craniectomy was done with evacuation of the left cerebellar abscess with excision of abscess wall. The pus was immediately sent to the microbiology laboratory.
Microbiological workup showed the pus was white and thick in consistency and Gram stain showed pleomorphic, Gram variable bacilli with round terminal spores. Aerobic culture on blood agar and MacConkey's agar yielded no growth.. Blood agar incubated anaerobically in MacIntosh and Filde's jar for 48 hours showed 1-2 mm nonhemolytic, irregular, translucent, entire colonies, sensitive to metronidazole (5µgm) disc. The colonies were aerotolerance negative. Bile esculin agar (Hi Media) showed enhanced growth with hydrolysis of esculin. Subsequent tests showed the isolate to be catalase negative and non motile. The isolate was identified as C.ramosum as it fermented lactose.[3]
The patient responded to combined therapy with ampicillin, chloramphenicol, and metronidazole. He was followed up for more than a month and did not show evidence of any spread.

 ~ Discussion Top

Anaerobic bacteria are a common cause of otogenic brain abscesses. In one study on abscesses of the CNS, the anaerobes found were Bacteroides species and Peptostreptococcus species.[4] The anaerobes found in another study of intracranial abscesses in children constituted anaerobic cocci, Actinomyces species, Fusobacterium species and Bacteroides species.[5] None of the studies had any Clostridial isolates. Previously, we have also isolated anaerobes from brain abscesses.[6] In our institution this is the first time we have reported a case of cerebellar abscess caused by Clostridium ramosum. Although it has been found in severe infections from virtually all body sites, C.ramosum can easily be misidentified or overlooked because it usually stains as a gram negative rod and its terminal spores are hard to demonstrate.
In the present case, the infection had mostly spread from the ear through the tegumen tympani or along the veins into the substance of the brain. Evidence of infection especially in the ear, nose and throat should be carefully sought.[7] The ear swab from our patient had only been processed aerobically. Hence it is also essential to process ear swabs anaerobically so that appropriate therapy can be instituted early. 

 ~ References Top

1.Anderson W. Boyd's pathology for the surgeon, 8th Ed. (Kothari Book Depot) 1967: 554 -556.  Back to cited text no. 1    
2.Sheld MM. In: Harrison's principles of internal medicine, Volume 2, 14th Ed.Fauci, Braunwald, Isselbacher, Wilson, Martin, Kasper, Hauser, Longo, Ed. (Mc Graw Hill) 1998; 2426 -2430.  Back to cited text no. 2    
3.Elmer W. Koneman, Stephen D. Allen, William M. Janda, Schreckenberger PC, Winn WC Jr. Colour atlas and textbook. Diagnostic Microbiology, 5th Ed. (Lippincott co.), Philadelphia; 1997: 767 - 772.  Back to cited text no. 3    
4.Louvois JD. Bacteriological examination of pus from abscesses of the central nervous system. J Clin Path 1980; 33: 66-71.  Back to cited text no. 4    
5.Brook I. Bacteriology of intracranial abscess in children J Neurosurg 1981; 54: 484 - 488.  Back to cited text no. 5    
6.Set R, Sequiera L, Angadi SA, Koppikar GV. Prevalence of anaerobic bacteria in pyogenic infections. Indian J Med Microbiology 1997; 15 (3 ) : 121-122.   Back to cited text no. 6    
7.Gantz NM, Brown RB, Berk SL, Esposito AL, Gleckman RA. Manual of Clinical problems in infectious disease, 3rd Ed. (Little, Brown and company) Boston, 1994:166-167.  Back to cited text no. 7    
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