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Medicine Apr 2023Descending necrotizing mediastinitis (DNM) is a rare but severe mediastinal infection. If not diagnosed and treated promptly, the consequences can be very serious. Here,... (Review)
Review
RATIONALE
Descending necrotizing mediastinitis (DNM) is a rare but severe mediastinal infection. If not diagnosed and treated promptly, the consequences can be very serious. Here, we shared a successful diagnosis and treatment case of DNM that originates from oral to neck and mediastinum caused by Streptococcus constellatus (S constellatus). S constellatus is a clinically uncommon gram-positive coccus and is known for its ability to form abscesses. Timely surgical drainage and the correct use of antibiotics are key to successful treatment.
PATIENT CONCERNS
A 53-year-old male admitted to hospital with painful swelling of the right cheek, persistent oral pus and moderate fever lasting 1 week, followed by rapid development of a mediastinal abscess.
DIAGNOSES
He was diagnosed with DNM caused by S constellatus.
INTERVENTIONS
On the evening of admission, an emergency tracheotomy and thoracoscopic exploration and drainage of the right mediastinum, floor of the mouth, parapharynx and neck abscess were performed. Antibiotics were administered immediately.
OUTCOMES
At 28 days post-operatively, the abscess was absorbed, bilateral lung exudate decreased and the patient temperature, aspartate transaminase, alanine transaminase, bilirubin and platelets returned to normal. The patient was discharged after completing 4 weeks of antibiotic therapy. Follow-up at 3 months after discharge revealed no recurrence of the abscess.
LESSONS
Early surgical drainage and antibiotics treatment are important in mediastinal abscesses and infectious shock due to Streptococcus asteroids.
Topics: Male; Humans; Middle Aged; Mediastinitis; Abscess; Streptococcus constellatus; Mediastinum; Mediastinal Diseases; Drainage; Anti-Bacterial Agents; Necrosis
PubMed: 37026905
DOI: 10.1097/MD.0000000000033458 -
European Journal of Case Reports in... 2022The detection of pneumococcal antigens in urine is an alternative to gram staining, and their culture is central to the diagnosis of pneumococcal pneumonia. We present a...
INTRODUCTION
The detection of pneumococcal antigens in urine is an alternative to gram staining, and their culture is central to the diagnosis of pneumococcal pneumonia. We present a case of the false-positive detection of urinary species pneumococcal antigen with a BinaxNOW test. This resulted in delayed diagnosis of a liver abscess.
CASE DESCRIPTION
A 70-year-old woman presented to the emergency department with a 1-day history of chills and difficulty walking. She had a fever and her physical examination was normal. Non-contrast chest computed tomography (CT) revealed a slight ground-glass opacity in the left lower lobe. Laboratory tests revealed liver injury and elevated C-reactive protein levels. A urinary pneumococcal antigen test was positive, and she was diagnosed with acute bronchopneumonia caused by . She was treated with ceftriaxone. However, abdominal contrast-enhanced CT performed the next day revealed portal vein thrombus and a left lobe liver abscess. was detected in a puncture specimen of the liver abscess. It was concluded that the positive urinary pneumococcal antigen test was a false-positive owing to infection.
DISCUSSION
False-positive results might be explained by the presence of C-polysaccharide antigens in the cell wall of . The positive urinary antigen test together with the finding of slight ground-glass opacity in the left lung on chest CT initially led to misdiagnosis. False positives may result in misdiagnosis and unnecessary antimicrobial therapy.
CONCLUSION
The overuse of the pneumococcal urinary antigen tests can lead to false positives and misdiagnosis.
LEARNING POINTS
False-positive pneumococcal urinary antigen results may lead to the misdiagnosis of pneumococcal pneumonia caused by and unnecessary antimicrobial therapy.False-positive results can occur in patients with infections caused by other species (e.g., liver abscess caused by ).The optimal use of pneumococcal urinary antigen tests needs to be studied in clinical practice settings.
PubMed: 35265559
DOI: 10.12890/2022_003198 -
Journal of Paediatrics and Child Health May 2022The Streptococcus anginosus group (SAG) comprises three bacterial species colonising the mouth and gastrointestinal and genitourinary tracts and capable of serious...
AIM
The Streptococcus anginosus group (SAG) comprises three bacterial species colonising the mouth and gastrointestinal and genitourinary tracts and capable of serious pyogenic infections. Although well-described in adults, studies in children are limited. Here, we characterise paediatric SAG infections from a single Australian centre.
METHODS
Hospitalised patients aged ≤18 years with positive SAG cultures from January 2009 to December 2019 were identified from Pathology Queensland's Gold Coast Laboratory database and their medical records were reviewed.
RESULTS
Two-hundred children (62% male), median age 12 years (interquartile range 6-16), with positive SAG cultures were identified. Overall, 90% received intravenous antibiotics, 89% underwent surgical drainage, 23% were readmitted and 15% required additional surgery. The most common sites were the abdomen (39%), soft tissues (36%) and head and neck regions (21%). Since 2011, Pathology Queensland reported SAG at the species level (n = 133). Of these, S. anginosus was the most prevalent (39%), then S. constellatus (34%) and S. intermedius (27%). Compared with the other two species, S. intermedius was most commonly associated with head and neck infections (relative risk (RR) = 2.2, 95% confidence interval (CI) 1.4-3.5), while S. constellatus (RR = 1.7, 95% CI 1.2-2.4) and S. anginosus (RR = 1.5, 95% CI 1.0-2.0) were each associated with a higher risk of intra-abdominal infection than S. intermedius. Since February 2015, the number of children admitted with SAG-associated intra-abdominal infection per 1000 hospitalisations increased by 29% annually compared with an annual decline of 8% in previous years.
CONCLUSIONS
SAG infections occur at various anatomical sites. Despite antibiotics and surgical management, almost one-quarter are re-hospitalised for further treatment.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Australia; Child; Child, Hospitalized; Female; Humans; Intraabdominal Infections; Male; Retrospective Studies; Streptococcal Infections; Streptococcus anginosus
PubMed: 34854155
DOI: 10.1111/jpc.15840 -
Intensive Care Medicine Feb 2024
Topics: Humans; Bilirubin; Streptococcus constellatus; Empyema
PubMed: 38117318
DOI: 10.1007/s00134-023-07302-6 -
Microbiology Spectrum Aug 2023This study aimed to identify which streptococcal species are closely associated with infective endocarditis (IE) and to evaluate risk factors for mortality in patients...
This study aimed to identify which streptococcal species are closely associated with infective endocarditis (IE) and to evaluate risk factors for mortality in patients with streptococcal IE. We performed a retrospective cohort study of all patients with streptococcal bloodstream infection (BSI) from January 2010 to June 2020 in a tertiary hospital in South Korea. We compared clinical and microbiological characteristics of streptococcal BSIs according to the diagnosis of IE. We performed multivariate analysis to evaluate the risk of IE according to streptococcal species and risk factors for mortality in streptococcal IE. A total of 2,737 patients were identified during the study period, and 174 (6.4%) were diagnosed with IE. The highest IE prevalence was in patients with Streptococcus mutans BSI (33% [9/27]) followed by S. sanguinis (31% [20/64]), S. gordonii (23% [5/22]), S. gallolyticus (16% [12/77]), and S. oralis (12% [14/115]). In multivariate analysis, previous IE, high-grade BSI, native valve disease, prosthetic valve, congenital heart disease, and community-onset BSI were independent risk factors for IE. After adjusting for these factors, S. sanguinis (adjusted OR [aOR], 7.75), S. mutans (aOR, 5.50), and S. gallolyticus (aOR, 2.57) were significantly associated with higher risk of IE, whereas S. pneumoniae (aOR, 0.23) and (aOR, 0.37) were associated with lower risk of IE. Age, hospital-acquired BSI, ischemic heart disease, and chronic kidney disease were independent risk factors for mortality in streptococcal IE. Our study points to significant differences in the prevalence of IE in streptococcal BSI according to species. Our study of risk of infective endocarditis in patients with streptococcal bloodstream infection demonstrated that Streptococcus sanguinis, S. mutans, and S. gallolyticus were significantly associated with higher risk of infective endocarditis. However, when we evaluated the performance of echocardiography in patients with streptococcal bloodstream infection, patients with S. mutans and S. gordonii bloodstream infection had a tendency of low performance in echocardiography. There are significant differences in the prevalence of infective endocarditis in streptococcal bloodstream infection according to species. Therefore, performing echocardiography in streptococcal bloodstream infection with a high prevalence of, and significant association with, infective endocarditis is desirable.
Topics: Humans; Retrospective Studies; Streptococcus; Endocarditis, Bacterial; Endocarditis; Streptococcal Infections; Sepsis
PubMed: 37284757
DOI: 10.1128/spectrum.01049-23 -
Cureus Dec 2023Lemierre syndrome is characterized by thrombophlebitis of the internal jugular vein (IJV) secondary to bacterial pharyngitis or tonsillitis. Though antibiotic use has...
Lemierre syndrome is characterized by thrombophlebitis of the internal jugular vein (IJV) secondary to bacterial pharyngitis or tonsillitis. Though antibiotic use has made this a rarer syndrome, it can nevertheless manifest in patients presenting with pharyngitis. Herein, we describe a 20-year-old male patient with no relevant medical history presenting with signs concerning for pneumonia and was ultimately diagnosed with Lemierre syndrome with bacteremia. Complications included IJV thrombus with presumed septic emboli to the lungs. The patient was discharged on ampicillin/sulbactam with plans to transition to amoxicillin/clavulanate.
PubMed: 38222167
DOI: 10.7759/cureus.50580 -
Annals of Palliative Medicine Apr 2022Streptococcus constellatus (S. constellatus) is a Gram-positive commensal bacterium that is commonly found in the oral, nasal, pharyngeal, gastrointestinal, and...
Streptococcus constellatus (S. constellatus) is a Gram-positive commensal bacterium that is commonly found in the oral, nasal, pharyngeal, gastrointestinal, and urogenital tracts. It can be further consisted by three subspecies: subsp, constellatus, subsp. pharynges, and subsp. viborgensis. As an opportunistic pathogen, S. constellatus can cause abscesses and bacteremia, so infection requires timely and accurate identification in clinical practice. There are a few case reports describing the range of infections caused by S. constellatus, which include intracardiac, thoracic, intracranial, and abdominal infections. Here we report the first case of thigh abscess caused by S. constellatus subsp. constellatus which was rarely insensitive to penicillin in a patient with exacerbation of bronchiectasis. The patient improved significantly after receiving antibiotic therapy with ceftriaxone and vancomycin, as well as percutaneous catheter drainage guided by color ultrasonography. The thigh abscess did not recur during follow-up. This case report demonstrates that although S. constellatus is a rare infectious pathogen, it is important to gain a better understanding of the range of possible infections to ensure timely diagnosis. Furthermore, although the prognosis of most patients with such infections is relatively good, the timely identify the resistant strains and administration of sensitive antibiotics along with abscess drainage may ensure effective treatment.
Topics: Abscess; Anti-Bacterial Agents; Bronchiectasis; Humans; Streptococcal Infections; Streptococcus; Thigh
PubMed: 34328004
DOI: 10.21037/apm-21-740 -
Microbial Drug Resistance (Larchmont,... Jul 2020The aim of the study was to characterize phenotypically and genotypically an uncommon mechanism of resistance to macrolides, lincosamides, and streptogramins (MLS) in a...
The aim of the study was to characterize phenotypically and genotypically an uncommon mechanism of resistance to macrolides, lincosamides, and streptogramins (MLS) in a group clinical isolate. The isolate UCN96 was recovered from an osteoradionecrosis wound, and was identified using the matrix assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry and the partial sequencing of the A gene. Antimicrobial susceptibility testing were carried out by the disk diffusion method and minimal inhibitory concentrations (MICs) were determined by the broth microdilution technique. PCR screening was performed for MLS resistance genes described in Gram-positive bacteria. Specific mutations in the ribosomal proteins L3-, L4-, and L22-encoding genes were also screened and those in domain V of the 23S rRNA gene (). The number of mutated copies of the gene was determined using amplification-refractory mutation system quantitative-polymerase chain reaction (qPCR) analysis. The clinical isolate UCN96 was unambiguously identified as . It was susceptible to all macrolides and lincosamides (ML) antibiotics except spiramycin (MIC >256 mg/L) while it was also resistant to streptogramins. Screening for all acquired resistance genes was negative and no mutation was found in genes coding for L3, L4, and L22 ribosomal proteins. Of interest, a single mutation, A2062C (according to numbering), was detected in the domain V of 23S rRNA. Mutations at the position 2062 of 23S rRNA have been detected once in , and not yet in other spp. This mechanism is very likely uncommon in Gram-positive bacteria because different copies of 23S rRNA operons should be mutated for development of such a resistance pattern.
Topics: Anti-Bacterial Agents; Bacterial Proteins; Drug Resistance, Bacterial; Erythromycin; Genotype; Humans; Lincosamides; Macrolides; Microbial Sensitivity Tests; Phenotype; RNA, Ribosomal, 23S; Real-Time Polymerase Chain Reaction; Spiramycin; Streptococcus constellatus; Streptococcus milleri Group; Streptogramins; Superoxide Dismutase
PubMed: 32031922
DOI: 10.1089/mdr.2019.0288 -
The Pediatric Infectious Disease Journal Oct 2023Pott's puffy tumor (PPT) is a rare complication of frontal sinusitis. Although it may occur at any age, the incidence is higher during adolescence. (Review)
Review
BACKGROUND
Pott's puffy tumor (PPT) is a rare complication of frontal sinusitis. Although it may occur at any age, the incidence is higher during adolescence.
METHODS
We report a series of 10 pediatric patients (9-17 years of age) who presented with PPT in 2 tertiary care pediatric hospitals in central Israel between January 2018 and August 2022 and review the published literature on pediatric PPT.
RESULTS
The most common clinical presentations included headache (10 cases), frontal swelling (6 cases) and fever (5 cases). Symptom duration before admission was between 1 and 28 days (median 10 days). The diagnosis of PPT was made by imaging studies at a median of 1 day after admission. All 10 patients underwent computed tomography studies, and 6 patients also underwent magnetic resonance imaging. The overall rate of intracranial complications was 70%. All 10 children were treated with systemic antibiotics and surgical interventions. Streptococcus constellatus group was the most common causal bacteria. All 10 patients recovered uneventfully.
CONCLUSIONS
Our findings show that a high index of suspicion for PPT should be applied to adolescents presenting with prolonged headache and frontal swelling. Contrast-enhanced computed tomography is an appropriate first tool for the evaluation; however, an magnetic resonance imaging should be performed to determine the necessity of intracranial interventional treatments if there is any suspicion of intracranial involvement. Complete recovery can be expected with appropriate antibiotic treatment and surgical intervention in most of the cases.
Topics: Adolescent; Humans; Child; Pott Puffy Tumor; Frontal Sinusitis; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Headache; Anti-Bacterial Agents
PubMed: 37406183
DOI: 10.1097/INF.0000000000004026