<i>Streptococcus intermedius</i>: An Unusual Case of Purulent Pericarditis

Denby, Kara; Byrne, Ryan; Gómez‐Duarte, Oscar G.

doi:10.1155/2017/5864694

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…Overall, reports of purulent pericarditis due to S. intermedius are rare. We identified six previously reported cases on a search of the literature, with notable features summarized in Table 5 [9,[11][12][13][14][15]. To our knowledge, this represents the seventh case of bacterial pericarditis caused by S. intermedius.…”

Section: Discussionmentioning

confidence: 99%

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Purulent Streptococcus intermedius Pericarditis in the Setting of Histoplasma Mediastinal Lymphadenitis: A Case Report and Literature Review

Christian-Miller,

Goraya,

O'Hayer

et al. 2024

Cureus

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Purulent pericarditis is a rare and potentially life-threatening condition characterized by infection of the pericardial space. We describe a case of purulent bacterial pericarditis in a 41-year-old male with no significant medical or surgical history who had concomitant pulmonary Histoplasma infection. Streptococcus intermedius was the bacteria directly responsible for the pericardial infection, though co-infection with histoplasmosis likely predisposed him to develop purulent pericarditis. We hypothesize histoplasmosis caused mediastinal lymphadenopathy, facilitating contact between a necrotic lymph node and the pericardium and contiguous suppuration of bacteria to the pericardial space. We treated S. intermedius and Histoplasma capsulatum with ceftriaxone and amphotericin B, respectively. Additionally, the patient presented in cardiac tamponade requiring emergent pericardiocentesis and drain placement. His course was also complicated by pericardial constriction. Cardiac magnetic resonance confirmed this, showing inflamed pericardium and abnormal septal motion with inspiration, and he had symptoms refractory to antimicrobials and anti-inflammatories. As such, he required pericardiectomy. This case demonstrates maintaining suspicion for secondary infectious foci as a contributor to the pathogenesis of purulent pericarditis is important, as pulmonary histoplasmosis played a pivotal role in allowing S. intermedius to spread to the pericardium but was not the primary infection. It also highlights the multifaceted evaluation and management of purulent pericarditis, highlighting the role of echocardiography and emergent pericardial drainage if cardiac tamponade is present, the importance of targeted antimicrobial therapy, the superior ability of cardiac magnetic resonance to identify pericardial constriction as a sequela of purulent pericarditis, and indications for pericardiectomy.

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Section: Discussionmentioning

confidence: 99%

“…Prototypical risk factors were absent in 3/7 (43%) cases [ 9 , 13 , 15 ]. Cardiac tamponade was present in a majority of cases, occurring in 5/7 (71%) patients [ 9 , 11 - 13 , 15 ]. Pericardiocentesis was the initial method of pericardial drainage in all but one case.…”

Section: Discussionmentioning

confidence: 99%

Purulent Streptococcus intermedius Pericarditis in the Setting of Histoplasma Mediastinal Lymphadenitis: A Case Report and Literature Review

Christian-Miller,

Goraya,

O'Hayer

et al. 2024

Cureus

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“…Likewise, Esposito et al reported a 3-year-old girl, without any history of severe congenital or acquired diseases or known risk factors, who developed a 6 × 5.6 cm brain abscess with surgical drainage cultures positive for S. intermedius ( 12 ). Denby et al illustrated an unusual case of life-threatening purulent pericarditis secondary to S. intermedius in an otherwise healthy male adolescent without typical risk factors ( 13 ). Despite the multiple known causes, these data highlight that the source of S. intermedius infection can remain unidentified, and S. intermedius could infect human subjects regardless of underlying diseases.…”

Section: Discussionmentioning

confidence: 99%

An isolated pulmonary nodule secondary to Streptococcus intermedius infection in an otherwise healthy 10-year-old boy: A case report and literature review

Huang

et al. 2022

Front. Pediatr.

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Streptococcus intermedius, as a Gram-positive commensal bacterium, tends to cause various infections, such as brain and liver abscesses, endocarditis, and empyema, especially in immunocompromised patients. However, an isolated pulmonary nodule caused by S. intermedius in previously healthy individuals without traditional risk factors is rarely reported. Herein, we present a case of a 10-year-old immunocompetent boy referred to our department with a 5-day history of intermittent, left-sided chest pain. Chest X-ray and computed tomography revealed a left lung nodule. Although his blood, sputum, and bronchoalveolar lavage fluid cultures were negative, metagenomic next-generation sequencing (mNGS) showed only the presence of S. intermedius in ultrasonography-guided lung biopsy tissue and pleural fluid (416 and 110 reads, respectively). He was then successfully treated with appropriate intravenous antibiotics and avoided surgical intervention. To the best of our knowledge, this is the first report of S. intermedius-related pulmonary nodule confirmed by mNGS analysis in healthy children. For achieving proper diagnosis and treatment, infection with S. intermedius should be included in the differential diagnosis when coming across such a similar pulmonary nodule. mNGS, as a valuable supplement to conventional culture methods, is an essential diagnostic tool for identifying pathogens without typical characteristics.

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“…From a search of the medical literature, we identified a total of 22 cases of bacterial pericarditis caused by S. anginosus ( milleri ) group from 1984 to 2017 [ 3 , 15 – 34 ]. Out of these, five cases were attributed to S. intermedius [ 18 , 28 , 31 , 34 ]. To the best of our knowledge, this is the sixth reported case of bacterial pericarditis caused by S. intermedius .…”

Section: Discussionmentioning

confidence: 99%

Primary purulent bacterial pericarditis due to Streptococcus intermedius in an immunocompetent adult: a case report

Khan

Banglore

et al. 2018

J Med Case Reports

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BackgroundAcute purulent bacterial pericarditis is of rare occurrence in this modern antibiotic era. Primary involvement of the pericardium without evidence of underlying infection elsewhere is even rarer. It is a rapidly progressive infection with high mortality. We present an extremely rare case of acute purulent bacterial pericarditis in an immunocompetent adult patient with no underlying chronic medical conditions.Case presentationA 33-year-old previously healthy white man presented with the complaints of chest pain and dyspnea. He was diagnosed as having acute pericarditis and was discharged home on indomethacin. Over a period of 2 weeks, his symptoms worsened gradually and he was readmitted to our hospital. He was found to have large pericardial effusion with cardiac tamponade. An urgent pericardiocentesis was done with drainage of 550 ml of purulent material. Cultures grew Streptococcus intermedius confirming the diagnosis of acute purulent bacterial pericarditis. No other focus of infection was identified on imaging workup suggesting primary infection of the pericardium. His clinical course was complicated by development of constrictive pericarditis for which he underwent surgical pericardiectomy. He received a total of 7 weeks of intravenously administered antibiotics with complete clinical recovery.ConclusionsAcute purulent bacterial pericarditis, although rare, should always be kept in mind as a possible cause of pericarditis. Early recognition and prompt intervention are important for a successful outcome.

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Streptococcus intermedius: An Unusual Case of Purulent Pericarditis

Cited by 4 publications

References 11 publications

Purulent Streptococcus intermedius Pericarditis in the Setting of Histoplasma Mediastinal Lymphadenitis: A Case Report and Literature Review

Purulent Streptococcus intermedius Pericarditis in the Setting of Histoplasma Mediastinal Lymphadenitis: A Case Report and Literature Review

An isolated pulmonary nodule secondary to Streptococcus intermedius infection in an otherwise healthy 10-year-old boy: A case report and literature review

Primary purulent bacterial pericarditis due to Streptococcus intermedius in an immunocompetent adult: a case report

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