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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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CT scan of the abdomen with contrast of Case 2 showing a large, loculated liver abscess measuring 10 cm.
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Figure 2: CT scan of the abdomen with contrast of Case 2 showing a large, loculated liver abscess measuring 10 cm.

Mentions: A 53 year-old female presented to the emergency department with fevers and chills for 12 days. Two days prior to admission, she had nausea, vomiting, and diarrhea. She denied abdominal pain, hematemesis, or hematochezia. She reported a 30 lb weight loss in the past six months, which she attributed to her new job. She drank 1–2 mixed drinks of vodka a day but denied problems with alcohol intoxication or withdrawal. On admission, the patient was alert and oriented, but appeared ill. Vital signs revealed a temperature of 102.5°F, blood pressure of 115/65, pulse 78/minute, and respiratory rate of 20/minute. Physical exam demonstrated right upper quadrant tenderness without distention, guarding, or rebound. The rest of her physical exam was unremarkable. Laboratory data showed a white blood count of 16,000/μL with 89% neutrophils and 1% bands, hemoglobin of 11.9 g/dL, platelets of 361,000/L, alkaline phosphatase of 220 units/L, bilirubin of 2.5 mg/dL, ALT of 51 units/L, and AST of 56 units/L. Amylase, lipase, electrolyte panel, BUN, and creatinine were within normal limits. A CT scan of the abdomen and pelvis showed multiple liver lesions with the largest measuring 10 cm by 9.9 cm with gallbladder wall thickening (Figure 2). An echocardiogram was not performed.


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)

CT scan of the abdomen with contrast of Case 2 showing a large, loculated liver abscess measuring 10 cm.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: CT scan of the abdomen with contrast of Case 2 showing a large, loculated liver abscess measuring 10 cm.
Mentions: A 53 year-old female presented to the emergency department with fevers and chills for 12 days. Two days prior to admission, she had nausea, vomiting, and diarrhea. She denied abdominal pain, hematemesis, or hematochezia. She reported a 30 lb weight loss in the past six months, which she attributed to her new job. She drank 1–2 mixed drinks of vodka a day but denied problems with alcohol intoxication or withdrawal. On admission, the patient was alert and oriented, but appeared ill. Vital signs revealed a temperature of 102.5°F, blood pressure of 115/65, pulse 78/minute, and respiratory rate of 20/minute. Physical exam demonstrated right upper quadrant tenderness without distention, guarding, or rebound. The rest of her physical exam was unremarkable. Laboratory data showed a white blood count of 16,000/μL with 89% neutrophils and 1% bands, hemoglobin of 11.9 g/dL, platelets of 361,000/L, alkaline phosphatase of 220 units/L, bilirubin of 2.5 mg/dL, ALT of 51 units/L, and AST of 56 units/L. Amylase, lipase, electrolyte panel, BUN, and creatinine were within normal limits. A CT scan of the abdomen and pelvis showed multiple liver lesions with the largest measuring 10 cm by 9.9 cm with gallbladder wall thickening (Figure 2). An echocardiogram was not performed.

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