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Pleural Empyema Caused by Streptococcus intermedius and Fusobacterium nucleatum: A Distinct Entity of Pleural
Ruben Dyrhovden1, Tomas Mikal Eagan2,3, Øystein Fløtten2,3
1Department of Microbiology, Haukeland University Hospital, Bergen, Norway.
Background:
Many community-acquired pleural infections are caused by facultative and anaerobic bacteria from the human oral microbiota. The epidemiology, clinical characteristics, pathogenesis, and etiology of such infections are little studied. The aim of the present prospective multicenter cohort study was to provide a thorough microbiological and clinical characterization of such oral-type pleural infections and to improve our understanding of the underlying etiology and associated risk factors.
Methods:
Over a 2-year period, we included 77 patients with community-acquired pleural infection, whereof 63 (82%) represented oral-type pleural infections. Clinical and anamnestic data were systematically collected, and patients were offered a dental assessment by an oral surgeon. Microbial characterizations were done using next-generation sequencing. Obtained bacterial profiles were compared with microbiology data from previous investigations on odontogenic infections, bacteremia after extraction of infected teeth, and community-acquired brain abscesses.
Results:
From the oral-type pleural infections, we made 267 bacterial identifications representing 89 different species. Streptococcus intermedius and/or Fusobacterium nucleatum were identified as a dominant component in all infections. We found a high prevalence of dental infections among patients with oral-type pleural infection and demonstrate substantial similarities between the microbiology of such pleural infections and that of odontogenic infections, odontogenic bacteremia, and community-acquired brain abscesses.
Conclusions:
Oral-type pleural infection is the most common type of community-acquired pleural infection. Current evidence supports hematogenous seeding of bacteria from a dental focus as the most important underlying etiology. Streptococcus intermedius and Fusobacterium nucleatum most likely represent key pathogens necessary for establishing the infection.
Insights
Oral-type pleural infections, often caused by oral bacteria like Streptococcus intermedius and Fusobacterium nucleatum, are the most common community-acquired pleural infections. Dental infections are a significant risk factor, with bacteria spreading through the bloodstream.
Area of Science:
- Microbiology
- Infectious Diseases
- Pulmonology
Background:
- Community-acquired pleural infections frequently originate from oral microbiota, involving facultative and anaerobic bacteria.
- Epidemiology, clinical features, pathogenesis, and etiology of these oral-type infections are under-researched.
- A prospective multicenter cohort study aimed to comprehensively characterize oral-type pleural infections.
Purpose of the Study:
- To provide detailed microbiological and clinical characterization of oral-type pleural infections.
- To enhance understanding of the etiology and risk factors associated with these infections.
- To identify key bacterial species involved in the pathogenesis.
Main Methods:
- A 2-year prospective cohort study included 77 patients with community-acquired pleural infection.
- 63 patients (82%) had oral-type pleural infections, with systematic data collection and dental assessments.
- Next-generation sequencing was used for microbial characterization, comparing profiles with odontogenic infections and brain abscesses.
Main Results:
- 267 bacterial identifications across 89 species were made from oral-type pleural infections.
- Streptococcus intermedius and/or Fusobacterium nucleatum were dominant in all identified infections.
- High prevalence of dental infections and significant microbiological similarities to odontogenic infections and brain abscesses were observed.
Conclusions:
- Oral-type pleural infection is the predominant form of community-acquired pleural infection.
- Hematogenous spread of bacteria from dental foci is the primary suspected etiology.
- Streptococcus intermedius and Fusobacterium nucleatum are likely crucial pathogens in establishing these infections.
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