INTERACTIVE CASE REPORT: A Case of Thoracic Empyema due to Streptococcus constellatus

A 61–year-old mentally retarded man with congenital neurological disability presented with cough, wheezing, fever, and agitation for one week. The preliminary diagnosis was bronchopneumonia and respiratory failure and a treatment consisted of empiric antibiotics, bronchodilators, mucolytics and oxygen therapy was initiated. Thoracentesis revealed empyema and a closed tube thoracotomy was placed. Streptococcus constellatus was isolated from the pleural fluid. The patient was not on an oral care. Our microbiology laboratory reported the isolation of Streptococcus constellatus. According to the published literature on the re-sistance to the first-line antibiotics such as beta-lactam inhibitors, macrolides, and metronidazole, antibiotics were changed accordingly. The patient's overall condition improved, the markers of infection normalized, the amount of pleural effusion regressed, and culture of pleural effusion became sterile. After the removal of the thoracic tube, he was discharged from the hospital. Patients with neurological disabilities lacking proper oral hygiene are at high-risk for mortality-bearing diseases such as empyema secondary to non-pathogenic bacteria, including Streptococcus constellatus. Isolating the causative microorganism can guide the antibi-otic therapy where the antibiotic susceptibility testing is not available.

ÝNTERAKTÝF OLGU SUNUMU: Streptococcus constellatus'a Baðlý Torasik Ampiyem Olgusu

Atmýþ bir yaþýnda konjenital nörolojik defisitli, mental retarde erkek hasta, bir haftadýr olan öksürük, hýrýltýlý solunum, ateþ, ajitasyonla baþvurdu. Yatýrýlarak plöropnömoni ve solunum yetmezliði tanýlarý ile ampirik antibiyotik, bronkodilatör ve oksijen tedavisi baþlandý. Torasentez ile ampiyem niteliðinde sývý alýndý, kapalý tüp torakostomi uygulandý. Aðýz bakýmýnýn yapýlmadýðý öðrenilen hastada sývýda Streptococcus constellatus izole edildi. O güne kadar kliniði ve enfeksiyon göstergeleri düzelmeyen has-tanýn tedavisinin deðiþtirilmesi planlandý. Literatürler ýþýðýnda etkenin betalaktam inhibitörleri, makrolidler ve metronidazol gibi ajanlara dirençli olabileceði göz önüne alýnarak antibiyoterapisi deðiþtirildi. Olgu; genel durumunun düzelmesi, enfeksiyon göstergelerinin düþmesi, sývýnýn azaldýðýnýn görülmesi, kültürünün negatifleþmesi, tüpünün çekilmesi sonrasýnda kontrole gelmek üzere taburcu edildi. Nörolojik defisitli hastalarda aðýz hijyeni yapýlmadýðýnda; normalde patojen olmayan Streptococcus constellatus gibi mikroorganizmalarýn mortal seyreden ampiyem gibi tablolara yol açabileceðini, elimizde bir antibiyogram olmasa da etkenin izolasyonunun uygun antibiyotik seçimi konusunda bize yol gösterebileceðini hatýrlatmak amacý ile olgumuzu sunmaktayýz.

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