Tuberc Respir Dis.  2011 Dec;71(6):476-479.

A Case of Massive Empyema Caused by Streptococcus constellatus and Anaerobic Bacteria for Mental Retardation

• Kim KH
• Kim SH
• Heo JW
• Lee SH
• Han SS
• Lee SJ
• Kim WJ

Abstract

The Streptococcus milleri group, which also includes S. anginosus, S. intermedius and S. constellatus, is found in the oropharynx, upper respiratory tract, gastrointestinal tract, and urogenital tract mucosa. Bacteria in the Streptococcus milleri group are associated with bacteremia and abscess formation. Most of the reports of of Streptococcus milleri group (SMG) infection occur in patients with underlying medical conditions. Predisposing factors that have been associated with S. milleri group empyema include mucosal disturbances (sinusitis, periodontal disease, enteric disease), preceding to pneumonia, thoracic surgery, malignancy, neurological disease, alcohol abuse, and also diabetes mellitus. We report on a 42-year-old man with mental retardation. He who suffered from dyspnea and a fever that he had developed for over 14 days. S. constellatus and anaerobic bacterias (Prevotella buccae and Micromonas micros) were cultured. The patient was treated with the drainage of pleural effusion and clindamycin and levofloxacin.

Keyword

Streptococcus milleri Group; Mental retardation; Empyema

MeSH Terms

Abscess
Adult
Alcoholism
Bacteremia
Bacteria
Bacteria, Anaerobic
Cheek
Clindamycin
Diabetes Mellitus
Drainage
Dyspnea
Empyema
Fever
Gastrointestinal Tract
Humans
Intellectual Disability
Mucous Membrane
Ofloxacin
Oropharynx
Periodontal Diseases
Pleural Effusion
Pneumonia
Respiratory System
Streptococcus
Streptococcus constellatus
Streptococcus milleri Group
Thoracic Surgery
Clindamycin
Ofloxacin

Figure

• 

  Figure 1 (A) Chest AP on admission shows massive pleural effusions and collapsed lung in the right lower lung field. (B) Pleural effusion decreased markedly after 7 weeks of treatment. AP: Anterior-Posterior.

• 

  Figure 2 (A) Multiloculated pleural effusion and air-fluid level are in the right anterior thorax. (B) Follow-up CT after 7 weeks of treatment shows markedly decreased multiloculated pleural effusion in the right thorax. CT: computed tomography.

Reference

1. Ruoff KL. Streptococcus anginosus ("Streptococcus milleri"): the unrecognized pathogen. Clin Microbiol Rev. 1988. 1:102–108.

2. Kobashi Y, Mouri K, Yagi S, Obase Y, Oka M. Clinical analysis of cases of empyema due to Streptococcus milleri group. Jpn J Infect Dis. 2008. 61:484–486.

3. Hocken DB, Dussek JE. Streptococcus milleri as a cause of pleural empyema. Thorax. 1985. 40:626–628.

4. Molina JM, Leport C, Bure A, Wolff M, Michon C, Vilde JL. Clinical and bacterial features of infections caused by Streptococcus milleri. Scand J Infect Dis. 1991. 23:659–666.

5. Weightman NC, Barnham MR, Dove M. Streptococcus milleri group bacteraemia in North Yorkshire, England (1989-2000). Indian J Med Res. 2004. 119:Suppl. 164–167.

6. Matsukawa Y, Kitamura N, Kaneko M, Yoshioka D, Miki T, Nishinarita S, et al. Multibacterial sepsis in an alcohol abuser with hepatic cirrhosis. Intern Med. 2003. 42:208–210.

7. Morita E, Narikiyo M, Yokoyama A, Yano A, Kamoi K, Yoshikawa E, et al. Predominant presence of Streptococcus anginosus in the saliva of alcoholics. Oral Microbiol Immunol. 2005. 20:362–365.

8. 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.

9. Maskell NA, Davies CW, Nunn AJ, Hedley EL, Gleeson FV, Miller R, et al. U.K. Controlled trial of intrapleural streptokinase for pleural infection. N Engl J Med. 2005. 352:865–874.

10. Kim YJ, Cha SI, Kwon JS, Yoo SS, Jun HJ, Kim EJ, et al. Treatment results and prognostic factors of complicated parapneumonic effusion and empyema. Tuberc Respir Dis. 2007. 63:24–30.

11. Porta G, Rodríguez-Carballeira M, Gómez L, Salavert M, Freixas N, Xercavins M, et al. Thoracic infection caused by Streptococcus milleri. Eur Respir J. 1998. 12:357–362.

12. Ahn HD, Park JC, Seo JG, Kim JY, Kim SY, Park YS, et al. A case of vertebral osteomyelitis with spinal epidural abscess caused by streptococcus constellatus. Infect Chemother. 2008. 40:288–291.

13. Kim YS, Kim JY, Park SM, Kim SY, Park YS, Seo YH, et al. A case of gas gangrene caused by Streptococcus constellatus. Korean J Med. 2008. 75:119–121.

14. Ryu YS, Lee JH, Lee BH, Kim SH, Yang DJ, Ryu SR, et al. A case of empyema caused by streptococcus constellatus. Tuberc Respir Dis. 2009. 66:463–466.