<i>Enterococcus</i> pneumonia complicated with empyema and lung abscess in an HIV-positive patient. Case report and review of the literature

Vanschooneveld, Trevor; Mindru, Cezarina; Madariaga, Miguel G.; Kalil, André C.; Florescu, Diana F.

doi:10.1258/ijsa.2008.008456

Cited by 18 publications

(29 citation statements)

References 12 publications

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“…We conducted a literature search based on PubMed in an attempt to identify all published cases of pleuropulmonary infection due to enterococcus, without time limits. Twenty-four cases of Enterococcus-associated pleuropulmonary infection previously published in the literature were eventually summarized in Table 1 [6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]. The enterococcal pneumonia cases previously described in the literature mainly occurred in elderly patients with immunosuppression, organ transplantation, hematological malignancies, solid cancer, renal failure, cardiocerebrovascular disease and chronic obstructive pulmonary disease.…”

Section: Discussionmentioning

confidence: 99%

Vancomycin-resistant Enterococcus faecium pneumonia in a uremic patient on hemodialysis: a case report and review of the literature

Wang

Sun

et al. 2020

BMC Infect Dis

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Background: Even though enterococci can cause serious infections in multiple sites, they are a rare cause of pneumonia. We reported a uremic patient with vancomycin-resistant E. faecium (VRE-fm) pneumonia, possibly related to epileptic seizures. Case presentation: A 57-year old man with uremia on hemodialysis was admitted to the hospital with complaint of recurrent epileptic seizures, followed by a two-week history of recurrent fever and cough with purulent sputum. Chest CT demonstrated multiple exudation of both lungs. He was diagnosed as community acquired pneumonia. Despite antibiotic combination therapy, abnormal chest shadows aggravated. Sputum and blood cultures were initially negative, but later blood culture grew VRE-fm. We suspected aspiration of gastrointestinal content induced by epilepsy as the most likely mechanism. The patient was successfully treated with a four-week course of linezolid according to the antibiotic susceptibility testing. Conclusions: Physicians should consider multi-drug resistant organisms such as VRE in uremic patients with pneumonia that fails to resolve with broad-spectrum antibiotics, especially in the cases with aspiration induced by epilepsy, immunocompromised conditions, and repeated or prolonged hospitalizations.

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Section: Discussionmentioning

confidence: 99%

Vancomycin-resistant Enterococcus faecium pneumonia in a uremic patient on hemodialysis: a case report and review of the literature

Wang

Sun

et al. 2020

BMC Infect Dis

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“…Enterococci are rarely considered pulmonary pathogens; when isolated from respiratory samples, they are usually considered colonizers of the airway [5].…”

Section: Discussionmentioning

confidence: 99%

“…Case reports of Enterococcus spp. pneumonia, empyema and lung abscesses have been described, especially in patients with underlying diseases, including cirrhosis, alcoholism and nephrotic syndrome [5]. A study of serious infections due to Enterococcus concluded that over the course of 1 year 110 enterococcal infections were found across six hospitals, with 4% of those infections located in the respiratory tract [7].…”

Section: Discussionmentioning

confidence: 99%

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Enterococcus faecalis-associated lung abscess in a male adolescent- a case report

et al. 2020

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Background: Enterococci are rarely considered pulmonary pathogens; they are usually regarded as colonizers of the airway. The authors present the case of a previously healthy male adolescent, with complaints of fatigue and chest pain, who was diagnosed with Enterococcus faecalis-associated acute primary lung abscess. Case presentation: A previously healthy 17-year old boy was admitted to the pediatric ward due to a one-week history of fatigue, inspiratory left side chest pain, dry cough and nasal obstruction. On admission at the emergency department, he was afebrile, with no signs of respiratory distress, but with diminished breath sounds on the left side. A chest x-ray showed a round opacity on the posterior basal segment of the left lower lobe; he was discharged with oral amoxicillin 1000 mg three times a day with the diagnosis of community-acquired pneumonia. Due to the worsening of the productive cough with purulent stinking sputum he was re-evaluated after 4 days. Laboratory studies showed a leukocyte count of 15200/uL and a c-reactive protein of 172 mg/l. The chest computed tomography scan was suggestive of a consolidation of the left lower lobe base and a central abscess. An intravenous course of ceftriaxone and clindamycin was initiated, with a favourable clinical evolution. The bronchofibroscopy performed on day four after his admission revealed the presence of a tracheal bronchus and numerous purulent secretions. Culture examination of bronchoalveolar lavage fluid samples was positive (> 10^5) for Enterococcus faecalis. No complications were registered during his stay in the pediatric ward. He was discharged after a 14-day course of intravenous ceftriaxone and clindamycin, with the recommendation to complete a four-week course of oral amoxicillin/clavulanic acid. On his reevaluation 4 weeks after his discharge, he was asymptomatic. Conclusion: This case report highlights the importance of considering Enterococcus faecalis as an etiologic agent in cases of non-resolving or complicated cases of pneumonia, such as lung abscesses, even in young patients with no comorbidities or risk factors.

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“…2 They are uncommon but emerging agents of upper and lower airway diseases, in particular, pneumonia and thoracic empyema and may jeopardize the clinical outcome of compromised, hospitalized hosts, as well as affect outpatients. 3,4 In Indian scenario pertaining to children etiological profile of empyema mainly remains staphylococci and streptococci, Gram-negative and anaerobes are next in order and enterococcus has been reported…”

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confidence: 99%

A case of Enterococcus Fecalis Spontaneous Empyema with Coexistent Tuberculosis

Agrawal

Rana

Aggarwal

2018

JCD

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Enterococci are normal inhabitants of the human gastrointestinal tract, increasingly becoming important human pathogen posing therapeutic challenges for long. The unique natural resistance of enterococci to several types of antibiotics and their inherent capacity to survive in different environments allows them to survive, proliferate, and fill the void when antibiotic-susceptible organisms are eliminated, contributing to the frequency of enterococci in nosocomial infections and unusual clinical consequence. 1 A three and a half year old girl child from low socioeconomic status weighed 12 kg (<-2 zscore), height 92 cm (<-2 score) moderately malnourished as per WHO criteria presented with complaints of fever moderate to high grade, cough for 8 days, and breathing difficulty 1 day. She was receiving some oral antibiotic 1 day prior to admission; next pleurocentesis was done for respiratory distress, 200 mL pus was removed and referred immediately. She had no significant past, family history, child was sick looking, febrile, had respiratory distress, features of parapneumonic effusion. Cardiac and abdominal examination was unexceptional except mild nontender hepatomegaly. She was put on supportive treatment, broad spectrum antibiotics after sending cultures and other investigations. Immediate ICD was placed and 400 mL pus was drained out. Laboratory analysis of pus revealed TLC 220,000/mm with 98% neutrophis, sugar 20 mg/dL, protein 5 gm/dL, ADA 452 IU/L and AFB +ve, so ATT was started. Hematological analysis showed HB 10 gm%, TLC 20200/mm 3 with 86% polymorphs. Blood culture was sterile at 72 hours; LFT, RFT normal. Her serology was negative for HIV. Her USG abdomen was not significant other than mild hepatomegaly. She continued to have fever spikes although her toxicity was decreased. On day 4, pus culture grew vancomycin-resistant Enteroccus faecalis (VRE) and antibiotics were changed to linezolid and ciprofloxacin as per sensitivity report. She became afebrile by day 6, her ICD was removed on day 10 and was discharged after completion of 2 weeks of antibiotics on ATT, hematinics. X-ray chest showed lung expansion; CT chest not done due to financial constraint but USG abdomen and chest did not show any other abnormality. Family screen for TB was negative. DiscussionEnterococci is an important cause of nosocomial infection, infective endocarditis, wound infections, and urinary tract infections but very rarely causes spontaneous pleural empyema. The infection sometimes occurs in the presence of peritonitis, possibly because of a dysfunctional reticuloendothelial system, but cases of E. faecalis empyema in the absence of peritonitis have been reported as well. 2 They are uncommon but emerging agents of upper and lower airway diseases, in particular, pneumonia and thoracic empyema and may jeopardize the clinical outcome of compromised, hospitalized hosts, as well as affect outpatients. 3,4 In Indian scenario pertaining to children etiological profile of empyema mainly remains staphylococci and streptococci, Gram-nega...

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Enterococcus pneumonia complicated with empyema and lung abscess in an HIV-positive patient. Case report and review of the literature

Cited by 18 publications

References 12 publications

Vancomycin-resistant Enterococcus faecium pneumonia in a uremic patient on hemodialysis: a case report and review of the literature

Vancomycin-resistant Enterococcus faecium pneumonia in a uremic patient on hemodialysis: a case report and review of the literature

Enterococcus faecalis-associated lung abscess in a male adolescent- a case report

A case of Enterococcus Fecalis Spontaneous Empyema with Coexistent Tuberculosis

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