Infectious endarteritis in aortic coarctation: two spectra of an infrequent disease / Endarterite infecciosa na coarctação da aorta: dois espectros de uma doença pouco frequente

ABSTRACT Objective: To describe two different degrees of clinical commitment and results in the evolution of infectious endarteritis in patients without a previous diagnosis of aortic coarctation. Case description: Two male patients aged 13 and 9 years old were admitted. The first due to a fever for 2 months, which started after dental cleaning, and the second due to high blood pressure, both patients with asthenia and weight loss. In the first case, the transthoracic echocardiogram showed aortic coarctation, and the transesophageal echocardiogram showed the presence of vegetations in the post-coarctation area, without pseudoaneurysms, with blood culture positive for Streptococcus mitis. This patient was treated for six weeks with crystalline penicillin, resolving the infection without complications. The second case was assessed for high blood pressure with a history of fever, and was treated with antibiotics. When performing a transthoracic echocardiogram, aortic coarctation was observed with a saccular image classified as a pseudoaneurysm by angiography and tomography. Blood culture was negative, and the patient developed an episode of hematemesis whose initial etiology could not be determined. Before surgical repair, he had a second episode of copious hematemesis with hypovolemic shock and death. Comments: We need to have a high index of clinical suspicion to establish the diagnosis of aortic coarctation complicated by endarteritis and start the appropriate antibiotic treatment, always maintaining surveillance for the early detection of pseudoaneurysms.

RESUMO Objetivo: Descrever dois diferentes graus de comprometimento clínico e resultados na evolução de endarterite infecciosa em pacientes sem diagnóstico prévio de coarctação da aorta. Descrição do caso: Dois pacientes do sexo masculino com idades entre 13 e nove anos foram internados. O primeiro por febre durante dois meses, iniciada após limpeza dentária. O segundo por hipertensão arterial. Ambos com astenia e perda de peso. No primeiro caso, o ecocardiograma transtorácico mostrou coarctação da aorta e o ecocardiograma transesofágico revelou vegetações na área pós-coarctação, sem pseudoaneurismas. A hemocultura foi positiva para de Streptococcus mitis. Este paciente foi tratado por seis semanas com penicilina cristalina, resolvendo a infecção sem complicações. O segundo caso foi avaliado pela presença de hipertensão arterial, com história de febre tratada com antibióticos. Ao realizar o ecocardiograma transtorácico, observou-se coarctação da aorta com imagem sacular classificada como pseudoaneurisma pela angiografia e tomografia. A hemocultura foi negativa. O paciente desenvolveu um episódio de hematêmese, cuja etiologia inicial não pôde ser determinada. Antes da correção cirúrgica, apresentou um segundo episódio de hematêmese profusa, com choque hipovolêmico e óbito. Comentários: Devemos ter um alto índice de suspeição clínica para poder estabelecer o diagnóstico de coarctação da aorta complicada com endarterite e iniciar o tratamento antibiótico adequado. É preciso manter a vigilância para a detecção precoce de pseudoaneurismas.

Native 1st Metatarso-Phalangeal Joint Infection: A Rare Case Report / 대한족부족관절학회지

Septic arthritis is a serious medical condition that can lead to significant complications if misdiagnosed or mismanaged. A rare case of a 1st metatarso-phalangeal joint septic arthritis in a native joint is presented in a patient with no significant risk factors. A 41-year-old patient was referred by his general practitioner owing to ongoing pain and swelling over his native 1st metatarso-phalangeal joint with difficulty on weightbearing for three months. After a series of investigations, including blood tests and a foot magnetic resonance imaging, which were inconclusive, the patient was led to the operating theatre for sampling and washout of his joint. The samples taken in the theatres revealed septic arthritis with Streptococcus mitis as the causative microorganism. The patient was treated with six weeks of oral antibiotics with a good functional outcome. This case report illuminates this rare condition and makes foot and ankle surgeons aware of its existence. A high suspicion for this condition can prevent misdiagnosis and mismanagement.

A rare case of streptococcus mitis infective endocarditis complicated by heart failure in a lactating mother with recurrent breast engorgement

@#Infective endocarditis during breastfeeding is rare. To the best of the authors’ knowledge, this is the second recorded case of infective endocarditis in a lactating mother. It is known that women of child-bearing age are susceptible to infective endocarditis during pregnancy when the immune system is compromised.1 Nevertheless, past cases were also exposed to a systemic infection via milk infected by their infant’s oral commensal. Streptococcus mitis (S.Mitis) endocarditis in pregnancy has also been reported, whereby a lady delivered via caesarean section and underwent mitral valve reconstruction and annuloplasty.1 S. mitis is considered a pioneer streptococci commensal in human oral mucosa, appearing as early as 1-3 days after delivery.2 As a child grows, their oral mucosa will be colonized by more viridans streptococci, including the teeth, oropharynx and nasopharynx. In a mother who breastfeeds, a crack in the nipple and breast engorgement can be predisposing factors for systemic infection stemming from an infant’s oral commensal. Both cases of breastfeeding-related infective endocarditis caused by pioneer streptococcus viridans, S.mitis in our report and S.salivarius3 in the previous report, affected the left-sided valves

Acute leukemia complicated with streptococcus mitis bacteriaemia in 8 children / 中华实用儿科临床杂志

Objective To investigate the risk factors for childhood acute leukemia complicated with streptococcus mitis bacteriaemia and to explore a better therapeutic regimen of antibiotics.Methods Seventy-eight cases of childhood acute leukemia complicated with bacteriaemia hospitalized in Zhujiang Hospital of Southern Medical University from January 2012 to December 2016 were collected,among them there were 8 cases (10.26％) caused by streptococcus mitis.The susceptible factors,clinical manifestations,drug susceptibility,treatments and outcomes of 8 cases of streptococcus mitis bacteriaemia were summarized and analyzed.Results All of 8 cases were attacked during the agranulocytosis phase lasting for more than 1 week after chemotherapy for acute leukemia.Four cases of them had been exposed to the third-generation cephalosporins for more than 7 days,and 5 cases exposed to proton pump inhibitor (PPI) for more than 10 days.The incidence of remittent fever,shiver,stomatitis and pneumonia was 100.0％ (8/8 cases),62.5％ (5/8 cases),62.5％ (5/8 cases) and 62.5％ (5/8 cases),respectively.And severe pneumonia occurred at a rate of 37.5％ (3/8 cases).The sensitivity to Linezolid,Vancomycin,Penicillin and Cefotaxime was 100.0％,100.0％,37.5％ and 25.0％,respectively.Five of the 7 cases treated with Meropenem had a fever 3 days later and then they took Linezolid as a replacement according to the drug sensitivity.One case was treated with Cefoperazone-Sulbactam.The duration time of fever,positive blood culture,agranulocytosis and course of antibiotics therapy was 1-19 d(10.4 d on average),4-22 d(13.4 d on average),10-30 d (21.6 d on average),9-26 d (18.3 d on average),respectively.Among 3 patients with severe pneumonia,1 patient received the respirator assisted ventilation for 1 week.Conclusions Streptococcus mitis is one of the major causes of severe infection among children with acute leukemia.Agranulocytosis after chemotherapy,stomatitis,exposure to PPI and antibiotics may be the risk factors for streptococcus mitis infection.Fever,stomatitis,respiratory and digestive symptoms are the common clinical manifestations.Streptococcus mitis is resistant to Penicillin and Cefotaxime,but sensitive to Linezolid,which can shorten the course of infection and improve the outcomes.Thus,Linezolid may serve as an optional therapy for streptococcemia mitis bacteriaemia.

A Case of Splenic Botryomycosis Caused by Streptococcus mitis in a Patient with a Previous Distal Gastrectomy / 대한내과학회지

Botryomycosis is an uncommon chronic suppurative bacterial infection of the skin and visceral organs seen primarily in immunocompromised patients. Here, we report a case of splenic botryomycosis caused by Streptococcus mitis in a 53-year-old immunocompetent woman with a history of distal gastrectomy for advanced gastric cancer.

Actividad antibacteriana de Pelargonium peltatum (L.) L'Hér. sobre Streptococcus mutans, Streptococcus sanguis y Streptococcus mitis frente a clorhexidina / Antibacterial activity of Pelargonium peltatum (L.) L'Her. against Streptococcus mutans, Streptococcus sanguis and Streptococcus mitis versus chlorhexidine

Introducción: Pelargonium peltatum (L.) L'Hér (geranio hiedra) es ampliamente utilizado en medicina natural para el tratamiento de enfermedades bucales, pero se desconocen aún sus propiedades farmacológicas, actividad antibacteriana y la composición de sus fitoconstituyentes. Objetivo: realizar un estudio comparativo de la actividad antibacteriana in vitro del extracto acuoso obtenido de las hojas de Pelargonium peltatum (L.) L'Hér (geranio hiedra) sobre Streptococcus mutans, Streptococcus sanguis y Streptococcus mitis, frente a la clorhexidina. Métodos: para el ensayo antibacteriano se empleó el método de difusión en agar. Se trabajó con 18 muestras de microorganismos de cada especie mencionada, aisladas de los pacientes de una clínica dental. Posteriormente, se prepararon 6 concentraciones diferentes del extracto acuoso, para comparar la actividad antibacteriana frente al colutorio de clorhexidina. El análisis fitoquímico preliminar se realizó mediante el ensayo a la gota. Los datos obtenidos se sometieron a análisis estadísticos como estimadores de media y dispersión, análisis de varianza unifactorial y prueba de Tukey. Resultados: la más alta actividad antibacteriana se obtuvo en la concentración de 400 mg/mL y la más baja en la de 25 mg/mL del extracto acuoso, sobre las tres especies de Streptococcus, en comparación con la clorhexidina; con efecto similar a la concentración de 200 mg/mL. El ensayo fitoquímico preliminar indicó la presencia de flavonoides, taninos, esteroides, antocianinas y saponinas. Conclusiones: el extracto acuoso de Pelargonium peltatum tiene actividad antibacteriana sobre Streptococcus mutans, Streptococcus mitis y Streptococcus sanguis.

Introduction: Pelargonium peltatum (L.) L'Her (ivy geranium) is widely used in natural medicine for the treatment of oral disease, but its pharmacological properties, antibacterial activity and phytoconstituent composition are still unknown. Objective: carry out a comparative study of the in vitro antibacterial activity of the aqueous extract obtained from leaves of Pelargonium peltatum (L.) L'Her (ivy geranium) against Streptococcus mutans, Streptococcus sanguis and Streptococcus mitis versus chlorhexidine. Methods: the agar diffusion method was used for the antibacterial assay. A study was conducted of 18 samples of microorganisms from the above-mentioned species, isolated from patients cared for at a dental clinic. Six different concentrations were prepared of the aqueous extract to compare antibacterial activity versus the chlorhexidine gargle. Preliminary phytochemical analysis was conducted by drop assay. The data obtained were subjected to statistical analyses such as mean and dispersion estimators, unifactorial analysis of variance and Tukey's test. Results: the highest antibacterial activity against the three species of Streptococcus was obtained with the 400 mg/ml concentration, and the lowest with the 25 mg/ml concentration of the aqueous extract, in comparison with chlorhexidine, with a similar effect to the 200 mg/ml concentration. The preliminary phytochemical assay revealed the presence of flavonoids, tannins, steroids, anthocyanins and saponins. Conclusions: the aqueous extract of Pelargonium peltatum has antibacterial activity against Streptococcus mutans, Streptococcus mitis and Streptococcus sanguis.

A Case of Endogenous Streptococcus Mitis Endophthalmitis in a Patient with Staphylococcus Aureus Sepsis

PURPOSE: To report a case of endogenous endophthalmitis due to Streptococcus mitis in a patient with Staphylococcus aureus sepsis. CASE SUMMARY: A 77-year-old male complained of sudden visual loss and ocular pain in his right eye and was treated with intravenous antibiotics for Staphylococcus aureus sepsis. With a diagnosis of endogenous endophthalmitis, the patient received pars plana vitrectomy and intravitreal injection of antibiotics. Vitreous fluid was obtained before surgery, and the organism was identified as Streptococcus mitis. Twenty-one days after the surgery, intraocular inflammation was stabilized, and visual acuity was improved from light perception to 20/60. CONCLUSIONS: Appropriate sampling and culture of vitreous fluid are important for the diagnosis of endogenous endophthalmitis. The possibility that the causative organism of endogenous endophthalmitis may be different from the result of blood culture should be considered.

Queratopatía cristalina: diagnóstico clínico y microbiológico de una infección corneal infrecuente causada por el grupo Streptococcus mitis

El objetivo del presente informe es describir un caso de queratopatía cristalina causada por microorganismos pertenecientes al grupo Streptococcus mitis en una paciente que concurrió a la consulta oftalmológica por molestias en su ojo derecho. Al examen oftalmológico presentó un punto de sutura interrumpida de nylon 10-0 sin tensión y con secreciones mucosas adheridas. El punto flojo fue retirado bajo normas de asepsia. Se indicó colirio de moxifloxacina al 0,5 %; el ojo tuvo una evolución adecuada, con una correcta epitelización. Sin embargo, luego de 15 días desarrolló un infiltrado blanquecino arboriforme. Se tomó una muestra en el quirófano, enhebrando el trayecto intraestromal de la sutura retirada con sutura de vicryl 7-0. Se indicaron colirios de vancomicina con 50 mg/ml. El infiltrado se mantuvo estable durante 45 días, luego se incrementó el tamaño y se produjo necrosis tisular con peligro de perforación corneal. Se realizó un recubrimiento conjuntival bipediculado. La paciente evolucionó favorablemente y luego de la retracción espontánea del recubrimiento, se observó leucoma cicatrizal y neovasos corneales.

Crystalline keratopathy: an infrequent corneal infection produced by the Streptococcus mitis group. The objective of this report is to describe a case of crystalline keratopathy caused by the Streptococcus mitis group corresponding to a patient who attended hospital for discomfort in his right eye. The ophthalmological examination showed an interrupted stitch of 10-0 nylon suture without tension and with attached mucus secretions. The loose suture was removed under aseptic conditions. Moxifloxacin 0.5 % eye drops were topically indicated. The treated eye successfully epithelialized and evolved favorably. However, after 15 days, a white tree-shaped infiltrate developed. A corneal sample was taken in the operating room, threading the intrastromal path of the removed stitch with a 7-0 vicryl suture. Vancomycin 50 mg/ml drops were indicated. The infiltrate, which was stable for 45 days, later increased its size and tissue necrosis occurred with danger of corneal perforation. A bipedicle conjunctival flap was performed in the affected corneal area, which evolved favorably. After spontaneous conjunctival flap retraction, only corneal scarring and neovascularization outside the visual axis were observed.

Neonatal Sepsis Caused by Multi-Resistant Streptococcus Mitis

PURPOSE: Streptococcus mitis, one of the Viridans streptococci, is a normal female genital tract flora. It is known as a common cause of chorioamnionitis and subsequent abortions in perinatal period. Although it has been suggested to be less virulent they can cause severe neonatal infections. In this study, we focused on the clinical presentations of neonatal septicemia and the antibiotic susceptibilities of Streptococcus mitis. METHODS: Nine newborns for whom Streptococcus mitis was isolated from normally sterile sites were seen in the NICU of Eulji University Hospital from Jan. 1 to Dec. 31 2005. Medical records were reviewed for the perinatal risk factors, maternal clinical manifestations, obstetric complications and the placental pathologic findings. We also observed the neonatal clinical courses and antibiotic susceptibilities of Streptococcus mitis. RESULTS: All nine infants were high-risk newborns because of prematurity, low birth weight and/or co-morbid diseases. Clinical manifestations varied from asymptomatic to severe neonatal sepsis. Six cases resistant to ampicillin were all sensitive to vancomycin. Five among them had clinical sepsis, and one infant was asymptomatic. Three cases were sensitive to ampicillin, two of them were asymptomatic and one infant with sepsis was successfully treated with ampicillin and aminoglycoside. CONCLUSION: Streptococci mitis should not be overlooked as a contaminant when isolated from normally sterile sites. If Streptococci mitis or Viridans streptococci are recovered from a high-risk newborn showing no clinical response to penicillin, it would be better to switch antibiotics to vancomycin until the susceptibility results available.