A Case of Massive Empyema Caused byStreptococcus constellatusand Anaerobic Bacteria for Mental Retardation

Abstract

The Streptococcus milleri group, which also includes S. anginosus, S. intermedius and S. constellatus, is found in the oropharynx, upper respiratory tract, gastrointestinal tract, and urogenital tract mucosa. Bacteria in the Streptococcus milleri group are associated with bacteremia and abscess formation. Most of the reports of of Streptococcus milleri group (SMG) infection occur in patients with underlying medical conditions. Predisposing factors that have been associated with S. milleri group empyema include mucosal disturbances (sinusitis, periodontal disease, enteric disease), preceding to pneumonia, thoracic surgery, malignancy, neurological disease, alcohol abuse, and also diabetes mellitus. We report on a 42-year-old man with mental retardation. He who suffered from dyspnea and a fever that he had developed for over 14 days. S. constellatus and anaerobic bacterias (Prevotella buccae and Micromonas micros) were cultured. The patient was treated with the drainage of pleural effusion and clindamycin and levofloxacin.

An empyema caused by Streptococcus constellatus in an older immunocompetent patient

“…The virulence of the SAG is associated with its capsular materials, which contribute to the pathogenicity of the SAG in patients with empyema [7] . Empyema caused by the SAG can infect the lungs through aspiration of oral secretions, direct transmission by trauma or surgery, transmission from surrounding tissues, and blood circulation from other parts of the body [8] . Pneumonia, thoracic surgery, malignancy, diabetes, neurologic disease, alcohol abuse, and mucosal damage (sinusitis and periodontal disease) are known risk factors for empyema [9,10] .…”

“…[ 7 ] Empyema caused by the SAG can infect the lungs through aspiration of oral secretions, direct transmission by trauma or surgery, transmission from surrounding tissues, and blood circulation from other parts of the body. [ 8 ] Pneumonia, thoracic surgery, malignancy, diabetes, neurologic disease, alcohol abuse, and mucosal damage (sinusitis and periodontal disease) are known risk factors for empyema. [ 9 , 10 ] Traditionally, the most predominant factor has been assumed to be bacterial pneumonia, but the bacterial etiology of empyema is not necessarily similar to that of pneumonia.…”