Seven-year review of bacteremia caused byStreptococcus milleri and other viridans streptococci

TheStreptococcus milleri group is associated with a spectrum of serious suppurative infections that have not been well defined. The purposes of this study were to ascertain the clinical significance ofStreptococcus milleri bacteremia and to determine the epidemiological, clinical, and microbiological features of these infections compared to those caused by other viridans streptococci. All cases of streptococcal bacteremia observed in a Spanish hospital in the period from January 1988 to December 1994 were reviewed. Of 137 cases ofStreptococcus milleri infection, 33 (24%) were documented cases of bacteremia. Twenty-four patients were men (mean age 57.8 ± 17.4 years). The majority of infections were abdominal in origin (20/33), the most frequent diagnoses being cholangitis/cholecystitis (18%) and appendicitis (12%). The origin of infection could not be established in three cases. Nine cases of bacteremia (27%) were polymicrobial. Six patients (18%) had septic shock; in four the infection was polymicrobial, and in two the infection was of abdominal origin. Eighteen of the 33 patients (54%) required surgery. Five patients died. All 33Streptococcus milleri isolates were susceptible to penicillin. Twenty-two cases of bacteremia caused by other viridans streptococci were observed during the same period. There were no statistically significant differences between the two groups in terms of age, sex, mortality, rate of polymicrobial infection, rate of nosocomial acquisition of bacteremia, or the occurrence of shock. An abdominal origin of infection was more frequent inStreptococcus milleri bacteremia (p=0.0001); a cardiovascular origin was more frequent in the viridans group (p=0.01), as was a diagnosis of endocarditis (p=0.004). Four patients with viridans streptococci bacteremia required surgery versus 18 patients withStreptococcus milleri bacteremia (p=0.01). Viridans streptococci were notably less susceptible to penicillin (89%), clindamycin (79%), and erythromycin (79%).     

Deep soft-tissue infections caused byStreptococcus pneumoniae

Three cases of deep soft-tissue infections caused by Streptococcus pneumoniae are presented. All patients were previously healthy adults. The first case was a man with a protracted illness in whom pelvic and inguinal abscesses developed at the site of a scar from a traumatic injury several years earlier. The second patient, a woman, had mastitis with systemic symptoms. The third patient was a woman who developed a gluteal abscess after an intra-muscular injection of a contraceptive. Cellulitis and deep soft-tissue infections caused by Streptococcus pneumoniae are uncommon, but may occur even in immunocompetent adults.     

Neonatal mortality in puppies due to bacteremia by Streptococcus dysgalactiae subsp. dysgalactiae

We report a case of bacteremia in puppies caused by Streptococcus dysgalactiae subsp. dysgalactiae. Identification was achieved by phenotypic and molecular genetic methods. This is the first report of the recovery of S. dysgalactiae subsp. dysgalactiae from dogs.     

First case of bacteremia caused by Janibacter hoylei

Janibacter hoylei has previously been isolated only from an air sample in the upper atmosphere and clinical significance of J. hoylei was not yet established. Herein, we report a case of bacteremia caused by J. hoylei. An 8‐week‐old previously healthy male infant presented to the emergency room with fever. Blood culture yielded growth of Gram‐positive bacilli and this microorganism could not be identified with conventional phenotypic methods. The isolate was identified by 16S rRNA gene sequencing, and the patient was successfully treated with vancomycin. To our knowledge, this is the first report of the recovery of J. hoylei in humans. This case shows that J. hoylei can be a potential pathogen in young children.     

Streptococcus dysgalactiae subsp. equisimilis bacteremia: an emerging infection

The importance of group C and G Streptococcus dysgalactiae subspecies equisimilis (S. dysgalactiae subsp. equisimilis) as a significant pathogen has recently been better recognized. S. dysgalactiae subsp. equisimilis disease can range in severity from milder skin and soft-tissue conditions such as wound infection, erysipelas, and cellulitis, to life-threatening necrotizing fasciitis and streptococcal toxic shock syndrome, thus sharing the clinical picture with S. pyogenes. The most common clinical manifestation of bacteremia is cellulitis. An increase in the incidence of S. dysgalactiae subsp. equisimilis bacteremia has been recognized. Invasive forms of this infection are most commonly found in elderly patients with underlying comorbidities and skin breakdown. The case fatality in bacteremia has been reported to be 15–18 %. In this review, the epidemiology, clinical characteristics, and emm types of S. dysgalactiae subsp. equisimilis bacteremia are summarized.     

Six cases of acute appendicitis with secondary peritonitis caused byStreptococcus pneumoniae

In six previously healthy children and adults with typical acute appendicitis,Streptococcus pneumoniae was isolated from peritoneal swabs or periappendicular pus in pure culture (four patients) or together with intestinal flora. Pneumococci recovered by abdominal paracentesis are not pathognomonic of socalled primary or spontaneous peritonitis.     

Meningitis caused by Streptococcus dysgalactiae in a preterm infant

This report describes a case of meningitis caused by a Lancefield group C streptococcus (Streptococcus dysgalactiae) in a 9-week-old infant. Bacteria of this group rarely cause serious infections in man. The organism was identified as a member of Lancefield group C by the acid extraction method and as S. dysgalactiae by biochemical tests. The patient's condition responded well to penicillin and tobramycin therapy, with no obvious neurologic sequelae.     

Nosocomial bacteremia caused byBacillus species

During a six year period, 11 cases of bacteremia caused byBacillus spp. were observed corresponding to 1 % of all bacteremic episodes in our hospital. Most patients had cancer as underlying disease. All cases of positive blood cultures were associated with a clinical syndrome compatible with sepsis including high fever. None of the subsequent deaths could be related to the bacteremia caused byBacillus spp. Four of eight cases ofBacillus subtilis bacteremia were associated with the absorption of an oral preparation containingBacillus subtilis spores, which was administered empirically in some units of the hospital to reduce what was considered to be tubefeeding related diarrhea.Research Associate, Fund for Medical Scientific Research, Belgium.     

A case of diarrhea, bacteremia, and fever caused by a novel strain of Escherichia coli.

A nonenteropathogenic strain of Escherichia coli from a patient with diarrhea and bacteremia possessed the attaching-effacing eae gene, was invasive in the gentamicin invasion assay, and expressed two types of pili and K1 antigen. This unique combination places the strain in a new category of attaching-effacing E. coli.     

Catheter-related bacteremia caused by Oerskovia turbata.

A case of Broviac catheter-related bacteremia in a 3-year-old boy infected with Oerskovia turbata is discussed. The blood cultures of the patient remained positive despite antibiotic therapy, and only with catheter removal was his blood sterilized. The microbiology and antimicrobial susceptibilities of this organism are described.     

Fatal case of community-acquired bacteremia and necrotizing fasciitis caused by Chryseobacterium meningosepticum: case report and review of the literature

A diabetic patient with chronic heart failure developed necrotizing fasciitis and bacteremia caused by Chryseobacterium meningosepticum, which rapidly evolved into death, even with fasciotomy and intensive care. A review of the English literature found 10 cases of soft tissue infection caused by C. meningosepticum, which is rarely acquired in the community.     

Incidence,seasonal pattern,and clinical manifestations of Streptococcus dysgalactiae subspecies equisimilis bacteremia; a population-based study

European Journal of Clinical Microbiology & Infectious Diseases - Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a human pathogen causing severe invasive infections....     

Fatal case of Listeria innocua bacteremia

Listeria innocua is widespread in the environment and in food. This species has to date never been described in association with human disease. We report a case of fatal bacteremia caused by L. innocua in a 62-year-old patient.     

Indwelling device-related bacteremia caused by serum-susceptible Campylobacter coli.

Two isolates of serum-susceptible Campylobacter coli were recovered in a 7-day interval from blood from a patient with hepatocellular carcinoma and liver cirrhosis whose peritoneal-caval (Denver's) shunt malfunctioned. Identical random amplified polymorphic DNA fingerprints, cellular fatty acid chromatograms, and antibiograms of the two isolates indicate that C. coli has the ability to cause catheter-related bacteremia following its colonization of the catheter.