BACKGROUND: Group B streptococcus (GBS) infection is a leading cause of neonatal morbidity and mortality worldwide. Here, we present the analytical and diagnostic usefulness of a new real-time PCR-based assay (Xpert GBS; Cepheid, USA) for rapid and accurate prenatal GBS screening. METHODS: We enrolled 175 pregnant women who were between 35 and 39 weeks of gestation. The analytical performance of the Xpert GBS assay was first tested using a reference GBS strain. Next, to test diagnostic performance, rectovaginal swabs were obtained from pregnant women who visited the hospital for regular antenatal screening after 34 weeks of gestation. The results of the Xpert GBS assay were compared to those of standard culture for the detection of prenatal GBS colonization. RESULTS: When any positive result from Xpert GBS or culture was considered a true positive, the sensitivity of the Xpert GBS assay and culture were 91% (20/22; 95% CI [confidence interval], 72-98) and 68% (15/22; 95% CI, 47-84), respectively. The specificity of both methods was 100% (153/153; 95% CI, 97-100). The sensitivity and specificity of the Xpert GBS assay, using the culture results as a reference, were 86.7% and 95.6%, respectively. In the Xpert GBS assay, the median threshold cycle of vaginally colonized samples was significantly lower than rectally colonized samples (P<0.01). CONCLUSIONS: The Xpert GBS assay is an accurate, rapid, easy-to-use test for the detection of maternal GBS colonization in prenatal screening that might be especially useful in clinical settings where standard culture is not feasible.
DNA, Bacterial/*analysis ; Female ; Gestational Age ; Humans ; Pregnancy ; Pregnancy Complications, Infectious/*diagnosis/microbiology ; Prenatal Diagnosis ; Reagent Kits, Diagnostic ; Real-Time Polymerase Chain Reaction ; Rectum/microbiology ; Sensitivity and Specificity ; Streptococcal Infections/*diagnosis/microbiology ; Streptococcus agalactiae/*genetics/isolation & purification ; Vagina/microbiology

Bacterial pericarditis has been recognized as a rare disease since the development of antibiotics. Usually, the disease is associated with underlying conditions or a seeding of infection elsewhere to the pericardium. Here we describe a case of group G streptococcal pericarditis as an initial presentation of colon cancer. A 52-yr-old man was admitted because of dyspnea. An electrocardiogram showed a diffuse ST-segment elevation and a two-dimensional echocardiogram showed a large amount of pericardial effusion. A pericardiocentesis was done and purulent fluid was drained. Group G streptococci was cultured in pericardial fluid. The patient was treated with antibiotics and pericardiostomy with saline irrigation. A colonoscopy revealed a small mass with moderately differentiated adenocarcinoma in rectosigmoid colon. He underwent a mucosectomy and was recovered without any complication.
Adenocarcinoma/complications/*diagnosis/surgery ; Colonic Neoplasms/complications/*diagnosis/surgery ; Echocardiography ; Electrocardiography ; Humans ; Male ; Middle Aged ; Pericardial Effusion ; Pericarditis/complications/drug therapy/*microbiology/surgery ; Streptococcal Infections/complications/drug therapy/*microbiology/surgery ; Streptococcus/*classification

Although the association between Streptococcus bovis endocarditis and colon carcinoma is well known, very few cases of S. bovis infection associated with underlying malignancies have been reported in Korea. The S. bovis group has been recently reclassified and renamed as Streptococcus gallolyticus and Streptococcus infantarius subspecies under a new nomenclature system. We report a case of infective endocarditis with colon cancer caused by S. gallolyticus subsp. gallolyticus (previously named S. bovis biotype I). A 59-yr-old woman presented with a 1-month history of fever. Initial blood cultures were positive for gram-positive cocci, and echocardiography showed vegetation on mitral and aortic valves. Antibiotic treatment for infective endocarditis was started. The infecting strain was a catalase-negative and bile-esculin-positive alpha-hemolytic Streptococcus susceptible to penicillin and vancomycin. The strain was identified as S. gallolyticus subsp. gallolyticus with the use of the Vitek 2 GPI and API 20 Strep systems (bioMerieux, USA). The 16S rDNA sequences of the blood culture isolates showed 100% homology with those of S. gallolyticus subsp. gallolyticus reported in GenBank. The identification of the infecting organism, and the subsequent communication among clinical microbiologists and physicians about the changed nomenclature, led to the detection of colon cancer. The patient recovered after treatment with antibiotics, valve surgery, and operation for colon cancer. This is the first report of biochemical and genetic identification of S. gallolyticus subsp. gallolyticus causing infective endocarditis associated with underlying colon cancer in a Korean patient.
Anti-Bacterial Agents/therapeutic use ; Colonic Neoplasms/*complications/diagnosis ; Echocardiography ; Endocarditis, Bacterial/complications/diagnosis/*microbiology ; Female ; Humans ; Middle Aged ; RNA, Ribosomal, 16S/genetics ; Sequence Analysis, DNA ; Streptococcal Infections/complications/diagnosis/*microbiology ; Streptococcus bovis/genetics/*isolation &purification

Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.
Anti-Bacterial Agents/therapeutic use ; Diabetes Mellitus, Type 2/complications/diagnosis ; Fasciitis, Necrotizing/*diagnosis/drug therapy/microbiology/surgery ; Fatal Outcome ; Humans ; Leg/surgery ; Liver Cirrhosis/complications/diagnosis ; Male ; Middle Aged ; Streptococcal Infections/*diagnosis/drug therapy ; Streptococcus pneumoniae/isolation & purification

We report a case of necrotizing fasciitis involving Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a 36-yr-old female diabetic patient, which started after a minor dog bite to the toe of the patient. This case suggested that a trivial infection after a minor dog bite in an immunocompromised patient such as diabetes patient could result in a significant complication such as necrotizing fasciitis. The life-threatening infection was cured by timely above-the-knee amputation, as well as penicillin G and clindamycin therapy.
Actinomycetales Infections/diagnosis/microbiology ; Adult ; Animals ; Anti-Bacterial Agents/therapeutic use ; Arcanobacterium ; Bites and Stings/*complications ; Clindamycin/therapeutic use ; Diabetes Mellitus/diagnosis/therapy ; *Dogs ; Fasciitis, Necrotizing/diagnosis/drug therapy/*microbiology ; Female ; Gram-Positive Bacterial Infections/diagnosis/microbiology ; Humans ; Penicillin G/therapeutic use ; Peptostreptococcus ; Streptococcal Infections/diagnosis/microbiology ; Streptococcus agalactiae

Streptococcus suis is a swine pathogen that causes meningitis, septicemia, pneumonia, and endocarditis. The first case of human S. suis infection was reported in Denmark in 1968, and since then, this infection with has been reported in many countries, especially in Southeast Asia because of the high density of pigs in this region. We report the case of a patient with septic arthritis and bacteremia caused by S. suis. Cases in which S. suis is isolated from the joint fluid are very rare, and to the best of our knowledge, this is first case report of S. suis infection in Korea. The identity of this organism was confirmed by phenotypic characterization and 16S rRNA sequence analysis. An 81-yr-old Korean woman who presented with fever, arthralgia, and headache was admitted to a secondary referral center in Korea. Culture of aspirated joint fluid and blood samples showed the growth of S. suis biotype II, which was identified by the Vitek2 GPI and API 20 Strep systems (bioMerieux, USA), and this organism was susceptible to penicillin G and vancomycin. The 16S rRNA sequences of the blood culture isolates showed 99% homology with those of S. suis subsp. suis, which are reported in GenBank. The patient's fever subsided, and blood and joint cultures were negative for bacterial growth after antibiotic therapy; however, the swelling and pain in her left knee joint persisted. She plans to undergo total knee replacement.
Aged, 80 and over ; Anti-Bacterial Agents/administration & dosage ; Arthritis, Infectious/complications/*diagnosis/microbiology ; Bacteremia/complications/*diagnosis/microbiology ; Female ; Humans ; Injections, Intravenous ; Microbial Sensitivity Tests ; Phenotype ; RNA, Ribosomal, 16S/chemistry/genetics ; Sequence Analysis, DNA ; Streptococcal Infections/complications/*diagnosis/microbiology ; Streptococcus suis/genetics/*isolation & purification

Thrombophlebitis of the portal venous system (PVS) with superimposed bacterial infection (septic pylephlebitis) is an extremely rare complication of Crohn's disease (CD), and therefore diagnosis of septic pylephlebitis is difficult without high clinical suspicion. A 16-year old male patient who was diagnosed with CD 3 months earlier was admitted with recurrent fever and abdominal pain. CD activity had been well controlled with conventional medical treatment during a follow-up period. Abdominal contrast-enhanced computed tomography showed massive thrombosis in the PVS without evidence of intra-abdominal infection, and blood cultures were positive for Streptococcus viridians. There was no evidence of deep vein thrombosis or pulmonary thromboembolism, and all laboratory tests for thrombophilia were normal. Based on these findings, the patient was diagnosed with septic pylephlebitis complicated with CD, and was successfully treated with intravenous antibiotic therapy combined with anticoagulation. This case suggests that early comprehensive evaluation is crucial for immediate diagnosis and proper treatment of septic pylephlebitis in patients with CD who present with fever and abdominal pain of unknown origin, even with stable disease activity and absence of other intra-abdominal infections.
Adolescent ; Anti-Bacterial Agents/therapeutic use ; Anticoagulants/therapeutic use ; Colonoscopy ; Crohn Disease/complications/*diagnosis ; Humans ; Male ; Phlebitis/complications/*diagnosis ; Portal Vein/radiography ; Sepsis/*diagnosis/microbiology ; Streptococcal Infections/diagnosis/drug therapy ; Thrombosis/drug therapy/radiography ; Tomography, X-Ray Computed ; Viridans Streptococci/isolation & purification