Streptococcus tigurinus is a newly described member of the Streptococcus mitis group. Due to the difficulty in distinguishing viridans group streptococci (VGS) by phenotype, analysis of 16S rRNA sequences is necessary for the accurate identification of most species. Through a laboratory policy of analyzing all clinically significant isolates from the VGS group by16S rRNA gene sequencing, we identified 14 S. tigurinus isolates from 11 patients. The Vitek 2 system most commonly gave an excellent rating to an incorrect identification (e.g., Streptococcus mitis), as did matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) (e.g., Streptococcus oralis). S. tigurinus strains were recovered from numerous body sites, including the blood, peritoneal fluid, bone, synovial fluid, a perianal abscess, and an arm wound. Retrospective chart review indicated that most isolates were clinically significant, with bacteremia (n ؍ 5), soft tissue infections (n ؍ 3) osteomyelitis (n ؍ 2), infected joint prosthesis (n ؍ 2), and peritonitis (n ؍ 2) being the most common, thus expanding the spectrum of disease associated with S. tigurinus.
Streptococcus tigurinus was first described after isolation from a patient with infective endocarditis. Isolates of alpha-hemolytic, catalase-negative Gram-positive cocci were recovered from multiple blood cultures of a 74-year-old patient. The isolates were initially identified as viridans group streptococci (VGS). However, analysis of 16S rRNA sequences revealed that the isolates were distinct members of the Streptococcus mitis group (SMG) and were closely related to Streptococcus pneumoniae, Streptococcus pseudopneumoniae, Streptococcus mitis, Streptococcus infantis, and Streptococcus oralis (1). This novel Streptococcus strain was named Streptococcus tigurinus. Since the first report of S. tigurinus infection in 2012, S. tigurinus has been isolated from several additional sterile sites, including cerebrospinal fluid, heart valves, and joint fluid (2, 3). It has been associated with serious invasive infections, including infective endocarditis, culture-negative endocarditis, spondylodiscitis, bacteremia, meningitis, prosthetic joint infections, and thoracic empyema (2, 4). Small colony variants of S. tigurinus were associated with a prosthetic joint infection (3). S. tigurinus has also been isolated from the subgingival plaque of a patient with periodontitis (5). In vitro studies have shown S. tigurinus to be highly virulent in a rat model of experimental endocarditis (6).Because of its relatedness to SMG, S. tigurinus has been hypothesized to be a commensal of the human oral cavity. Data to support this hypothesis, however, are conflicting (7). In a screen of saliva specimens from 31 volunteers, S. tigurinus was not identified among the more than 600 strains of alpha-hemolytic bacterial colonies isolated (2). In a second study that used a specific 16S rRNA gene real-time TaqMan PCR assay, however, S. tigurinus was detected in the saliva and subgingiv...