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Infections of the Central Nervous System Due to Nutritionally Variant Streptococci: Report of 4 Cases and Review of the Literature

Bakker, Richard Gerrit MD, PhD; Koletar, Susan Lynn MD; Bazan, Jose Antonio DO

Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e3182354a91
Review Articles

Abstract: Central nervous system (CNS) infections due to nutritionally variant streptococci (NVS) have seldom been described. The authors describe 4 patients with CNS infections due to NVS and review all published cases. Infections of the oral cavity (45%) or prior neurosurgical procedures (36%) were commonly reported before diagnosis. Common presenting symptoms included fever (64%), headache (55%), nausea and emesis (55%), and mental status changes (55%). Imaging revealed intracranial abscesses in 91% of the patients. Neurosurgical intervention was required in all patients with intracranial abscesses for diagnostic and therapeutic purposes. Isolation of NVS was made by subculture of abscess and/or cerebrospinal fluid into media cross-streaked with Staphylococcus aureus and/or supplemented with L-cysteine or pyridoxal. Penicillin or third-generation cephalosporins with or without synergistic gentamicin were the most common antimicrobial regimens used (82%). The median duration of therapy was 49 days (range, 10–118 days). Clinical outcomes were favorable for most patients.

Author Information

From the Division of Infectious Diseases, The Ohio State University Medical Center, Columbus, OH.

Correspondence to: Jose Antonio Bazan, DO, Division of Infectious Diseases, The Ohio State University Medical Center, N-1137 Doan Hall, 410 West 10th Ave, Columbus, OH 43210. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.