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Empyema caused by Streptococcus constellatus: a case report and literature review
Jingyan Xia1, Lexin Xia2, Hui Zhou2
1Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
Background:
Streptococcus constellatus is a member of Streptococcus anginosus group (SAG) that tends to cause pyogenic infections in various sites. However, Streptococcus constellatus is easily ignored by routine clinical laboratory tests for its prolonged anaerobic culture environment.
Case Presentation:
A 71-year-old man was admitted to our hospital due to productive cough, fever, chest pain and shortness of breath for 3 weeks. Chest computed tomography showed patchy opacities and right-sided pleural effusion, so a chest tube was inserted and purulent and hemorrhagic fluid was aspirated. The routine etiological examinations of the pleural effusion were all negative, and next-generation sequencing (NGS) detected Streptococcus constellatus. Intravenous piperacillin-tazobactam 4.5 g every 8 h was used accordingly. The patient recovered and subsequent chest computed tomography confirmed the improvement.
Conclusions:
We reported a case of empyema secondary to Streptococcus constellatus infection, which was identified by NGS, instead of bacterial culture. This case highlights the utility of NGS in detecting pathogens negative in traditional bacterial tests.
Insights
Streptococcus constellatus, a cause of pyogenic infections, was identified via next-generation sequencing (NGS) in a patient with empyema. This highlights NGS’s utility when traditional bacterial cultures fail.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Diagnostic Technology
Background:
- Streptococcus constellatus, part of the Streptococcus anginosus group (SAG), is associated with pyogenic infections.
- This bacterium is often overlooked in routine laboratory diagnostics due to its requirement for prolonged anaerobic culture conditions.
Observation:
- A 71-year-old male presented with symptoms of pneumonia and was found to have a right-sided pleural effusion.
- Initial etiological examinations of the pleural fluid were negative.
- Next-generation sequencing (NGS) successfully identified Streptococcus constellatus as the causative pathogen.
Findings:
- The patient was treated with intravenous piperacillin-tazobactam and showed clinical improvement.
- Chest computed tomography confirmed resolution of the empyema following treatment.
Implications:
- This case demonstrates the effectiveness of NGS in diagnosing infections caused by fastidious or difficult-to-culture bacteria.
- NGS offers a valuable alternative diagnostic tool when conventional methods yield negative results for suspected infections.
