Streptococcus milleri head and neck abscesses: A case series

June 4, 2012
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Streptococcus milleri infections and abscesses in the head and neck region have been previously reported, but there is still a dearth of clinical literature on this topic. To add to the available reports and to promote a better understanding and awareness of this clinically important entity, we present this retrospective review of 7 cases of head and neck abscess caused by S milleri infection. We have placed particular emphasis on antibiotic sensitivity patterns. These patients—6 men and 1 woman, aged 28 to 73 years (mean: 42.7)—had been seen at a district general hospital in Gosford, Australia, over a 6-month period. All patients had undergone surgical intervention and had been treated with intravenous antibiotics. All the S millericultures were sensitive to penicillin G, cephalexin, and erythromycin. Six of these patients experienced a resolution of their abscess, while 1 patient died from overwhelming sepsis. We believe that the initiation of penicillin G, cephalexin, or erythromycin is a good starting point for empiric therapy. S milleri should be considered as a causative organism in a patient who presents with a head and neck abscess, especially in the presence of a dental infection. Such a patient should be monitored closely for airway obstruction and distal infective sequelae. Also in this article, we compare our findings with those reported in two other published series.


Streptococcus milleri comprises a group of three distinct gram-positive species: Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus. The identification and classification of this group of bacteria have been historically complicated, and hence recognition of S milleri infections may be under-reported.1

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