Fatal Streptococcus pseudoporcinus disseminated infection in decompensated liver cirrhosis: a case report
George D Liatsos1, Athanasia Tsiriga2, Spyridon P Dourakis3
1Department of Internal Medicine, "Hippokration" General Hospital, 114 Vass. Sophia's Ave., 115 27, Athens, Greece. geoliatsos@yahoo.gr.
Background:
Streptococcus pseudoporcinus (S. pseudoporcinus) was first identified in 2006. It cross-reacts with Lancefield group B antigen agglutination reagents and has been misidentified as S. agalactiae. Sites of S. pseudoporcinus isolation include the female genitourinary tract, urine, wounds, and dairy products. The prevalence of vaginal colonization is reportedly between 1 and 5.4%. Two uneventful cases of soft tissue infection caused by S. pseudoporcinus were reported in the past. However, since late 2019, six cases of invasive S. pseudoporcinus infections have emerged in the literature, one of which was fatal.
Case Presentation:
We describe a fatal case of a Caucasian male with spontaneous bacterial peritonitis associated with bacteremia due to a multidrug-resistant S. pseudoporcinus strain in a patient with decompensated liver cirrhosis. Despite the patient's good general condition and stable blood test results when he had visited the outpatient clinic for large-volume paracentesis a few days before admission, this time he presented to the emergency department with a rapidly worsening clinical condition and with laboratory features consistent with multiple-organ dysfunction syndrome, and succumbed within a short period.
Conclusions:
Contrary to what was thought until recently, multidrug-resistant S. pseudoporcinus may cause invasive, disseminated, fatal disease in humans. According to current limited data, vancomycin, linezolid, daptomycin, levofloxacin, clindamycin, and tetracycline seem to be the most effective antimicrobial agents against multidrug-resistant strains, and should be the empirical choice in cases of disseminated S. pseudoporcinus infection until laboratory antimicrobial susceptibility results are available. Improvements and new approaches for bacterial identification in routine clinical microbiology laboratories may reveal the real spectrum of S. pseudoporcinus infections in humans, which is currently believed to be underestimated. SS. pseudoporcinus could emerge as a serious medical problem in the near future, similar to other β-hemolytic streptococci.
Insights
Multidrug-resistant Streptococcus pseudoporcinus, previously misidentified, can cause severe invasive infections. This bacterium may lead to fatal outcomes, necessitating prompt and effective antimicrobial treatment.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Bacteriology
Background:
- Streptococcus pseudoporcinus, identified in 2006, is often misidentified as S. agalactiae due to Lancefield group B antigen cross-reactivity.
- Reported isolation sites include the genitourinary tract, urine, wounds, and dairy products, with vaginal colonization prevalence between 1-5.4%.
- Previously, only two cases of soft tissue infection were documented; however, since 2019, six invasive cases have emerged, including one fatality.
Observation:
- A fatal case of spontaneous bacterial peritonitis with bacteremia caused by a multidrug-resistant S. pseudoporcinus strain is presented.
- The patient, a male with decompensated liver cirrhosis, rapidly deteriorated from a stable condition to multiple-organ dysfunction syndrome.
- Despite initial stability, the patient succumbed shortly after presentation to the emergency department.
Findings:
- Multidrug-resistant S. pseudoporcinus can cause invasive, disseminated, and fatal human infections, challenging previous assumptions.
- Effective antimicrobial agents identified include vancomycin, linezolid, daptomycin, levofloxacin, clindamycin, and tetracycline.
- Improved bacterial identification methods may uncover a broader spectrum of S. pseudoporcinus infections, currently considered underestimated.
Implications:
- S. pseudoporcinus may represent a significant future public health concern, akin to other beta-hemolytic streptococci.
- Prompt empirical treatment with effective agents is crucial for disseminated S. pseudoporcinus infections pending susceptibility results.
- Enhanced diagnostic capabilities in clinical microbiology are vital for accurate identification and understanding the true prevalence of S. pseudoporcinus infections.
