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Clinical features of Streptococcus intermedius infection in children: a case series study
Zhufei Xu1, Lichao Gao2, Dan Xu1
1Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Insights
Streptococcus intermedius infections in children often lead to abscesses, particularly in the abdomen. High-throughput sequencing can aid diagnosis, even with negative cultures, for invasive pulmonary infections.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Clinical Microbiology
Background:
- Streptococcus intermedius is an opportunistic pathogen linked to severe outcomes in adults.
- Clinical data on pediatric Streptococcus intermedius infections are limited.
Purpose of the Study:
- To describe the clinical features, infection sites, and antibiotic susceptibility of Streptococcus intermedius in children.
- To highlight diagnostic challenges and potential improvements.
Main Methods:
- Retrospective case series of 40 children with Streptococcus intermedius infection.
- Bacterial cultures and high-throughput sequencing for diagnosis.
- Antibiotic susceptibility testing and evaluation of clinical manifestations.
Main Results:
- Most common infection sites: abdominal cavity, skin/soft tissue, intracranial, and pulmonary.
- High susceptibility to ceftriaxone, vancomycin, and linezolid; significant resistance to erythromycin and clindamycin.
- Pulmonary involvement included abscesses and pleural effusion; high-throughput sequencing identified cases with negative cultures.
Conclusions:
- Streptococcus intermedius infections in children carry a high risk of pus/abscess formation.
- Consider Streptococcus intermedius in pediatric pulmonary abscess/pleural effusion, even with negative cultures.
- Advancements in high-throughput sequencing are crucial to minimize misdiagnosis.
Introduction:
Streptococcus intermedius is an opportunistic pathogen associated with prolonged hospital stays and high mortality rates in adults. However, little is currently known about the clinical features of Streptococcus intermedius infection in children.
Methods:
This retrospective case series study included 40 children diagnosed with Streptococcus intermedius, confirmed through bacterial cultures or high-throughput sequencing. Antibiotic resistance was assessed through susceptibility testing. The site and clinical manifestations were evaluated for all patients.
Results:
The common infection sites were the abdominal cavity, skin and soft tissue, intracranial, and invasive pulmonary, with the abdominal cavity being the most frequently affected. The drug susceptibility test showed 100% sensitivity to ceftriaxone, levofloxacin, chloramphenicol, vancomycin, and linezolid, 92.6% sensitivity to penicillin, 73.3% resistance to erythromycin, and 76.7% resistance to clindamycin. Besides antibiotic therapy, surgical intervention or pus drainage was often necessary. Lung imaging of four patients revealed pulmonary abscesses, nodules, or encapsulated pleura. Two cases yielded positive culture results, while three were identified as positive through high-throughput nucleotide sequencing of pleural effusion.
Discussion:
In children with Streptococcus intermedius infection, emphasis should be placed on the risk of pus or abscess formation. In cases of pulmonary abscess and pleural effusion, especially in male children, Streptococcus intermedius should be suspected even if the culture is negative. Improvements in high-throughput nucleotide sequencing are required to reduce misdiagnosis rates.
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