An autopsy report of rare purulent pericarditis caused by Streptococcus anginosus infection that spread from the liver abscess

Nadiawati Abdul Razak,  Siti Asma’ Mohd Saman,  Rahnuma Ahmad,  Mainul Haque   

Nadiawati Abdul Razak1,2, Siti Asma’ Mohd Saman1, Rahnuma Ahmad3, Mainul Haque4

1Department of Forensic Medicine, Hospital Serdang, Kajang, Malaysia.

2Unit of Forensic Medicine, Pathology Department, Faculty of Medicine and Defence Health, National Defence University of Malaysia, Kuala Lumpur, Malaysia.

3Department of Physiology, Medical College for Women and Hospital, Dhaka, Bangladesh.

4Faculty of Medicine and Defence Health, Kuala Lumpur, Malaysia.

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Published:  May 20, 2023

DOI: 10.7324/JAPS.2023.143934
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Abstract

Streptococcus anginosus group (SAG) is Gram-positive streptococci and a commensal in the upper airway and gastrointestinal and conceptive swathe. It is a commensal microorganism and not well recognized as a pathogen that causes the disease; moreover, death due to the infection is also rare. However, it can cause invasive infections and induce purulent infection with abscess formation under certain conditions and risk factors. We report a rare case of purulent pericarditis in a male deceased who presented with sudden death. The underlying purulent pericarditis that spread from the liver abscess was identified through autopsy examination. Local spread from adjacent organs is rare. The culprit organism was a commensal that became a pathogen under a certain environment. SAG pyogenic pericarditis is an infrequent but severe and fatal condition. A holistic approach to the case must emphasize autopsy findings in a case where the history is limited, especially in forensic practice. Two crucial processes are required to determine the cause of death: through a thorough autopsy and by understanding causation. To conclude that a death was caused by a commensal pathogen is the most difficult task in forensic pathology, and careful examination of postmortem investigations is essential.


Keyword:     End-of-life Streptococcus anginosus group autopsy appraisal genital infection septic pancarditis forensic pathology commensal pathogen liver abscess

Citation:

Razak NA, Saman SAM, Ahmad R, Haque M. An autopsy report of rare purulent pericarditis caused by Streptococcus anginosus infection that spread from the liver abscess. J Appl Pharm Sci, 2023. https://doi.org/10.7324/JAPS.2023.143934

Copyright: © The Author(s). This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Reference

Burn CC. Experimental studies of post-mortem bacterial invasion in animals. J Infect Dis, 1934; 54(3):388-94. https://doi.org/10.1093/infdis/54.3.388

Carpenter HM, Wilkins RM. Autopsy bacteriology: review of 2,033 cases. Arch Pathol, 1964; 77:73–81.

Cartmell T, Luheshi GN, Hopkins SJ, Rothwell NJ, Poole S. Role of endogenous interleukin-1 receptor antagonist in regulating fever induced by localised inflammation in the rat. J Physiol, 2001; 531(Pt 1):171–80; https://doi.org/10.1111/j.1469-7793.2001.0171j.x

Catania A, Airaghi L, Motta P, Manfredi MG, Annoni G, Pettenati C, Brambilla F, Lipton JM. Cytokine antagonists in aged subjects and their relation with cellular immunity. J Gerontol A Biol Sci Med Sci, 1997; 52(2): B93–7; https://doi.org/10.1093/gerona/52a.2.b93

Claridge JE 3rd, Attorri S, Musher DM, Hebert J, Dunbar S. Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus (“Streptococcus milleri group”) are of different clinical importance and are not equally associated with abscess. Clin Infect Dis, 2001; 32(10):1511–5; https://doi.org/10.1086/320163

El-Solh AA, Sikka P, Ramadan F, Davies J. Etiology of severe pneumonia in the very elderly. Am J Respir Crit Care Med, 2001; 163(3 Pt 1):645–51; https://doi.org/10.1164/ajrccm.163.3.2005075

Epstein EZ, Kugel MA. The significance of post-mortem bacteriological examination. J Infect Dis, 1929; 44(4):327-34. https://doi.org/10.1093/infdis/44.4.327

Fazili T, Riddell S, Kiska D, Endy T, Giurgea L, Sharngoe C, Javaid W. Streptococcus anginosus group bacterial infections. Am J Med Sci, 2017; 354(3):257–61; https://doi.org/10.1016/j.amjms.2017.05.011

Fredette JW. Bacteremias in the agonal period. J Lab Clin Med, 1916; 2:180–8.

Gradwohl RBH. Importance de l’examen bactériolique pratiqué sur les cadavers. Ann Inst Pasteur (Paris), 1904; 18:767–73.

Hocken DB, Dussek JE. Streptococcus milleri as a cause of pleural empyema. Thorax, 1985; 40(8):626–8; https://doi.org/10.1136/thx.40.8.626

Jiang S, Li M, Fu T, Shan F, Jiang L, Shao Z. Clinical characteristics of infections caused by Streptococcus anginosus group. Sci Rep, 2020; 10(1):9032; https://doi.org/10.1038/s41598-020-65977-z

Junckerstorff RK, Robinson JO, Murray RJ. Invasive Streptococcus anginosus group infection-does the species predict the outcome?. Int J Infect Dis, 2014; 18:38–40; https://doi.org/10.1016/j.ijid.2013.09.003

Kellerman GD, Waterman NG, Scharefenberger LF. Demonstration in vitro of post-mortem bacterial transmigration. Am J Clin Pathol, 1976; 66(5):911–5; https://doi.org/10.1093/ajcp/66.5.911

Koneman EW, Davis MA. Post-mortem bacteriology. 3. Clinical significance of microorganisms recovered at autopsy. Am J Clin Pathol, 1974; 61(1):28–40; https://doi.org/10.1093/ajcp/61.1.28

Li W, Ding C, Yin S. Severe pneumonia in the elderly: a multivariate analysis of risk factors. Int J Clin Exp Med, 2015; 8(8):12463– 75. Available via https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4612842/pdf/ijcem0008-12463.pdf

Morris JA, Harrison LM, Partridge SM. Practical and theoretical aspects of post-mortem bacteriology. Curr Diagn Pathol, 2007; 13(1):65– 74; https://doi.org/10.1016/j.cdip.2006.07.005

Okada F, Ono A, Ando Y, Nakayama T, Ishii H, Hiramatsu K, Sato H, Kira A, Otabe M, Mori H. High-resolution CT findings in Streptococcus milleri pulmonary infection. Clin Radiol, 2013; 68(6):e331– 7; https://doi.org/10.1016/j.crad.2013.01.019

Riedel S. The value of post-mortem microbiology cultures. J Clin Microbiol, 2014;52(4):1028–33; https://doi.org/10.1128/JCM.03102-13

Rose GW, Hockett RN. The microbiologic evaluation and enumeration of post-mortem specimens from human remains. Health Lab Sci, 1971;8(2):75–8.

Saegeman V, Verhaegen J, Lismont D, Verduyckt B, De Rijdt T, Ectors N. Influence of post-mortem time on the outcome of blood cultures among cadaveric tissue donors. Eur J Clin Microbiol Infect Dis, 2009; 28(2):161–8; https://doi.org/10.1007/s10096-008-0609-0

Smith RF, Linares HA, Jorgensen JH. Bacteremia and post-mortem microbiology in burned children. Am J Clin Pathol, 1975; 63(4):502–8; https://doi.org/10.1093/ajcp/63.4.502

Stefferl A, Hopkins SJ, Rothwell NJ, Luheshi GN. The role of TNF-alpha in fever: opposing actions of human and murine TNF-alpha and interactions with IL-beta in the rat. Br J Pharmacol, 1996; 118(8):1919–24; https://doi.org/10.1111/j.1476-5381.1996.tb15625.x

Tuomisto S, Karhunen PJ, Vuento R, Aittoniemi J, Pessi T. Evaluation of post-mortem bacterial migration using culturing and real-time quantitative PCR. J Forensic Sci, 2013; 58(4):910–6; https://doi.org/10.1111/1556-4029.12124

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