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Published on: March 23, 2019
Streptococcus mitis as a New Emerging Pathogen in Pediatric Age: Case Report and Systematic Review
Claudia Colomba1,2, Valeria Garbo1, Giovanni Boncori1
1Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy.
Abstract:
Streptococcus mitis, a normal inhabitant of the oral cavity, is a member of Viridans Group Streptococci (VGS). Generally recognized as a causative agent of invasive diseases in immunocompromised patients, S. mitis is considered to have low pathogenic potential in immunocompetent individuals. We present a rare case of sinusitis complicated by meningitis and cerebral sino-venous thrombosis (CSVT) caused by S. mitis in a previously healthy 12-year-old boy with poor oral health status. With the aim of understanding the real pathogenic role of this microorganism, an extensive review of the literature about invasive diseases due to S. mitis in pediatric patients was performed. Our data define the critical role of this microorganism in invasive infections, especially in immunocompetent children and in the presence of apparently harmful conditions such as sinusitis and caries. Attention should be paid to the choice of therapy because of VGS's emerging antimicrobial resistance patterns.
Insights
Streptococcus mitis, a common oral bacterium, can cause severe invasive infections like meningitis and cerebral sino-venous thrombosis, even in healthy children. This highlights the importance of oral health and careful antibiotic selection due to emerging resistance.
Area of Science:
- Microbiology
- Infectious Diseases
- Pediatrics
Background:
- Streptococcus mitis (S. mitis) is a Viridans Group Streptococci (VGS) species typically found in the oral cavity.
- While generally considered low-pathogenicity in immunocompetent individuals, S. mitis can cause invasive diseases, particularly in immunocompromised patients.
Purpose of the Study:
- To investigate the pathogenic role of S. mitis in invasive infections.
- To review literature on invasive S. mitis diseases in pediatric patients.
- To highlight the importance of oral health status in invasive infections.
Main Methods:
- Case report of a previously healthy 12-year-old boy with sinusitis, meningitis, and cerebral sino-venous thrombosis (CSVT) caused by S. mitis.
- Extensive literature review on invasive S. mitis infections in pediatric populations.
Main Results:
- S. mitis can cause severe invasive infections, including meningitis and CSVT, in immunocompetent children.
- Poor oral health status (e.g., sinusitis, caries) may be a predisposing factor for invasive S. mitis infections.
- Emerging antimicrobial resistance patterns in VGS necessitate careful consideration of therapeutic choices.
Conclusions:
- S. mitis plays a critical role in invasive infections, even in immunocompetent children with predisposing conditions.
- Maintaining good oral hygiene is crucial for preventing invasive bacterial infections.
- Awareness of VGS antimicrobial resistance is essential for effective treatment strategies.
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Etiology
Three primary contributing factors have been identified.

