Gas gangrene is usually caused by clostridial species; non-clostridial gas gangrene is infrequently reported. S. constellatus belongs to the Streptococcus milleri group, which are considered part of the normal flora and frequently associated with abscess formation. We report a rare case of spontaneous gas gangrene caused by S. constellatus. An 86-year-old man was admitted with gas gangrene of the left hip. He was treated with surgical debridement of the necrotic tissue, and antibiotic therapy, and had a satisfactory clinical course.
Abscess ; Aged, 80 and over ; Debridement ; Gangrene ; Gas Gangrene ; Hip ; Humans ; Streptococcus ; Streptococcus constellatus ; Streptococcus milleri Group

Anginosus group streptococci (AGS) were classified based on the nucleotide sequences of the 16S rRNA gene (16S rDNA) and comprised Streptococcus anginosus, Streptococcus intermedius, and Streptococcus constellatus. It is known that AGS is a causative factor of oral and systematic diseases. The purpose of this study was to discriminate the 56 clinical strains of AGS isolated from Korean oral cavities using phylogenetic analysis of 16S rDNA and species-specific PCR at the species-level. The 16S rDNA of clinical strains of AGS was sequenced using the dideoxy chain termination method and analyzed using MEGA version 5 software. PCR was performed to identify the clinical strains using species-specific primers described in previous studies and S. intermedius-specific PCR primers developed in our laboratory. The resulting phylogenetic data showed that the 16S rDNA sequences can delineate the S. anginosus, S. intermedius, and S. constellatus strains even though the 16S rDNA sequence similarity between S. intermedius and S. constellatus is above 98%. The PCR data showed that each species-specific PCR primer pair could discriminate between clinical strains at the species-level through phylogenetic analysis of 16S rDNA nucleotide sequences. These results suggest that phylogenetic analysis of 16S rDNA and PCR are useful tools for discriminating between AGS strains at the species-level.
Base Sequence ; DNA, Ribosomal ; Genes, rRNA ; Mouth ; Polymerase Chain Reaction ; Streptococcus anginosus ; Streptococcus constellatus ; Streptococcus intermedius

We report a case of vertebral osteomyelitis with epidural abscess caused by Streptococcus constellatus. The patient was present with fever, back pain, and dyspnea for 1 week. The patient was previously healthy and did not have any predisposing factor. After evaluation, the patient was diagnosed as Streptococcus constellatus vertebral osteomyelitis. He was successfully treated with surgical debridement and antibiotic therapy. To the best of our knowledge, this is the first case of S. constellatus vertebral osteomyeltis with epidural abscess to be reported in Korea.
Back Pain ; Debridement ; Dyspnea ; Epidural Abscess ; Fever ; Humans ; Korea ; Osteomyelitis ; Streptococcus ; Streptococcus constellatus

We report a case of vertebral osteomyelitis with epidural abscess caused by Streptococcus constellatus. The patient was present with fever, back pain, and dyspnea for 1 week. The patient was previously healthy and did not have any predisposing factor. After evaluation, the patient was diagnosed as Streptococcus constellatus vertebral osteomyelitis. He was successfully treated with surgical debridement and antibiotic therapy. To the best of our knowledge, this is the first case of S. constellatus vertebral osteomyeltis with epidural abscess to be reported in Korea.
Back Pain ; Debridement ; Dyspnea ; Epidural Abscess ; Fever ; Humans ; Korea ; Osteomyelitis ; Streptococcus ; Streptococcus constellatus

Pulmonic valve infective endocarditis in isolation is a rare clinical entity. The formation of an abscess in the right ventricular outflow tract as a consequence of vegetations affecting the pulmonic valve in a structurally normal heart is extremely rare and has not been reported. We report a case of isolated pulmonic valve endocarditis complicated by a regional abscess formed within the right ventricular outflow tract caused by Streptococcus Constellatus (S. Constellatus), a member of the Streptococcus Milleri group in a young male whose risk factor was alcohol abuse and he was treated medically, a comprehensive literature review on the subject is also reported. Our case is the first reported in literature with infective endocarditis caused by S. Constellatus affecting the pulmonic valve, and the first with pulmonic valve endocarditis and perivalvular abscess formation in a structurally normal heart.
Abscess* ; Alcoholism ; Endocarditis* ; Heart* ; Humans ; Male ; Pneumonia* ; Pulmonary Valve ; Risk Factors ; Streptococcus ; Streptococcus constellatus* ; Streptococcus milleri Group

BACKGROUND: Viridans group streptococci (VGS) are being increasingly reported as pathogens causing septicemia in neutropenic and other immunocompromised patients since 1980s. In the past, VGS were nearly uniformly susceptible to beta-lactam antimicrobial agents, aminoglycosides, tetracyclines, and macrolides. Several recent published studies, however, indicate that antimicrobial resistance may be emerging as a problem with VGS. The purpose of this study was to determine the antimicrobial susceptibility of VGS strains isolated from blood cultures in recent period. METHODS: A total of 45 consecutive strains of VGS isolated from blood cultures between May 2001 and March 2002 at Wonju Christian Hospital were tested for antimicrobial susceptibility. Identification of VGS were performed by API Strep 32(bioMerieux sa, Marcy-l'Etoile, France) commercial kit. Antimicrobial susceptibility tests were done by NCCLS recommended disk diffusion method and penicillin MICs were determined by E test. RESULTS: Among the 45 VGS strains, frequently isolated organisms were Streptococcus mitis (31.1%), Streptococcus oralis (17.8%), Streptococcus constellatus (11.1%), and Streptococcus anginosus (8.9%). Overall intermediate-and resistant rates to antimicrobial agents of VGS were as follows: penicillin; 26.7% and 8.9%, erythromycin; 4.4% and 28.9%, clindamycin 2.2% and 22.2%, and ceftriaxone; 4.4% and 6.7%, respectively. Resistant rates of Streptococcus mitis and Streptococcus oralis were as follows: penicillin; 50% vs 50%, erythromycin 43% vs 37%, clindamycin 21% vs 37%, and ceftriaxone 7% vs 25%, respectively. CONCLUSIONS: These results indicate the species-related variability of susceptibility among VGS isolated from blood in recent period. In addition to S. mitis, S. oralis also displayed high rates of resistance to penicillin, macrolides, and ceftriaxone. The difference in susceptibilities between species of VGS indicates the importance of accurate identification and the need for continuing monitoring of antimicrobial resistance.
Aminoglycosides ; Anti-Infective Agents ; Ceftriaxone ; Clindamycin ; Diffusion ; Erythromycin ; Gangwon-do ; Immunocompromised Host ; Macrolides ; Penicillin Resistance ; Penicillins ; Sepsis ; Streptococcus anginosus ; Streptococcus constellatus ; Streptococcus mitis ; Streptococcus oralis ; Tetracyclines ; Viridans Streptococci*

Streptococcus constellatus (S. constellatus) is a commensal microorganism belonging to the "Streptococcus milleri" group, but may cause infections in different locations in immunocompromised patients. The infection of S. constellatus has high mortality and morbidity due to its tendency to cause abscesses in infected patients, which require immediate surgical drainage for effective treatment. We report on a 72-year-old woman with end stage renal disease, who suffered from dyspnea and general weakness that had developed over 7 days. Chest CT showed loculated pleural effusion. S. constellatus was cultured from exudative pleural effusions and confirmed by an analysis of 16S rRNA sequence. The patient was treated with drainage of pleural effusion and piperacillin/tazobactam for 5 weeks.
Abscess ; Aged ; Drainage ; Dyspnea ; Empyema ; Female ; Humans ; Immunocompromised Host ; Kidney Failure, Chronic ; Pleural Effusion ; Streptococcus ; Streptococcus constellatus ; Streptococcus milleri Group ; Thorax

Gas-containing spinal epidural abscesses are uncommon. Moreover, acute spinal epidural abscesses rarely complicate bacterial meningitis in adults. Here, we report a rare case of a gas-containing cervical epidural abscess accompanying bacterial meningitis. In spite of aggressive fluid and continuous antibiotic therapy after the isolation of Streptococcus anginosus and Streptococcus constellatus in the cerebrospinal fluid cultures, the patient showed remaining motor dysfunction and bladder involvement. Our experience suggests that the effort to prevent neurologic deterioration by emergent surgical decompression and drainage of pus is mandatory to avoid additional spinal cord dysfunction in patients with spinal epidural abscesses accompanying bacterial meningitis.
Abscess ; Adult* ; Cerebrospinal Fluid ; Decompression, Surgical ; Drainage ; Epidural Abscess* ; Humans ; Meningitis ; Meningitis, Bacterial* ; Spinal Cord ; Streptococcus anginosus ; Streptococcus constellatus ; Suppuration ; Urinary Bladder

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.
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

BACKGROUND: Although Pneumococcal (SPN) pneumonia is the most common cause of community-acquired pneumonia, non-pneumococcal streptococcal (NSPN) pneumonia is also frequently reported. However, there are insufficient data on characteristics of NSPN pneumonia which makes it difficult to decide treatment plans or to assess the prognosis. MATERIALS AND METHODS: Between March 2002 and February 2009, medical records including clinical and epidemiological data on patients aged > or =18 years with community-acquired streptococcal pneumonia were reviewed retrospectively. Clinical characteristics were compared between community-acquired NSPN pneumonia and SPN pneumonia. RESULTS: During the 7 year study periods, 248 patients were hospitalized with community-acquired streptococcal pneumonia and 30 of them had NSPN pneumonia. There were 12 cases of Streptococcus constellatus, 7 cases of S. anginosus, 4 cases of S. mitis, 3 cases of S. pyogenes, 2 cases of S. oralis, 1 case of S. alactolyticus and 1 case of S. agalactiae. There was no difference in percentage of patients with a chronic underlying disease between SPN and NSPN pneumonia groups. The most common was chronic obstructive pulmonary disease (SPN 29.8%, NSPN 16.7%) followed by diabetes mellitus (SPN 22.0%, NSPN 13.3%). Bacteremia (SPN 7.3%, NSPN 20.0%, P=0.04) and empyema (SPN 1.4%, NSPN 53.3%, P<0.001) were more common in NSPN pneumonia. However, there was no significant difference in the CURB-65 pneumonia severity score and 30-day mortality between the two groups. According to multivariate analysis results, the significant risk factor for NSPN pneumonia was the history of frequent alcohol drinking (Adjusted OR 3.81, 95% CI 1.36 to 10.67). CONCLUSION: Pneumonia caused by NPSN is more commonly accompanied by bacteremia and empyema compared to SPN pneumonia, but there was no difference in the 30-day mortality between the two groups. NSPN pneumonia should be considered if a patient with a history of chronic alcoholism presents with pneumonia and pleural effusion, especially when Gram positive diplococci is seen in the sputum Gram stain.
Aged ; Alcohol Drinking ; Alcoholism ; Bacteremia ; Diabetes Mellitus ; Empyema ; Humans ; Medical Records ; Multivariate Analysis ; Pleural Effusion ; Pneumonia ; Pneumonia, Pneumococcal ; Prognosis ; Pulmonary Disease, Chronic Obstructive ; Retrospective Studies ; Risk Factors ; Sputum ; Streptococcus ; Streptococcus constellatus