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Streptococcus Agalactiae ISSN: 2643-4008 Kaya et al. Int Arch Med Microbiol 2019, 2:010 DOI: 10.23937/2643-4008/1710010 Volume 2 | Issue 1 International Archives of Open Access Medical Microbiology CliNiCAl imAgE Streptococcus Agalactiae: An Unusual Agent of Inguinal Abscess Abdurrahman Kaya, MD1*, Mehtap Turfan, MD2, Acar Yurtbaşi Nuran3, Ekrem Sezgin, MD4 and Sibel Yıldız Kaya5 1Specialist, Department of Infectious Diseases, İstanbul Training and Research Hospital, Istanbul, Turkey 2Specialists, İstanbul Training and Research Hospital, Turkey 3Biologist, Department of Microbiology, İstanbul Training and Research Hospital, Turkey Check for updates 4Specialist, Department of General Surgery, İstanbul Training and Research Hospital, Istanbul, Turkey 5Infectious Diseases unit, Sungurlu State Hospital, Çorum, Turkey *Corresponding author: Abdurrahman Kaya, Specialist, MD, Department of Infectious Disease, İstanbul Training and Research Hospital, Istanbul, Turkey, Tel: +90-506-6113328 chemoprophylaxis, the diseases caused by the patho- Abstract gen have dramatically decreased. However, the inci- Streptococcus agalactiae (group B streptococcus; GBS) is dence of invasive GBS disease has appeared to increase gram-positive bacterium frequently colonized in pharynx, gastrointestinal and female genital tract. While the micro- among non-pregnant adults and those with significant organism is also responsible for a wide range of infections underlying conditions in the recent years [1,5]. Here, which include sepsis and meningitis in newborn and cho- we report an unusual presentation of this bacterium. rioamnionitis and urinary tract infection in pregnant wom- en, the incidence of invasive GBS disease has appeared Case Description to increase among non-pregnant adults and those with significant underlying conditions in the recent years. The 45-year-old man was admitted our clinic with com- infections of patient with medical illness are a common en- plaint of low-grade fever and right inguinal mass and countering problem in clinical practice. Individuals with sig- fatigue for ten days. On admission, body temperature nificant medical condition have been increased all over the was 37.5 °C and pulse was 90/min, this mass was swol- world. GBS-associated disease should be included in the early differential diagnosis in these patients and particularly len, painful and erythematous and tender to palpation. inguinal abscesses. It was fluctuating. In the medical history, the patient has been alcoholic for 20 years. Laboratory tests were Keywords as follows: leukocyte 13000/mm3 (with neutrophilia Streptococcus agalactiae, Inguinal abscess, Mass predominance; 90%), C-reactive protein 20 mg/L (N: 0-5). Screening for HIV and syphilis were negative. Introduction Ultrasound revealed a localized collection of puru- Streptococcus agalactiae (group B streptococcus; lent fluid with septations measuring 35 × 14 mm in size GBS) is gram-positive, β-hemolytic microorganism fre- and that was consistent with an abscess formation (Fig- quently colonized in pharynx, gastrointestinal and fe- ure 1). In the inguinal region, several reactive lymph- male genital tract [1,2]. The microorganism is also re- adenopathies measuring 18 × 7 mm were seen. Sub- sponsible for a wide range of infections which include sequently, this collection was drained and cultured. In sepsis and meningitis in newborn and chorioamnioni- the gram stain of the aspirated sample, plenty of poly- tis and urinary tract infection in pregnant women [3]. morphonuclear leukocytes and gram-positive bacteria These infections cause severe morbidity and mortality were seen. Cefazolin 3 gr/day was immediately initiat- in these populations [4]. With prenatal screening and ed empirically. Streptococcus agalactiae isolates were Citation: Kaya A, Turfan M, Nuran AY, Sezgin E, Kaya SY (2019) Streptococcus Agalactiae: An Unusual Agent of Inguinal Abscess. Int Arch Med Microbiol 2:010. doi.org/10.23937/2643-4008/1710010 Accepted: October 15, 2019; Published: October 17, 2019 Copyright: © 2019 Kaya A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Kaya et al. Int Arch Med Microbiol 2019, 2:010 • Page 1 of 2 • DOI: 10.23937/2643-4008/1710010 ISSN: 2643-4008 Figure 1: Ingunial abscess with septations on ultrasound. isolated from the solid and liquid medium culture of in the early differential diagnosis in these patients and the samples. The antibiotic therapy switched to amox- particularly inguinal abscesses. icillin/clavulanate after 3 days of parenteral treatment. He was improved and then the swelling and erythema Conflict of Interest regressed within one week. The abnormal biochemistry None. returned to normal ranges. The therapy was continued up to two weeks. On follow-ups, the patient is doing References well and with no recurrence. 1. Schrag SJ, Zywicki S, Farley MM, Reingold AL, Harrison LH, et al. Group B streptococcal disease in the era of in- Streptococcus agalactiae is a very rare cause of in- trapartum antibiotic prophylaxis. N Eng J Med 342: 15-20. fection in humans, other than newborn and pregnant 2. Zangwill KM, Schuchat A, Wenger JD (1992) Group B women. A wide range of diseases including diabetes streptococcal disease in the United States, 1990: Report mellitus, malignancy, AIDS, hepatic and renal disease from a multistate active surveillance system. MMWR CDC have been recognized as frequent predisposing factors Surveill Summ 41: 25-32. for invasive GBS [6]. According to some studies, alcohol- 3. Wessels MR, Kasper KL (1993) The changing spectrum of ism is another risk factor for these bacterial infections group B Streptococcal disease. N Eng J Med 328: 1843- [7]. While GBS-associated skin and soft tissue infections 1844. are one of the most common syndromes, inguinal ab- 4. Krohn MA, Hillier SL, Baker CJ (1999) Maternal peripartum scess is very rarely reported clinical presentation [6]. complications associated with vaginal Group B Streptococ- ci colonization. J Infect Dis 179: 1410-1415. As in this case, appropriate antimicrobial therapy com- bined with surgical intervention is essential for success- 5. Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Har- rison LH, et al. (2008) Epidemiology of invasive group B ful management in some cases. streptococcal disease in the United States, 1999-2005. As a conclusion, the infections of patient with medi- JAMA 299: 2056-2065. cal illness are a common encountering problem in clin- 6. Farley MM (2001) Group B streptococcal disease in non- ical practice. As a result of technological developments pregnant adults. Clin Infect Dis 33: 556-561. in modern treatment approaches, individuals with sig- 7. Perovic O, Crewe-Brown HH, Khoosal M, Karstaedt AS nificant medical condition have been increased all over (1999) Invasive group B streptococcal disease in nonpreg- the world, GBS-associated disease should be included nant adults. Eur J Clin Microbiol Infect Dis 18: 362-364. Kaya et al. Int Arch Med Microbiol 2019, 2:010 • Page 2 of 2 •.
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