Streptococcus intermediusBacteremia and Liver Abscess following a Routine Dental Cleaning

Abstract

Streptococcus intermedius is a member of the Streptococcus anginosus group of bacteria. This group is part of the normal flora of the oropharynx, genitourinary, and gastrointestinal tracts; however, they have been known to cause a variety of purulent infections including meningitis, endocarditis, and abscesses, even in immunocompetent hosts. In particular, S. intermedius has been associated with the development of liver and brain abscesses. There have been several case reports of S. intermedius liver abscesses with active periodontal infection. To our knowledge, however, there has not been a case following a routine dental procedure. In fact, the development of liver abscesses secondary to dental procedures is very rare in general, and there are only a few case reports in the literature describing this in relation to any pathogen. We present a rare case of S. intermedius bacteremia and liver abscess following a dental cleaning. This case serves to further emphasize that even routine dental procedures can place a patient at risk of the development of bacteremia and liver abscesses. For this reason, the clinician must be sure to perform a detailed history and careful examination. Timely diagnosis of pyogenic liver abscesses is vital, as they are typically fatal if left untreated.

Multiple liver abscesses and bacteremia caused by Streptococcus constellatus infection: a case report

“…In contrast, all of the 10 previously healthy patients with SMG‐associated PLA were infected with SMG alone , suggesting that altered immune responses in patients with malignancy may partially contribute to mixed infections. Lachara et al reported a case of SMG‐associated PLA following a routine dental cleaning, suggesting that temporary bacteremia can also cause SMG‐associated PLA; this indicates the importance of hematogenous spread of SMG. In the present case, the presence of septic thrombophlebitis of the portal vein (pylephlebitis) strongly suggests that portal bacteremia led to the onset of PLA.…”

Comparing Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry and Phenotypic and Molecular Methods for Identification of Species within the Streptococcus anginosus Group

“…However, these bacteria may also cause infections that can range from mild, such as pharyngitis, to severe, such as bacteremia and abscesses in internal organs, with the three SAG species tending to be associated with different clinical syndromes. Abscesses caused by S. intermedius are more likely to spread hematogenously and be deep seated (4,14,15). On the other hand, S. anginosus is less likely to be implicated in abscess formation, but it predominates in blood cultures and is also commonly isolated from urogenital and gastrointestinal sources (4, 11).…”

Pyogenic Liver Abscess Secondary to Sigmoid Diverticulitis: An Unusual Presentation

“…In conclusion, it is advocated that the presence of S. milleri group bacteraemia should alert the clinician to the possibility of an underlying abscess as a source of infection [13]. Although portal bacteraemia is a known complication of ulcerative colitis, the development of liver abscesses is rare.…”