Infect Chemother.  2008 Oct;40(5):281-283. 10.3947/ic.2008.40.5.281.

A Case of Humeral Osteomyelitis and Soft Tissue Abscess Accompanied with Streptococcus anginosus Bacteremia

• Han WJ
• Cho MS
• Lee JH
• Ahn HD
• Yoon KH
• Seo JG
• Kim JY
• Kim SY
• Park YS
• Seo YH
• Cho YK

• KMID: 2285053
• DOI: http://doi.org/10.3947/ic.2008.40.5.281

Abstract

Streptococcus anginosus is a normal flora found in multiple body sites and belongs to the Streptococcus milleri group. It has often been associated with pyogenic infection, such as perio-dontitis, endocarditis, pulmonary abscess and abdominal or cerebral abscess. Also uncommonly, it can cause osteomyelitis. A 42-year-old man was admitted due to gastric ulcer perforation. At 12th hospital day, left humeral osteomyelitis and soft tissue abscess developed. Streptococcus anginosus grew in blood culture. He was treated with intravenous penicillin and surgical debridement of the necrotic tissue which lead to a satisfactory result. We report a rare case of Streptococcus anginosus-induced humeral osteomyelitis and soft tissue abscess.

Keyword

Streptococcus anginosus; Bacteremia; Osteomyelitis; Humerus

MeSH Terms

Abscess
Adult
Bacteremia
Brain Abscess
Debridement
Endocarditis
Humans
Humerus
Lung Abscess
Osteomyelitis
Penicillins
Stomach Ulcer
Streptococcus
Streptococcus anginosus
Streptococcus milleri Group
Penicillins

Figure

• 

  Figure 1 Lt. shoulder AP image reveals soft tissue swelling at the left upper arm with internal air bubbles which suggest of gas forming infection. There is no definite evidence of bony abnormalities.

• 

  Figure 2 (A) On left shoulder T1-weighted and (B) T2-weighted MRI, the left proximal humerus shows diffuse heterogeneous signal intensity on T2WI with irregular enhancement on gadolinium administration suggesting bone marrow involvement. There is an abscess, measuring about 7×5 cm, around the proximal humerus showing heterogeneous high signal intensity on T2WI with peripheral enhancement on sagittal gadolinium enhanced T1WI.

Reference

1. Mirzanejad Y, Stratton CW. Mandell GL, Bennet JE, Dolin R, editors. Streptococcus angionosus Group. Principles and Practice of Infectious Diseases. 2005. 6th. Churchill Livingstone;2451–2455.

2. Gray T. Streptococcus anginosus group: Clinical significance of an important group of pathogens. Clin Microbiol Newsl. 2005. 27:155–159.

3. Nagamune H, Whiley RA, Goto T, Inai Y, Maeda T, Hardie JM, Kourai H. Distribution of the intermedilysin gene among the anginosus group streptococci and correlation between intermedilysin production and deep-seated infection with Streptococcus intermedius. J Clin Microbiol. 2000. 38:220–226.

4. Jacobs JA, Schot CS, Schouls LM. Haemolytic activity of the Streptococcus milleri group' and relationship between haemolysis restricted to human red blood cells and pathogenicity in S. intermedius. J Med Microbiol. 2000. 49:55–62.

5. Whiley RA, Beighton D, Winstanley TG, Fraser HY, Hardie JM. Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus (the Streptococcus milleri group): association with different body sites and clinical infections. J Clin Microbiol. 1992. 30:243–244.

6. Claridge JE 3rd, Attorri S, Musher DM, Hebert J, Dunbar S. Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus ("Streptococcus milleri group") are of different clinical importance and are not equally associated with abscess. Clin Infect Dis. 2001. 32:1511–1515.

7. Morita E, Narikiyo M, Yokoyama A, Yano A, Kamoi K, Yoshikawa E, Yamaguchi T, Igaki H, Tachimori Y, Kato H, Saito D, Hanada N, Sasaki H. Predominant presence of Streptococcus anginosus in the saliva of alcoholics. Oral Microbiol Immunol. 2005. 20:362–365.

8. Bert F, Bariou-Lancelin M, Lambert-Zechovsky N. Clinical significance of bacteremia involving the "Streptococcus milleri" group: 51 cases and review. Clin Infect Dis. 1998. 27:385–387.

9. Bantar C, Fernandez Canigia L, Relloso S, Lanza A, Bianchini H, Smayevsky J. Species belonging to the "Streptococcus milleri" group: antimicrobial susceptibility and comparative prevalence in significant clinical specimens. J Clin Microbiol. 1996. 34:2020–2022.

10. Limia A, Jiménez ML, Alarcón T, López-Brea M. Fiv-eyear analysis of antimicrobial susceptibility of the Streptococcus milleri group. Eur J Clin Microbiol Infect Dis. 1999. 18:440–444.