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[Clinical spectrum of a common and insidious pathogen: Streptococcus milleri]
F Spertini1, J D Baumgartner, J Bille
1Département de médecine, Centre hospitalier universitaire vaudois, Lausanne.
Abstract:
We studied the clinical significance of S. milleri isolated in our hospital in 68 patients during a 18-month period. In 51 patients (median age: 43 years, no underlying diseases in 29 patients), the isolates were associated with significant infections. They were beta-hemolytic in 32 cases and non-hemolytic in 19. The primary infection sites were the head and neck area (21 cases), the lungs (5 cases of pneumonia), the gastrointestinal tract (12 cases), the urogenital tract (3 cases), the soft tissues (6 cases), and the heart (2 endocarditis). Two septicemias were of unknown origin. Head and neck infections and pneumonia were most often associated with beta-hemolytic strains, and bacteremia, gastrointestinal and urogenital tract infections with alpha-hemolytic strains. S. milleri was found in pure culture in 24 cases. Polymicrobial associated flora (27 cases) was more frequent in the abdominal infections (87%) than in supra-diaphragmatic infections (42%). Severe complications were observed in 12 head and neck infections (57%) (cerebral abscesses 3, lethal mediastinitis 2, osteitis 1, meningitis 1, other suppurative lesions 5). When abscesses were present (27 cases), surgery was required in all cases. Despite the high frequency and severity of local complications, the clinical outcome was usually favorable. However, deaths directly related to S. milleri infections occurred in 2 cases of mediastinitis complicating the course of apparently harmless primary infections. Owing to the possible occurrence of life-threatening complications, S. milleri infections require early identification, treatment and surgery when indicated.
Insights
Streptococcus milleri (S. milleri) causes serious infections, particularly in the head, neck, and lungs. Early identification and treatment are crucial for favorable outcomes, though severe complications like mediastinitis can be life-threatening.
Area of Science:
- Medical Microbiology
- Infectious Diseases
Context:
- Streptococcus milleri (S. milleri) is a group of bacteria often found in the human body.
- The clinical significance and infection patterns of S. milleri require further investigation.
Purpose:
- To analyze the clinical significance of S. milleri isolates in a hospital setting.
- To identify common infection sites, associated factors, and outcomes of S. milleri infections.
Summary:
- A study of 68 patients over 18 months found S. milleri associated with significant infections in 51 cases.
- Infections commonly occurred in the head and neck (21 cases) and lungs (5 cases), with beta-hemolytic strains linked to head/neck and pneumonia, and alpha-hemolytic strains to bacteremia and GI/GU infections.
- Severe complications, including cerebral abscesses and mediastinitis, were noted, especially in head and neck infections. Surgery was required for all abscesses. While outcomes were often favorable, two deaths resulted from mediastinitis, highlighting the potential severity.
Impact:
- S. milleri infections, despite often favorable outcomes, can lead to severe, life-threatening complications.
- Early identification, prompt treatment, and surgical intervention when indicated are essential for managing S. milleri infections effectively.