Streptococcus intermediusCausing Necrotizing Pneumonia in an Immune Competent Female: A Case Report and Literature Review

Abstract

We report a case of a 52-year-old immunocompetent Caucasian female treated for necrotizing Streptococcus intermedius pneumonia and review available literature of similar cases. Our patient presented with respiratory failure and required hospitalization and treatment in the intensive care unit. Moreover, she required surgical drainage of right lung empyema as well as decortication and resection. The review of literature revealed three cases of S. intermedius pneumonia, one of which was a mortality. Comparison of the published cases showed a highly varied prehospital course and radiological presentations, with a symptomatic phase ranging from 10 days to five months. Radiological findings varied from an isolated pleural effusion to systemic disease with the presence of brain abscesses. Immunocompetence appears to correlate well with the overall prognosis. In addition, smoking appears to be an important risk factor for S. intermedius pneumonia. In 2 (50%) of cases, pleural fluid analysis identified S. intermedius. In contrast, no organism was found in our patient, necessitating the acquisition of lung tissue sample for the diagnosis. In conclusion, both medical and surgical management are necessary for effective treatment of S. intermedius pneumonia. The outcome of treatment is good in immunocompetent individuals.

Lung abscess caused by Streptococcus intermedius in an immunocompetent patient

“…Their virulence can be linked to inhibition of neutrophil cytotoxins as well as production of enzymes that aid in tissue destruction and liquefaction [23,24] . However, despite its virulence and presence in the oropharyngeal flora, only a few cases of pulmonary infection by S. intermedius have been described in literature, with the bacteria being more often associated with abscesses of soft tissue, liver, and brain [25,26,27,28] . In such rare patients with lung infections by S. intermedius, the duration of symptoms prior to hospitalization is highly variable, ranging from 10 days to 5 months.…”

“…In cases of pleural space collections and empyema, patients are more likely to benefit from invasive drainage procedures [21] . Despite the virulence of the pathogen, the outcome and prognosis when appropriate antibiotic therapy is provided is usually favorable [28,29] .…”

Isolated Streptococcus intermedius pulmonary nodules

“…Reviews by Wong et al and Hannoodi et al describe multiple common characteristics found in S. intermedius cases. These reviews found a mean age of 61 and predisposing factors including alcohol abuse, tobacco use, periodontal disease, prior thoracic surgeries and malignancy [3], [4]. The gentleman described above is a 29-year-old male with good dentition, and no prior surgeries.…”

Streptococcus intermedius Pleuropulmonary Disease: A Not So Commonly Seen Radiological Picture

“…Technique Treatment The radiological findings seen in the patient population diagnosed with S. intermedius infection broadly include consolidation, loculated pleural effusion, cavitary lesions, nodules, empyema, and lung abscess [1][2][3][4][5][6][7][8][9][10]. In our patient, it is difficult to differentiate an empyema vs. an empyema with abscesses or malignancy with superimposed infection.…”