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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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Gram stain of brain tissue from Case 3 showing gram positive cocci in chains.
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Figure 3: Gram stain of brain tissue from Case 3 showing gram positive cocci in chains.

Mentions: On the following day, the patient had a bifrontal craniotomy with evacuation of the abscess and cranialization of the frontal sinuses. Pathology of the surgical specimen revealed abscess and granulation tissue with acute and chronic inflammation. A gram stain of the brain tissue showed gram positive cocci in chains (Figure 3). Cultures from the surgical drainage grew viridans group streptococci with negative anaerobic cultures. Because of the extent and severity of the sinusitis, the patient underwent bilateral ethmoidectomy, bilateral maxillary antrostomy, left sphenoidotomy, and left concha bullosa resection. The patient finished an 8-week course of ceftriaxone monotherapy. A repeat MRI of the brain showed resolution of the frontal abscess.


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)

Gram stain of brain tissue from Case 3 showing gram positive cocci in chains.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Gram stain of brain tissue from Case 3 showing gram positive cocci in chains.
Mentions: On the following day, the patient had a bifrontal craniotomy with evacuation of the abscess and cranialization of the frontal sinuses. Pathology of the surgical specimen revealed abscess and granulation tissue with acute and chronic inflammation. A gram stain of the brain tissue showed gram positive cocci in chains (Figure 3). Cultures from the surgical drainage grew viridans group streptococci with negative anaerobic cultures. Because of the extent and severity of the sinusitis, the patient underwent bilateral ethmoidectomy, bilateral maxillary antrostomy, left sphenoidotomy, and left concha bullosa resection. The patient finished an 8-week course of ceftriaxone monotherapy. A repeat MRI of the brain showed resolution of the frontal abscess.

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