Complicated Pneumonia With Empyema Caused by Streptococcus Anginosus in a Child

Abstract

Objective: To highlight the pathogenicity of Streptococcus anginosus, which is rare in pediatric patients, but can cause severe infections that are known to have a better outcome when treated early with interventional procedures and prolonged antibiotic therapy. Case description: The patient is a 6-year-old boy with global developmental delay, examined in the emergency room due to fever and respiratory distress. The physical examination and diagnostic workout revealed complicated pneumonia with empyema of the left hemithorax; he started antibiotic therapy and underwent thoracic drainage. Pleural fluid cultures grew Streptococcus anginosus. On day 11, the child had a clinical deterioration with recurrence of fever, hypoxia, and respiratory distress. At this point, considering the causative agent, he was submitted to video-assisted thoracoscopic decortication, with good progress thereafter. Comments: Streptococcus anginosus is a commensal bacterium of the human oral cavity capable of causing severe systemic infections. Although reports of complicated thoracic infections with this agent are rare in the pediatric population, they have been increasing in adults. Streptococcus anginosus has a high capacity to form abscess and empyema, requiring different therapeutic approaches when compared to complicated pneumonia caused by other agents. Objetivo: Alertar para a patogenicidade do Streptococcus anginosus que, apesar de raro em pediatria, pode causar infeções graves que necessitam de tratamento invasivo e antibioterapia de longo curso para obter um melhor prognóstico. Descrição do caso: Criança de seis anos, com atraso do desenvolvimento psicomotor, avaliado no serviço de urgência por febre e dificuldade respiratória. O exame físico, juntamente com os exames complementares, revelou uma pneumonia complicada com empiema no hemitórax esquerdo, tendo iniciado antibioterapia e sido submetido à drenagem do líquido pleural. Foi identificado Streptococcus anginosus nesse líquido. No 11º dia de doença, a criança agravou o seu estado clínico, com recidiva da febre, hipoxemia e dificuldade respiratória. Considerando-se o microrganismo identificado, o paciente foi submetido à decorticação pulmonar por videotoracoscopia, com boa evolução clínica posterior. Comentários: Streptococcus anginosus é uma bactéria comensal da cavidade oral humana, que pode causar infecções sistêmicas graves. Apesar de serem raros os casos descritos em pediatria, têm sido cada vez mais descritas infecções torácicas complicadas em adultos. Esse microrganismo também tem a capacidade de formar abcessos e empiemas, que precisam de intervenções terapêuticas diferentes, quando comparados a pneumonias complicadas causadas por outros agentes. Palavras-chave: Pneumonia bacteriana; Empiema pleural; Streptococcus anginosus; Cirurgia torácica por videotoracoscopia. ABSTRACTRESUMO

Clinical Microbiology Perspective of Empyema caused by Streptococcus constellatus in Malignancy Patient: A Case Report

“…Empyema is a serious condition that requires treatment. 2,9,10 In this case, empyema in the patient happened as a complicated of PPE-confirmed on chest…”

Streptococcus anginosus Empyema Induced by Dental Abscess: A Case Report

“…For this reason, our patient’s antibiotics were decelerated to ampicillin-sulbactam after sensitivities confirmed susceptibility. The mean treatment length for S. milleri group has been about 34 days; however, the decision was made to treat our patient for a total of 6 weeks [ 13 ].…”

“…In retrospective studies, S. anginosus was found to cause severe empyema and removal of purulent drainage, as with a chest tube, improved patient survival [ 11 ]. In addition, loculated or purulent empyema has been defined as an indication for surgical intervention using VATS [ 13 , 14 ]. As described in our case, the patient presented developed a large loculated empyema due to S. anginosus infection.…”

Evaluation of Extraction Methods for Clinical Metagenomic Assay

“…A number of pathogenic bacteria were found in her analyzed throat swab: Streptococcus pneumoniae (101 f), Moraxella catarrhalis (36 f), and Dolosigranulum pigrum with a maximum frequency 33,972. Several streptococcal species were detected: Streptococcus mitis (9294 f), Streptococcus pseudopneumoniae (388 f), Streptococcus agalactiae (140 f), and Streptococcus anginosus (5011 f), which are associated with pleuropulmonary infections [23]. Furthermore, Corynebacterium pseudodiphtheriticum was detected in the sample with 1396 f. In addition, sample analysis showed two viruses: an RNA virus, Respiratory syncytial virus (2398 f), and a DNA virus, Human adenovirus (41 with 45 f).…”