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COMPLICATED PNEUMONIA WITH EMPYEMA CAUSED BY STREPTOCOCCUS ANGINOSUS IN A CHILD
Ana Reis-Melo1, Diana Soares2, Manuel Ferreira Magalhães1
1Centro Hospitalar de São João, Porto, Portugal.
Insights
Streptococcus anginosus can cause severe pediatric infections like empyema. Early intervention with surgery and antibiotics improves outcomes for these rare but serious cases.
Area of Science:
- Pediatric Infectious Diseases
- Thoracic Surgery
- Medical Microbiology
Background:
- Streptococcus anginosus, a common oral commensal, is increasingly recognized for causing severe systemic infections.
- While rare in children, thoracic infections due to S. anginosus, such as empyema, pose significant clinical challenges.
- Prompt diagnosis and management are crucial for favorable outcomes in pediatric patients.
Observation:
- A 6-year-old boy with developmental delay presented with fever and respiratory distress, diagnosed with complicated pneumonia and empyema.
- Initial treatment included antibiotics and thoracic drainage, but the patient deteriorated.
- The child subsequently underwent video-assisted thoracoscopic decortication, leading to clinical improvement.
Findings:
- Pleural fluid cultures confirmed Streptococcus anginosus as the causative agent.
- The infection led to severe empyema, necessitating advanced surgical intervention.
- S. anginosus demonstrates a propensity for abscess and empyema formation.
Implications:
- This case underscores the importance of considering S. anginosus in pediatric complicated pneumonia and empyema.
- Aggressive management, including surgical decortication, may be required for severe S. anginosus thoracic infections.
- Early and appropriate intervention, combining antibiotics and surgical procedures, is key to improving outcomes in pediatric empyema.
Objective:
To highlight the pathogenicity of Streptococcus anginosus, which is rare in pediatric patients, but can cause severe infections that are known to have a better outcome when treated early with interventional procedures and prolonged antibiotic therapy.
Case:
description: The patient is a 6-year-old boy with global developmental delay, examined in the emergency room due to fever and respiratory distress. The physical examination and diagnostic workout revealed complicated pneumonia with empyema of the left hemithorax; he started antibiotic therapy and underwent thoracic drainage. Pleural fluid cultures grew Streptococcus anginosus. On day 11, the child had a clinical deterioration with recurrence of fever, hypoxia, and respiratory distress. At this point, considering the causative agent, he was submitted to video-assisted thoracoscopic decortication, with good progress thereafter.
Comments:
Streptococcus anginosus is a commensal bacterium of the human oral cavity capable of causing severe systemic infections. Although reports of complicated thoracic infections with this agent are rare in the pediatric population, they have been increasing in adults. Streptococcus anginosus has a high capacity to form abscess and empyema, requiring different therapeutic approaches when compared to complicated pneumonia caused by other agents.
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