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Streptococcus intermedius causing infective endocarditis and abscesses: a report of three cases and review of the literature.

Tran MP, Caldwell-McMillan M, Khalife W, Young VB - BMC Infect. Dis. (2008)

Bottom Line: We confirmed our microbiologic diagnosis through 16S sequencing and found a common virulence gene in each case.Our report illustrates three different clinical manifestations due to Streptococcus intermedius infection that can be encountered in healthy individuals in a community hospital setting.The use of molecular methods may allow a better understanding of the epidemiology and pathogenesis of this organism.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Infectious Diseases Division, Michigan State University, East Lansing, Michigan, USA. maryann.tran@hc.msu.edu

ABSTRACT

Background: Streptococcus intermedius is a member of the Streptococcus anginosus group. Clinical disease with S. intermedius is characterized by abscess formation and rarely endocarditis. Identification of Streptococcus intermedius is difficult, leading to the development of molecular methods to more accurately identify and characterize this organism.

Case presentation: Over a period of 6 months we encountered three cases of invasive Streptococcus intermedius infection presenting as hepatic abscesses, brain abscess, and endocarditis. We confirmed our microbiologic diagnosis through 16S sequencing and found a common virulence gene in each case.

Conclusion: Our report illustrates three different clinical manifestations due to Streptococcus intermedius infection that can be encountered in healthy individuals in a community hospital setting. To our knowledge, this is the first case of Streptococcus intermedius endocarditis confirmed by 16S sequencing analysis. The use of molecular methods may allow a better understanding of the epidemiology and pathogenesis of this organism.

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Related in: MedlinePlus

Transesophageal echocardiogram image of the mitral valve showing a highly mobile linear echodensity on the ventricular side of the mitral leaflet.
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Figure 1: Transesophageal echocardiogram image of the mitral valve showing a highly mobile linear echodensity on the ventricular side of the mitral leaflet.

Mentions: The patient was initially treated for community-acquired pneumonia with ceftriaxone 2 g once daily and azithromycin 500 mg once daily. Blood cultures drawn on admission grew viridans group streptococci, and azithromycin was discontinued. A transesophageal echocardiogram showed vegetation on the anterior leaflet of the mitral valve (Figure 1), and ceftriaxone was continued for treatment of endocarditis. A CT scan of the abdomen performed due to persistent abdominal pain revealed multiple liver abscesses. One of the abscesses was drained percutaneously under CT guidance. Cultures of the aspirate also grew only viridans group streptococci. Anaerobic cultures were negative. The patient continued to spike fevers, and antibiotics were changed to penicillin 24 million units a day and low dose gentamicin. Repeat blood cultures were negative. However, the patient remained febrile and tachycardic with increasing leukocytosis. Because of worsening clinical status, he required additional percutaneous drainage of three more abscesses. After six months of antibiotic therapy, the patient is doing well with significant clinical improvement.


Streptococcus intermedius causing infective endocarditis and abscesses: a report of three cases and review of the literature.

Tran MP, Caldwell-McMillan M, Khalife W, Young VB - BMC Infect. Dis. (2008)

Transesophageal echocardiogram image of the mitral valve showing a highly mobile linear echodensity on the ventricular side of the mitral leaflet.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2600825&req=5

Figure 1: Transesophageal echocardiogram image of the mitral valve showing a highly mobile linear echodensity on the ventricular side of the mitral leaflet.
Mentions: The patient was initially treated for community-acquired pneumonia with ceftriaxone 2 g once daily and azithromycin 500 mg once daily. Blood cultures drawn on admission grew viridans group streptococci, and azithromycin was discontinued. A transesophageal echocardiogram showed vegetation on the anterior leaflet of the mitral valve (Figure 1), and ceftriaxone was continued for treatment of endocarditis. A CT scan of the abdomen performed due to persistent abdominal pain revealed multiple liver abscesses. One of the abscesses was drained percutaneously under CT guidance. Cultures of the aspirate also grew only viridans group streptococci. Anaerobic cultures were negative. The patient continued to spike fevers, and antibiotics were changed to penicillin 24 million units a day and low dose gentamicin. Repeat blood cultures were negative. However, the patient remained febrile and tachycardic with increasing leukocytosis. Because of worsening clinical status, he required additional percutaneous drainage of three more abscesses. After six months of antibiotic therapy, the patient is doing well with significant clinical improvement.

Bottom Line: We confirmed our microbiologic diagnosis through 16S sequencing and found a common virulence gene in each case.Our report illustrates three different clinical manifestations due to Streptococcus intermedius infection that can be encountered in healthy individuals in a community hospital setting.The use of molecular methods may allow a better understanding of the epidemiology and pathogenesis of this organism.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, Infectious Diseases Division, Michigan State University, East Lansing, Michigan, USA. maryann.tran@hc.msu.edu

ABSTRACT

Background: Streptococcus intermedius is a member of the Streptococcus anginosus group. Clinical disease with S. intermedius is characterized by abscess formation and rarely endocarditis. Identification of Streptococcus intermedius is difficult, leading to the development of molecular methods to more accurately identify and characterize this organism.

Case presentation: Over a period of 6 months we encountered three cases of invasive Streptococcus intermedius infection presenting as hepatic abscesses, brain abscess, and endocarditis. We confirmed our microbiologic diagnosis through 16S sequencing and found a common virulence gene in each case.

Conclusion: Our report illustrates three different clinical manifestations due to Streptococcus intermedius infection that can be encountered in healthy individuals in a community hospital setting. To our knowledge, this is the first case of Streptococcus intermedius endocarditis confirmed by 16S sequencing analysis. The use of molecular methods may allow a better understanding of the epidemiology and pathogenesis of this organism.

Show MeSH
Related in: MedlinePlus