|Year : 2020 | Volume
| Issue : 4 | Page : 2119-2120
Bacteremia because of Streptococcus pseudoporcinus in a Syphilis-HIV co-infected patient: A case report
Kavita Gupta, Monalisa Mohanty, Sutapa Rath
Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
|Date of Submission||20-Aug-2019|
|Date of Decision||20-Aug-2019|
|Date of Acceptance||16-Dec-2019|
|Date of Web Publication||30-Apr-2020|
Dr. Kavita Gupta
Dr. Kavita Gupta, B-013, Cosmopolis Apartment, Bhubaneswar - 751 019, Odisha
Source of Support: None, Conflict of Interest: None
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. The bacterium was first isolated from the female genito-urinary tract in the year 2006. 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. 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. 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. 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|| |
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.
| Discussion|| |
Streptococcus pseudoporcinu s is usually found as a colonizer of the female genital tract has been rarely associated with bacteremia. Most of the reported cases of Streptococcus pseudoporcinus infection were from female genital tract isolates.,, 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. 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.
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Conflicts of interest
There is no conflicts of interest.
| References|| |
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.
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.
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.
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.
Peir-Yu F, Gandhi SA. Streptococcus pseudoporcinus
subacute mitral valve endocarditis: A case report. Int J Case Rep Images 2017;8:105-7.
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.
Mahlen SD, Clarridge JE. Thumb infection caused by Streptococcus pseudoporcinus.
JClin Microbiol 2009;47:3041-2.