Septic shock from multiple intra-abdominal Streptococcus constellatus abscesses unamenable to percutaneous drainage

Faraz Badar, Aqsa Ashraf, Shaheryar Usman, Asma Iftikhar

Abstract


Streptococcus constellatus are gram-positive cocci belonging to the Streptococcus milleri group that have a propensity to cause bacteremia and abscesses, especially in immunocompromised patients. Here, we report the case of a 39-year-old male who was initially admitted to the hospital for diabetic ketoacidosis. During the hospitalization, he developed sepsis and blood cultures grew Streptococcus constellatus. CT imaging revealed multiple hepatic abscesses. A periapical abscess of the left mandibular central incisor found on CT Scan of face was identified as the likely source of infection. IR-guided drainage was performed however the patient went on to develop septic shock despite attempted source control and IV antibiotic therapy. Repeat imaging showed persistent hepatic abscesses in addition to new intraperitoneal abscesses necessitating exploratory laparotomy, drainage and abdominal washout. Fluid cultures grew Streptococcus constellatus and common enteric flora. Our report highlights the need for high clinical suspicion in cases of Streptococcus constellatus bacteremia to obtain diagnostic imaging for any abscess formation. Prolonged antibiotic therapy is a must and imaging guided or surgical drainage may be needed.

Keywords


bacteremia; streptococcus; liver abscesses; septic shock

Full Text:

PDF

References


Wong CA, Donald F, Macfarlane JT. Streptococcus milleri pulmonary disease: a review and clinical description of 25 patients. Thorax. 1995; 50(10):1093-1096. doi:10.1136/thx.50.10.1093

Whiley RA, Beighton D. Emended descriptions and recognition of Streptococcus constellatus, Streptococcus intermedius, and Streptococcus anginosus as distinct species. Int J Syst Bacteriol. 1991; 41(1):1-5. doi: 10.1099/00207713-41-1-1.

Guthof O. Ueber pathogene vergrünende Streptokokken; Streptokokken-Befunde bei dentogenen Abszessen und Infiltraten im Bereich der Mundhöhle [Pathogenic strains of Streptococcus viridans; streptocci found in dental abscesses and infiltrates in the region of the oral cavity]. Zentralbl Bakteriol Orig. 1956; 166(7-8):553-64. German. PMID: 13393398.

Bert F, Bariou-Lancelin M, Lambert-Zechovsky N. Clinical significance of bacteremia involving the "Streptococcus milleri" group: 51 cases and review. Clin Infect Dis. 1998; 27(2):385-7. doi: 10.1086/514658. PMID: 9709892.

Han JK, Kerschner JE. Streptococcus milleri: An Organism for Head and Neck Infections and Abscess. Arch Otolaryngol Head Neck Surg. 2001; 127(6):650–654. doi:10.1001/archotol.127.6.650

Esplin N, Stelzer J W, All S, et al. A Case of Streptococcus anginosus Brain Abscess Caused by Contiguous Spread from Sinusitis in an Immunocompetent Patient. Cureus 2017; 9(10): e1745. doi:10.7759/cureus.1745

Xia, J., Xia, L., Zhou, H. et al. Empyema caused by Streptococcus constellatus: a case report and literature review. BMC Infect Dis. 2021; 21:1267. https://doi.org/10.1186/s12879-021-06955-2.

Morii K, Fujiwara S, Nakamura S, Okushin H. Streptococcus Anginosus Group-associated Pyogenic Liver Abscess. Intern Med. 2018; 57(15):2271-2272. doi:10.2169/internalmedicine.0212-17

Feng Y, Wang Y, Zeng C, Mao H. Pyogenic thigh abscess caused by Streptococcus constellatus subsp. constellatus in a patient with exacerbation of bronchiectasis: a case report. Ann Palliat Med. 2022; 11(4):1526-1532. doi: 10.21037/apm-21-740

Meddings L, Myers RP, Hubbard J, Shaheen AA, Laupland KB, Dixon E, Coffin C, Kaplan GG. A population-based study of pyogenic liver abscesses in the United States: incidence, mortality, and temporal trends. Am J Gastroenterol. 2010; 105(1):117-24. doi: 10.1038/ajg.2009.614. PMID: 19888200.

Issa E, Salloum T, Tokajian S. From Normal Flora to Brain Abscesses: A Review of Streptococcus intermedius. Front Microbiol. 2020; 11:826. Published 2020 May 7. doi:10.3389/fmicb.2020.00826

Tracy M, Wanahita A, Shuhatovich Y, Goldsmith EA, Clarridge JE 3rd, Musher DM. Antibiotic susceptibilities of genetically characterized Streptococcus milleri group strains. Antimicrob Agents Chemother. 2001;45(5):1511-4. doi: 10.1128/AAC.45.5.1511-1514.2001. PMID: 11302819; PMCID: PMC90497.

Barber KE, Loper JT, Morrison AR, Stover KR, Wagner JL. Impact of Obesity on Ceftriaxone Efficacy. Diseases. 2020;8(3):27. doi:10.3390/diseases8030027

Chokshi R, Restrepo MI, Weeratunge N, Frei CR, Anzueto A, Mortensen EM. Monotherapy versus combination antibiotic therapy for patients with bacteremic Streptococcus pneumoniae community-acquired pneumonia. Eur J Clin Microbiol Infect Dis. 2007; 26(7):447-451. doi:10.1007/s10096-007-0307-3

Vogl TJ, Estifan F. Pyogenic liver abscess: interventional versus surgical therapy: technique, results and indications. Rofo. 2001; 173(7):663-667. doi:10.1055/s-2001-15845




DOI: http://dx.doi.org/10.22551/2022.36.0903.10215

Copyright (c) 2022 Faraz Badar, Aqsa Ashraf, Shaheryar Usman, Asma Iftikhar

Creative Commons License
Archive of Clinical Cases is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

 

ISSN: 2360-6975