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B1 and B2) Transesophageal echocardiogram images revealing anechoic lesions in the interatrial septum (arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Cabezón-Gutiérrez, Laura Espinosa-Pinzón, Eduardo Alegría-Barrero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "Cabezón-Gutiérrez" ] 1 => array:2 [ "nombre" => "Laura" "apellidos" => "Espinosa-Pinzón" ] 2 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Alegría-Barrero" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621004575?idApp=UINPBA00004N" "url" => "/23870206/0000015700000007/v1_202110050801/S2387020621004575/v1_202110050801/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Aggregatibacter aphrophilus brain abscess after tooth manipulation" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "355" "paginaFinal" => "356" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Raquel Fernández González, Amara González Noya, Ricardo Fernández-Rodríguez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Raquel" "apellidos" => "Fernández González" "email" => array:1 [ 0 => "raquelferngonz@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Amara" "apellidos" => "González Noya" ] 2 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Fernández-Rodríguez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna-Unidad de Enfermedades Infecciosas, Complexo Hospitalario Universitario de Ourense, Orense, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Absceso cerebral por <span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> tras manipulación dental" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> is a slow-growing gram-negative coccobacillus that is part of the oropharyngeal flora. It belongs to the HACEK group (<span class="elsevierStyleItalic">Haemophilus</span>, <span class="elsevierStyleItalic">Aggregatibacter</span>, <span class="elsevierStyleItalic">Cardiobacterium</span>, <span class="elsevierStyleItalic">Eikenella</span>, <span class="elsevierStyleItalic">Kingella</span>) and is known as a rare cause of endocarditis. Brain abscesses due to this microorganism are rare, especially in adults. We report a case of <span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> brain abscess after dental procedures.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient is a 57-year-old male with a history of hypertension and dyslipidaemia. Five years earlier he had a dental implant in the upper right second molar. He went to his dentist for a 1-week history of pain in the right maxillary area. The upper right lateral incisor underwent root canal therapy, without antibiotic prophylaxis. After 15 days he visited the clinic for weakness in the left limbs and bradypsychia. On arrival he was afebrile, oriented but with bradypsychia and with mild left hemiparesis; cardiopulmonary auscultation was normal. Lab tests results showed: 10,280 WBC/uL (91.7% neutrophils), CRP <0.1<span class="elsevierStyleHsp" style=""></span>mg/dL, HIV serology negative. A head CT scan was performed showing a right frontotemporoparietal lesion with a mass effect. He was admitted to Neurosurgery with the suspected diagnosis of glioblastoma multiforme.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A right frontoparietotemporal craniotomy was performed: an oedematous brain with discharge of purulent material was described. Intraoperative Gram stain showed branched gram-positive bacilli, so removal was completed and empirical treatment with cotrimoxazole (1800/320<span class="elsevierStyleHsp" style=""></span>mg i.v. every 6<span class="elsevierStyleHsp" style=""></span>h) and meropenem (2<span class="elsevierStyleHsp" style=""></span>g every 8<span class="elsevierStyleHsp" style=""></span>h i.v.) was started. With a diagnosis of brain abscess, he was transferred to the Internal Medicine-Infectious Diseases Department. Subsequently, ampicillin, amoxicillin-clavulanic acid, cefuroxime, gentamicin, ciprofloxacin, clarithromycin, and trimethoprim-sulfamethoxazole sensitive <span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> was isolated in intraoperative cultures. After 15 days of meropenem treatment, the patient was switched to ceftriaxone (2<span class="elsevierStyleHsp" style=""></span>g every 24<span class="elsevierStyleHsp" style=""></span>h i.v.) for 6 weeks. From admission, treatment was associated with dexamethasone (4<span class="elsevierStyleHsp" style=""></span>mg every 8<span class="elsevierStyleHsp" style=""></span>h i.v.), with subsequent tapering until discontinuation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Transthoracic and transoesophageal echocardiograms showed no valvular lesions suggestive of endocarditis. A CT scan of the face ruled out maxillary sinus disease.</p><p id="par0025" class="elsevierStylePara elsevierViewall">At discharge, the patient was asymptomatic and remained so at 4<span class="elsevierStyleHsp" style=""></span>months, with normal follow-up brain MRI.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> is an aerobic, non-motile, oxidase- and catalase-negative gram-negative coccobacillus, included in the HACEK group. It was first described in 1940 by Khairat, as a micro-organism causing endocarditis; at that time, <span class="elsevierStyleItalic">aphrophilus</span> or "foam-loving" was used to describe the preference of this micro-organism for growth in a CO<span class="elsevierStyleInf">2</span>-enriched atmosphere. Initially classified as <span class="elsevierStyleItalic">Haemophilius aphrophilus</span>, it was reclassified in 2006 as we know it today, <span class="elsevierStyleItalic">Aggregatibacter aprhrophilus</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. It is part of the normal oropharyngeal flora; has been isolated from dental plaque, interdental material and gums<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. It has low pathogenicity and slow growth, so it is a rare cause of infection in immunocompetent individuals.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Endocarditis is the most common complication, especially in patients with underlying valve disease and previous dental procedures, but <span class="elsevierStyleItalic">Aggregatibacter aprhrophilus</span> is also a rare causative agent of arthritis, osteomyelitis, splenic or hepatic abscess, empyema, endophthalmitis, meningitis and brain abscess, among other infections <a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A few cases of <span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> brain abscess have been reported, more in the paediatric population, especially in children with congenital heart disease; it is rare in adults<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4,5</span></a>. <span class="elsevierStyleItalic">Aggregatibacter aprhrophilus</span> brain abscess has been linked to dental procedures and has also been reported in people who have close contact with pets <a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The optimal treatment and its duration are not well established. The treatment of choice is third-generation cephalosporins, since cases of beta-lactamase-producing <span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> with therapeutic failure to ampicillin have been reported, although they are uncommon. Some authors recommend meropenem for its excellent penetration into the central nervous system<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The case we report here highlights the importance of antibiotic prophylaxis in certain dental procedures.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they received no funding for the preparation of this paper.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interests" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández González R, González Noya A, Fernández-Rodríguez R. Absceso cerebral por <span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> tras manipulación dental. Med Clin (Barc). 2021;157:355–356.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reclassification of <span class="elsevierStyleItalic">Actinobacillus actinomycetemcomitans</span>, <span class="elsevierStyleItalic">Haemophilus aphrophilus</span>, <span class="elsevierStyleItalic">Haemophilus paraphrophilus</span> and <span class="elsevierStyleItalic">Haemophilus segnis</span> as <span class="elsevierStyleItalic">Aggregatibacter actinomycetemcomitans</span> gen. nov., comb. nov., <span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> comb. nov. and <span class="elsevierStyleItalic">Aggregatibacter segnis</span> comb. nov. emended description of <span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> to include V factor-dependet and V factor-independent isolates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. 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Vol. 157. Issue 7.
Pages 355-356 (October 2021)
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Vol. 157. Issue 7.
Pages 355-356 (October 2021)
Letter to the Editor
Aggregatibacter aphrophilus brain abscess after tooth manipulation
Absceso cerebral por Aggregatibacter aphrophilus tras manipulación dental
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Raquel Fernández González
, Amara González Noya, Ricardo Fernández-Rodríguez
Corresponding author
Servicio de Medicina Interna-Unidad de Enfermedades Infecciosas, Complexo Hospitalario Universitario de Ourense, Orense, Spain
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