Creighton University, Omaha, NE
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Student/Resident Case Report Poster - Chest Infections II
SESSION TYPE: Student/Resident Case Report Poster
PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM
INTRODUCTION: Empyema is often caused by Streptococcus pneumonia as well as Staphylococcus aureus and a variety of gram-negative organisms and anaerobes. However, to the best of our knowledge, Streptococcus gordonii has not yet been reported as a causative agent for empyema. We describe a case of a 65-year-old man who was found to have empyema and splenic abscess due to S. gordonii.
CASE PRESENTATION: A 65-year-old male with a history of tobacco abuse presented with severe sepsis and respiratory distress. Physical examination revealed dental caries and decreased breath sounds in the bibasilar regions. Computed Tomography (CT) of the chest and abdomen demonstrated left sided pleural effusion and a splenic fluid collection measuring 4.3 cmx2.8 cm clinically suspicious for an abscess. He was started on intravenous vancomycin and piperacillin-tazobactam; however, blood cultures were negative. Drainage of the splenic abscess was performed and cultures yielded a rare species, S.gordonii, sensitive to penicillin. A CT guided thoracentesis yielded 450 ml of exudative fluid with 4329 nucleated white blood cells (79% neutrophils) with cultures growing S.gordonii. This was followed by a CT scan of the head and neck which ruled out an intra-oral abscess. Intravenous penicillin was administered for a total of 6 weeks. Follow-up CT scan after treatment showed resolution of both the splenic abscess and left parapneumonic effusion.
DISCUSSION: In the pre-antibiotic era, S.pneumoniae, S.pyogenes and S.aureus were the most common pathogens associated with empyema. However, anaerobes have also been identified in 25-76% of cases either as sole organisms or in mixed cultures. Recently, the Streptococcus anginosus group subgroup of viridans streptococci has been reported as the leading bacterial cause of empyema. S.gordonii often colonizes tooth surfaces by creating biofilms in the human mouth, which leads to periodontal disease. There have been case reports of septic arthritis and infective endocarditis caused by this organism.
CONCLUSIONS: Viridans streptococci, which includes S.gordonii, are pioneer oral bacteria that are often associated with dental plaque formation. Our patient presented with unusual complications of S.gordonii. To our knowledge, this organism has not previously been reported to cause empyema. In our presentation, it was likely that the aspiration of dental plaque contents was responsible for his pleuro-pulmonary infection and subsequent contiguous splenic infection.
Reference #1: Kilic, A., Tao, L., Zhang, Y et al. Involvement of Streptococcus gordonii beta-glucoside metabolism systems in adhesion, biofilm formation, and in vivo gene expression. Journal of Bacteriology. 2004;186:4246-4253
Reference #2: Schultz KD, Fan LL, Pinsky J,et al. The changing face of pleural empyemas in children: epidemiology and management. Pediatrics 2004;113:1735-40
Reference #3: Yombi J, Belkhir L,Jonckheere SStreptococcus gordonii septic arthritis:two cases and review of literature. BMC Infect Dis. 2012;12:215.
DISCLOSURE: The following authors have nothing to disclose: Manasa Velagapudi, Felicia Ratnaraj, Mridula Krishnan, Nagarjuna Gujjula, Laurel Preheim
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