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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 -
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 -
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 -
Revista Do Instituto de Medicina... 2023Streptococcus constellatus is a gram-positive coccus member of the Streptococcus anginosus group (SAG). It can be found in the oral flora, and may cause abscess more...
Streptococcus constellatus is a gram-positive coccus member of the Streptococcus anginosus group (SAG). It can be found in the oral flora, and may cause abscess more commonly in the gastrointestinal tract, lungs, and heart. Brain abscesses are severe neurological infections with high mortality rates. Streptococcus species other than S. pneumoniae are rare causes of brain abscesses. This case report highlights a severe case of extra and intracranial abscesses due to S. constellatus in an immunocompetent host.
Topics: Humans; Streptococcus constellatus; Sagittal Sinus Thrombosis; Brain Abscess
PubMed: 36722672
DOI: 10.1590/S1678-9946202365010 -
Frontiers in Cellular and Infection... 2022The combination of maxillofacial infections (MI) with descending necrotizing mediastinitis (DNM) is a complex disease characterized by rapid development and high...
The combination of maxillofacial infections (MI) with descending necrotizing mediastinitis (DNM) is a complex disease characterized by rapid development and high mortality. Here, we performed metagenomic next-generation sequencing (mNGS) using samples from 21 patients with MI and eight patients with DNM. In this study, we found that the species richness of the DNM group was higher than that of the MI group, and the species diversity of the DNM group was higher than that of the MI group, with no statistically significant differences between groups (P > 0.05). LefSE analysis revealed that the main species differing between groups were , , , and ( and ). In addition, the PLS-DA analysis revealed that the dominant groups in the DNM group at the species level were , , , , , and . Next, we correlated the clinical characteristics of the patients with the relative abundance of the pathogens identified in the LefSe and PLS-DA analyses. The relative abundance of was positively correlated with C-reactive protein (CRP) and calcitoninogen (PCT) but negatively correlated with the percentage of lymphocytes (Lymph%) (P < 0.05). On the other hand, was positively correlated with the percentage of neutrophils (Neut%) and glycated hemoglobin (GLU) (P < 0.05), and was positively correlated with CRP (P < 0.05).
Topics: Eubacterium; Humans; Mediastinitis; Streptococcus
PubMed: 35755831
DOI: 10.3389/fcimb.2022.873161 -
Case Reports in Obstetrics and... 2019Previous reports have described cases of abscess formation by involving the oral cavity, gastrointestinal tract, and septic thrombophlebitis of the right ovarian vein...
BACKGROUND
Previous reports have described cases of abscess formation by involving the oral cavity, gastrointestinal tract, and septic thrombophlebitis of the right ovarian vein with subsequent bacteremia and septic shock. Ascending infection from the genital tract to the fallopian tubes resulting in peritonitis from is a rare clinical circumstance where there is minimal information in the literature to guide its diagnosis, management, and expected prognosis.
CASE
A 36-year-old G3P0111 developed a tubo-ovarian abscess two weeks after intrauterine device (IUD) removal and then rapidly decompensated with septic shock from peritonitis due to infection. The patient was also newly diagnosed with diabetes and in diabetic ketoacidosis (DKA) on presentation. She received broad-spectrum antibiotic coverage and required two exploratory surgical procedures to obtain source control. Two Interventional Radiology- (IR-) guided drainage procedures were subsequently performed to drain remaining fluid collections. Her recovery involved a prolonged ICU stay. On hospital day seventy-three, after receiving approximately 8 weeks of antibiotics and the above noted procedures the patient was discharged to a subacute rehabilitation facility.
CONCLUSION
is a highly pathogenic organism once a systemic septic infection has become established that can cause an ascending genital tract infection resulting in tubo-ovarian abscess formation, peritonitis, and septic shock.
PubMed: 31467746
DOI: 10.1155/2019/6491617 -
Cureus Aug 2020Streptococcus constellatus is a member of Streptococcus milleri group which is a subgroup of Viridans streptococci, first described by Guthof in 1956 after being...
Streptococcus constellatus is a member of Streptococcus milleri group which is a subgroup of Viridans streptococci, first described by Guthof in 1956 after being isolated from dental abscesses. S. constellatus, a gram positive, non-sporing, non-motile, catalase negative cocci, is the normal flora of the oropharyngeal, gastrointestinal and urogenital tract. It is not a commonly encountered pathogen but has a propensity to form abscesses and cause bacteremia in the immunocompromised patient. Here, we report a 78-year-old man with sepsis due to Streptococcus constellatus liver abscess. The patient had a history of hypertension, stroke, benign prostatic hyperplasia, vascular dementia and myocardial infarction status post coronary artery bypass grafting. There has been no particular link between any of these conditions to S. constellatus. However, immunocompromised status predisposes to fulminant infection and formation of abscesses. The patient was febrile with a temperature of 99.1°F, blood pressure of 143/73 mmHg and the heart rate (HR) of 98. Labs revealed a leukocytosis of 16.90 K/uL, hemoglobin 11.8 g/dL, hematocrit 35.8%, total bilirubin 1.7 mg/dL, direct bilirubin 1.0 mg/dL, aspartate aminotransferase (AST) 44 IU/L, alanine aminotransferase (ALT) 28 IU/L, alkaline phosphatase (ALKP) 176 IU/L and lactate dehydrogenase (LDH) was 290 IU/L. He was started on intravenous Maxipime and Unasyn which was switched to Rocephin and Clindamycin based on the Infectious disease recommendations. Metronidazole was also started and the serologies were sent for Entamoeba histolytica. Computerized tomography (CT) scan showed an abscess in the right lobe of the liver which was finally drained using an interventional radiology (IR)-guided approach. The cultures from the fluid and blood yielded S. constellatus and thus Metronidazole was discontinued. The patient improved after a few days and the drainage catheter was pulled out and the patient discharged in stable condition.
PubMed: 32953314
DOI: 10.7759/cureus.9802