The clinical features of respiratory infections caused by the Streptococcus anginosus group

BMC Pulmonary Medicine

Hiroshi Mukae²  Chiharu Yoshii¹  Hiroshi Ishimoto²  Ikuko Shimabukuro¹  Kentaro Akata²  Keisuke Naito²  Kei Yamasaki²  Toshinori Kawanami²  Kazuhiro Yatera²  Shingo Noguchi¹ 

[1] Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan, 1-17-1, Hamamachi, Wakamatsuku, Kitakyushu city 808-0024, Fukuoka, Japan;Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu City 807-8555, Fukuoka, Japan

关键词: Pleural effusion;    Bacterial pleurisy;    Lung abscess;    Pneumonia;    S. anginosus group;   

Others  :  1231054
DOI  :  10.1186/s12890-015-0128-6

 received in 2015-06-25, accepted in 2015-10-15,  发布年份 2015

【 摘 要 】

Background

The Streptococcus anginosus group (SAG) play important roles in respiratory infections. It is ordinarily difficult to distinguish them from contaminations as the causative pathogens of respiratory infections because they are often cultured in respiratory specimens. Therefore, it is important to understand the clinical characteristics and laboratory findings of respiratory infections caused by the SAG members. The aim of this study is to clarify the role of the SAG bacteria in respiratory infections.

Methods

A total of 30 patients who were diagnosed with respiratory infections which were caused by the SAG bacteria between January 2005 and February 2015 were retrospectively evaluated.

Results

Respiratory infections caused by the SAG were mostly seen in male patients with comorbid diseases and were typically complicated with pleural effusion. Pleural effusion was observed in 22 (73.3%) patients. Empyema was observed in half of the 22 patients with pleural effusion. S. intermedius, S. constellatus and S. anginosus were detected in 16 (53.3 %), 11 (36.7 %) and 3 (10.0 %) patients, respectively. Six patients had mixed-infections. The duration from the onset of symptoms to the hospital visit was significantly longer in “lung abscess” patients than in “pneumonia” patients among the 24 patients with single infections, but not among the six patients with mixed-infection. The peripheral white blood cell counts of the “pneumonia” patients were higher than those of the “lung abscess” patients and S. intermedius was identified significantly more frequently in patients with pulmonary and pleural infections (pneumonia and lung abscess) than in patients with bacterial pleurisy only. In addition, the patients in whom S. intermedius was cultured were significantly older than those in whom S. constellatus was cultured.

Conclusions

Respiratory infections caused by the SAG bacteria tended to be observed more frequently in male patients with comorbid diseases and to more frequently involve purulent formation. In addition, S. intermedius was mainly identified in elderly patients with having pulmonary infection complicated with pleural effusion, and the aspiration of oral secretions may be a risk factor in the formation of empyema thoracis associated with pneumonia due to S. intermedius.

【 授权许可】

   
2015 Noguchi et al.

【 图 表 】

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【 参考文献 】

• [1]Wong CA, Donald F, Macfarlane JT. Streptococcus milleri pulmonary disease: a review and clinical description of 25 patients. Thorax. 1995; 50:1093-6.
• [2]Whiley RA, Fraser H, Hardie JM, Beighton D. Phenotypic differentiation of Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus strains within the “Streptococcus milleri group”. J Clin Microbiol. 1990; 28:1497-501.
• [3]Whiley RA, Beighton D, Winstanley TG, Fraser HY, Hardie JM. Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus (the Streptococcus milleri group): association with different body sites and clinical infections. J Clin Microbiol. 1992; 30:243-4.
• [4]El-Solh AA, Pietrantoni C, Bhat A, Aquilina AT, Okada M, Grover V, Gifford N. Microbiology of severe aspiration pneumonia in institutionalized elderly. Am J Respir Crit Care Med. 2003; 167:1650-4.
• [5]Takayanagi N, Kagiyama N, Ishiguro T, Tokunaga D, Sugita Y. Etiology and outcome of community-acquired lung abscess. Respiration. 2010; 80:98-105.
• [6]Ishida T, Tachibana H, Ito A, Yoshioka H, Arita M, Hashimoto T. Clinical characteristics of nursing and healthcare-associated pneumonia: a Japanese variant of healthcare-associated pneumonia. Intern Med. 2012; 51:2537-44.
• [7]Yamasaki K, Kawanami T, Yatera K, Fukuda K, Noguchi S, Nagata S, Nishida C, Kido T, Ishimoto H, Taniguchi H, Mukae H. Significance of anaerobes and oral bacteria in community-acquired pneumonia. PLoS One. 2013; 8:e63103.
• [8]Noguchi S, Mukae H, Kawanami T, Yamasaki K, Fukuda K, Akata K, Ishimoto H, Taniguchi H, Yatera K. Bacteriological assessment of healthcare-associated pneumonia using a clone library analysis. PLoS One. 2015; 10:e0124697.
• [9]Shinzato T, Saito A. The Streptococcus milleri group as a cause of pulmonary infections. Clin Infect Dis. 1995; 21 Suppl 3:S238-43.
• [10]Porta G, Rodríguez-Carballeira M, Gómez L, Salavert M, Freixas N, Xercavins M, Garau J. Thoracic infection caused by Streptococcus milleri. Eur Respir J. 1998; 12:357-62.
• [11]Ahmed RA, Marrie TJ, Huang JQ. Thoracic empyema in patients with community-acquired pneumonia. Am J Med. 2006; 119:877-83.
• [12]Siegman-Igra Y, Azmon Y, Schwartz D. Milleri group streptococcus--a stepchild in the viridans family. Eur J Clin Microbiol Infect Dis. 2012; 31:2453-9.
• [13]Sunwoo BY, Miller WT. Streptococcus anginosus infections: crossing tissue planes. Chest. 2014; 146:e121-5.
• [14]Jerng JS, Hsueh PR, Teng LJ, Lee LN, Yang PC, Luh KT. Empyema thoracis and lung abscess caused by viridans streptococci. Am J Respir Crit Care Med. 1997; 156:1508-14.
• [15]Kawanami T, Fukuda K, Yatera K, Kido M, Mukae H, Taniguchi H. A higher significance of anaerobes: the clone library analysis of bacterial pleurisy. Chest. 2011; 139:600-8.
• [16]Umeki K, Tokimatsu I, Yasuda C, Iwata A, Yoshioka D, Ishii H, Shirai R, Kishi K, Hiramatsu K, Matsumoto B, Kadota J. Clinical features of healthcare-associated pneumonia (HCAP) in a Japanese community hospital: comparisons among nursing home-acquired pneumonia (NHAP), HCAP other than NHAP, and community-acquired pneumonia. Respirology. 2011; 16:856-61.
• [17]Sakoda Y, Ikegame S, Ikeda-Harada C, Takakura K, Kumazoe H, Wakamatsu K, Nakanishi Y, Kawasaki M. Retrospective analysis of nursing and healthcare-associated pneumonia: analysis of adverse prognostic factors and validity of the selection criteria. Respir Investig. 2014; 52:114-20.
• [18]von Baum H, Welte T, Marre R, Suttorp N, Ewig S. Community-acquired pneumonia through Enterobacteriaceae and Pseudomonas aeruginosa: Diagnosis, incidence and predictors. Eur Respir J. 2010; 35:598-605.
• [19]Mukae H, Yatera K, Noguchi S, Kawanami T, Yamasaki K, Tokuyama S, Inoue N, Nishida C, Kawanami Y, Ogoshi T et al.. Evaluation of a rapid immunochromatographic ODK0501 assay for detecting Streptococcus pneumoniae antigens in the sputum of pneumonia patients with positive S. pneumoniae urinary antigens. J Infect Chemother. 2015; 21:176-81.
• [20]Molina JM, Leport C, Bure A, Wolff M, Michon C, Vilde JL. Clinical and bacterial features of infections caused by Streptococcus milleri. Scand J Infect Dis. 1991; 23:659-66.
• [21]Okada F, Ono A, Ando Y, Nakayama T, Ishii H, Hiramatsu K, Sato H, Kira A, Otabe M, Mori H. High-resolution CT findings in Streptococcus milleri pulmonary infection. Clin Radiol. 2013; 68:e331-7.
• [22]Ripley RT, Cothren CC, Moore EE, Long J, Johnson JL, Haenel JB. Streptococcus milleri infections of the pleural space: operative management predominates. Am J Surg. 2006; 192:817-21.
• [23]Junckerstorff RK, Robinson JO, Murray RJ. Invasive Streptococcus anginosus group infection-does the species predict the outcome? Int J Infect Dis. 2014; 18:38-40.
• [24]Gogineni VK, Modrykamien A. Lung abscesses in 2 patients with Lancefield group F streptococci (Streptococcus milleri group). Respir Care. 2011; 56:1966-9.
• [25]Claridge JE, Attorri S, Musher DM, Hebert J, Dunbar S. Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus (“Streptococcus milleri group”) are of different clinical importance and are not equally associated with abscess. Clin Infect Dis. 2001; 32:1511-5.
• [26]Kobashi Y, Mouri K, Yagi S, Obase Y, Oka M. Clinical analysis of cases of empyema due to Streptococcus milleri group. Jpn J Infect Dis. 2008; 61:484-6.
• [27]Teramoto S, Fukuchi Y, Sasaki H, Sato K, Sekizawa K, Matsuse T. High incidence of aspiration pneumonia in community- and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc. 2008; 56:577-9.
• [28]Shinzato T, Saito A. A mechanism of pathogenicity of “Streptococcus milleri group” in pulmonary infection: synergy with an anaerobe. J Med Microbiol. 1994; 40:118-23.