Tuberc Respir Dis.  2015 Jul;78(3):196-202. 10.4046/trd.2015.78.3.196.

Clinical Characteristics of Community-Acquired Viridans Streptococcal Pneumonia

Affiliations
  • 1Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea. sicha@knu.ac.kr
  • 2Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea.

Abstract

BACKGROUND
Viridans streptococci (VS) are a large group of streptococcal bacteria that are causative agents of community-acquired respiratory tract infection. However, data regarding their clinical characteristics are limited. The purpose of the present study was to investigate the clinical and radiologic features of community-acquired pneumonia (CAP) with or without parapneumonic effusion caused by VS.
METHODS
Of 455 consecutive CAP patients with or without parapneumonic effusion, VS were isolated from the blood or pleural fluid in 27 (VS group, 5.9%) patients. Streptococcus pneumoniae was identified as a single etiologic agent in 70 (control group) patients. We compared various clinical parameters between the VS group and the control group.
RESULTS
In univariate analysis, the VS group was characterized by more frequent complicated parapneumonic effusion or empyema and bed-ridden status, lower incidences of productive cough, elevated procalcitonin (>0.5 ng/mL), lower age-adjusted Charlson comorbidity index score, and more frequent ground glass opacity (GGO) or consolidation on computed tomography (CT) scans. Multivariate analysis demonstrated that complicated parapneumonic effusion or empyema, productive cough, bed-ridden status, and GGO or consolidation on CT scans were independent predictors of community-acquired respiratory tract infection caused by VS.
CONCLUSION
CAP caused by VS commonly presents as complicated parapneumonic effusion or empyema. It is characterized by less frequent productive cough, more frequent bed-ridden status, and less common CT pulmonary parenchymal lesions. However, its treatment outcome and clinical course are similar to those of pneumococcal pneumonia.

Keyword

Community-Acquired; Empyema; Respiratory Tract Infections; Viridans Streptococci

MeSH Terms

Bacteria
Comorbidity
Cough
Empyema
Glass
Humans
Incidence
Methods
Multivariate Analysis
Pneumonia*
Pneumonia, Pneumococcal
Respiratory Tract Infections
Streptococcus pneumoniae
Tomography, X-Ray Computed
Treatment Outcome
Viridans Streptococci

Figure

  • Figure 1 Viridans streptococcal isolates. Streptococcus mitis/oralis is the most common pathogen, followed by S. sanguis and S. constellatus (%, the number of each isolate per the number of total viridans streptococcal isolates): S. mitis/oralis is isolated from blood (n=8) and pleural fluid (n=2); S. sanguis is from blood (n=6); S. constellatus is from blood (n=2) and pleural fluid (n=2); S. intermedius is from pleural fluid (n=3) and blood (n=1); S. salivarius, S. parasanguinis, and S. anginosus is from blood (n=2, respectively).

  • Figure 2 Antibiotic regimens for community-acquired pneumonia. Each regimen includes the following antibiotics: cefotaxime+macrolide: cefotaxime (or ceftriaxone) plus macrolide (or fluoroquinolone); ampicillin+sulbactam: ampicillin+sulbactam with or without macrolide; piperacillin+tazobactam: piperacillin+tazobactam (piperacillin+sulbactam, ticarcillin+clavulanic acid, or maxipime) with or without fluoroquinolone (or macrolide); cefotaxime+clindamycin: cefotaxime plus clindamycin; meropenem+teicoplanin: meropenem plus teicoplanin (or vancomycin); levofloxacin: levofloxacin (or moxifloxacin).


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