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The Streptococcus milleri group in chronic obstructive pulmonary disease
Lucie Navratilova1, Jan Bardon2, Radko Novotny1
1Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
Background And Aims:
S. anginosus, constellatus and intermedius, also known as the Streptococcus milleri group (SMG) are three streptococcal species more frequently detected in cases of invasive disease, abscesses and empyema in particular. Recent research suggests they play a role in exacerbations of cystic fibrosis (CF). Owing to poor recovery on standard culture media and difficult differentiation from non-pathogenic streptococci, SMG may be underdiagnosed in routine settings. We aimed to establish the incidence of SMG in chronic obstructive pulmonary disease (COPD) patients compared to CF patients and to examine possible links of SMG to exacerbations that plays a key role in progression of COPD.
Methods:
Altogether, 90 respiratory tract samples of patients suffering from CF or COPD were examined during the period from July 2012 to December 2013. Semi-selective McKay agar was used for primary cultivation of SMG and MALDI TOF MS was used for species identification that was confirmed by biochemical profiling and specific PCR.
Results:
We confirmed the presence of SMG in CF (17.6% incidence in adult patients) and newly established its presence in COPD (10.3% incidence). In COPD, SMG was detected in 4 cases of acute exacerbations, where no other bacterial pathogen was detected. In 3/4 cases, increased CRP level indicated bacterial infection as a cause of the exacerbation and in all 3 cases, patients recovered during antibiotic treatment.
Conclusions:
Our data indicate SMG may act as opportunist pathogens able to cause exacerbations in COPD.
Insights
The Streptococcus milleri group (SMG) was found in 10.3% of chronic obstructive pulmonary disease (COPD) patients, potentially causing acute exacerbations. This suggests SMG may act as an opportunistic pathogen in COPD, impacting disease progression.
Area of Science:
- Medical Microbiology
- Pulmonary Medicine
Background:
- The Streptococcus milleri group (SMG) comprises S. anginosus, S. constellatus, and S. intermedius.
- SMG is associated with invasive diseases, abscesses, empyema, and cystic fibrosis (CF) exacerbations.
- Underdiagnosis of SMG is common due to cultivation and differentiation challenges.
Observation:
- This study investigated SMG incidence in chronic obstructive pulmonary disease (COPD) and CF patients.
- 90 respiratory samples from CF and COPD patients were analyzed between July 2012 and December 2013.
- Semi-selective McKay agar, MALDI TOF MS, biochemical profiling, and PCR were used for SMG identification.
Findings:
- SMG was detected in 17.6% of adult CF patients and 10.3% of COPD patients.
- In COPD, SMG was identified in 4 cases of acute exacerbations without other pathogens.
- Bacterial infection was indicated by elevated CRP in 3 of these 4 COPD exacerbation cases, with successful antibiotic treatment.
Implications:
- SMG may function as an opportunistic pathogen in COPD exacerbations.
- These findings highlight the potential role of SMG in COPD pathogenesis and progression.
- Further research is warranted to understand SMG's clinical significance in COPD management.
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