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s of articles written in other languages have been selected, papers published in the last 5 years, from January 2011 to November 2015, using all the combinations between the key words brain or cerebral abscess and: S. anginosus, S. constellatus, S. intermedius or S. milleri. The anginosus streptococci may produce cerebral abscess by contiguous spread from a focal infection, such as: dental infections, sinusitis, mastoiditis, otitis media.7, 8 The frontal lobe is the main location of the brain abscess in most patients9, but the temporal lobe is more affected in case of otitis media complications10 Pansinusitis may lead also to subperiosteal scalp abscess, epidural abscess and other intracranial abscess.11 However, some brain abscesses develop as posttraumatic complications, including neurosurgery and other cranial trauma followed by wound infection and cerebritis. Another possibility of bacterial dissemination is the haematogenic spread at distance from the oral cavity, respiratory or gastrointestinal tract. These streptococci, like other microorganisms belonging to the normal oropharyngeal flora, may produce bacteremia also after common tooth brushing or dental procedures. As opposed to the contiguous dissemination which usually leads to solitary abscess, the bacteraemia frequently generates multiple abscesses, produced in different internal organs. Many papers showed that the anginosus streptococci as the most common microorganisms involved in brain abscess pathogenesis, followed by the anaerobic bacteria. Thus, a consecutive case series study from Pakistan indicated that S. milleri was the most frequent etiological agent (20.7%) of the brain abscess cases investigated, closely followed by the anaerobic isolates (15.1%).9 Each of the 3 species may be the single etiological agent of the brain abscess, but usually they are isolated in association with other microorganisms, especially with the anaerobic bacteria. The S. anginosus group causes infections mainly in an immunocompromised host, but there are many articles describing life-threatening infections in previously healthy subjects too. Sometimes the evolution might be fatal, as happened in a Figure 1. The most frequent clinical signs and symptoms found in brain abscess cases Figure 2. Classification of the intracranial abscesses ORAL MICROBIOLOGY

Streptococcus anginosus group - brief characterization and its contribution to the brain abscess pathogenesis