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Rothia mucilaginosa: A Surprising Culprit of Pneumonia in an Absolute Immunocompetent Patient
Sujal R Agarwal1, Abhinandan Jangid2, Shashikala T Surkunda3
1MBBS Student, Department of Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India, Orcid: https://orcid.org/0009-0006-7609-0067.
Introduction:
Rothia mucilaginosa, a gram-positive coccus and typical resident of the oropharyngeal and upper respiratory system, has increasingly been recognized as a human pathogen since its first identification in 1978. While it commonly affects immunocompromised individuals, causing serious infections like endocarditis, septicemia, and pneumonia, infection in immunocompetent hosts is rare. This article presents a case of pneumonia caused by R. mucilaginosa in an immunocompetent individual.
Case Description:
A 42-year-old male with no significant medical history presented with a persistent cough and high-grade fever. Investigations revealed elevated neutrophils, C-reactive protein (CRP), and high-resolution computed tomography (HRCT) thorax indicating multifocal consolidation. Empirical management with piperacillin-tazobactam and clindamycin was ineffective, leading to a switch to meropenem-sulbactam. Bronchoalveolar lavage (BAL) identified R. mucilaginosa, prompting cotrimoxazole therapy. The patient's fever subsided, and inflammatory markers decreased. After a 2-week course and follow-up, the patient exhibited no symptoms or recurrence of infection and remained stable.
Discussion:
R. mucilaginosa primarily affects immunocompromised individuals or those with underlying comorbidities. Diagnosis requires careful specimen collection and identification techniques. Treatment is challenging due to variable antibiotic susceptibility, with vancomycin, third-generation cephalosporins, and rifampicin often used. The pathogen's ability to cause pneumonia in healthy individuals without comorbidities remains unreported. Underreporting due to misidentification and the need for awareness among clinicians are significant concerns in managing R. mucilaginosa infections.
Conclusion:
R. mucilaginosa is a significant pathogen causing pneumonia in diverse patient groups. Without formal treatment guidelines, diagnosis relies on clinical experience. Early detection and appropriate antibiotic therapy are crucial for effective management.
Insights
Rothia mucilaginosa pneumonia is rare in healthy individuals. This case highlights successful treatment with cotrimoxazole in an immunocompetent patient, emphasizing early diagnosis and awareness for this emerging pathogen.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pulmonology
Background:
- Rothia mucilaginosa, a gram-positive coccus, is a common oropharyngeal resident.
- It is increasingly recognized as a pathogen, typically causing severe infections in immunocompromised individuals.
- Infection in immunocompetent hosts is rare, with this case detailing pneumonia in such an individual.
Purpose of the Study:
- To present a rare case of Rothia mucilaginosa pneumonia in an immunocompetent adult.
- To discuss diagnostic challenges and treatment strategies for this pathogen.
- To raise clinician awareness regarding Rothia mucilaginosa as a potential pathogen in diverse patient groups.
Main Methods:
- A 42-year-old immunocompetent male presented with persistent cough and fever.
- Diagnostic workup included laboratory tests (neutrophils, CRP) and high-resolution computed tomography (HRCT) of the thorax.
- Bronchoalveolar lavage (BAL) identified Rothia mucilaginosa, guiding antibiotic therapy with cotrimoxazole.
Main Results:
- Initial empirical antibiotic therapy was ineffective.
- Following identification of Rothia mucilaginosa and initiation of cotrimoxazole, the patient's fever resolved, and inflammatory markers decreased.
- The patient completed a 2-week course of therapy and showed no signs of recurrence.
Conclusions:
- Rothia mucilaginosa pneumonia, though rare in immunocompetent hosts, can occur.
- Diagnosis requires meticulous specimen handling and identification, and treatment can be challenging due to variable antibiotic susceptibility.
- Increased clinical awareness and prompt, appropriate antibiotic therapy are crucial for managing Rothia mucilaginosa infections.
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