The Significance of Streptococcus anginosus Group in Intracranial Complications of Pediatric Rhinosinusitis

Deutschmann, Michael W.; Livingstone, Devon; Cho, John J.; Vanderkooi, Otto G; Brookes, James T.

doi:10.1001/jamaoto.2013.1369

Cited by 64 publications

(49 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…intermedius, a common cause of brain abscesses, 4,11 was found in 8 pus samples (Table 1). In vitro, S. intermedius formed ammonia from amino acids.…”

Section: Ammonia Formation From Amino Acids By S Intermedius and S mentioning

confidence: 99%

“…20 To see if brain abscesses contain ammonia we determined the extracellular concentration of ammonia in pus from patients with brain abscesses and, for comparison, in CSF from patients with external cerebroventricular drains. The ability of Streptococcus intermedius and Staphylococcus aureus, two common microbial causes of brain abscesses in humans, 4,11 to produce ammonia from amino acids was investigated in vitro.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Toxic levels of ammonia in human brain abscess

Dahlberg¹,

Ivanović²,

Hassel

2016

JNS

View full text Add to dashboard Cite

obJective Brain abscesses could lead to cerebral symptoms through tissue destruction, edema, changes in brain architecture, and increased intracranial pressure. However, the possibility that the pus itself could contribute to symptoms has received little attention. Brain abscesses are areas of tissue destruction, proteolysis, and formation of free amino acids, which are energy substrates for bacteria and possible sources of ammonia. Ammonia is neurotoxic, may cause brain edema, and could contribute to the symptoms of brain abscesses. methods The authors analyzed the extracellular phase of pus from 14 patients with brain abscesses with respect to ammonia and amino acids. For comparison, CSF from 10 patients undergoing external ventricular drainage was included. The ammonia-forming ability of Streptococcus intermedius and Staphylococcus aureus, two common microbial isolates in brain abscesses, was studied in vitro. results In brain abscesses ammonia was 15.5 mmol/L (median value; range 1.7-69.2 mmol/L). In CSF ammonia was 29 µmol/L (range 17-55 µmol/L; difference from value in pus: p < 0.001). The total concentration of amino acids in brain abscesses was 1.12-16 times higher than the ammonia concentration (p = 0.011). The median glucose value in pus was 0 mmol/L (range 0-2.1 mmol/L), lactate was 21 mmol/L (range 3.3-26.5 mmol/L), and pH was 6.8 (range 6.2-7.3). In vitro, S. intermedius and S. aureus formed ammonia at 6-7 mmol/L in 24 hours when incubated with 20 proteinogenic amino acids plus g-aminobutyric acid (GABA), taurine, and glutathione at 1 mmol/L. coNclusioNs Intracerebral abscesses contain toxic levels of ammonia. At the concentrations found in pus, ammonia could contribute to the brain edema and the symptoms of brain abscesses.

show abstract

“…intermedius, a common cause of brain abscesses, 4,11 was found in 8 pus samples (Table 1). In vitro, S. intermedius formed ammonia from amino acids.…”

Section: Ammonia Formation From Amino Acids By S Intermedius and S mentioning

confidence: 99%

mentioning

confidence: 99%

Toxic levels of ammonia in human brain abscess

Dahlberg¹,

Ivanović²,

Hassel

2016

JNS

View full text Add to dashboard Cite

show abstract

“…S. anginosus is more commonly isolated in blood cultures, and the other two have a higher capacity to form abscesses. 5,11 Previous studies in the pediatric age group reported brain abscesses or intracranial complications 12 and intra-abdominal infections 10 caused by SAG pathogens. Older adults are more affected by thoracic infections, particularly pneumonia, caused by S. anginosus.…”

Section: Discussionmentioning

confidence: 99%

Complicated Pneumonia With Empyema Caused by Streptococcus Anginosus in a Child

Reis-Melo

Soares

Ferreira-Magalhães

et al. 2020

Rev. paul. pediatr.

View full text Add to dashboard Cite

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

show abstract

“…S. anginosus is nowadays often detected in blood cultures and abscesses and has been described as an emerging pathogen in cystic fibrosis patients (Grinwis et al, ; Parkins, Sibley, Surette, & Rabin, ). Especially in brain abscesses it was identified with high frequencies (Al Masalma et al, ; Deutschmann, Livingstone, Cho, Vanderkooi, & Brookes, ; Mishra & Fournier, ). A recent study investigating infections caused by S. anginosus and closely related species found an annual incidence of 8.8/10,000 hospital admissions in Israel, with S. anginosus as the most predominant species (Siegman‐Igra et al, ).…”

Section: Introductionmentioning

confidence: 99%

Heterogeneity of Streptococcus anginosus ß‐hemolysis in relation to CRISPR/Cas

Bauer

Neffgen

Grempels

et al. 2020

Molecular Oral Microbiology

View full text Add to dashboard Cite

Streptococcus anginosus is a commensal of the oral mucosa that can cause severe invasive infections. A considerable proportion of Streptococcus anginosus strains are ß‐hemolytic due to the presence of an SLS‐like gene cluster. However, the majority of strains do not display ß‐hemolysis. To investigate ß‐hemolysin heterogeneity in S. anginosus, we determined the presence of sag genes and correlated it with the presence of CRISPR/Cas genes in a collection of ß‐hemolytic and non‐ß‐hemolytic strains. All of the ß‐hemolytic strains carried the sag gene cluster. In contrast to other streptococci, clinical S. anginosus strains that do not display ß‐hemolysis do not harbor sag genes. Phylogenetic analysis of the ß‐hemolytic strains revealed that they belong to two previously defined clusters within S. anginosus. Correlation with CRISPR/Cas genes showed a significant difference for the presence of CRISPR/Cas in ß‐hemolytic versus non‐ß‐hemolytic isolates. The presence of the CRISPR/Cas type IIA or type IIC locus is associated with the absence of sag genes; in 65% of the non‐ß‐hemolytic strains a CRISPR/Cas locus was found, while only 24% of ß‐hemolytic strains carry CRISPR/Cas genes. Further analysis of the spacer content of the CRISPR systems revealed the presence of multiple self‐targeting sequences directed against S. anginosus genes. These results support the hypothesis that horizontal gene transfer is involved in the acquisition of ß‐hemolysin genes and that CRISPR/Cas may limit DNA uptake in S. anginosus.

show abstract

The Significance of Streptococcus anginosus Group in Intracranial Complications of Pediatric Rhinosinusitis

Cited by 64 publications

References 16 publications

Toxic levels of ammonia in human brain abscess

Toxic levels of ammonia in human brain abscess

Complicated Pneumonia With Empyema Caused by Streptococcus Anginosus in a Child

Heterogeneity of Streptococcus anginosus ß‐hemolysis in relation to CRISPR/Cas

Contact Info

Product

Resources

About