Moffitt Pearls 9/19: Septation and Strep anginosus

Thanks to Katie and Lily for presenting the case of an older man with oral cavity SCC who acutely developed cough, fevers, and was found to have an empyema with Streptococcus anginosus.

Top Pearls:

  • Per Harry: sonographic septation within a pleural effusion is a radiographic Light’s criterion (see article below of septation predicting empyemas)
  • Streptococcus anginosus is recognized as normal oral/GI tract flora in humans with the sneaky ability to cause abscesses which sets it apart from other pathogenic strep

More knowledge nuggets! Streptococcus anginosus

  • …is part of the Streptococcus anginosus group which is a subgroup of viridans streptococci and consists of three distinct species: S. intermedius, S. constellatus, S. anginosus (see figure below; bottom row is the bacteria of the hour!)
  • Has propensity for invasion, meningitis, abscess production, and bacteremia
  • Can have buttery, butterscotch-like smell (mmmmm!) due to diacetyl. This is a useful, but not a sufficiently sensitive screening test
  • RARELY a contaminant when present in blood cultures
  • Mechanism of infxn includes producing pyrogenic exotoxins or hydrolytic enzymes such as hyaluronidase that spread organisms through tissues and tissue planes
  • Synergizes with other bacteria, esp anaerobes and members of Enterbacteriaceae family
  • Generally sensitive to our favorite abx: PCN!!!




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