Journal Article

Streptococcus salivarius pneumonia-associated pneumomediastinum: a case report and literature review

Xiang, Keheng, Liu, Bicui, Chen, Zhuo, Wang, Kaijin

2024

Overview

Background Streptococcus salivarius is an opportunistic pathogen, and there have been no reported cases of Streptococcus salivarius pneumonia to date. Pneumomediastinum is usually secondary to tracheal or esophageal injury and is very rare as a complication of pneumonia. We report a case of Streptococcus salivarius pneumonia complicated by pneumomediastinum, aiming to enhance clinicians’ awareness of rare pathogens and uncommon complications in pneumonia. Case presentation The patient, a 36-year-old male, presented with a persistent cough and sputum production for one week, accompanied by a sore throat that had developed just one day prior. Chest computed tomography (CT) disclosed pneumomediastinum alongside obstructive atelectasis in the left lower lobe. Streptococcus salivarius infection was conclusively identified through bronchoalveolar lavage metagenomic next-generation sequencing (mNGS), as well as smear and culture analyses. The patient was administered intravenous amoxicillin-clavulanate potassium for a duration of seven days as part of the anti-infection regimen. Given the stability of the patient’s respiratory and circulatory systems, a tube drainage procedure was deemed unnecessary. Post-treatment, the patient’s clinical symptoms notably improved. A subsequent chest CT scan revealed the re-expansion of the left lower lung and near-complete resolution of pneumomediastinum. Conclusion There are numerous pathogens that can cause pneumonia. While focusing on common pathogens, it is important not to overlook rare ones. When considering infections from rare pathogens, it is recommended to promptly perform a bronchoscopy and submit bronchoalveolar lavage fluid for mNGS to improve pathogen detection rates. During the diagnosis and treatment of pneumonia, it is crucial to be vigilant for rare complications. When a patient presents with symptoms such as dyspnea or subcutaneous emphysema, it is advisable to immediately perform a chest CT scan to rule out pneumomediastinum.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Alveoli / Amoxicillin / Analysis / Anti-Bacterial Agents - therapeutic use / Atelectasis / Bacteria / Blood / Bronchoalveolar Lavage Fluid - microbiology / Bronchoscopy / Bronchus / Care and treatment / Case Report / Case reports / Chest / Complications and side effects / Computed tomography / Cough / CT imaging / Cultures (Biology) / Diagnosis / Dyspnea / Emphysema / Foreign bodies / Humans / Infections / Infectious Diseases / Internal Medicine / Lavage / Leukocytes / Literature reviews / Male / Mediastinal Emphysema - diagnostic imaging / Mediastinal Emphysema - microbiology / Medical imaging / Medical Microbiology / Medicine / Medicine & Public Health / Metagenomics / Neutrophils / Next-generation sequencing / Opportunist infection / Parasitology / Pathogens / Patients / Penicillin / Pharyngitis / Pneumomediastinum / Pneumonia / Pneumonia, Bacterial - complications / Pneumonia, Bacterial - diagnosis / Pneumonia, Bacterial - diagnostic imaging / Pneumonia, Bacterial - drug therapy / Pneumonia, Bacterial - microbiology / Pneumonia, Pneumococcal / Potassium / Respiration / Risk factors / Sputum / Streptococcal Infections - complications / Streptococcal Infections - diagnosis / Streptococcal Infections - drug therapy / Streptococcal Infections - microbiology / Streptococcus infections / Streptococcus salivarius / Streptococcus salivarius - isolation & purification / Tomography, X-Ray Computed / Trauma / Tropical Medicine / Viral infections / Young adults