Peptostreptococcus infection is rarely reported in general practice, but this genus of anaerobic bacteria can cause infections of virtually any tissue. Osteomyelitis, endocarditis, genitourinary and upper respiratory tract infections, as well as central nervous system infections, have all been described in the literature. This pathogen, being sensitive to aerobic conditions, is often underrecognized due to improper sampling and storage. Meticulous microbiological workup is crucial in order to identify Peptostreptococcus as the cause of infection.
Presentation
Peptostreptococcus infection is a term encompassing a wide range of infections caused by Peptostreptococci, a large group of more than a dozen bacteria [1] [2] [3]. Peptostreptococci are the main representatives of Gram-positive anaerobic cocci and most notable species are Peptostreptococcus micros and Peptostreptococcus magnus, both being a part of the normal flora of the skin, genitourinary tract, and the oral cavity [1] [3] [4]. Although these bacterial species have been confirmed as causative agents of many types of infections, Peptostreptococcus seems to be missed in many cases, presumably because of its sensitivity to oxygen and poorly handled specimens obtained for microbiological investigations [1] [3] [5] [6] [7]. Nevertheless, endocarditis (involving both native and artificial valves), infections of the oral cavity, osteomyelitis, genitourinary (such as prostatitis) and respiratory tract infections, as well as central nervous system (CNS), cutaneous, and intra-abdominal infections, have all been documented by various authors [1] [2] [4] [5] [7] [8]. Furthermore, they are among the most frequently described pathogens when it comes to polymicrobial infections, especially in the formation of abscesses [4]. The clinical presentation depends on the site. Severe localized pain is typical for joint and other soft tissue infections [1], whereas high fever and chills, either with or without heart murmurs, are seen in cases of endocarditis [6].
Entire Body System
- Weight Loss
Summary A 44-year-old alcoholic (and therefore immunocompromised) hospital cleaner presented with general malaise, weight loss, and erythematous skin nodules. [ijidonline.com]
Chest pain, coughing, difficulty breathing, fever, foul-smelling sputum, and weight loss. Intraabdominal infection. Pain, fever, and possibly, if following surgery, foul-smelling drainage from the wound. Pelvic infection. [encyclopedia.com]
Respiratoric
- Pleural Effusion
Effusion (water on the lungs): 4 people, 57.14% Consciousness - Decreased: 4 people, 57.14% Leukocytosis (increased white blood cells): 4 people, 57.14% Ventricular Bigeminy (alternating normal sinus and premature ventricular complexes): 4 people, 57.14% [ehealthme.com]
Gastrointestinal
- Nausea
Azithromycin, Prednisone, Avelox, Clarithromycin ( latest reports from 239,089 Pneumonia patients ) Peptostreptococcus Infection Peptostreptococcus infection has been reported by people with metastases to bone, breast cancer, rheumatoid arthritis, nausea [ehealthme.com]
Skin
- Acne Vulgaris
P. acnes can cause shunt infections, 6 and play a role in the pathogenesis of acne vulgaris. Propionibacterium acnes Gram-negative bacilli Bacteroides fragilis group are the most frequently recovered species of Bacteroidaceae. [anaerobicinfections.blogspot.com]
Propionibacterium species are colonizing the human skin and mouth and are frequently recovered from mixed infections of the skin and soft tissue, acne vulgaris and infections linked to operative procedures or foreign bodies (13, 48). [antimicrobe.org]
Workup
The diagnosis of a Peptostreptococcus infection starts with a thorough clinical assessment. A detailed patient history, during which the physician must assess the presence of symptoms, their course, and progression, is highly important. The role of a proper physical examination has an equal value, particularly if endocarditis, osteomyelitis, or CNS infections are suspected. Once sufficient evidence is obtained and a presumptive diagnosis of an infection is made, microbiological testing is the cornerstone for identifying the underlying cause. Because Peptostreptococci are anaerobes, the use of swabs for obtaining a sample for evaluation can often yield a false-negative result. Aspirates, tissue specimens, or blood are much better samples for the preservation of Peptostreptococcus species during the process of microbiological identification [1] [4]. Despite the fact that Peptostreptococci are commensals of the skin and the oral cavity, their presence must not be overlooked when other sites are involved in the infectious process, particularly if a polymicrobial infection is recognized. Additional methods to confirm Peptostreptococcus are described, such as enzyme assays. The introduction of molecular methods such as polymerase chain reaction (PCR) has greatly improved the overall rate of the diagnosis [1] [3] [4].
Microbiology
- Staphylococcus Aureus
Dessutom Staphylococcus aureus samt Enterobacteriacae spp Ritters sjukdom (SSSS) ----- Staphylococcus aureus Sekundär peritonit ----- Se Bukabscess Septisk artrit ----- Enterobacteriaceae spp, GBS, Staphylococcus aureus, Haemophilus influenzae typ b, [referensmetodik.folkhalsomyndigheten.se]
Combined with Streptococcus pyogenes and Staphylococcus aureus (STAU) evoke anaerobic streptococcal myonecrosis clinically similar Clostridium myonecrosis, but with a slower course. [wikilectures.eu]
The infecting organism in these patients is usually Staphylococcus aureus or Pseudomonas aeruginosa. Peptostreptococcus species are Gram-positive anaerobic cocci and are part of the normal flora of human mucocutaneous surfaces. [tmu.pure.elsevier.com]
These include Staphylococcus aureus, Streptococcus species, Fusobacterium species, and pigmented Prevotella and Porphyromonas species. [emedicine.medscape.com]
- Streptococcus Pneumoniae
Available online at https://arupconsult.com/content/streptococcus-pneumoniae. Accessed on 5/05/18. Murdocy, D. et. al. (2017 June 15, Updated). The Diagnostic Utility of Induced Sputum Microscopy and Culture in Childhood Pneumonia. [labtestsonline.it]
References: [1] [2] Gram-positive cocci Streptococcus and enterococcus Genus Important species Reservoir Characteristics and important virulence factors Diseases Antibiotic of choice Streptococcus Streptococcus pneumoniae ( pneumococci ) Nasopharynx Facultative [amboss.com]
- Neisseria Gonorrhoeae
[…] meningitidis, Neisseria gonorrhoeae, Chlamydia trachomatis, Yersinia enterocolitica, Bartonella spp, tbb Prostataabscess ----- Neisseria gonorrhoeae, vanliga uropatogener, Staphylococcus aureus Prostatit ----- Se Akut bakteriell prostatit Protes-/implantatinfektion [referensmetodik.folkhalsomyndigheten.se]
Pleura
- Pleural Effusion
Effusion (water on the lungs): 4 people, 57.14% Consciousness - Decreased: 4 people, 57.14% Leukocytosis (increased white blood cells): 4 people, 57.14% Ventricular Bigeminy (alternating normal sinus and premature ventricular complexes): 4 people, 57.14% [ehealthme.com]
Treatment
Antimicrobial treatment of orthopedic implant-related infections with rifampin combinations. Clin Infect Dis 1992, 14, 1251–1253. PubMed Google Scholar 15. Bengtson, S., Knutson, K., Lidgren, L. Treatment of infected arthroplasty. [link.springer.com]
[…] infections have decreased in the last 30 years and will continue to do so due to better treatment. [en.wikipedia.org]
This case highlights the importance of a multidisciplinary approach for an effective treatment of pyogenic brain abscess in HIV-1 patients. [mdpi.com]
Prognosis
Article Sidebar Published: Mar 18, 2014 Clinical Cases Keywords Ocular infections, Severe prognosis in ocular infections, Endophthalmitis, Peptostreptococcus tetradius. [pagepressjournals.org]
Prognosis Complete recovery should be achieved with the appropriate surgery and antibiotic treatment. Untreated or uncontrolled infections can cause severe tissue and bone destruction, which would require plastic surgery to repair. [encyclopedia.com]
Hence, pharmacotherapy for effective elimination of this potentially pathogenic microorganism can have a beneficial effect on the prognosis of root canal retreatments. [ijpsr.com]
[…] patients described in these studies were either newborns or were over 6 weeks of age and suffered from chronic debilitating disorders such as malignant neoplasms, immunodeficiencies, chronic renal insufficiency, or decubitus ulcers and carried a poor prognosis [ccforum.biomedcentral.com]
Etiology
The first years of the 21st century have witnessed many exciting discoveries in the etiology and pathogenesis of rheumatic disorders. [books.google.de]
The microbiology of pyogenic brain abscess has Staphylococcus and Streptococcus as the leading etiologic pathogens in immunocompetent individuals. Peptostreptococcus is also recognized as a common cause of brain abscess in this patient population. [mdpi.com]
Septic arthritis was experienced one week to one year after reconstructive surgery, and had evolved for several months to years before etiologic diagnosis in 5 cases. [pubmed.ncbi.nlm.nih.gov]
Mediastinit efter hjärtkirurgi – mikrobiologisk etiologi och patogenes. Svenska Läkarsällskapets riksstämma 2000, p.211. Hansson C, Hoborn J, Möller A, Swanbeck G. The microbial flora in venous leg ulcers without clinical signs of infection. [referensmetodik.folkhalsomyndigheten.se]
Epidemiology
Epidemiology: Peptostreptococcus species are commensal organisms in humans, living predominantly in the mouth, skin, gastrointestinal, vagina and urinary tracts, and compose a portion of the bacterial gut flora. [quizlet.com]
Tropical Countries 859 Endemic and Travelers Diarrhea in Tropical Countries 875 Eosinophilia in Travelers to Tropical Countries 881 Infections after Animal Bites and Scratches 885 EctoparasiteRelated Diseases 891 Human Immunodeficiency Virus and AIDS 903 Epidemiology [books.google.de]
J Infect 55:1–7 Article CAS PubMed Google Scholar Lamagni T (2014) Epidemiology and burden of prosthetic joint infections. [link.springer.com]
Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, Society for Healthcare Epidemiology [emedicine.medscape.com]
Tissierellia) Epidemiology[edit] Since they are commonly found in soils and in microbiota of humans and animals, Clostridia wounds and infections are found worldwide. [en.wikipedia.org]
Pathophysiology
A new species within the genus Peptostreptococcus is Peptostreptococcus hydrogenalis; it contains the indole-positive, saccharolytic strains of the genus. [9] Pathophysiology Peptostreptococcus organisms are part of the normal florae of human mucocutaneous [microjeganesh.blogspot.com]
Pathophysiology and treatment. New York: Marcel Dekker Inc., 1991. [referensmetodik.folkhalsomyndigheten.se]
A new species within the genus Peptostreptococcus is Peptostreptococcus hydrogenalis; it contains the indole-positive, saccharolytic strains of the genus. [10] Pathophysiology Peptostreptococcus organisms are part of the normal florae of human mucocutaneous [emedicine.medscape.com]
Prevention
Getting treatment for minor infections can help prevent the spread of bacteria. [healthline.com]
A patient's recovery from anaerobic infection depends on prompt and proper treatment according to the following principles: (1) neutralizing toxins produced by anaerobes, (2) preventing local bacterial proliferation by changing the environment, and (3 [emedicine.medscape.com]
Endemic and Travelers Diarrhea in Tropical Countries 875 Eosinophilia in Travelers to Tropical Countries 881 Infections after Animal Bites and Scratches 885 EctoparasiteRelated Diseases 891 Human Immunodeficiency Virus and AIDS 903 Epidemiology and Prevention [books.google.de]
The highlighting of oral infectious foci, their eradication, and the follow-up of patients who had been subject to a vascular graft procedures are essential elements in preventing any associated lesions. [jomos.org]
Hyaluronic acid capsule : prevents phagocytosis, forms mucoid colonies Frequently, protein F Erythrogenic exotoxin A : superantigen that causes toxic shock syndrome Bacitracin sensitive Erythrogenic scarlet fever exotoxins Head and neck: tonsillitis, [amboss.com]
References
- Riesbeck K, Sanzén L. Destructive Knee Joint Infection Caused by Peptostreptococcus micros: Importance of Early Microbiological Diagnosis. J Clin Microbiol. 1999;37(8):2737-2739.
- Capunitan JA, Conte HA. Peptostreptococcus species: an unusual cause of infective endocarditis. Conn Med. 2010;74(2):93-96.
- Murdoch DA. Gram-Positive Anaerobic Cocci. Clinical Microbiology Reviews. 1998;11(1):81-120.
- Riggio MP, Lennon A. Identification of Oral Peptostreptococcus Isolates by PCR-Restriction Fragment Length Polymorphism Analysis of 16S rRNA Genes. J Clin Microbiol. 2003;41(9):4475-4479.
- Wu PH, Lin YT, Lin CY, et al. Peptostreptococcus anaerobius infective endocarditis complicated by spleen infarction. Am J Med Sci. 2011;342(2):174-176.
- Van der Vorm ER, Dondorp AM, van Ketel RJ, Dankert J. Apparent Culture-Negative Prosthetic Valve Endocarditis Caused by Peptostreptococcus magnus. J Clin Microbiol. 2000;38(12):4640-4642.
- Brook I. Recovery of anaerobic bacteria from clinical specimens in 12 years at two military hospitals. J Clin Microbiol. 1988;26:1181-1188
- Magri V, Restelli A, Marras E, Perletti G. A severely symptomatic case of anaerobic chronic bacterial prostatitis successfully resolved with moxifloxacin therapy. Anaerobe. 2010;16(3):206-209.