Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 4715
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
CASE REPORT
Year : 2020  |  Volume : 9  |  Issue : 4  |  Page : 2119-2120  

Bacteremia because of Streptococcus pseudoporcinus in a Syphilis-HIV co-infected patient: A case report


Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Date of Submission20-Aug-2019
Date of Decision20-Aug-2019
Date of Acceptance16-Dec-2019
Date of Web Publication30-Apr-2020

Correspondence Address:
Dr. Kavita Gupta
Dr. Kavita Gupta, B-013, Cosmopolis Apartment, Bhubaneswar - 751 019, Odisha
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_663_19

Rights and Permissions
  Abstract 


A 43 year old male patient came to the emergency department with complaints of severe breathlessness and pedal edema with on & off fever since 15 days. The patient also gave history of sexual exposures with multiple partners. ECHO revealed moderate LV dysfunction, severe aortic regurgitation (AR), trivial mitral regurgitation (MR) with mild pulmonary edema. The patient was diagnosed as a case of severe Aortic regurgitation with atrial fibrillation. The patient was found sero-positive for HIV and Syphilis. His blood cultures obtained prior to initiation of antibiotics showed growth of small 0.5-1mm in diameter, β- hemolytic colonies on blood agar The isolate was identified to be Streptococcus pseudoporcinous by VITEK2 Compact system and was sensitive to vancomycin, linezolid, penicillin, cotrimoxazole and ciprofloxacin. Streptococcus pseudoporcinus is usually found as colonizer of female genital tract has been rarely associated with bacteremia. In the present report the patient possibly has acquired the infection from female genital tract because of his abnormal sexual behaviour. Association of Streptococcus pseudoporcinus with increased numbers of sexual partners and sexually transmitted infections suggests that further studies of this organism are warranted.

Keywords: Bacteremia, HIV, streptococcus pseudoporcinus, syphilis


How to cite this article:
Gupta K, Mohanty M, Rath S. Bacteremia because of Streptococcus pseudoporcinus in a Syphilis-HIV co-infected patient: A case report. J Family Med Prim Care 2020;9:2119-20

How to cite this URL:
Gupta K, Mohanty M, Rath S. Bacteremia because of Streptococcus pseudoporcinus in a Syphilis-HIV co-infected patient: A case report. J Family Med Prim Care [serial online] 2020 [cited 2021 Feb 27];9:2119-20. Available from: https://www.jfmpc.com/text.asp?2020/9/4/2119/283439



Streptococcus pseudoporcinus earlier known as Streptococcus porcinus usually found in theupper respiratory and genital tracts of swine.[1] The bacterium was first isolated from the female genito-urinary tract in the year 2006.[2] S. pseudoporcinus usually recovered from the female genital tract as a colonizer. People having two or more sexual partners were significantly more likely to acquire S. pseudoporcinus than monogamous or abstinent persons.[3] On blood agar, colonies are generally small, circular with a large zone of complete hemolysis. The species cross-react with Lancefield group B Streptococcus (GBS) antisera.[4] Therefore, the organism can be misidentified as Streptococcus aglactiae especially in specimens of the female genital tract. The first case of Streptococcus pseudoporcinus bacteremia was reported in the year 2017 associated with endocarditis from a nongenitourinary source.[5] Currently, little is known about the epidemiology of this organism or its role in human disease. Here, we report a case of bacteremia because of Streptococcus pseudoporcinus in a patient having syphilis-HIV co-infection.


  History Top


A 43-year-old male patient came to the emergency department with complaints of severe breathlessness and pedal edema with on and off a fever for 15 days. On physical examination, his temperature was 101°F, pulse 120 beats per minute water-hammer pulse, respiration rate was 18 per minute, blood pressure 128 mmHg/60 mmHg, and SPO2 was 98%. On auscultation, early diastolic murmur (EDM) was noticed. His blood sample was sent for routine hematological investigation and culture. The patient was admitted to the hospital and received ceftriaxone 2 gm IV. His hematological investigations revealed white blood cell count 13,860/uL, with neutrophilia of 90.7%, hemoglobin 8.3 g/dL, and platelet 134,000/uL. Erythrocyte sediment rate 66 mm/h and C-reactive protein 8.04 mg/dL. The patient also gave a history of sexual exposures with multiple partners. His blood was sent for HIV and Syphilis. The patient was found seropositive for HIV and Syphilis (point of care test Alere Determine Syphilis-TP). Venereal Disease Research Laboratory (VDRL) testing was done to detect active Syphilis and titer was found as 8 dils. An ECHO was advised to see any cardiac complication because of syphilis, which revealed moderate LV dysfunction, severe aortic regurgitation (AR), trivial mitral regurgitation (MR) with mild pulmonary edema. The patient was diagnosed as a case of severe aortic regurgitation with atrial fibrillation. His blood cultures showed growth of small 0.5–1 mm in diameter, white circular colonies with a wide zone of β-hemolysis on blood agar after 24 h of incubation. [Figure 1] shows growth of Streptococcus pseudoporcinus blood agar Colonies were catalase-negative. Growth in 6.5% NaCl broth, bile esculin and hippurate hydrolysis test were positive. The isolate was identified to be Streptococcus pseudoporcinous by the VITEK2 Compact system (bioMe´rieux) was sensitive to vancomycin, linezolid, penicillin, cotrimoxazole and ciprofloxacin.
Figure 1: Growth of Streptococcus pseudoporcinus on Blood agar

Click here to view



  Discussion Top


Streptococcus pseudoporcinu s is usually found as a colonizer of the female genital tract has been rarely associated with bacteremia.[2] Most of the reported cases of Streptococcus pseudoporcinus infection were from female genital tract isolates.[2],[4],[6] Previous studies reported variability of cross-reactivity of B antigen agglutination tests of S. pseudoporcinus isolates Hence it can be misidentified as Streptococcus agalactie. S. pseudoporcinus infection might not be associated with invasive disease to the same extent that S. agalactiae infection. The clinical significance of genitourinary S. pseudoporcinus, patients' clinical characteristics, and their relationship to peripartum neonatal and maternal infections requires further investigation. More studies are needed to address this hypothesis. Other than genitourinary, only one case of a thumb infection has been reported because of Streptococcus pseudoporcinus reported from an injury sustained by a car door.[7] In the present report, the patient possibly has acquired the infection from the female genital tract because of his abnormal sexual behavior. To the best of our knowledge, there has been no published report of Streptococcus pseudoporcinus bacteremia in-patient with syphilis-HIV co-infection in a male patient. Moreover, its co-epidemiology with increased numbers of sexual partners and sexually transmitted infections suggests that further studies of this organism are warranted.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There is no conflicts of interest.



 
  References Top

1.
Collins MD, Farrow JAE, Katic V, Kandler O. Taxonomic studies on streptococci of serological groups E, P, U, and V: Description of Streptococcus porcinussp. nov. Syst Appl Microbiol 1984;5:402-13.  Back to cited text no. 1
    
2.
Bekal S, Gaudreau C, Laurence RA, Simoneau E, Raynal L. Streptococcus pseudoporcinus sp. nov., a novel species isolated from the genitourinary tract of women. J Clin Microbiol 2006;44:2584-6.  Back to cited text no. 2
    
3.
Suwantarat N, Grundy M, Rubin M, Harris R, Miller JA. Recognition of Streptococcus pseudoporcinus colonization in women as a consequence of using matrix-assisted laser desorption ionization–time of flight mass spectrometry for group B streptococcus identification. J Clin Microbiol 2015;53:3926-30.  Back to cited text no. 3
    
4.
Shewmaker PL, Steigerwalt AG, Whitney AM, Morey RE, Graziano JC, Facklam RR, et al. Evaluation of methods for identification and determination of the taxonomic status of strains belonging to the Streptococcus porcinus-Streptococcus pseudoporcinus complex isolated from animal, human, and dairy sources. J Clin Microbiol 2012;50:3591-7.  Back to cited text no. 4
    
5.
Peir-Yu F, Gandhi SA. Streptococcus pseudoporcinus subacute mitral valve endocarditis: A case report. Int J Case Rep Images 2017;8:105-7.  Back to cited text no. 5
    
6.
Stoner KA, Rabe LK, Austin MN, Meyn LA, Hillier SL. Incidence and epidemiology of Streptococcus pseudoporcinus in the genital tract. J Clin Microbiol 2011;49:883-6.  Back to cited text no. 6
    
7.
Mahlen SD, Clarridge JE. Thumb infection caused by Streptococcus pseudoporcinus. JClin Microbiol 2009;47:3041-2.  Back to cited text no. 7
    


    Figures

  [Figure 1]



 

Top
   
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  History
  Discussion
   References
   Article Figures

 Article Access Statistics
    Viewed469    
    Printed3    
    Emailed0    
    PDF Downloaded65    
    Comments [Add]    

Recommend this journal