Streptococcus Intermedius Research Articles

In vitro Interactions between Streptococcus intermedius and Streptococcus salivarius K12 on a Titanium Cylindrical Surface.

Peri-implantitis is a steadily rising disease and is caused by oral bacterial pathogens able to form biofilm on implant surfaces and peri-implant tissues, making antibiotics treatment less effective. The use of commercial probiotics against oral pathogens could serve as an alternative to prevent biofilm formation. Streptococcus intermedius is one of the early colonizers of biofilm formation in dental implants. The aim of this study was to model the interaction between S. intermedius and Streptococcus salivarius strain K12, a probiotic bacterium producing bacteriocins. S. intermedius was co-cultured with S. salivarius K12 in an in vitro model simulating the biofilm formation in a dental implant composed by a titanium cylinder system. Biofilm formation rate was assessed by Real-Time PCR quantification of bacterial count and expression levels of luxS gene, used in response to cell density in the biofilm. Biofilm formation, bacteriocin production, luxS expression patterns were found to be already expressed within the first 12 h. More importantly, S. salivarius K12 was able to counter the biofilm formation in a titanium cylinder under the tested condition. In conclusion, our dental implant model may be useful for exploring probiotic-pathogen interaction to find an alternative to antibiotics for peri-implantitis treatment.

Streptococcus intermedius is the most common streptococcus in soft tissue infections in injection drug users

Background: There have been reports of “Streptococcus milleri” group (now Streptococcus anginosus group) SAG, in soft tissue infections in iv drug users (IVDU). However, the significance of Streptococcus intermedius (SI) has not been reported. In our study of 1321 streptococcal isolates SI was the predominant Streptococcus in IVDU soft tissue infections. Other 2 members of the group, S constellatus (SC) and S anginosus (SA) were less frequent. Methods and materials: We studied 1321 Streptococcal isolates from different body sites admitted to our 10 network hospitals during a 3 year period ending in December 2019.There were 125 (9.5%) group A, 481 (36.4%) group B, 78 (5.9%) group C, 83 (6.3%) group G, 335 (25.4%) Streptococcus anginosus group (SAG) and 45 S gallolyticus and 174 others.There were 335 Streptococcus anginosus group (SAG) isolates from 167 males and 166 females, with ages ranging from 1 month to 90 years, consisting of 151 (84 M/67F) S anginosus, 107 (56 M/51F) SI and 77 (47 M/30/F) S constellatus (SC). We reviewed the clinical presentation, lab results, and susceptibilities of all streptococcal isolates. There were 32 drug users in patients culture positive for streptococci. Results: Streptococcal infections in 32 IV drug users were: 15 (46.9%) SI, 9 (28.1%) group A, 4 (12.5%) SA, 3 Streptococcus constellatus (9.4%), 1 each group C, group F, S dysgalactiae and alpha Streptococcus sp. There were no group B or G infections associated with IVDU. Majority were in the upper extremity 24/31 (77.4%), with 4/31 (12.9%) lower extremity, 1 pneumonia and 1 line infection. Other oral bacteria present in mixed infections were Prevotella oralis, P denticola, P intermedius, Eikenella corrodens, Haemophilus para influenzae and group C Streptococcus. Of 7 positive blood cultures in IVDU 5 were group A, one SI and 1 SC. Conclusion: SAG was common in soft tissue infections in IVDU with SI being the predominant Streptococcus. In IVDU with bacteremia, group A Streptococcus was the most common blood isolate. Mixed infections with other oral bacteria were often present. Group B and group G Streptococci were not isolated in IVDU in this study.

Periodontal pathogens and their association with incident all‐cause and Alzheimer’s disease dementia in a large national survey

AbstractBackgroundInfectious agents including periodontal pathogens have recently appeared as important actors in Alzheimer’s Disease (AD) pathology. We examined associations of serum immunoglobulin G (IgG) against periodontal pathogens and Pd markers with incident all‐cause and AD dementia as well as AD mortality among U.S. middle‐aged and older adults.MethodPeriodontal disease (Pd) markers [Clinical Attachment Loss (CAL); probing depth and periodontal pathogen immunoglobulin G (IgG)] were investigated in relation to AD and all‐cause dementia incidence and to AD mortality, using data from the third National Health and Nutrition Examination Surveys (NHANES III, 1988‐1994) linked longitudinally with National Death Index and Medicare data through January 1st, 2014, with up to 26y of follow‐up. Sex‐ and age group‐specific multivariable‐adjusted Cox proportional hazards models were conducted.ResultAmong those ≥65y, AD incidence and mortality were consistently associated with probing depth, two factors and one cluster comprised of IgG titers against Porphyromonas gingivalis (Pg), Prevotella melaninogenica (Pm) and Campylobacter rectus (Cr) among others. Specifically, AD incidence was linked to a composite of Cr and Pg titers (per SD, aHR=1.22; 95% CI, 1.04‐1.43, P=0.012), while AD mortality risk was increased with another composite (per SD, aHR=1.46; 95% CI, 1.09‐1.96, P=0.017) loading highly on Pg, Prevotella intermedia, Prevotella nigrescens, Fusobacterium nucleatum, Cr, Streptococcus intermedius, Capnocylophaga Ochracea and Pm.ConclusionThis study provides evidence for an association between periodontal pathogens and AD, which was stronger for older adults. Effectiveness of periodontal pathogen treatment on reducing sequelae of neurodegeneration should be tested in randomized controlled trials.

Flavorless vs. Flavored Electronic Cigarette-Generated Aerosol and E-Liquid on the Growth of Common Oral Commensal Streptococci.

IntroductionElectronic cigarette (ECIG) use or vaping has become popular globally. While the question “Is vaping safer than smoking?” continues, it is becoming clearer that one of the most dangerous components of E-liquids are the flavorings. Since the oral cavity is the first anatomical site to be assaulted by ECIG aerosol, the aim of this study is to test the hypothesis that flavored ECIG aerosols or E-liquids pose a more detrimental effect on the growth of commensal oral streptococcal bacteria compared to flavorless aerosols or E-liquids.MethodsKirby Bauer assays and 24-h planktonic growth curves were used to compare the effects of flavorless vs. flavored (tobacco, menthol, cinnamon, strawberry and blueberry) ECIG-generated aerosols and E-liquids on the growth of four common strains of oral commensal bacteria (Streptococcus gordonii, Streptococcus intermedius, Streptococcus mitis and Streptococcus oralis).ResultsKirby Bauer assays revealed inhibition of growth for all bacteria tested when exposed to 100% menthol, cinnamon or strawberry flavors. In contrast, 5% flavor in E-liquid had no effect. When exposed to 100 puffs of ECIG-generated aerosol ± flavors (≈ 0.05% flavor in brain heart infusion media) or an equivalent amount of E-liquid ± flavors, twenty-four hour planktonic growth curves indicated no effect on growth for all streptococci tested. Subsequent twenty-four hour planktonic growth curves testing the effects of E-liquid ± flavors (0.0625, 0.125, 0.25, 0.3125, 0.625, and 1.25% flavor in brain heart infusion media) revealed dose-dependent inhibition of growth, particularly for menthol, cinnamon and strawberry), for all bacteria tested.ConclusionThese results support the hypothesis that flavored E-liquids are more detrimental to the growth of oral commensal bacteria than unflavored E-liquids. The streptococci tested in this study are early colonizers and part of the foundation of oral biofilms and dental plaque. Disturbances in the composition and growth of these primary colonizers is crucial to the development of a healthy dental plaque and host-bacteria interactions. E-liquids and their aerosols containing flavoring agents alter the growth of these bacteria. Such perturbations of pioneering oral communities pose a potential risk to the health of the oral cavity and, ultimately, health in general.

Spontaneous Pan-Vertebral Epidural Abscesses Caused by Streptococcus Intermedius in an Immunocompetent Patient

Spinal epidural abscess (SEA) is a rarely reported condition. Here, we present a unique case of a 54-year-old immunocompetent man who developed worsening lower back pain of 2 weeks duration. A full spine magnetic resonance imaging (MRI) was performed with contrast. This showed extensive epidural abscess extending from C2 to S2, more extensive around L5-S2, with left paraspinal, left iliopsoas and right psoas abscess confirming the diagnosis of spinal epidural abscess of the spine. Blood cultures grew Streptococcus intermedius, an anaerobic commensal bacterium of the normal flora of the mouth and upper airways. The patient was treated conservatively with intravenous Ceftriaxone 2g and oral Rifampicin 600mg. He was discharged on those medication for 10 weeks. There was remarkable improvement in his symptoms as he retained his baseline strength in his lower extremity and has regained function to the extent that he is independent with his activities of daily living. A high index of clinical suspicion and a low threshold of appropriate imaging, magnetic resonance imaging (MRI) being the gold standard, are important for accurate diagnosis. Though our patient was treated Medically, Prompt medical and surgical treatment may avert complications, and although the patient presented made a complete recovery, patients may be left with neurological deficits.

Genomic Analysis of Oral Lichen Planus and Related Oral Microbiome Pathogens.

Oral lichen planus (OLP) is a common chronic inflammatory disease affecting the oral mucosa. The pathogenesis of OLP is incompletely understood but is thought to be related to the immune system. As the oral cavity is a major reservoir and transmission gateway for bacteria, viruses, and fungi, the microbial composition of the oral cavity could play a role in the pathogenesis of OLP. However, limited by analytic technology and knowledge of the microbial community in the oral cavity, it is not yet clear which pathogens are associated with OLP. Next generation sequencing (NGS) is a powerful tool to identify pathogens for many infectious diseases. In this study, we compared the host cell gene expression profiles and the microbial profiles between OLP patients and matched healthy individuals. We identified the activation of the hepatocyte nuclear factor alpha (HNF4A) network in OLP patients and potential pathogens, including Corynebacterium matruchotii, Fusobacterium periodonticum, Streptococcus intermedius, Streptococcus oralis, and Prevotella denticola. Prevotella denticola is capable of activating the HNF4A gene network. Our findings shed light on the previously elusive association of OLP with various diseases like hepatitis, and indicate that OLP is a T-helper type 17 (Th17) mediated mucosal inflammatory process. The identified molecular pathways and microbes could be used to inform future investigations into OLP pathogenesis and to develop novel therapeutics for OLP treatment.

Differential diagnosis of atypical encephalopathy in critical care: a case report

BackgroundA lower level of consciousness is a common presentation in critical care, with many different causes and contributory factors, of which more than one may be present concurrently.Case presentationWe described a woman with poorly controlled diabetes and steroid-dependent asthma who presented in a deep coma. She was found to have Streptococcus intermedius bacteremia and pyogenic ventriculitis that originated from right middle lobe pneumonia. Also, multiple small parenchymal lesions were observed on brain magnetic resonance imaging and increased protein concentration was noted in cerebral spinal fluid. Initially, her coma was thought to be due to diabetic ketoacidosis and septic encephalopathy. However, her lowered level of consciousness was disproportionate to either diabetic ketoacidosis or septic encephalopathy, and her clinical course was not as expected for these two conditions. Treatment with antibiotic, corticosteroid and antihelminthic drugs was administered resulting in improving consciousness. The Streptococcus intermedius pneumonia progressed to form a large cavity that needed an early surgical lobectomy and resulted in the unexpected diagnosis of chronic cavitary pulmonary aspergillosus.ConclusionsIn critical care, a lowered level of consciousness may have many etiologies, and critical care clinicians should be familiar with the signs and symptoms of all possible causes to enable prompt diagnosis and appropriate treatment.

S2749 Streptococcus intermedius Liver Abscesses in a Patient Presenting With Fatigue

INTRODUCTION: Streptococcus intermedius is part of the Streptococcus milleri group. It can be found as part of the normal flora of the oropharyngeal cavity and gastrointestinal tract. Although rare, Streptococcus intermedius can cause hematogenous infection in addition to liver abscesses in healthy patients. We describe a case of Streptococcus intermedius liver abscesses and bacteremia in a patient who presented with fatigue. CASE DESCRIPTION/METHODS: A 73 year old male patient with a past medical history of coronary artery disease and hypertension presented to the hospital with progressively worsening weakness and fatigue in addition to generalized abdominal pain. Patient had a previous history of resolved hepatitis C infection. There was no signs of hepatic decompensation or weight loss. On presentation, patient’s vital signs were within normal limits. Physical exam was remarkable for generalized abdominal tenderness. Labs were significant for a WBC of 12.6 × 109/L and INR of 1.4. Liver function tests were significant for an ALT of 50 U/L and a total bilirubin of 3.1 U/L. A CT of the abdomen and pelvis showed nonspecific sigmoid colitis or diverticulitis. Blood cultures were taken. Patient was started on appropriate antibiotics for suspected diverticulitis. Blood cultures were later positive for Streptococcus intermedius. Liver ultrasound showed multiple small hypoechoic lesions in the liver, and signs of hepatic steatosis. MRI of the abdomen was suggestive of multifocal hepatic abscesses. He was treated with IV ceftriaxone for six weeks followed by Augmentin for 2 two weeks. Follow up MRI one month after initial presentation showed decrease in the size of liver abscesses. Complete resolution of abscesses was seen on MRI a month later. DISCUSSION: Although it is uncommon, Streptococcus intermedius is notorious for causing abscesses with reported cases of brain, lung, and liver abscesses in the literature. It is likely that the bacteremia occurred first followed by abscess formation. The source of the bacteremia is unclear though it is most likely from a GI source in the setting of colitis seen on CT scan in this case. Patient is scheduled for colonoscopy to look for malignancy as the nidus for this infection. He will also undergo cardiac echo to rule out endocarditis although rare. There should be high suspicion for liver abscesses in patients with Streptococcus intermedius bacteremia. Timely diagnosis is important as untreated pyogenic liver abscesses can be fatal.

The distribution of cultivable oral anaerobic microbiota identified by MALDI-TOF MS in healthy subjects and in patients with periodontal disease

In this study, we aimed to identify the cultivatable oral anaerobic bacterial distribution in oral cavity by MALDI-TOF Biotyper. The bacterial distribution of three groups, including subjects with/without periodontal disease, two clusters of age (60 years as the cutoff), and before/after treatment, were investigated in this study. There were 38 participants recruited in this study, involving 18 subjects with moderate to severe periodontal-infected patients and 20 healthy controls. Total number of 126 bacterial species were identified by MALDI-TOF MS. The relative abundance of Streptococcus gordonii and Streptococcus intermedius in periodontal patients is higher than healthy controls indicating potential biomarkers for periodontal disease. Participants with periodontal disease were subdivided in to two clusters of age (60 years as the cutoff), 11 and 7 participants were age <60 years and>60 years, respectively. Meanwhile, the incidence of Streptococcus pneumoniae and Streptococcus oralis infection were higher in the subjects above 60 years old than below. Moreover, the bacterial distribution between pre-treatment and post-treatment was similar indicating that basic treatment without the ability to redistribute the microbiota.In summary, the cultivable oral anaerobic bacteria were identified by MALDI-TOF MS and the bacterial distribution shifting was shown to be associated with the progress of periodontal disease to aging and basic treatment. This study provided information for diagnosis and treatment guidelines for oral healthcare.

Symmetry breaking and structural polymorphism in a bacterial microcompartment shell protein for choline utilization.

Bacterial microcompartments are protein-based organelles that carry out specialized metabolic functions in diverse bacteria. Their outer shells are built from several thousand protein subunits. Some of the architectural principles of bacterial microcompartments have been articulated, with lateral packing of flat hexameric BMC proteins providing the basic foundation for assembly. Nonetheless, a complete understanding has been elusive, partly owing to polymorphic mechanisms of assembly exhibited by most microcompartment types. An earlier study of one homologous BMC shell protein subfamily, EutS/PduU, revealed a profoundly bent, rather than flat, hexameric structure. The possibility of a specialized architectural role was hypothesized, but artifactual effects of crystallization could not be ruled out. Here we report a series of crystal structures of an orthologous protein, CutR, from a glycyl-radical type choline-utilizing microcompartment from the bacterium Streptococcus intermedius. Depending on crystal form, expression construct, and minor mutations, a range of novel quaternary architectures was observed, including two spiral hexagonal assemblies. A new graphical approach helps illuminate the variations in BMC hexameric structure, with results substantiating the idea that the EutS/PduU/CutR subfamily of BMC proteins may endow microcompartment shells with flexible modes of assembly.

Update on minocycline in vitro activity against odontogenic bacteria

Periodontitis, which is a chronic inflammation caused by biofilm from numerous gram-negative and -positive oral bacterial species between gingiva and tooth, is known to have a poor prognosis.Susceptibility of standard strains (19 strains) and clinical isolates (90 strains) of aerobic and anaerobic oral bacteria, including a recently recovered as novel pathogens for periodontitis called Filifactor alocis, was tested to minocycline (MINO) by using the agar dilution method according to the Clinical and Laboratory Standards Institute.MINO is a well-used therapeutic antibiotic for periodontits. In this study, minimum inhibitory concentrations (MICs) of MINO against Aggregatibacter actinomycetemcomitans (n = 1), Porphyromonas gingivalis (n = 5), Prevotella intermedia (n = 1), Tannerella forsythia (n = 1) and F. alocis (n = 1), were 0.12, ≤0.016–0.03, ≤0.016, 0.03, and 2 μg/mL, respectively. MICs range of MINO against clinical isolates (10 isolates each) Streptococcus intermedius, P. gingivalis, P. intermedia, Fusobacterum nucleatum, Parvimonas micra were 0.06–16, ≤0.016–0.03, ≤0.016–1, ≤0.016–0.12, and ≤0.016–0.25 μg/mL, respectively.These results showed that MINO has superior in vitro activities against to known and recent recovered oral bacteria. Moreover, low prevalence in non-susceptible bacteria was observed to MINO.

The Role of Endoscopic Sinus Surgery in Children Undergoing External Drainage of Non-Medial Subperiosteal Orbital Abscess.

The extent of surgery required in the management of pediatric non-medial subperiosteal orbital abscess (SPOA) due to medically refractory complicated acute sinusitis is unknown. The primary objective is to compare operative outcomes of children treated with combined endoscopic sinus surgery (ESS) and external orbital drainage (EOD) versus those treated with EOD alone. Retrospective case series from a tertiary children's hospital analyzing outcomes in children requiring surgical management for acute sinusitis complicated by non-medial SPOA between November 2007 and September 2019. Sixteen children with a mean age of 9.4 years (95% CI: 7.3-11.4) met inclusion. Eleven (68.8%) underwent combined EOD and ESS, while five (31.2%) underwent EOD alone. Groups were similar in age, symptom duration, white blood cell count, C-reactive protein level, intraocular pressure, Lund-Mackay score, and abscess volume. There was no significant difference in median length of stay between patients treated with a combined approach versus those treated by EOD alone. Cultures identified non-beta-hemolytic Streptococcus species in 56.3% of patients, with Streptococcus intermedius representing the most common organism in 37.5%. In one case, ESS identified a pathogen not acquired via concomitant EOD, which did influence management. No child required a subsequent surgical procedure and there were no operative complications. The addition of ESS in the management of pediatric non-medial SPOA was not associated with a statistically different duration of hospitalization. Cultures from concomitant ESS rarely aided in diagnosis or antibiotic therapy. Further study should delineate the indications for ESS in these cases.

Antimicrobial effects of a pulsed electromagnetic field: an in vitro polymicrobial periodontal subgingival biofilm model

The objective was to test the influence of a pulsed electromagnetic field (PEMF) on bacterial biofilm colonization around implants incorporated with healing abutments. Healing abutments with (test group) and without (control group) active PEMF devices were placed in a multispecies biofilm consisting of 31 different bacterial species. The biofilm composition and total bacterial counts (x105) were analyzed by checkerboard DNA-DNA hybridization. After 96 h, the mean level of 7 out of the 31 bacterial species differed significantly between groups, namely Eubacterium nodatum, Fusobacterium nucleatum ssp. nucleatum, Streptococcus intermedius, Streptococcus anginosus, Streptococcus mutans, Fusobacterium nucleatum ssp. Vicentii and Capnocytophaga ochracea were elevated in the control group (p < 0.05). The mean total bacterial counts were lower in the Test group vs the control group (p < 0.05). An electromagnetic healing cap had antimicrobial effects on the bacterial species and can be used to control bacterial colonization around dental implants. Further clinical studies should be conducted to confirm these findings.

Immunomodulation Mediated by Azithromycin in Experimental Periapical Inflammation

IntroductionThe purpose of the present study was to compare the immunomodulatory effect of azithromycin (AZM), ampicillin (AMP), amoxicillin (AMX), and clindamycin (CLI) in vitro and AZM on preexisting periapical lesions compared with AMP. MethodsThe susceptibility of 4 common human endodontic pathogens (Parvimonas micra, Streptococcus intermedius, Prevotella intermedia, and Fusobacterium nucleatum) to AZM, AMP, AMX, and CLI was confirmed by agar disk diffusion assay. Preexisting periapical lesions in C57BL/6J mice were treated with AZM, AMP, or phosphate-buffered saline (PBS). Periapical bone healing and the pattern of inflammatory cell infiltration were evaluated after a 10-day treatment by micro–computed tomographic and histology, respectively. Besides, the effect of antibiotics in pathogen-stimulated nuclear factor kappa B activation and the production of interleukin 1 alpha and tumor necrosis factor alpha was assessed in vitro by luciferase assay and enzyme-linked immunosorbent assay. ResultsAll examined endodontic pathogens were susceptible to AZM, AMP, AMX, and CLI. AZM significantly attenuated periapical bone loss versus PBS. PBS resulted in widely diffused infiltration of mixed inflammatory cells. By contrast, AZM brought about localized infiltration of neutrophils and M2 macrophages and advanced fibrosis. Although the effect of AMP on bone was uncertain, inflammatory cell infiltration was considerably milder than PBS. However, most macrophages observed seemed to be M1 macrophages. AZM suppressed pathogen-stimulated nuclear factor kappa B activation and cytokine production, whereas AMP, AMX, and CLI reduced only cytokine production moderately. ConclusionsThis study showed that AZM led to the resolution of preexisting experimental periapical inflammation. Our data provide a perspective on host response in antibiotic selection for endodontic treatment. However, well-designed clinical trials are necessary to better elucidate the benefits of AZM as an adjunctive therapy for endodontic treatment when antibiotic therapy is recommended. Although both AZM and AMP were effective on preexisting periapical lesions, AZM led to advanced wound healing, probably depending on its immunomodulatory effect.

Scalp, epidural, subdural and brain abscesses caused by Streptococcus intermedius secondary to sinusitis: A case report

Scalp, epidural, subdural and brain abscesses caused by Streptococcus intermedius secondary to sinusitis: A case report

Multiple brain abscesses with good prognosis in an infant with cyanotic congenital heart disease: a case report

BackgroundBrain abscesses are relatively rare, but they are a potentially life-threatening condition. Predictive factors for poor outcome are a young age and the presence of multiple abscesses. We report a case of a 15-month-old girl with cyanotic congenital heart disease who developed multiple brain abscesses caused by Streptococcus intermedius. The patient was treated with a combination of surgical aspiration and antimicrobial therapy without apparent neurological sequelae. To the best of our knowledge, this is the youngest such patient to have been reported in the literature. We explore the possible causes of her good outcome.Case presentationAt the age of 15 months, the Japanese patient initially was presented to our hospital with transient eye deviation to the left and vomiting. In a blood examination, her white blood cell count (12,720 per mm3 with a left shift) and C-reactive protein level (1.23 mg/ml) were slightly elevated. Magnetic resonance imaging of the brain showed three mass lesions. These were 1.5-cm, 1.9-cm, and 1.2-cm rim-enhancing lesions with extensive surrounding edema. Brain abscesses were diagnosed, and vancomycin (50 mg every 12 hours) and meropenem (40 mg every 8 hours) were started empirically. However, because each brain abscess was enlarged at 8 days after admission, surgical aspiration was performed at 10 days after admission, and cultures of the aspirated pus grew S. intermedius. Penicillin G (0.7 million units every 4 hours) and ceftriaxone (280 mg every 12 hours), to which this isolate is susceptible, were then administered, and the brain abscesses reduced in size. After 1 month of ceftriaxone and 3 months of penicillin G treatment, all of the brain abscesses disappeared. Apparent neurological sequelae were not observed at 6 months after onset.ConclusionsA good outcome can be obtained if multiple brain abscesses develop in infancy or early childhood in cases without unconsciousness at admission, meningitis, or sepsis. Appropriate antimicrobial therapy should be started immediately after diagnosis, with surgical aspiration performed to identify the causative pathogen and avoid intraventricular rupture of the brain abscesses.

Abscess of the clivus in an adolescent with complicated acute rhinosinusitis: a case report

BackgroundComplications of acute sinusitis affecting multiple sites are very uncommon, and generally develop for a delayed diagnosis of the primary infection, with possible severe and life-threatening evolution. Patients can have variable presentations according to the site and extent of the infection. Multiple forms generally include the coexistence of orbital manifestations and intracranial infections. We here present a case with unusual multiple sites locations (i.e.: intraorbital intraconic abscess, sigmoid sinus thrombosis, preclival abscess, multiple splanchnocranium osteomyelitic processes).Case presentationA 13-year-old male presented at our hospital with right progressive orbital oedema with eyesight worsening and signs of meningitis. Computed tomography and magnetic resonance (MRI) demonstrated right intraorbital intraconic abscess, left sphenoidal sinusitis, transverse and sigmoid sinus thrombosis. Ophthalmologic evaluation documented a right optic nerve sufferance. Endoscopic and superior right trans-palpebral surgical decompression was performed, and the abscess was drained. Microbiological analysis revealed the presence of multi-sensitive Streptococcus Intermedius. Subsequent prolonged antibiotic and anti-thrombotic treatments were started. In the following two-weeks the sinusal and ophthalmologic clinical conditions improved, whereas the patients complained of mild to moderate cervical pain and suffered from intermittent pyrexia. Control MRI documented clival abscess extending up to preclival soft tissues posterior to the nasopharynx, associated with mandible osteomyelitis, occipital condyles and anterior part of the temporal bone hyper intensity. Endoscopic trans-nasal surgical approach to the clival compartment with neurosurgery navigation-guided achieved preclival abscess drainage. Complete clinical and radiological recovery was achieved after 45 days of medical treatment.ConclusionsMultiple sites complicated rhinosinusitis is uncommon, and its management is challenging. A proper history and thorough clinical examination along with a radiological evaluation are key factors in the final diagnosis of patients with complicated multiple sites acute rhinosinusitis. A quick multidisciplinary approach is always necessary to avoid unwanted life-threatening complications.

Comparison of bacterial maxillary sinus cultures between odontogenic sinusitis and chronic rhinosinusitis.

Bacterial odontogenic sinusitis (ODS) is distinct from other forms of rhinosinusitis. Diagnosing ODS can be challenging because of nonspecific clinical presentations and underrepresentation in the literature. The purpose of this study was to compare maxillary sinus bacterial cultures between patients with ODS and chronic rhinosinusitis (CRS), to determine whether certain bacteria are associated with ODS. This was a retrospective case-control study of 276 consecutive patients from August 2015 to August 2019 who underwent endoscopic sinus surgery (ESS) for bacterial ODS, CRS without nasal polyps (CRSsNP), or CRS with nasal polyps (CRSwNP). When present, pus was sterilely cultured from maxillary sinuses after maxillary antrostomy, and aerobic and anaerobic cultures were immediately sent for processing. Demographics and culture results were compared between ODS and CRS patients, and then separately between ODS and CRSsNP, and ODS and CRSwNP. ODS culture results were also compared between different dental pathologies (endodontic vs oroantral fistula). The following bacteria were significantly more likely in ODS compared to CRS: mixed anaerobes, Fusobacterium spp., Eikenella corrodens, Streptococcus intermedius, Streptococcus anginosus, and Streptococcus constellatus. Staphylococcus aureus and Pseudomonas aeruginosa were inversely related to ODS. There were no significant differences in cultures between the different dental pathologies. Certain bacteria were more likely to be associated with ODS compared to CRS when purulence was cultured from the maxillary sinus. Physicians should evaluate for an odontogenic source of sinusitis when these ODS-associated bacteria are identified in maxillary sinus cultures.

Arachnoid cyst with bony erosion of the posterior frontal sinus wall as cause of a subdural empyema after pansinusitis

Intracranial arachnoid cysts (AC) can lead to a bony thinning of the surrounding skull. We present a young man, in whom a frontal AC has caused a thinning of the frontal calvaria and of the posterior wall of the frontal sinus. This bony vulnerability allowed a frontal sinusitis to spread intracranially and finally led to a subdural empyema with neurological deterioration. The treatment consisted of an emergency craniotomy with evacuation of the empyema and appropriate antibiotic treatment of the causing pathogen (Streptococcus intermedius).

Characterization and pathogenicity of fibronectin binding protein FbpI of Streptococcus intermedius.

Streptococcus intermediusis a causative agent of brain or liver abscesses. S. intermedius produces intermedilysin that plays a pivotal role in pathogenicity. We identified other pathogenic factors and described a fibronectin binding protein (FBP) homolog of S. intermedius (FbpI) that mediated bacterial adhesion to epithelial cells and virulence for mice. The amino acid sequence of FbpI is similar to that of atypical FBPs, which do not possess a conventional secretion signal and an anchoring motif. A full-length recombinant FbpI (rFbpI) bound to immobilized fibronectin in a dose-dependent manner. The fibronectin binding activity of an N-terminal construct of rFbpI comprising the translation initiation methionine of the open reading frame to lysine 265 (rFbpI-N) bound immobilized fibronectin to a much lesser extent compared with rFbpI. A construct comprising the C-terminal domain (alanine 266 to methionine 549; rFbpI-C) bound immobilized fibronectin equivalently to rFbpI. Adherence of the isogenic mutant ΔfbpI to cultured epithelial cells and immobilized fibronectin was significantly lower than that of the wild-type strain. Abscess formation of ΔfbpI reduced in a mouse infection model compared with that in the wild-type. Thus, FbpI may play a role in bacterial adhesion to host cells and represent a critical pathogenic factor of S. intermedius.