[Suppurative Thrombophlebitis of the Posterior Neck Caused by Streptococcus constellatus: A Case Report and Literature Review].

We report a rare case of suppurative thrombophlebitis of the posterior neck caused by Streptococcus constellatus. A 69-year-old female patient was admitted to the hospital with neck pain and fever, which had persisted for 16 days prior to hospitalization. On day 1 (day of admission), blood cultures (later identifying S. constellatus) were performed, and ceftriaxone (CTRX) IV (2 g SID) was started. On day 3, suppurative thrombophlebitis of the posterior neck was diagnosed by CT scan. The antimicrobials were changed from CTRX to ampicillin/sulbactam IV (12 g QID) to guard against the possibility of complicated infection with Fusobacterium spp. or Prevotella spp. On day 17, a CT scan revealed that the thrombus remained. Therefore, oral edoxaban (30 mg SID) was started. On day 27, the patient was discharged after her medication was changed to oral amoxicillin/clavulanate (1500 mg/375 mg TID). On day 33, the amoxicillin/clavulanate was changed to oral cefaclor (1500 mg TID) and edoxaban was discontinued due to itching. On day 45, the course of cefaclor was completed. The patient went on to follow an uneventful course with no relapses or complications for two years since the conclusion of treatment. These results suggest that when a patient presents with persistent neck pain accompanied by fever, suppurative thrombophlebitis of the posterior neck should be considered. In antimicrobial therapy, the treatment could be switched from intravenous to oral. In addition, direct-acting oral anticoagulants may be an alternative to other forms of anticoagulants.

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.

A chinese case of prevotella intermedia and streptococcus constellatus intracranial mixed infection.

Streptococcal Species is increasingly recognized as a potentially preventable emerging infection in human's brain with high prevalence around the world. Streptococcus constellatus is one of the most common pathogens. Meanwhile, anaerobic bacteria are the rare causes for intracranial infection. To date, intracranial mixed infection caused by Prevotella intermedia and Streptococcus constellatus has not been reported. We reported a Chinese case to raise the global awareness of severity of the intracranial mixed infection. Here, we illustrated the epidemiological risk factors, clinical manifestations and outcomes of the patient. For patients who suffer from exacerbated brain infection with fetid cerebrospinal fluid, early repeated imaging is urgently needed and empiric antibiotic therapy should consider anaerobic and aerobic bacteria in these situations.

Molecular pathogenicity of Streptococcus anginosus.

Streptococcus anginosus and the closely related species Streptococcus constellatus and Streptococcus intermedius, are primarily commensals of the mucosa. The true pathogenic potential of this group has been under-recognized for a long time because of difficulties in correct species identification as well as the commensal nature of these species. In recent years, streptococci of the S. anginosus group have been increasingly found as relevant microbial pathogens in abscesses and blood cultures and they play a pathogenic role in cystic fibrosis. Several international studies have shown a surprisingly high frequency of infections caused by the S. anginosus group. Recent studies and a genome-wide comparative analysis suggested the presence of multiple putative virulence factors that are well-known from other streptococcal species. However, very little is known about the molecular basis of pathogenicity in these bacteria. This review summarizes our current knowledge of pathogenicity factors and their regulation in S. anginosus.

A streptolysin S homologue is essential for ß-haemolytic Streptococcus constellatus subsp. constellatus cytotoxicity.

Streptococcus constellatus is a member of the Anginosus group streptococci (AGS) and primarily inhabits the human oral cavity. S. constellatus is composed of three subspecies: S. constellatus subsp. constellatus (SCC), S. constellatus subsp. pharyngis and the newly described subspecies S. constellatus subsp. viborgensis. Although previous studies have established that SCC contains ß-haemolytic strains, the factor(s) responsible for ß-haemolysis in ß-haemolytic SCC (ß-SCC) has yet to be clarified. Recently, we discovered that a streptolysin S (SLS) homologue is the ß-haemolytic factor of ß-haemolytic Streptococcus anginosus subsp. anginosus (ß-SAA), another member of the AGS. Furthermore, because previous studies have suggested that other AGS species, except for Streptococcus intermedius, do not possess a haemolysin(s) belonging to the family of cholesterol-dependent cytolysins, we hypothesized that, as with ß-SAA, the SLS homologue is the ß-haemolytic factor of ß-SCC, and therefore aimed to investigate and characterize the haemolytic factor of ß-SCC in the present study. PCR amplification revealed that all of the tested ß-SCC strains were positive for the sagA homologue of SCC (sagA(SCC)). Further investigations using ß-SCC strain W277 were conducted to elucidate the relationship between sagA(SCC) and ß-haemolysis by constructing sagA(SCC) deletion mutants, which completely lost ß-haemolytic activity. This loss of ß-haemolytic activity was restored by trans-complementation of sagA(SCC). Furthermore, a co-cultivation assay established that the cytotoxicity of ß-SCC was clearly dependent on the presence of sagA(SCC). These results demonstrate that sagA(SCC) is the factor responsible for ß-SCC ß-haemolysis and cytotoxicity.

Absceso retroorbitario por «Streptococcus constellatus» en un paciente con neurocisticercosis / Retro orbital abscess by "Streptococcus constellatus" in a patient with neurocysticercosis

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Milleri group streptococcus--a stepchild in the viridans family.

The purpose of this investigation was to provide a comprehensive review of the pathogenic role and spectrum of disease of milleri group streptococci, with special attention to bloodstream invasion and to possible differential roles among the three species. All consecutive isolates of milleri group streptococci from any anatomic source, during a 37-month period, in a tertiary care teaching hospital in Tel-Aviv, Israel, were thoroughly investigated. Identification to the species level was performed by an automated system.Streptococcus anginosus constituted 82% of the 245 patient-unique isolates from hospitalized patients. All nonurinary isolates were involved in pyogenic infections mostly originating from the gastrointestinal tract, with bacteremia in 28 cases. The 71 urinary isolates represented either urinary tract infection or nonsignificant bacteriuria. No specific association could be detected between species and the infection site, except for a higher relative representation of Streptococcus constellatus in bacteremia. Milleri group streptococci are common in clinical practice and play a different pathogenic role to other viridans streptococci. Due to their invariable association with pyogenic processes, their presence in blood warrants immediate focus identification. In addition, they have a previously unappreciated clinical niche concerning urinary tract infection. The identification of viridans streptococci to the species level is of paramount clinical significance.

Empiema causado por Streptococcus constellatus / Emphyema by Streptococcus constellatus

We presented a case of patient with bipolar disorder that he was admitted in the respiratory unit of our hospital by empyema produced by Streptococcus constellatus (S. constellatus). S. constellatus can produce lung infections, specially patients with airway manipulation. The response to treatment with penicillin usually are good (AU)

Presentamos el caso de un paciente diagnosticado de trastorno bipolar que ingresa en el servicio de neumología de nuestro hospital por un empiema producido por Streptococcus constellatus (S. constellatus). El S. constellatus puede producir infecciones pulmonares, especialmente en pacientes con una manipulación previa de la vía aérea. La respuesta al tratamiento con penicilinas suele ser buena (AU)

Relapse of polymicrobial endocarditis in an intravenous drug user.

A 26-year-old male intravenous drug user (IDU) presented twice within 6 months with relapsed polymicrobial infective endocarditis (IE) due to Eikenella corrodens and Streptococcus constellatus after completing two courses of appropriate antimicrobial therapy. This report points to relapsing endocarditis as a clinical entity that warrants attention in IDUs when E. corrodens or S. constellatus are causative agents of IE.

Diagnóstico y tratamiento de la fascitis necrotizante cervical. Evolución tras una angida de Ludwig / Diagnostic and treatment of necrotizing cervical fascitis. Evolution after a ludwig angina

La «angina de Ludwig» es una infección del suelo de la boca y región submandibular, frecuentemente tras una extracción dental o por una pieza en mal estado. Cuando sobrepasa el músculo milohiodeo se extiende disecando los planos aponeuróticos superficiales, pudiendo evolucionar hacia una fascitis necrotizante. Presentamos el caso de un hombre de 67 años con tumefacción dolorosa del suelo de la boca y región submandibular. La TC reflejaba una lesión heterogénea submaxilar que se extendía por la fascia profunda cervical hasta introducirse en el tórax. Bajo tratamiento antibiótico se drenó el pus mediante cervicotomía, con curas diarias durante 3 semanas

The Ludwig angina is an infection of the base of the mouth and submandibular region, frecuently after a dental extraction or a piece in bad state. When it surpassees the milohioid muscle it extends dissecting the superficial aponeurotic planes, and can evolve to a necrotisant fascitis. We present the case oía 67 years old man with a painful tumefaction of the mouth base and submandibular region. The CT reflected an heterogenous submaxilar lesion that extended by the deep cervical fascia introducing itself in the thorax. Under antibiotic treatment the pus was drained by cervicotomy, with daily cures during 3 weeks

Bacteriemia, neumonía y meningitis por Streptococcus constellatum / Bacteremia, pneumonia and meningitis due to Streptococcus constellatum

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In vitro activity of sitafloxacin compared with several fluoroquinolones against Streptococcus anginosus and Streptococcus constellatus.

The in vitro activities of sitafloxacin and seven other fluoroquinolones a (ciprofloxacin, tosufloxacin, sparfloxacin, levofloxacin, T-3811ME, moxifloxacin and trovafloxacin) were examined by the microdilution method against 79 clinically isolated 'Streptococcus milleri' group (SMG) microorganisms. No statistically significant differences were found between the minimum inhibitory concentrations (MIC(50) and MIC(90)) against Streptococcus anginosus and Streptococcus constellatus. Sitafloxacin was the most active agent of the eight fluoroquinolones tested against SMG, with a MIC(90) of 0.06 microg/mL, which was 8 times more active than ciprofloxacin and 16 times more active than levofloxacin. Although none of the SMG strains showed high resistance to any of the fluoroquinolones tested, three agents (trovafloxacin, sitafloxacin and T-3811ME) had low MICs against 23 SMG strains against which levofloxacin had a MIC> 1 microg/mL. In conclusion, several fluoroquinolones have low MICs against SMG, but sitafloxacin has the lowest.

Experimental abscess formation caused by human dental plaque.

Human dental plaque consists of a wide variety of microorganisms, some of which are believed to cause systemic infections, including abscesses, at various sites in the body. To confirm this hypothesis experimentally, we examined the abscess-forming ability of native dental plaque in mice, the microbial features of the infectious locus produced by the plaque, and the anti-phagocytic property of microbial isolates. Aliquots of a suspension of supragingival dental plaque containing 6 x 10(6) colony-forming unit of bacteria were injected subcutaneously into the dorsa of mice. Abscess formation was induced in 76 of 85 mice using ten different plaque samples. Thirteen microorganisms were isolated from pus samples aspirated from abscess lesions. The microbial composition of pus, examined in 17 of 76 abscesses, was very simple compared to that of the plaque sample that had induced the abscess. The majority of the isolates belonged to the Streptococcus anginosus group, normally a minor component of plaque samples. S. anginosus was the most frequently detected organism and the most prevalent in seven abscesses, and Streptococcus intermedius and Streptococcus constellatus were predominant in one and three abscess samples, respectively. Each isolate of S. anginosus group produced abscesses in mice, and heat-treated supragingival dental plaque influenced the abscess-forming ability of S. anginosus isolate. These isolates possessed a high antiphagocytic capacity against human polymorphonuclear leukocytes. Our results suggest that human supragingival dental plaque itself is a source of the infectious pathogens that cause abscess formation.