An unusual case of thoracic empyema caused by Granulicatella elegans (nutritionally variant streptococci) in a patient with pulmonary tuberculosis and human immunodeficiency virus infection.

Nomonde R Mvelase,Koleka P Mlisana,Olga Hattingh,Kanitha Marajh

doi:10.1099/jmmcr.0.005058

Abstract

Introduction:Nutritionally variant streptococci (NVS) are an infrequent cause of human infection with Granulicatella elegans being the least encountered species in clinical specimens. The most common infection caused by NVS is infective endocarditis.Case Presentation: We report an unusual case of thoracic empyema due to G. elegans in a patient with pulmonary tuberculosis (TB) and human immunodeficiency virus infection. The patient responded favourably to drainage and penicillin.Conclusion:This case illustrates that even though TB is responsible for the majority of pleural effusions in this setting, other rare opportunistic bacteria may cause infection in susceptible patients. Therefore, microbiological investigations should be performed in all patients presenting with pleural effusion.

Highlights

Variant streptococci (NVS) are an infrequent cause of human infection with Granulicatella elegans being the least encountered species in clinical specimens
Variant streptococci (NVS) were originally named as such because of their resemblance to streptococci on Gram stain smears and the requirement of pyridoxal hydrochloride or cystein for growth (Carey et al, 1975; Frenkel & Hirsch, 1961; Ruoff, 1991)
G. elegans is rarely encountered in human specimens, probably because it was found to constitute the least amount of Nutritionally variant streptococci (NVS) isolated from the human mouth (Sato et al, 1999)

Summary

Introduction

Variant streptococci (NVS) were originally named as such because of their resemblance to streptococci on Gram stain smears and the requirement of pyridoxal hydrochloride (vitamin B6) or cystein for growth (Carey et al, 1975; Frenkel & Hirsch, 1961; Ruoff, 1991). NVS are facultatively anaerobic Gram positive cocci that form part of the normal flora of the upper respiratory tract, gastrointestinal tract and urogenital tract in humans (Ruoff, 1991; Sato et al, 1999) They are an infrequent cause of infection, with the majority of cases presenting as infective endocarditis, accounting for 5 % of streptococcal endocarditis (Brouqui & Raoult, 2001; Roberts et al, 1979). The TB diagnosis was initially based on clinical features as the Xpert MTB/RIF (Cepheid GeneXpert, Sunnyvale, Ca, USA) sputum results were negative. She was started empirically on the standard first line TB treatment (rifampicin, isoniazid, pyrazinamide and ethambutol). The treatment was changed to penicillin and the patient improved and was subsequently discharged after three weeks in hospital

Conclusion

Findings

Discussion