Fatal Streptococcus pseudoporcinus disseminated infection in decompensated liver cirrhosis: a case report

Abstract

Background Streptococcus pseudoporcinus (S. pseudoporcinus) was first identified in 2006. It cross-reacts with Lancefield group B antigen agglutination reagents and has been misidentified as S. agalactiae. Sites of S. pseudoporcinus isolation include the female genitourinary tract, urine, wounds, and dairy products. The prevalence of vaginal colonization is reportedly between 1 and 5.4%. Two uneventful cases of soft tissue infection caused by S. pseudoporcinus were reported in the past. However, since late 2019, six cases of invasive S. pseudoporcinus infections have emerged in the literature, one of which was fatal. Case presentation We describe a fatal case of a Caucasian male with spontaneous bacterial peritonitis associated with bacteremia due to a multidrug-resistant S. pseudoporcinus strain in a patient with decompensated liver cirrhosis. Despite the patient’s good general condition and stable blood test results when he had visited the outpatient clinic for large-volume paracentesis a few days before admission, this time he presented to the emergency department with a rapidly worsening clinical condition and with laboratory features consistent with multiple-organ dysfunction syndrome, and succumbed within a short period. Conclusions Contrary to what was thought until recently, multidrug-resistant S. pseudoporcinus may cause invasive, disseminated, fatal disease in humans. According to current limited data, vancomycin, linezolid, daptomycin, levofloxacin, clindamycin, and tetracycline seem to be the most effective antimicrobial agents against multidrug-resistant strains, and should be the empirical choice in cases of disseminated S. pseudoporcinus infection until laboratory antimicrobial susceptibility results are available. Improvements and new approaches for bacterial identification in routine clinical microbiology laboratories may reveal the real spectrum of S. pseudoporcinus infections in humans, which is currently believed to be underestimated. SS. pseudoporcinus could emerge as a serious medical problem in the near future, similar to other β-hemolytic streptococci.

Case report: Multidrug-resistant Streptococcus pseudoporcinus isolated from an infected surgical wound of a 9-year-old spayed female Great Dane dog

“…On blood agar plates, colonies were small, round, and circular with β-hemolysis. This characteristic is similar to biochemical profiles shown by Streptococcus agalactiae (group B Streptococcus, GBS) (3). Consequently, this cross-reaction with standard GBS test kits raises concerns about the misdiagnosis of this bacterium in suspected GBS cultures.…”

“…Microbiological testing on the wound swab revealed the causative agent as S. pseudoporcinus. This bacterium is a usual colonizer of healthy female genitourinary tracts and has been implicated in liver cirrhosis, leg cellulitis, endocarditis, thumb infection, and fetal demise (3,(5)(6)(7)(8)(9) and has also been associated with bacteremia in a patient co-infected with Syphilis-HIV (5,10).…”

Untitled

“…First recordings demonstrated S.pseudoporcinus as an emerging pathogen for adverse maternal or neonatal outcomes in pregnancy [3][4]. Additionally, it has been reported as the virulent factor of soft tissue infections [1,5,15] or for more invasive infections, for instance bacteremia/infective endocarditis [6][7][8][9][13][14][15] and peritonitis [9]. In fact, 5 cases of S. pseudoporcinus related endocarditis have been identified through a thorough literature review [5][6][7][8], all involving native valves.…”

Endocarditis with Streptococcus pseudoporcinus Associated with Mastocytosis and Spondylodiscitis—A Coincidental Association? A Case Report

“…Two cases of infective endocarditis have been reported in the literature [ 3 , 4 ], a case of pneumonia complicated with empyema associated with Prevotella oris [ 3 ], and a case of bacteremia in an immunosuppressed patient with syphilis and HIV co-infections [ 5 ]. Vergadi et al report a difficult-to-treat case of cellulitis associated with bacteremia in a pediatric patient with Klippel-Trenaunay syndrome [ 6 ], Liatsos et al report spontaneous peritonitis in a patient with liver cirrhosis with unfavorable outcome [ 7 ], and more recently, Dong et al describe a case of orbital cellulitis resulting in corneal perforation, that required both antibiotic therapy and surgical intervention [ 8 ].…”

“…In terms of antibiotic susceptibility testing, S. pseudoporcinus is susceptible to beta-lactams, macrolides, glycopeptides, sulfamethoxazole/trimethoprim, and clindamycin, and is resistant to tetracycline [ 11 ]. Liatsos et al isolates a multidrug resistance strain, a strain that was resistant to penicillin, third-generation cephalosporins, and carbapenems [ 7 ].…”