The Role of Corticosteroids in Adult Respiratory Distress Syndrome Caused by Viridans Group Streptococci Bacteremia in Neutropenic Patients

Abstract

In the past decades, viridans group Streptococci (VGS) have emerged as an important cause of bacteremia in neutropenic patients with cancer. The clinical course of VGS bacteremia can be devastating including septic shock and adult respiratory distress syndrome (ARDS). It has been suggested that septicemia with VGS triggers the development of noncardiogenic pulmonary edema in patients with pre-existing damage of the lungs due to aggressive cytotoxic treatment. Thus, the preemptive administration of corticosteroid to patients diagnosed with VGS bacteremia with early onset of respiratory failure has been employed to prevent ARDS. While this management strategy has been suggested in the literature, little published data are available to validate this practice. In this study, we sought to review the benefit of early administration of corticosteroid to patients who developed symptom or early signs of respiratory failure while being neutropenic with VGS bacteremia.

Plantar Purpura as the Initial Presentation of Viridians Streptococcal Shock Syndrome Secondary toStreptococcus gordoniiBacteremia

“…sanguinis group, and is one of the VGS, a genetically heterogeneous group of bacteria predominating in the human oropharynx [ 15 ]. The risk factors associated with VGS that have been identified are oral mucositis [ 16 ], profound neutropenia, high-dose chemotherapy like cytosine arabinoside, malignancy, particularly in pediatric patients with leukemia [ 17 ] and neutropenic cancer [ 10 ] and patients undergoing stem-cell transplants [ 18 ], antimicrobial prophylaxis with trimethoprim-sulfamethoxazole or fluoroquinolone, and the use of antacids, histamine type 2 receptor antagonists, or proton pump inhibitors [ 19 , 20 ]. Our patient did not have oral symptoms and showed no evidence of mucositis.…”

“…The mortality rate among patients with VGS bacteremia who develop complications is high: up to 80% in some case series and between 40% and 100% in children [ 18 ]. The current reported VGS species related VSSS include S. mitis , S. oralis, and S. viridans [ 20 ]. S. mitis is the most common VGS species associated with VSSS compared to non- S. mitis organisms [ 2 , 19 ].…”

“…Yacoub et al proposed that the administration of moderate dose corticosteroids with short administration duration may be beneficial for preventing the development of ARDS in patients with S . mitis bacteremia [ 20 ]. Yacoub et al carried out a study among a group of VSSS patients and reported a 100% recovery from ARDS.…”

“…Yacoub et al carried out a study among a group of VSSS patients and reported a 100% recovery from ARDS. Though the case number is small, the study results may give VSSS a novel direction for effective therapy [ 20 ]. Our patient did not receive corticosteroid therapy during the hospital course due to no definite evidence of initial corticosteroid use according to the ARDS therapy guidelines.…”

Nutritionally Variant Streptococci Bacteremia in Cancer Patients: a Retrospective Study, 1999-2014

“…Unlike streptococcus viridans, NVS does not typically cause adult respiratory distress syndrome and septic shock and is more benign. 22 , 23 Although patients who develop fungemia, gram-negative bacteremia, or sepsis syndrome are best treated by catheter removal in addition to antimicrobial therapy, an increasing body of evidence suggests that many gram-positive bacterial catheter infections can be treated by use of antimicrobial agents without catheter removal. 24 , 25 …”