Tuberc Respir Dis.  2011 Dec;71(6):476-479.

A Case of Massive Empyema Caused by Streptococcus constellatus and Anaerobic Bacteria for Mental Retardation

Affiliations
  • 1Department of Internal Medicine, Kangwon National University Hospital, Kangwon National Univsersity School of Medicine, Chuncheon, Korea. pulmo2@kangwon.ac.kr

Abstract

The Streptococcus milleri group, which also includes S. anginosus, S. intermedius and S. constellatus, is found in the oropharynx, upper respiratory tract, gastrointestinal tract, and urogenital tract mucosa. Bacteria in the Streptococcus milleri group are associated with bacteremia and abscess formation. Most of the reports of of Streptococcus milleri group (SMG) infection occur in patients with underlying medical conditions. Predisposing factors that have been associated with S. milleri group empyema include mucosal disturbances (sinusitis, periodontal disease, enteric disease), preceding to pneumonia, thoracic surgery, malignancy, neurological disease, alcohol abuse, and also diabetes mellitus. We report on a 42-year-old man with mental retardation. He who suffered from dyspnea and a fever that he had developed for over 14 days. S. constellatus and anaerobic bacterias (Prevotella buccae and Micromonas micros) were cultured. The patient was treated with the drainage of pleural effusion and clindamycin and levofloxacin.

Keyword

Streptococcus milleri Group; Mental retardation; Empyema

MeSH Terms

Abscess
Adult
Alcoholism
Bacteremia
Bacteria
Bacteria, Anaerobic
Cheek
Clindamycin
Diabetes Mellitus
Drainage
Dyspnea
Empyema
Fever
Gastrointestinal Tract
Humans
Intellectual Disability
Mucous Membrane
Ofloxacin
Oropharynx
Periodontal Diseases
Pleural Effusion
Pneumonia
Respiratory System
Streptococcus
Streptococcus constellatus
Streptococcus milleri Group
Thoracic Surgery
Clindamycin
Ofloxacin

Figure

  • Figure 1 (A) Chest AP on admission shows massive pleural effusions and collapsed lung in the right lower lung field. (B) Pleural effusion decreased markedly after 7 weeks of treatment. AP: Anterior-Posterior.

  • Figure 2 (A) Multiloculated pleural effusion and air-fluid level are in the right anterior thorax. (B) Follow-up CT after 7 weeks of treatment shows markedly decreased multiloculated pleural effusion in the right thorax. CT: computed tomography.


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