Combined Rothia dentocariosa and Streptococcus viridans Corneal Ulcer in an Immunocompromised Patient

Keratitis is a very common condition seen by ophthalmologists. However, many factors can complicate the treatment of this depending on the causative organism and other patient comorbid conditions. The objective of this clinical case report is to highlight the treatment of keratitis caused by Rothia dentocariosa. It also looks at the unique considerations in keratitis presentations for patients immunocompromised by chemotherapy agents. Our patient is a 58 yo female undergoing chemotherapy with folinic acid, fluorouracil, irinotecan, and panitumumab who presented with several days of a red, painful right eye with mucous discharge. Cultures were positive for Rothia dentocariosa and Streptococcus viridans. The patient ultimately underwent a conjunctival flap procedure as medical therapy with proper oral and topical antibiotics failed to resolve keratitis. This case is unique as previously, only a couple of cases of keratitis caused by Rothia dentocariosa have been reported and none of those patients were immunocompromised nor failed antibiotic therapy.

Multiple Cranial Nerve Palsies in a Pediatric Case of Lemierre’s Syndrome due to Streptococcus viridans

Background. Lemierre’s syndrome is a rare condition of internal jugular vein thrombosis following oropharyngeal infection. While it usually results from Fusobacterium necrophorum infection, atypical cases associated with other pathogens have been reported. Objective. To describe a unique case of pediatric Lemierre’s syndrome with Streptococcus viridans infection resulting in cavernous sinus thrombosis and oculomotor, trochlear, and abducens nerve palsies. Case Report. A 14-year-old female initially presented after six days of fever, myalgias, and sore throat and was admitted for hyperbilirubinemia and acute kidney injury. She developed a fixed, dilated pupil with complete ophthalmoplegia, ptosis, and severe pain. Imaging revealed retromandibular space abscess, external and internal jugular vein thrombosis, cavernous sinus thrombosis, internal carotid artery stenosis, pulmonary embolism, and bilateral pneumonia. She was diagnosed with Lemierre’s syndrome with cultures positive for Streptococcus viridans and treated with a combination of antibiotics and anticoagulation. Conclusion and Relevance. Both antibiotics and anticoagulation were effective management for this Lemierre’s syndrome patient with cavernous sinus thrombosis. Early diagnosis and treatment of Lemierre’s syndrome is essential. A multidisciplinary treatment team is beneficial for managing the sequelae of this condition.

Phlegmonous gastritis: a case series

Background Phlegmonous gastritis is a rare and fatal infectious disease of the stomach, presenting varied and nonspecific endoscopic images, which are therefore difficult to diagnose. This report discusses three cases of phlegmonous gastritis, each with unique endoscopic images, and considers the differential diagnosis of this disease. These cases were initially suspected of scirrhous gastric cancer, gastric syphilis, and acute gastric mucosal lesion. Case presentation Case 1 A 32-year-old Asian man visited our hospital complaining of upper abdominal pain. Endoscopy raised suspicion of scirrhous gastric cancer. However, a histopathological examination showed no malignant cells, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, which was effective. Case 2 A 33-year-old Asian man visited our hospital complaining of epigastralgia. Endoscopy raised suspicion of gastric syphilis. However, the serum test for syphilis was negative, and Streptococcus viridans was detected in the biopsy specimen culture, which led to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in significant improvement in the endoscopic image after 2 weeks. Case 3 A 19-year-old Asian man visited our hospital complaining of epigastric pain. Endoscopy raised suspicion of acute gastric mucosal lesion. A gastric juice culture showed Pseudomonas aeruginosa and Streptococcus viridans, thus leading to the diagnosis of phlegmonous gastritis. The patient was started on antibiotic therapy, resulting in the disappearance of the gastric lesions. Conclusion In severe cases of phlegmonous gastritis, immediate surgical treatment is generally required. However, the endoscopic images are varied and nonspecific. These three cases suggest that clinicians need to consider the differential diagnosis of phlegmonous gastritis and make accurate diagnoses at an early stage.

Uji Efektivitas Ekstrak Etanol Daun Upo-upo (Phyllodium pulchellum (L.) Desv.) sebagai Antibakteri terhadap Pertumbuhan Streptococcus viridans dan Streptococcus pyogenes

Telah dilakukan penelitian untuk menguji efektivitas ekstrak etanol daun Upo-upo (Phyllodium pulchellum (L.) Desv.) terhadap pertumbuhan Streptococcus viridans dan Streptococcus pyogenes. Penelitian ini bertujuan untuk menentukan konsentrasi ekstrak yang paling efektif. Penelitian ini menggunakan metode ekstraksi maserasi terhadap bahan uji dan uji mikrobiologis menggunakan metode Disc diffusion menurut Kirby & Bauer dengan konsentrasi ekstrak 1; 1,5; 2; dan 2,5%, dengan kontrol positif cefixime dan kontrol negatif CMC Na 1%. Hasil pengujian menunjukkan bahwa ekstrak etanol daun Upo-upo dapat menghambat pertumbuhan S. viridans pada konsentrasi ekstrak 1; 1,5; 2; dan 2,5%, masing-masing dengan diameter hambatan 9,01; 9,58; 10,24; dan 12,27 mm, sedangkan zona hambatan untuk kontrol positif 22,07 mm dan kontrol negatif tanpa zona hambatan. Zona hambatan terhadap S. pyogenes pada konsentrasi ekstrak 1; 1,5; 2; dan 2,5% masing-masing adalah 9,51; 9,91; 10,93; dan 13,59 mm, dimana zona hambatan kontrol positif 25,77 mm dan kontrol negatif tanpa zona hambatan. Dapat disimpulkan bahwa ekstrak etanol daun Upo-upo pada semua tingkat konsentrasi mempunyai efektivitas antibakteri terhadap S. viridans dan S. pyogenes. Efektivitas antibakteri ekstrak etanol daun Upo-upo terhadap pertumbuhan S. viridans dan S. pyogenes menunjukkan bahwa semakin tinggi konsentrasi ekstrak, maka semakin besar pula zona hambat yang dihasilkan. Konsentrasi yang paling efektif adalah 2,5%.

Tratamento da endocardite bacteriana causada pelo uso de prótese valvar e cateteres: uma revisão bibliográfica

Objetivo: O presente trabalho tem como objetivo a realização de uma revisão bibliográfica em relação aos possíveis tratamentos da endocardite bacteriana, causada pelo uso de prótese valvar e cateteres, e seus principais agentes etiológicos. Revisão Bibliográfica: A endocardite bacteriana (EB) ocorre pela inflamação do endocárdio, sendo frequente em indivíduos portadores de prótese valvares e cateteres vasculares. Estudos indicam que as principais bactérias encontradas na endocardite são: Staphylococcus aureus, Streptococcus viridans, Streptococcus epidermis e Enterococcus e Gram negativos. Os tratamentos mais utilizados são feitos a partir do uso de penicilina, associada ou não a aminoglicosídeos e vancomicina no caso de bactérias resistentes à penicilina. Considerações finais: A partir dos estudos analisados é possível inferir que a EB está associada a morbidade e mortalidade significativas e por isso, é importante identificar os fatores determinantes para o desenvolvimento da doença, como indivíduos que utilizam prótese valvar e cateteres. Além disso, percebe-se que de acordo com o agente etiológico identificado a partir de exames específicos, é possível elaborar estratégias eficazes de tratamento e controle da doença.

253. Is Echocardiogram always indicated in Bacteremia?

Background Echocardiography (ECHO) is a commonly used test; and is part of the Duke’s criteria for diagnosing endocarditis (IE). Our objectives were to analyze utilization and results of ECHO in pts with bacteremia growing organisms not typically associated with IE, and to evaluate whether ECHO contributed to a diagnosis of IE. Methods A retrospective review in a 680-bed tertiary care hospital from 2013–2019. Adult pts with bacteremia with at least 2 positive blood cultures for an organism not typically associated with IE such as Streptococcus viridans, Staphylococcus spp. and enterococcus, and who underwent ECHO were included. Data was collected on demographics, blood cultures, timing of ECHO and its’ findings. Modified Duke’s criteria was used to diagnose IE. Results Ninety four pts were included. Mean age 62 yrs. (range 23-91yrs). 50 (53%) were men. DM noted in 49(52%), CAD in 37(39%), CHF in 54 (57%), chronic kidney disease in 22(23%), hemodialysis in 19(20%), history of IE in 9 (10%). Transthoracic ECHO in 34 (36%), transesophageal ECHO in 28(30%), 32(34%) had both. Identifiable sources of bacteremia were urinary tract infection in 9 (10%), pneumonia 5 (5%), PICC line 5 (5%), wound/tissue infection 3 (3%).Clinicians did not specify the indication for ECHO in any of the cases. Unidentified source of bacteremia noted in 72(77%). Bacteremia was community acquired in 70(74%). Mean days of positive blood cultures 5.6 days (range 1–34 days). Gram (-) organism isolated in 44(47%), Gram (+) in 50(53%), of these, 50 (54%) had an implanted devices/indwelling catheter: 39 cardiac implantable device, 12 indwelling/tunneled catheter. The overall yield of ECHO in bacteremia was 11/94 (12%). ECHO in Gram (-) bacteremia had yield of 9% (4/44 pts) of them only 1 met possible IE by Duke’s criteria. Gram (+) bacteremia had an ECHO yield of 14% (7/50pts); of them 4 met possible IE Duke’s criteria. None of the cases met definite criteria for IE. Conclusion Yield of ECHO for the diagnosis of IE in pts with bacteremia with organisms other than Streptococcus viridans, staphylococci or enterococci was low even in the presence of implanted devices or indwelling catheters. Better criteria for ECHO utilization will reduce its use and potentially increase its yield. Disclosures All Authors: No reported disclosures

Influencia del estrés académico percibido, sobre la calidad del microbiota oral y el pH salival

Objetivo: determinar la influencia del estrés académico percibido sobre la microbiota oral y el pH salival en los estudiantes de quinto año de la Facultad de Odontología - UMSS en la segunda rotación de la gestión 2018. Métodos: estudio descriptivo y prospectivo longitudinal. Se trabajó con 26 estudiantes, se les realizaron pruebas al inicio y al final de la segunda rotación: Cuestionario de Estrés Percibido (CPE), hisopado bucal (identificación microbiota) y toma de muestra salival (determinación pH). Resultados: test psicológico, inicio de rotación: 69,2% de los estudiantes nivel 2 “medianamente estresado”, 23,0% nivel 3 “estresado” y 7,6% nivel 1 “poco estresado”. Final de rotación: 46,1% nivel 3 “estresado”, 30,7% nivel 2 “medianamente estresado”, 19,2% nivel 4 “muy estresado” y 3,8% nivel 1 “poco estresado. Análisis del pH salival, primera toma: valor promedio 6,79. Segunda toma: valor promedio 6,20. Prueba microbiológica, primera toma: en los 26 cultivos se desarrolló Streptococcus viridans, en 3 Staphylococcus spp, en 3 Cándida albicans, en 2 Escherichia coli y en 1 Staphylococcus aureus. Segunda toma: en los 26 cultivos se desarrolló Streptococcus viridans, en 6 Cándida albicans, en 1 Klebsiella spp, en 3 Escherichia coli y en 1 Staphylococcus aureus; en esta última toma hubo incremento significativo del desarrollo microbiano en todos los casos. Conclusión: los niveles de estrés académico percibidos por los estudiantes de la Facultad de Odontología - UMSS son elevados al finalizar la segunda rotación de la gestión 2018, concordantes con el incremento del desarrollo de Streptococcus viridans y Cándida albicans, acompañados por un descenso marcado en el pH salival.

Infective Endocarditis Caused by Oral Microorganisms and Entrance Door and Previous Dental Procedures: Does a Relationship Exists?

There are no recent studies that have evaluated the epidemiological relationship between dental manipulations the etiology of IE by these microorganisms, basically Streptococcus viridans. Our objective is to analyse the relationship between these variables and the possible therapeutic implications. For this, we have analysed a prospective single-center series of IE in patients not addicted to parenteral drugs collected and followed between 1987 and 2018. 403 cases of native and late prosthetic IE were diagnosed and followed up in our center. Of them, 91 were produced by oral streptococci (22.6%). The percentage of this microorganism has remained constant throughout the 30 years (24.8% of the cases from 1987-1997, 25% of those from 1998-2007 and 19.1% from 2008-2018. Although there was a history of dental manipulation in a greater proportion in cases of IE due to Streptococcus viridans (24% vs. 6.5%, p <0.001), in most cases due to Streptococcus viridans (76% of them) there was no previous dental manipulation. In these cases, the infection may be due to the usual daily manipulations of the mouth (brushing, dental floss) or periodontal disease. Given this low sensitivity, it cannot be ruled out that IE is caused by this microorganism in the absence of a history of visiting the dentist, with the implications for empirical antibiotic treatment that this entails