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Infections in a Modern Society
Published in Keith Struthers, Clinical Microbiology, 2017
For the IDU, social exclusion, poverty, malnutrition and drug use all contribute to weakening the individual's immune status. Repeated injections into the groin to access the femoral vein, for example, compromise the integrity of the skin and soft tissues. Repeated introduction of bacteria from the flora of the groin gives rise to cellulitis and abscess formation; septic thrombophlebitis of the femoral vein can also occur. Staphylococcus aureus, streptococci of the Streptococcus anginosus group and anaerobes should always be considered in these infections.
Telithromycin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Eric Wenzler, Keith A. Rodvold
Telithromycin has been tested in vitro on numerous Gram-positive species, including pathogens isolated from patients with varying sites of infection and levels of immunosuppression. Of 101 isolates of S. pneumoniae collected from patients with AECB, the organisms showed 100% and 98% susceptibility to telithromycin according to CLSI and EUCAST breakpoints, respectively, including strains producing biofilms (Vandevelde et al., 2014). Telithromycin has demonstrated retained activity against multidrug resistant (MDR) strains of S. pneumoniae, including those with penicillin MICs up to 32 mg/l, making telithromycin a viable option for empiric therapy of CAP in adults (Rodriguez-Cerrato et al., 2010). Importantly, telithromycin has also been shown to reduce the expression of the S. pneumoniae capsule, the mechanism responsible for the organism’s virulence, significantly better than penicillin (Brook and Hausfeld, 2006). Telithromycin has also demonstrated excellent activity against other species of Streptoccoccus, including those from the viridans group isolated from neutropenic cancer patients with bloodstream infections (Alcaide et al., 2001). Resistance to telithromycin has rarely been reported in strains of Streptococcus bovis (Rodriguez-Avial et al., 2005) and Streptococcus mitis (Malhotra-Kumar et al., 2004). Telithromycin has shown to be more effective than macrolides against clinical isolates from the Streptococcus anginosus group (Yamamoto et al., 2006), an increasingly clinically worrisome group of pathogens (Wenzler et al., 2015). Resistance among group A streptococci from pharyngeal cultures has also been exceedingly low at 0.2% (Green et al., 2005).
Frontal sinus abscess with cutaneous fistula secondary to Streptococcus constellatus
Published in Orbit, 2021
William Carrera, William B Lewis, Rona Z Silkiss
A 49 year-old man presented with a several-day history of right upper eyelid swelling and purulent discharge. He had a history of inhalational heroin use. Examination noted intact visual acuity, proptosis, lateral globe displacement, and a cutaneous fistula. MRI revealed an anterior orbital and right frontal sinus abscess with bony erosion of the walls of the frontal sinus and the superior orbital rim (Figure 1). He underwent drainage of the abscess and treatment with intravenous vancomycin, ceftriaxone, and metronidazole. He demonstrated rapid and marked improvement. Cultures taken at the time of drainage grew Streptococcus constellatus. Streptococcus constellatus, a member of the Streptococcus anginosus Group (SAG), is a commensal organism of the mucous membranes, but may form abscesses, commonly of the abdomen and respiratory tract. Orbital involvement of Streptococcus constellatus has been reported in association with Pott’s puffy tumor, orbital cellulitis, and cavernous sinus thrombosis and in one case with frontal sinus abscess. To our knowledge, neither frontal sinus cutaneous fistula nor an association with heroin inhalation has been previously described. Recent epidemiologic studies have suggested that SAG organisms are a significantly under-appreciated cause of orbital abscess and complicated sinusitis.
Odontogenic Lemierre’s syndrome with septic superior ophthalmic vein and cavernous sinus thrombophlebitis complicated by blindness and ophthalmoplegia
Published in Orbit, 2023
Donald Tran, Shivesh Varma, Thomas G. Hardy
Lemierre’s syndrome was suspected. After consultation with infectious diseases, empiric intravenous (IV) piperacillin/tazobactam, metronidazole, and vancomycin were commenced. Oral and maxillofacial surgery drained purulent collections from the right pterygomandibular and submasseteric spaces, and the patient was returned to the intensive care unit (ICU) post-operatively. Haematology was consulted, and therapeutic anticoagulation with enoxaparin was commenced. Surgical and blood culture specimens found heavy growth of the Streptococcus anginosus group and multiple anaerobes. Fusobacterium species were not cultured. Following sensitivity results, antibiotics were rationalised to IV ceftriaxone and metronidazole.
Microbiology of orbital cellulitis with subperiosteal abscess in children: Prevalence and characteristics of Streptococcus anginosus group infection
Published in Orbit, 2022
Caroline N Vloka, Donna H Kim, John D Ng
The most common organisms isolated in our series were pathogens from the Streptococcus anginosus group (9 S. anginosus, 1 S. intermedius) isolated in 37% of the patients. SAG organisms have been identified as the predominant pathogens in other studies that evaluated the microbiology of subperiosteal abscess in pediatric patients.2,9,16,18–23 Quintanilla-Dieck et al. (2016)22 found that almost 30% of their pediatric cohort had orbital cellulitis with SPA due to SAG infections. In their population, seven of the eight patients with this pathogen had a medial SPA. We found similar results with eight of the 10 patients with SAG having a medial SPA, as well as one superior and one inferior abscess.