Abstract
BackgroundStreptococcus pseudoporcinus (S. pseudoporcinus) was first identified in 2006. It cross-reacts with Lancefield group B antigen agglutination reagents and has been misidentified as S. agalactiae. Sites of S. pseudoporcinus isolation include the female genitourinary tract, urine, wounds, and dairy products. The prevalence of vaginal colonization is reportedly between 1 and 5.4%. Two uneventful cases of soft tissue infection caused by S. pseudoporcinus were reported in the past. However, since late 2019, six cases of invasive S. pseudoporcinus infections have emerged in the literature, one of which was fatal.Case presentationWe describe a fatal case of a Caucasian male with spontaneous bacterial peritonitis associated with bacteremia due to a multidrug-resistant S. pseudoporcinus strain in a patient with decompensated liver cirrhosis. Despite the patient’s good general condition and stable blood test results when he had visited the outpatient clinic for large-volume paracentesis a few days before admission, this time he presented to the emergency department with a rapidly worsening clinical condition and with laboratory features consistent with multiple-organ dysfunction syndrome, and succumbed within a short period.ConclusionsContrary to what was thought until recently, multidrug-resistant S. pseudoporcinus may cause invasive, disseminated, fatal disease in humans. According to current limited data, vancomycin, linezolid, daptomycin, levofloxacin, clindamycin, and tetracycline seem to be the most effective antimicrobial agents against multidrug-resistant strains, and should be the empirical choice in cases of disseminated S. pseudoporcinus infection until laboratory antimicrobial susceptibility results are available. Improvements and new approaches for bacterial identification in routine clinical microbiology laboratories may reveal the real spectrum of S. pseudoporcinus infections in humans, which is currently believed to be underestimated. SS. pseudoporcinus could emerge as a serious medical problem in the near future, similar to other β-hemolytic streptococci.
Highlights
Streptococcus pseudoporcinus (S. pseudoporcinus) was first identified in 2006
Improvements and new approaches for bacterial identification in routine clinical microbiology laboratories may reveal the real spectrum of S. pseudoporcinus infections in humans, which is currently believed to be underestimated
We report a patient with liver cirrhosis who presented with spontaneous bacterial peritonitis and sepsis, hepatic encephalopathy, type 1 hepatorenal syndrome resulting in metabolic acidosis, acute liver failure, and complications from multiple-organ dysfunction syndrome (MODS)
Summary
S. pseudoporcinus is an emerging pathogen that colonizes the female genitourinary tract, with a population prevalence ranging between 1 and 5.4%, and is associated with adverse obstetric outcomes. Risk factors associated with invasive infection are shown, as they emerge collectively from the seven recently reported cases [11,12,13,14,15], including our case. S. pseudoporcinus could be an emerging multidrug-resistant pathogen, as it is more recognizable with the new advanced biochemical techniques. Recent studies underline the potential of S. pseudoporcinus to cause severe, invasive infections via gastrointestinal/oropharynx colonization and subsequent bacteremia, leading to life-threatening diseases [11,12,13,14]. S. pseudoporcinus resistance to penicillin, to third-generation cephalosporins, and even to carbapenems was reported in a previous case [5], and is consistent with the antibiotic susceptibility of our isolate.
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