Streptococcus Constellatus Research Articles

Herpes zoster in the ophthalmic branch of the trigeminal ganglia obscuring cavernous sinus thrombosis due to Streptococcus constellatus subsp. constellatus - A case report.

BackgroundHerpes zoster ophthalmicus (HZO) is an infectious disease that results from the reactivation of latent varicella zoster virus in the ophthalmic branch of the trigeminal ganglia. HZO manifests with herpes zoster-like symptoms such as rash with or without signs of ocular involvement. Cavernous sinus thrombosis (CST) is a life-threatening condition accompanied by signs and symptoms involving the eyes and the cranial nerves.CaseWe report a case of septic cavernous sinus thrombosis (caused by Streptococcus constellatus subsp. constellatus) which was masked by the simultaneous occurrence of HZO in this patient, resulting in delayed diagnosis.ConclusionsCST may be obscured by HZO, prompt diagnosis and treatment is necessary when such case arrive.

Development of Oral Care Chip, a novel device for quantitative detection of the oral microbiota associated with periodontal disease.

Periodontal disease, the most prevalent infectious disease in the world, is caused by biofilms formed in periodontal pockets. No specific bacterial species that can cause periodontitis alone has been found in any study to date. Several periodontopathic bacteria are associated with the progress of periodontal disease. Consequently, it is hypothesized that dysbiosis of subgingival microbiota may be a cause of periodontal disease. This study aimed to investigate the relationship between the subgingival microbiota and the clinical status of periodontal pockets in a quantitative and clinically applicable way with the newly developed Oral Care Chip. The Oral Care Chip is a DNA microarray tool with improved quantitative performance, that can be used in combination with competitive PCR to quantitatively detect 17 species of subgingival bacteria. Cluster analysis based on the similarity of each bacterial quantity was performed on 204 subgingival plaque samples collected from periodontitis patients and healthy volunteers. A significant difference in the number of total bacteria, Treponema denticola, Campylobacter rectus, Fusobacterium nucleatum, and Streptococcus intermedia bacteria in any combination of the three clusters indicated that these bacteria gradually increased in number from the stage before the pocket depth deepened. Conversely, Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, and Streptococcus constellatus, which had significant differences only in limited clusters, were thought to increase in number as the pocket depth deepened, after periodontal pocket formation. Furthermore, in clusters where healthy or mild periodontal disease sites were classified, there was no statistically significant difference in pocket depth, but the number of bacteria gradually increased from the stage before the pocket depth increased. This means that quantitative changes in these bacteria can be a predictor of the progress of periodontal tissue destruction, and this novel microbiological test using the Oral Care Chip could be effective at detecting dysbiosis.

Descending necrotizing mediastinitis caused by Streptococcus constellatus in an immunocompetent patient: case report and review of the literature

Descending necrotizing mediastinitis is a severe infection of the mediastinum. This syndrome manifests as fever and chest pain following cough and sputum production. A 49-year-old woman presented with fever and a 14-day history of pneumonia. CT showed mediastinal abscesses with a giant calcified mediastinal lymph node (21 × 18 mm) and pneumonia. Bronchoscopy by EBUS-TBNA under general anesthesia was performed. The pathogen found in the puncture culture was Streptococcus constellatus, and antibiotics (mezlocillin/sulbactam 3.375 IVGTT q8h) was administered. A proximal right main bronchial neoplasm, suspected lung cancer, was found and conformed to inflammatory granuloma. A total of 22 months post-discharge the patient was clinically stable. We also conducted a review of the literature for all Streptococcus constellatus descending necrotizing mediastinitis infections between 2011 and 2017.

Comparative In Vitro Resistance of Human Periodontal Bacterial Pathogens to Tinidazole and Four Other Antibiotics.

The in vitro resistance of selected red/orange complex periodontal pathogens to tinidazole was compared with four other antibiotics. Subgingival biofilm samples from 88 adults with severe periodontitis were anaerobically incubated on enriched Brucella blood agar with and without supplementation with tinidazole (16 mg/L), metronidazole (16 mg/L), amoxicillin (8 mg/L), doxycycline (4 mg/L), or clindamycin (4 mg/L). Growth of Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia/nigrescens, Parvimonas micra, Fusobacterium nucleatum, Streptococcus constellatus, or Campylobacter rectus on antibiotic-supplemented plates indicated their in vitro antibiotic resistance. Tinidazole inhibited all test species, except P. intermedia/nigrescens, P. micra, and S. constellatus in 3.8%, 10.2%, and 88.9% of species-positive patients, respectively. Significantly fewer patients yielded tinidazole-resistant test species, and had significantly lower subgingival proportions of tinidazole-resistant organisms, than patients with amoxicillin, doxycycline, or clindamycin-resistant species, but not those with metronidazole-resistant strains. Joint in vitro species resistance to tinidazole and amoxicillin, or metronidazole and amoxicillin, was rare. Tinidazole performed in vitro similar to metronidazole, and markedly better than amoxicillin, doxycycline, or clindamycin, against fresh clinical isolates of red/orange complex periodontal pathogens. As a result of its similar antimicrobial spectrum, and more convenient once-a-day oral dosing, tinidazole should be considered in place of metronidazole for systemic periodontitis drug therapy.

Screening of in vitro Antibacterial Activity of Rumex vesicarius (L.) Leaves Extract against Twelve Pathogenic Bacterial

There is an alternative approaches from eradication of infections causes by pathogenic bacteria especially resistant bacteria. Methanol extract of Rumex vesicarius leaves were evaluated from in vitro antibacterial activity against twelve bacterial species were used which are four of them gram positive which are Streptococcus constellatus, Staphylococcus gallinarum, Staphylococcus sciuri and Streptococcus iniae and eight of them gram negative which are Aeromonas diversa, Xanthomonas campestris, Xanthomonas axonopodies, Siccibacter colletis, Edwardsielloa anguillarum, Aeromonas cavernicala, Enterobacter xiangfangenis and Vibro rotiferianus. The plant extract showed highest 12 mm zone of inhibition against Staphylococcus constellatus at the concentration of 20 μg/disc and no zone of inhibition was found from Aeromonas diversa. In minimum inhibitory concentration (MIC) test, methanol extract of Rumex vesicarious in 200μg/ml concentration showed best result against Vibrio rotiferianus. It can be concluded that methanol extracts of Rumex vesicarious leaves may be used as natural antibacterial from treatment of some diseases, especially local skin diseases.

Activity of five antimicrobial peptides against periodontal as well as non-periodontal pathogenic strains

ABSTRACT Background: Due to the increasing emergence of multi-resistant bacteria the search for alternative antimicrobial substances is of high interest. Promising agents are antimicrobial peptides which are host defense molecules of the innate immune system in a wide range of different species. Objectives: The aim of this study was to assess the activity of nisin, melittin, lactoferrin, parasin-1 and LL-37 against 35 oral bacteria and Candida albicans employing the gold standard method for anaerobic susceptibility testing. Methods: The activity of the peptides was determined by an agar dilution method under anaerobic and aerobic conditions. The test media contained final peptide concentrations between 0.125 µg/ml and 8 µg/ml (melittin, lactoferrin, parasin-1, LL-37) and between 0.125 µg/ml and 128 µg/ml (nisin). Results: Nisin completely inhibited the growth of Megasphaera sp., Bifidobacterium longum, Parvimonas micra, Actinomyces israelii, Actinomyces naeslundii, Actinomyces odontolyticus, Prevotella intermedia, Streptococcus anginosus, Streptococcus constellatus and Staphylococcus aureus. Melittin and lactoferrin reduced the growth of Megasphaera sp., P. micra, B. longum (melittin) and Selenomonas flueggei (lactoferrin). Parasin-1 and LL-37 showed no activity. Conclusion: AMPs, especially nisin and to a smaller degree lactoferrin, might be promising alternatives to antibiotics because of their antimicrobial activity, high resistance to environmental conditions and partially low costs.

Microbiological analysis of primary infected root canals with symptomatic and asymptomatic apical periodontitis of young permanent teeth

Background/Aim: Understanding the composition of bacteria in infected root canals is important for ameliorating the treatment strategies that lead to the elimination of pathogens and infection control, but also prevent reinfection. Aim of this study was to investigate microbial composition of primary infected root canals with apical periodontitis of young permanent teeth, originating form school children in Serbia, and its association with clinical symptoms. Material and Methods: To determine the bacterial composition of infected root canals in children, 35 endodontic samples were obtained. The identification of cultured bacteria was performed by MALDI-TOF MS analysis. The presence or absence of clinical symptoms were recorded. Results: Facultative anaerobes were 2,2 times more frequent than obligate anaerobes. The most common facultative anaerobes belonged to following genera, Streptococcus (58 isolates), Actinomyces (10) and Enterococcus (8), while predominant obligate anaerobes, belonged to genera Veillonella (15), Prevotella (9) and Fusobacterium (8). The most common clinical isolates recovered from infected root canals with symptomatic apical periodontitis were Veillonella parvula (10) and Fusobacterium nucleatum (7), while from the asymptomatic ones, they were Streptococcus mitis/Streptococcus oralis (5). Prevalence of Parvimonas micra, Prevotella buccae and Streptococcus constellatus within the root canals might be associated to clinical symptoms. Conclusions: Species of genera Streptococcus and Veillonella were the most common isolates from primary infected root canals with apical periodontitis in Serbian school children. Facultative anaerobes were predominant over obligate anaerobes. The prevalence of obligate anaerobes was much higher in symptomatic compared to asymptomatic root canal infections. No specific bacterial strain might be associated to a single examined clinical symptom (pain, tenderness to percussion or swelling), but majority of the strains are associated to all of the examined three symptoms.

143 Successful Treatment of Recurrent Bilateral Corpora Cavernosal Abscesses using the Carrion Cast: A Novel Case Study

The Carrion Cast was first published in 2014 as a method of treating infected penile prostheses1. To describe the successful application of this technique to treat a persistent penile abscess. This is a case report. A 67-year-old gentleman with multiple medical comorbidities presented to an ER with penile pain and swelling. Upon presentation he had sepsis with a temperature of 103°F and leukocytosis. Urinalysis, urine culture, and blood cultures were unremarkable. Non-contrast CT scan of the pelvis was ordered by the ER and showed left greater than right mild penile swelling without discrete abscess or collection. He was observed on IV antibiotics and antifungals without significant clinical or laboratory improvement for 48 hours, at which point MRI with gadolinium was obtained. This study revealed bilateral 8x1.5cm distal corpora cavernosal abscesses. Upon further discussion, the patient revealed that three weeks prior to this event he had inserted a metal barbecue skewer per urethra to augment penile rigidity during masturbation. He had also decided to place an earthworm into his urethra for sexual gratification. He said that both objects were removed whole and intact following orgasm. He was then taken to the OR for cystoscopy, incision and drainage of the bilateral corpora, cavernosal dilation, and cavernosal washout via penoscrotal approach. The earthworm was not encountered during cystoscopy, and there was no evidence of urethral mucosal injury seen. Copious purulent material was encountered, and the corpora were washed out with triple antibiotic solution (vancomycin/zosyn/amphotericin). Bilateral corporal drains were placed and the incision was closed. His cultures grew streptococcus constellatus and he was transitioned to augmentin and discharged home several days later.

Subgingival microbial profile of women with breast cancer: a cross-sectional study

BackgroundSome prospective studies have observed associations between periodontal disease and breast cancer. Therefore, the aim of the present study was to investigate the composition of the subgingival biofilm of women diagnosed with breast cancer, who also presented with chronic periodontitis.MethodsAll subjects underwent clinical and microbiological assessment. Subgingival biofilm samples were taken from at least three sites of 44 women who had breast cancer. The mean levels and proportions of 40 bacterial species were determined by checkerboard DNA-DNA hybridization. Spearman correlation was used to assess possible associations between the mean levels of bacterial species and clinical conditions.ResultsThe five species found at the highest levels were Prevotella nigrescens, Actinomyces gerencseriae, Neisseria mucosa, Porphyromonas gingivalis and Tannerella forsythia. The species detected in the lowest counts were Propionibacterium acnes, Streptococcus constellatus, Streptococcus intermedius, Eubacterium saburreum and Streptococcus anginosus. No significant association between levels and proportion of bacterial species and clinical parameters were found.ConclusionIn conclusion, the results of the present study found no direct association between the subgingival microbiota and breast cancer and an indirect pathway should be addressed in further studies.Trial registrationRetrospectively registered.

176. Streptococcus intermedius: A Study of 107 Isolates

Background Streptococcus anginosus (SA), Streptococcus constellatus (SC), and Streptococcus intermedius (SI) constitute the S. anginosus group (SAG). The majority of SI reports are single or few cases and small series. In a 2017 study of 263 cases of SAG only 36 (13.7%) were identified as SI, responsible for pyogenic nonbacteremic infections. Another study (2001) found 14 SI out of 122 SAG isolates of which 12 were from abscesses. In some reports, SI was only identified after molecular sequencing as original culture reports were negative. We present results of the analysis of 335 SAG isolates during a 3-year period with much higher numbers of SI (107) 32%, and bacteremia (17) 16% than previously reported. SI isolates exceeded S. constellatus (77) 23% with SA being the majority (45%)151. Our study disclosed previously unreported sites of infection and differences in the type of bacteremia (monomicrobial vs. polymicrobial).MethodsWe reviewed the charts of 1321 Streptococcal isolates which included 335 SAG with 107 SI during the last 3 years, in patients admitted to our network hospitals. Age, sex, clinical findings, lab reports, procedures, imaging, and susceptibilities were analyzed.ResultsAge range was one month to 90 years with 167 males and 166 females. There were 335 SAG isolates, SA 151(67M/84F), SI 107(56M/51F) and SC 77 (47M/30F). 70% of SI patients were in the 40–80 age group. There were 17 SI bacteremias (all monomicrobial) compared with 26 SA (17%), with 14 (54%) polymicrobial and 11 SC with 5 polymicrobial l (46%). 16 isolates were from empyema fluid, 11 related to IVDU, 9 liver abscesses, 6 perforated bowel, 3 peritonsillar abscesses, 3 breast abscesses, 3 mandibular osteomyelitis, 3 neck infections, 3 myositis, 3 pancreas associated, 1 each of mandibular sialadenitis, epidural abscess, cranial osteomyelitis, brain abscess, vertebral osteomyelitis and remainder soft-tissue infections in extremities or face. Some were related to poor oral hygiene or dental procedures. One abdominal wall infection was from a toothpick puncture. Twenty-five were polymicrobial infections. There were 4 deaths, three attributable to SI infection. All isolates tested (32) were susceptible to penicillin (MIC 0.008–0.125 μg/mL), ceftriaxone (MIC = 0.032–0.125 μg/mL) and vancomycin (MIC 0.38–1.0 μg/mL).ConclusionSI appears to be underreported. All SI bacteremias in the study were monomicrobial in contrast to 54% SA and 45% SC blood cultures with multiple organisms. The most common isolation site was empyema fluid. Almost all isolates appeared to originate from oral or gastrointestinal flora. Several of the sites encountered have not been reported previously. All isolates tested were susceptible to penicillin, ceftriaxone, and vancomycin.Disclosures All authors: No reported disclosures.

2073 A Rare Case of S. Constellatus Bacteremia Secondary to a Perianal Abscess in an Individual With Crohn's Disease

INTRODUCTION: Organisms of the Streptococcus anginosus group consists of three distinct streptococcal species: Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus. These organisms are commonly associated with abscesses, but polymicrobial infections in the setting of an immunocompromised patient can infrequently cause bacteremia. Here we report the case of a 37-year-old male with Crohn’s disease who was found to have bacteremia secondary to a perianal abscess due to a co-infection of Streptococcus constellatus and Parvimonas micra. CASE DESCRIPTION/METHODS: A 37-year-old male with Crohn’s disease who presented with fever, leukocytosis and rectal pain was found to have bacteremia due to a polymicrobial infection of Streptococcus constellatus and Parvimonas micra. A CT abdomen and pelvis performed excluded any acute abdominopelvic disease. A MRI was done to determine a source of infection which showed a left perianal abscess measuring 3.2 × 1.6 × 4.7 cm. Our patient underwent an examination under anesthesia with biopsy, anoscopy and surgical drainage with seton placement. He received intravenous antibiotic therapy with Ceftriaxone and Metronidazole for three days and was discharged on a two week course of oral Augmentin after two repeat blood cultures were negative. Patient continues to have the seton drain in place six months from surgery with no complications or reoccurrence of infection. DISCUSSION: This case report sheds light on a rarely described pathogen causing bacteremia and provides a comprehensive approach to diagnosis and management. S. constellatus is a common cause of abscesses in the alimentary tract but rarely causes infection in blood. Co-infection with an anaerobe in the setting of an immunocompromised individual such as Crohn's disease increases the likelihood for blood infections. Bacteremia from this group must prompt evaluation for possible intra-abdominal abscess, deep-seated head and neck infection, brain abscess and endocarditis to determine the underlying source of infection. Treatment of infections due to the S. anginosus group consist of abscess drainage and antimicrobial therapy with Ceftriaxone being the preferred agent.

Microbiological substantiation of application of phytopreparations in treatment of inflammatory periodontal diseases

Relevance:Inflammatory-destructive periodontal diseases are the most complicated and became the main cause of tooth loss in adult population. Herbal medicines have a variety of pharmacological properties, so the development and introduction of new forms for the treatment of inflammatory periodontal diseases is an urgent task today.Purpose– experimental evaluation of effectiveness of the use of herbal medicines “Tonzinal” and “CM-1” in relation to the priority periodontal pathogenes.Materials and methods:in experimental studies, the basis for the experiment was the system for the cultivation of microorganisms in real time – the Revers-Spinner RTS-1 bioreactor. With the priority strains of periodontitis pathogens, the study of the growth dynamics of the culture was carried out in several parallels.Results:herbal medicines “CM-1” and “Tonsinal” has a multilateral therapeutic effect, exerting a diverse influence on the key stages of development of such bacterial populations as Aggregatibacter actinomycetemcomitans, Streptococcus constellatus, Candida albicans.Conclusion:tan integrated approach in the treatment of patients with inflammatory periodontal diseases is promising and will contribute to a more prolonged remission and increase the effectiveness of treatment.

Streptococcus constellatus causing bony destruction secondary to odontogenic infection: three rare cases

Streptococcus constellatus is part of the Str milleri subgroup. It is a commensal organism that is often present in the oral flora, and has been implicated in pyogenic infections of the central nervous system, abdomen, and deep neck spaces. We present three patients within our unit who developed bony destruction in the facial bones and base of the skull after odontogenic infections. Str constellatus, a known oral and gut commensal that may cause atypical presentations in odontogenic abscesses, was cultured in all cases.

Streptococcus periodonticum sp. nov., Isolated from Human Subgingival Dental Plaque of Periodontitis Lesion.

A novel facultative anaerobic and Gram-stain-positive coccus, designated strain ChDC F135T, was isolated from human subgingival dental plaque of periodontitis lesion and was characterized by polyphasic taxonomic analysis. The 16S rRNA gene (16S rDNA) sequence of strain ChDC F135T was closest to that of Streptococcus sinensis HKU4T (98.2%), followed by Streptococcus intermedia SK54T (97.0%), Streptococcus constellatus NCTC11325T (96.0%), and Streptococcus anginosus NCTC 10713T (95.7%). In contrast, phylogenetic analysis based on the superoxide dismutase gene (sodA) and the RNA polymerase beta-subunit gene (rpoB) showed that the nucleotide sequence similarities of strain ChDC F135T were highly similar to the corresponding genes of S. anginosus NCTC 10713T (99.2% and 97.6%, respectively), S. constellatus NCTC11325T (87.8% and 91.4%, respectively), and S. intermedia SK54T (85.8% and 91.2%, respectively) rather than those of S. sinensis HKU4T (80.5% and 82.6%). The complete genome of strain ChDC F135T consisted of 1,901,251bp and the G+C content was 38.9mol%. Average nucleotide identity value between strain ChDC F135T and S. sinensis HKU4T or S. anginosus NCTC 10713T were 75.7% and 95.6%, respectively. The C14:0 composition of the cellular fatty acids of strain ChDC F135T (32.8%) was different from that of S. intermedia (6-8%), S. constellatus (6-13%), and S. anginosus (13-20%). Based on the results of phylogenetic and phenotypic analysis, strain ChDC F135T (= KCOM 2412T = JCM 33300T) was classified as a type strain of a novel species of the genus Streptococcus, for which we proposed the name Streptococcus periodonticum sp. nov.

Complex Microbiome in Brain Abscess Revealed by Whole-Genome Culture-Independent and Culture-Based Sequencing.

Brain abscess is a severe infectious disease with high mortality and mobility. Although culture-based techniques have been widely used for the investigation of microbial composition of brain abscess, these approaches are inherent biased. Recent studies using 16S ribosomal sequencing approaches revealed high complexity of the bacterial community involved in brain abscess but fail to detect fungal and viral composition. In the study, both culture-independent nanopore metagenomic sequencing and culture-based whole-genome sequencing using both the Illumina and the Nanopore platforms were conducted to investigate the microbial composition and genomic characterization in brain abscess. Culture-independent metagenomic sequencing revealed not only a larger taxonomic diversity of bacteria but also the presence of fungi and virus communities. The culture-based whole-genome sequencing identified a novel species in Prevotella and reconstructs a Streptococcus constellatus with a high GC-skew genome. Antibiotic-resistance genes CfxA and ErmF associated with resistance to penicillin and clindamycin were also identified in culture-based and culture-free sequencing. This study implies current understanding of brain abscess need to consider the broader diversity of microorganisms.

Indirect Bactericidal Properties of Recombinant Human Bone Morphogenetic Protein 2 In Vitro

Bone morphogenetic proteins (BMPs) are secreted cytokines and are involved in various metabolic functions and inflammatory processes in different organs. The purpose of this study was to investigate whether BMPs also possess antimicrobial properties in direct or indirect ways. Antibacterial properties of recombinant human BMP2 (rhBMP2) were tested on 4 bacteria species (Staphylococcus aureus, Escherichia coli, Streptococcus mitis, Streptococcus constellatus) to examine the potential synergism of rhBMP2 with antibiotics. Indirect antibacterial properties were tested by infecting neutrophils with rhBMP2 and bacteria to investigate bacterial survival. Reactive oxidative species (ROS) production in neutrophils in the presence of rhBMP2 also was tested. RhBMP2 in cardboard disks or sponge collagen as carriers did not show antibacterial activity against all tested bacteria. Further, synergism of rhBMP2 with antibiotics was not evident. Survival of bacteria inoculated with neutrophils and rhBMP2 led to a marked decrease in bacterial survival compared with neutrophils without rhBMP2. Although rhBMP2 inoculation of neutrophils alone did not induce ROS, its presence with the bacterial infection showed augmented ROS production for all tested bacteria. RhBMP2 did not show direct antibacterial properties but did exhibit an indirect bactericidal effect in the presence of neutrophils. ROS production indicated that rhBMP2 has a role as a priming agent for neutrophils by augmenting their bactericidal capabilities and suggests the importance of its presence in contaminated surgical bone augmentation sites.

Identification of microbiota in peri-implantitis pockets by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

The purpose of this study was to identify the microbial communities that colonize peri-implantitis pockets using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Subjects having at least one implant with peri-implantitis, no diabetes, and not taking antibiotics in the previous 3 months were selected. Peri-implantitis was defined when surrounding bone loss ≥0.5 mm and bleeding on probing was found. Microbial samples were collected from peri-implantitis pockets using paper points. After incubation and isolation, the colonies were analyzed by MALDI-TOF MS. A total of 126 isolates were cultivated and identified from 12 samples, in identification rates of 82.5% at the species level and 12.72% at the genus level. Although the compositions were highly variable, major habitants in different peri-implant pockets could be identified. Among them the most distinguished were Neisseria flavescens (87%), Streptococcus constellatus (56%), Slackia exigua (46%), Streptococcus intermedius (45%), Fusobacterium nucleatum (45%) and Gemella morbillorum (43%). This preliminary study provides comprehensive and reliable data for future study designs involving MALDI-TOF MS and peri-implantitis in a more specific, easy, rapid and economical way. MALDI-TOF MS could be a new clinical method to evaluate and monitor oral microbiota associated with the disease.

ERCP-associated infected intrahepatic pancreatic pseudocyst.

IntroductionPancreatic pseudocysts are abnormal mature collections of pancreatic fluid that can develop in association with acute or chronic pancreatitis. Here, we share the discovery of an infected hepatic subcapsular pseudocyst of the pancreas causing septic shock following endoscopic retrograde cholangiopancreatography (ERCP).Presentation of CaseA 55-year-old woman with ethanol-related chronic pancreatitis and biliary stricture was transferred to the ICU for hypotension 8 hours following ERCP. Examination revealed mild right upper quadrant tenderness without sign of peritonitis. Laboratory studies were notable for leukocytosis (14.6 k/L) and slightly elevated serum lipase (489 U/L). Abdominal CT scan revealed a previously undescribed subcapsular fluid collection. She underwent CT-guided percutaneous subcapsular drainage with return of opaque yellowish fluid. Fluid analysis showed elevated lipase of 62,901 U/L with cultures positive for ESBL Escherichia coli, Streptococcus constellatus, and Enterococcus faecium.DiscussionA majority of pancreatic pseudocysts develop in peripancreatic regions, while, in a recent study, over a quarter of cases were found in usual sites. The management of subcapsular pseudocysts has not been standardized and often involves endoscopic or percutaneous drainage. Operative intervention is reserved for severe infection or rupture in patients with intrahepatic pseudocysts. Rarely do subcapsular pseudocysts become infected. In this case, we postulate the pseudocyst became seeded by bacteria during ERCP resulting in infection and then sepsis.ConclusionThis case report highlights an atypical presentation of pancreatic pseudocyst as well as a rare septic complication of ERCP.

Periorbital purulent drainage of resulting from bacterial pansinusitis

Periorbital cellulitis is much more common in younger children than in adolescents or adults, and most cases of uncomplicated periorbital cellulitis can be treated with antibiotics alone. Here, we report a case of a 53-year-old man with periorbital purulent discharge. Computed tomography imaging revealed pansinusitis. Pus culture isolated a pathogen of Streptococcus constellatus, but it was refractory to 2 weeks of antibiotic therapy with amoxicillin–clavulanate. The patient underwent debridement and functional endoscopic sinus surgery, followed by 10 days of hyperbaric oxygen treatment. The above antibiotic was changed to full-dose intravenous clindamycin. Two weeks after the surgery, the patient was discharged from the hospital. At 1-month follow-up, no purulent discharge was noted; however, mild left-eyelid contracture was observed. This study suggested that if conservative therapy for periorbital purulent discharge in an adult is not effective, progressive treatment, including surgery, should be considered.

Case Report of Streptococcus constellatus Bacteremia in an 11-Month-old Child-clinical and Microbiological Aspects

Case Report of Streptococcus constellatus Bacteremia in an 11-Month-old Child-clinical and Microbiological Aspects