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Primary purulent mediastinitis due to Streptococcus milleri
H Shishido1, K Watanabe, K Matsumoto
1Department of Respiratory Diseases, Tokyo National Chest Hospital, Japan.
Respiration; International Review of Thoracic Diseases
|January 1, 1997
Summary
Streptococcus milleri caused purulent mediastinitis in a patient, resolving with clindamycin and surgical drainage. This suggests S. milleri should be recognized as a cause of mediastinitis, even without prior surgery.
Area of Science:
- Infectious Diseases
- Bacteriology
- Thoracic Surgery
Background:
- Mediastinitis is a serious infection of the mediastinum.
- Common causes include esophageal perforation and thoracic surgery.
- The role of Streptococcus milleri in primary mediastinitis is not well-established.
Observation:
- A 44-year-old male presented with primary purulent mediastinitis.
- The condition was successfully treated with a combination of parenteral antibiotics and surgical drainage.
- In vitro testing revealed clindamycin had the highest activity against the isolated Streptococcus milleri.
Findings:
- Streptococcus milleri was identified as the causative agent of primary purulent mediastinitis in this patient.
- Combined antibiotic therapy and surgical intervention led to complete resolution of the infection.
- Clindamycin demonstrated significant in vitro efficacy against the specific S. milleri isolate.
Implications:
- This case highlights Streptococcus milleri as a potential cause of primary purulent mediastinitis.
- The findings suggest that S. milleri should be considered in the differential diagnosis of mediastinitis, particularly in non-surgical cases.
- Effective management involves targeted antibiotic therapy, guided by in vitro susceptibility, and surgical drainage.