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

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

Streptococcus anginosus is a member of Streptococcus milleri group, and is found in the oral mucosa, respiratory tract, and gastrointestinal tract as normal flora. It can develop into a disease in patients with deteriorating clinical condition or with clinical risk factors. A previously healthy 15-year-old boy was admitted due to fever, abdominal discomfort and vomiting which lasted for 7 days. He had a history of dental procedure 1 day before the development of fever. He was diagnosed with acute acalculous cholecystitis based on the clinical, laboratory, and imaging finding, and S. anginosus was isolated from the blood culture. The patient was successfully treated with antibiotic therapy.
Acalculous Cholecystitis ; Adolescent ; Bacteremia ; Cholecystitis ; Fever ; Gastrointestinal Tract ; Humans ; Mouth Mucosa ; Respiratory System ; Risk Factors ; Streptococcus ; Streptococcus anginosus ; Streptococcus milleri Group ; Vomiting

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

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

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

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: 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*

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