A Case of Dialister pneumosintes Bacteremia-Associated Neck and Mediastinal Abscess

Abstract

Patient: Female, 30-year-old Final Diagnosis: Dialister pneumosintes bacteraemia associated mediastinal and neck abscess Symptoms: Diarrhoea • fever • vomiting Medication: — Clinical Procedure: Incision and drainage Specialty: General and Internal Medicine Objective: Rare disease Background: Dialister pneumosintes is a suspected periodontal pathogen. It can affect different parts of the body either by hematogenous transmission or regional spread. Here, we report a case of 30-year-old previously healthy woman diagnosed with mediastinal and neck abscess caused by this pathogen. Case Report: A 30-year-old woman presented with a 1-day history of fever, vomiting, and diarrhea. She was on her last dose of a 2-week course of oral antibiotic for suspected dental abscess. On admission, parenteral broad-spectrum antibiotic was started for sepsis of unknown source. Because of intermittent spike of high temperature despite being on an antibiotic, cross-sectional imaging was performed, which revealed a superior mediastinal abscess with extension in the neck. She was referred to the ENT surgeon for incision and drainage of the collection. However, the procedure was complicated by injury to the right internal jugular vein. Her postoperative period was also convoluted with the development of pulmonary embolism, followed by deep vein thrombosis of the right upper limb. Her pus polymerase chain reaction test detected 16s rRNA gene, suggestive of gram-negative anaerobic bacilli, and anaerobic blood culture grew Dialister pneumosintes . After a prolonged course of illness and antibiotic treatment, she recovered well, and now is back to her normal activities. Conclusions: Potential life-threatening complications may develop from periodontal infection by this microorganism. In patients being treated for sepsis of unknown origin, not responding to antibiotic treatment, and with a history of recent periodontal infection, a deep-seated abscess needs to be considered.

Severe Pneumonia and Sepsis Caused by Dialister pneumosintes in an Adolescent

“…Six of the reviewed cases show either a sinusal or dental focus as cause for the infection with D. pneumosintes [6,[13][14][15][16], the other reports don't further specify the supposed origin of D. pneumosintes even though all cases refer to D. pneumosintes as a known pathogen of the oropharyngeal cavity causing periodontitis and sinusitis as outlined before.…”

“…Interestingly, D. pneumosintes could also be identified in these lastly mentioned cases in anaerobic blood cultures due to a systemic bacteremia. Overall, more than half (six) of the reviewed reports could identify D. pneumosintes through blood cultures [4][5][6][13][14][15]. Most recently, a case of 30-year-old previously healthy woman was diagnosed with mediastinal and neck abscess caused by D. pneumosintes, after she already received a 2-week course of oral antibiotic for suspected dental abscess [15].…”

“…Out of these four, D. pneumosintes was cultivated in two cases with pneumonia from a bronchoalveolar lavage [10,11] and in the other two cases from pus of a drained brain abscess and liver [14,16]. In total 6 of the 10 reviewed cases needed surgical treatment [6,[13][14][15][16].…”

Lemierre Syndrome Due to Dialister pneumosintes: A Case Report

“…Although data are limited, a PubMed search yielded six other reports of bacteremia due to D. pneumosintes . 4 , 5 , 18–21 In our available literature review from PubMed search ( Table 3 ), D. pneumosintes caused severe infection in both children and adults, with women more likely to be infected than men. Notably, with our case included, 4 of 7 cases (57%) had oral infections such as cavities, gingivitis, and periodontitis.…”

“… 1 It is a commensal oral microbe and is mainly associated with oral cavity infections, such as gingivitis, 2 periodontitis, 3 and periapical abscess; 4 however, it sometimes causes severe systemic infections even in previously healthy patients. 5 …”