Multiple liver abscesses with isolation of streptococcus intermedius related to a pyogenic dental infection in an immuno-competent patient
© I. Holzapfel Publishers 2010
Received: 20 February 2010
Accepted: 21 May 2010
Published: 26 July 2010
Streptococcus intermedius - a member of the Streptococcus anginosus group - is part of the normal microbial flora of the oral cavity. Despite being regarded as a harmless apathogenic commensal, Streptococcus intermedius has been described to cause abscesses in various locations of the body.
We report the clinical case and course of treatment of a 18-year-old male patient presenting with multiple hepatic abscesses associated with an untreated pyogenic dental infection.
Streptococcus intermedius can cause liver abscesses emerging from dental infectious foci even in previously healthy patients without underlying innate or aquired immunodeficiency. The case illustrates the potential danger and underestimated risk associated with untreated dental infections.
KeywordsStreptococcus intermedius Streptococcus anginosus liver abscess dental infection
Streptococcus intermedius is a member of the "Streptococcus anginosus group" (consisting of S. intermedius, S. constellatus, and S. anginosus), formerly also known as "Streptococcus miller group" or "Streptococcus intermedius group". Streptococcus intermedius is a spherical or ovoid, microaerophilic/anaerobic gram positive bacterium forming pairs or chains . The members of the Streptococcus anginosus group are frequently found in the human oral cavity, where they are considererd to be harmless commensals. They can also colonize the throat, nasopharynx, gastrointestinal tract, and genitourinary tract (which probably represents spread from the oral cavity). within the Streptococcus anginosus group, Streptococcus intermedius is most commonly found in dental plaques . Members of the S. anginosus group are regularly isolated from dental abscesses [3, 4] and have frequently been found to cause local and metastatic purulent infections [5, 6]. In particular Streptococcus intermedius has been reported to cause liver and brain abscesses (and rarely infective endocarditis) [2, 7–11]. As commensal organism of the intestinal tract members of the S. anginosus group have also been found to cause various infections within the abdominal cavity including liver abscesses, peritonitis, pelvic and subphrenic abscesses, appendicitis, abdominal wound infections and cholangitis [5, 12, 13]. Aspiration of commensal oropharyngeal Streptococcus anginosus can lead to pneumonia, lung abscess, and pleural empyema [3, 14–17]. Other infections caused by members of the Streptococcus anginosus s group are peritonsillar abscesses , mediastinitis , osteomyelitis , septic arthritis , and soft tissue infections [3, 21, 22]. An interesting feature of Streptococcus intermedius is the ability to replicate more rapidly in an environment with other microbes (e.g. Eikenella corrodens and anaerobes): It has been shown in vitro, that Streptococcus intermedius grows exponentially in mixed culture with E. cor rodens within 6 hours post inoculation, in comparison to 25 hours without E. corrodens . A possible clinical correlate of such a mixed infection has been described . In a murine model of pneumonia a synergistic effect between members of the S. anginosus group and oral anaerobes has been published (higher mortality, more histopathologic abnormalities and more viable bacteria in the lungs of mice with mixed infections than in the lungs of mice with monomicrobial infection) .
Our reported case corroborates published literature reporting Streptococcus intermedius as a cause of liver abscesses emerging from dental infectious foci even in previously healthy patients without underlying innate or aquired immunodeficiency [9, 24]. The case illustrates the potential danger and underestimated risk associated with untreated dental infections.
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