SESSION TITLE: Variety in Chest Infections Case PostersSESSION TYPE: Case Report PostersPRESENTED ON: 10/19/2022 12:45 pm - 01:45 pmINTRODUCTION: Group B Streptococcus (GBS) is a part of normal flora of skin, rectum, pharynx, cervix and urethra. Incidence of invasive bacterial infection from GBS is increasing and has become a major problem in healthy adults beside neonates and pregnant women. From a study done from 2008 to 2016, the incidence of GBS has increased from 8.1 cases per 100,000 population to 10.9 in 2016 (1). Obesity, diabetes, liver disease, neurological disorder and old age are the common risk factors for invasive GBS. We are presenting an unusual case of cavitary lung disease caused by GBS in an otherwise healthy adult.CASE PRESENTATION: A 37 year old lady with history of polysubstance abuse, and smoker presented with few days of cough and pleuritic chest pain and right nipple infection. She reported recent travel to Puerto Rico. On physical examination, vitals were stable. Right nipple was erythematous and draining pus. Rest of the examination was normal. Blood work showed leucocytosis (WBC- 15.4 with Neutrophil- 77.9%). CT chest revealed multiple lung nodules and some of them with cavitation. Patient was started on Bactrim for nipple infection. Wound culture from the right nipple came positive for Beta hemolytic Group B streptococcus, sensitive to Penicillin. Three sets of sputum were negative. HIV was negative. . Blood cultures, sputum culture for fungus, histoplasma antigen, cryptococcal antigen, Galactomannan and Beta-D glucan tests were negative. Patient was started on Ampicillin- Sulbactam. Transthoracic Echocardiogram was done that was negative for any vegetation. Repeat CT done in 3 days that showed resolving cavitation opacities and resolving nodular densities. Patient was discharged home on Amoxicillin-Clavulanate acid for 2 weeks and instructed to follow up in infectious disease clinic after discharge.DISCUSSION: GBS can cause serious invasive infection. From a study, 10% of GBS infections will develop into invasive GBS and has mortality as high as 25% in 24 hours. Most of the GBS bacteremia has unknown sources of infection. Skin and the soft tissue infection is the most documented source of infection. Of all invasive GBS infections, 15-20% infections are skin and soft tissue infections. Pneumonia accounts for about 12% of all invasive GBS bacteremia. Most of the GBS pneumonia are nosocomial and polymicrobial. Bacterial endocarditis is a rare presentation, sometimes leading to multiple pulmonary septic emboli giving pulmonary cavity (3). Septic emboli usually seen in IV drug use, infected prosthesis or septic thrombophlebitis. Severe GBS infection is treated with IV antibiotics. First line of treatment is Penicillin G(2)and duration of therapy ranges from 10 days to weeks depending on severity and clinical response.CONCLUSIONS: Invasive GBS infection is a major health problem in healthy adults beside neonates and pregnant women. GBS can cause serious pulmonary infection including cavitary lung lesion.Reference #1: Francois Watkins, L. K., McGee, L., Schrag, S. J., Beall, B., Jain, J. H., Pondo, T., Farley, M. M., Harrison, L. H., Zansky, S. M., Baumbach, J., Lynfield, R., Snippes Vagnone, P., Miller, L. A., Schaffner, W., Thomas, A. R., Watt, J. P., Petit, S., & Langley, G. E. (2019). Epidemiology of Invasive Group B streptococcal infections among nonpregnant adults in the United States, 2008-2016. JAMA Internal Medicine, 179(4), 479. https://doi.org/10.1001/jamainternmed.2018.7269Reference #2: Raabe, V. and Shane, A., 2019. Group B Streptococcus ( Streptococcus agalactiae ). Microbiology Spectrum, 7(2).Reference #3: Teran, C., Antezana, A., Salvani, J. and Abaitey, D., 2011. Group B Streptococcus Endocarditis Associated with Multiple Pulmonary Septic Emboli. Clinics and Practice, 1(1), p.e7.DISCLOSURES: No relevant relationships by Htun Aungno disclosure on file for Danilo Enriquez;No relevant relationships by Tahmina JahirNo relevant relationships by ahmad ali khanNo relevant relationships by Aneeta Kumarino disclosure on file for Harish Patel;No relevant relationships by Ruby RisalNo relevant relationships by M. Frances Schmidtno disclosure on file for Kamal Subedi; SESSION TITLE: Variety in Chest Infections Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Group B Streptococcus (GBS) is a part of normal flora of skin, rectum, pharynx, cervix and urethra. Incidence of invasive bacterial infection from GBS is increasing and has become a major problem in healthy adults beside neonates and pregnant women. From a study done from 2008 to 2016, the incidence of GBS has increased from 8.1 cases per 100,000 population to 10.9 in 2016 (1). Obesity, diabetes, liver disease, neurological disorder and old age are the common risk factors for invasive GBS. We are presenting an unusual case of cavitary lung disease caused by GBS in an otherwise healthy adult. CASE PRESENTATION: A 37 year old lady with history of polysubstance abuse, and smoker presented with few days of cough and pleuritic chest pain and right nipple infection. She reported recent travel to Puerto Rico. On physical examination, vitals were stable. Right nipple was erythematous and draining pus. Rest of the examination was normal. Blood work showed leucocytosis (WBC- 15.4 with Neutrophil- 77.9%). CT chest revealed multiple lung nodules and some of them with cavitation. Patient was started on Bactrim for nipple infection. Wound culture from the right nipple came positive for Beta hemolytic Group B streptococcus, sensitive to Penicillin. Three sets of sputum were negative. HIV was negative. . Blood cultures, sputum culture for fungus, histoplasma antigen, cryptococcal antigen, Galactomannan and Beta-D glucan tests were negative. Patient was started on Ampicillin- Sulbactam. Transthoracic Echocardiogram was done that was negative for any vegetation. Repeat CT done in 3 days that showed resolving cavitation opacities and resolving nodular densities. Patient was discharged home on Amoxicillin-Clavulanate acid for 2 weeks and instructed to follow up in infectious disease clinic after discharge. DISCUSSION: GBS can cause serious invasive infection. From a study, 10% of GBS infections will develop into invasive GBS and has mortality as high as 25% in 24 hours. Most of the GBS bacteremia has unknown sources of infection. Skin and the soft tissue infection is the most documented source of infection. Of all invasive GBS infections, 15-20% infections are skin and soft tissue infections. Pneumonia accounts for about 12% of all invasive GBS bacteremia. Most of the GBS pneumonia are nosocomial and polymicrobial. Bacterial endocarditis is a rare presentation, sometimes leading to multiple pulmonary septic emboli giving pulmonary cavity (3). Septic emboli usually seen in IV drug use, infected prosthesis or septic thrombophlebitis. Severe GBS infection is treated with IV antibiotics. First line of treatment is Penicillin G(2)and duration of therapy ranges from 10 days to weeks depending on severity and clinical response. CONCLUSIONS: Invasive GBS infection is a major health problem in healthy adults beside neonates and pregnant women. GBS can cause serious pulmonary infection including cavitary lung lesion. Reference #1: Francois Watkins, L. K., McGee, L., Schrag, S. J., Beall, B., Jain, J. H., Pondo, T., Farley, M. M., Harrison, L. H., Zansky, S. M., Baumbach, J., Lynfield, R., Snippes Vagnone, P., Miller, L. A., Schaffner, W., Thomas, A. R., Watt, J. P., Petit, S., & Langley, G. E. (2019). Epidemiology of Invasive Group B streptococcal infections among nonpregnant adults in the United States, 2008-2016. JAMA Internal Medicine, 179(4), 479. https://doi.org/10.1001/jamainternmed.2018.7269 Reference #2: Raabe, V. and Shane, A., 2019. Group B Streptococcus ( Streptococcus agalactiae ). Microbiology Spectrum, 7(2). Reference #3: Teran, C., Antezana, A., Salvani, J. and Abaitey, D., 2011. Group B Streptococcus Endocarditis Associated with Multiple Pulmonary Septic Emboli. Clinics and Practice, 1(1), p.e7. DISCLOSURES: No relevant relationships by Htun Aung no disclosure on file for Danilo Enriquez; No relevant relationships by Tahmina Jahir No relevant relationships by ahmad ali khan No relevant relationships by Aneeta Kumari no disclosure on file for Harish Patel; No relevant relationships by Ruby Risal No relevant relationships by M. Frances Schmidt no disclosure on file for Kamal Subedi;