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PubMedDate not supplied

Streptococcus milleri group (Streptococcus anginosus): recovery from intra-abdominal and soft tissue sites.

One hundred thirty-three Streptococcus milleri group (S. anginosus) isolates were recovered from 487 surgical patients. The streptococci were recovered from 33 percent of intra-abdominal infection cultures (84/257). 22 percent of samples from penetrating visceral trauma (19/86), 52 percent of perirectal abscess specimens (13/25), 13 percent of nonpuerperal breast abscess cultures (8/60), and 15 percent of diabetic foot lesions (9/59). Ninety-eight percent of the S. milleri (131/133) were recovered as companion flora in polymicrobial cultures. The organisms were highly susceptible to the beta-lactam antibiotics. The precise pathogenic role of the S. milleri group (S. anginosus) is unknown. However, intrinsic virulence may be expressed in patients with severe infection or other predisposing factors.

Abdomen↗
PubMed1996

In-vitro antimicrobial susceptibility of the "Streptococcus milleri' group (Streptococcus anginosus, Streptococcus constellatus and Streptococcus intermedius).

A collection of 423 clinical "Streptococcus milleri' strains was speciated and tested for susceptibilities to twelve antibiotics. Only 1.4% of the strains were of intermediate susceptibility to penicillin. None of the strains exhibited high-level resistance to gentamicin. Strains resistant to erythromycin, roxithromycin and clindamycin were found with a frequency of 2.6%, 2.4% and 2.4% respectively. Doxycycline resistance was found in 5.7% of the strains and occurred most frequently in Streptococcus anginosus. All the strains were susceptible to cefotaxime, vancomycin and teicoplanin. The results of this study do not indicate changing antibiotic resistance in strains of the "S. milleri' group, but local differences in antibiotic susceptibilities may occur.

Anti-Bacterial Agents↗
PubMed1994

Lancefield group C Streptococcus milleri group strains aggregate human platelets.

Lancefield group C Streptococcus milleri group (SMG) strains are the only SMG types that are able to aggregate human platelets. Complete aggregation occurred within 10 min of mixing bacterial cells and platelets together in the ratio 8:1. Substances which (i) chelated cations; (ii) inhibited the cycloxygenase pathway in platelets; (iii) reduced the availability of ADP and disrupted platelet membrane stability; (iv) reduced bacterial aggregation of platelets. The platelet-interacting substance on the surface of the SMG appeared to be proteinacious as digestion of bacterial cells with protease inhibited aggregation whereas treatment with lipase, periodate or antisera to Lancefield group C polysaccharide had no effect.

Abscess↗
PubMed1986

The Streptococcus milleri group.

The Streptococcus milleri group is newly recognized as a cause of pyogenic infection. It is important that microbiologists and physicians become aware of these organisms. The heterogeneous nature of this group of streptococci does mean that laboratories will have to use a combination of antigenic, physiologic, and hemolytic characteristics to identify these pathogenic streptococci. Physicians need to recognize that these microorganisms as a group are able to cause serious infections that may require prolonged treatment and/or surgical drainage of abscesses.

Female↗
PubMed2001

Interaction between human polymorphonuclear leukocytes and Streptococcus milleri group bacteria.

Because Streptococcus milleri group (SMG) bacteria--Streptococcus constellatus, Streptococcus intermedius, and Streptococcus anginosus--exhibit a striking propensity to cause abscesses, the interaction of these organisms with human polymorphonuclear leukocytes (PMNL) was examined. After incubation in pooled normal human serum, SMG stimulated less chemotaxis than did Staphylococcus aureus, in contrast to viridans streptococci, which caused greater chemotaxis than did S. aureus. PMNL ingested greater numbers of SMG and viridans streptococci than S. aureus but killed these organisms more slowly and less completely. Relative resistance to killing by PMNL is expected in organisms that cause abscesses, and inhibition of chemotaxis may contribute to pathogenicity, because delayed arrival of PMNL gives a head start to proliferating bacteria. This study helps explain the capacity of SMG to cause abscesses. It is unclear, however, why viridans streptococci, bacteria that rarely produce abscesses, share some of these same properties.

Abscess↗
PubMed1992

Streptococcus milleri group: renewed interest in an elusive pathogen.

The following review examines the bacteriological characteristics, epidemiology, pathogenicity and antimicrobial susceptibility of the "Streptococcus milleri group". "Streptococcus milleri group" is a term for a large group of streptococci which includes Streptococcus intermedius, Streptococcus constellatus and Streptococcus anginosus. Usually considered commensals, these organisms are often associated with various pyogenic infections including cardiac, abdominal, skin and central nervous system infections. Organisms of the "Streptococcus milleri group" are often unrecognized pathogens due to the lack of uniformity in classifications and difficulties in microbiological identification. Penicillin G, cephalosporins, clindamycin and vancomycin all possess activity against these streptococci. Use of agents with poor activity may promote infections with "Streptococcus milleri group" and allow it to exhibit its pathogenicity. An understanding of these organisms may aid in their recognition and proper treatment.

Animals↗
PubMed1991

[Studies on clinical significance of "Streptococcus milleri group" in respiratory infections].

"Streptococcus milleri group" are the part of the indigenous oral flora, and they are proposed to contain three distinct species: Streptococcus anginosus, Streptococcus constellatus, and Streptococcus intermedius. Though not included in the approved lists of bacterial names, "S. milleri group" are regarded as the causative organisms of suppurative infections, such as oral abscess, brain abscess, lung abscess and empyema. I have studied the clinical significance of the "S. milleri group" in respiratory infections. An investigation was performed to confirm the incidence of "S. milleri group" colonization in healthy 120 volunteers' (20 y/o-80 y/o) throats, and it was found that 11.7% (14/120) were positive. On the other hand, attention should be paid to the fact that the "S. milleri group" was highly isolated, 24 (24.7%) in 97 purulent respiratory specimens (94 sputa and 3 throat swabs) from which no other significant microorganism was recovered. I have measured the serum antibody titers of the "S. milleri group", employing the IFA technique, in 10 patients from whose specimens "S. milleri group" was predominantly isolated, and compared with those of 18 healthy volunteers. Whereas all of the titers of healthy volunteers reveal less than 1:256, those of the patients reveal more than 1:512. And antibody titers to "S. milleri group" showed the highest in two weeks after "S. milleri group" isolation, and came down to healthy adult levels in six weeks or more. Thus far, about half of the causative organisms of acute pneumonia have been reported unknown. In this study I have suggested that the "S. milleri group" plays an important role as the causative organism in respiratory infections including pneumonia.

Adult↗
PubMed2004

Clinical features of acute respiratory infections associated with the Streptococcus milleri group in the elderly.

The Streptococcus milleri group are becoming increasingly recognized as important pulmonary pathogens which may lead to the development of empyema or lung abscesses. Although several small series have been reported, the clinical and laboratory features of Streptococcus milleri infection have yet to be fully characterized in the elderly. We retrospectively examined the clinical features of 19 patients with Streptococcus milleri pulmonary disease who were admitted to our hospital between 2000 and 2002, based on their clinical records and laboratory data. The microbiological diagnosis was based on the results of quantitative sputum culture and other invasive procedures, including transthoracic needle aspiration or bronchoscopic examinations. There were thirteen cases of pneumonia, two of contaminant pneumonia and pleuritis, one of bronchitis, two of pulmonary abscess, and one of empyema. The patients ranged in age from 65 to 91. The most common symptoms at presentation were shortness of breath, coughing, sputum, and weight loss. An underlying disease existed in 14 of the 19 cases. We conclude that the Streptococcus milleri group is a more important cause of pulmonary infections than has been previously recognized.

Acute Disease↗
PubMed1999

A study of susceptibility of 100 clinical isolates belonging to the Streptococcus milleri group to 16 cephalosporins.

The Streptococcus milleri group are uniformly susceptible to penicillin G, but their susceptibilities to different cephalosporins vary considerably. The antimicrobial susceptibilities of 100 clinically significant strains of the S. milleri group to 16 cephalosporins were determined by the agar dilution method. The majority of first-generation cephalosporins were highly active. Cefamandole, cefuroxime and cefprozil were the most active second-generation agents examined. Third-generation parenteral cephalosporins exhibited excellent activity, with the exception of ceftazidime. The most active of the oral preparations of this group was cefpodoxime, with cefixime and ceftibuten being considerably less active. MICs of cefepime, the only fourth-generation cephalosporin tested, were higher than those of cefotaxime and ceftriaxone.

Cephalosporins↗
PubMedDate not supplied

[Evaluation of phenotype characteristics of streptococci in the identification of the Streptococcus anginosus (Streptococcus milleri) group].

Microorganisms referred to as Streptococcus anginosus (Streptococcus milleri) group which consist of S. anginosus, S. intermedius and S. constellatus is very difficult to identify to the species level, because of their diversity of biochemical, hemolytic and serological characteristics and because of confusion surrounding their taxonomy. Identification procedures on three isolates from primary sterile sites of three different patients, using API 20A system are described. Streptococcus intermedius was established in two and Streptococcus anginosus in one case. The importance of these organisms as human pathogens should enhance efforts of clinical microbiologist towards their accurate identification.

Adolescent↗
PubMed1999

Five-year analysis of antimicrobial susceptibility of the Streptococcus milleri group.

Susceptibility to 17 antibiotics was studied in 180 strains of the Streptococcus milleri group (88 Streptococcus anginosus, 63 Streptococcus constellatus, and 29 Streptococcus intermedius) isolated over a 5-year period. Minimum inhibitory concentrations of penicillin were in the intermediate range for 5.6% of the strains. Resistance to erythromycin and clindamycin was found in 17.1% and 16.6% of the isolates, respectively. A steady increase in the susceptibility to ciprofloxacin was observed over the study period. Imipenem was the most active beta-lactam agent tested. Glycopeptide antibiotics showed excellent activity. Only slight differences between the three species were found in terms of antibiotic susceptibility. Intermediate resistance to penicillin is appearing among the Streptococcus milleri group in our area; consequently, care must be taken when choosing a macrolide for the management of infections caused by these microorganisms.

Anti-Bacterial Agents↗
PubMed2002

Trends in antimicrobial susceptibility of the Streptococcus milleri group.

A collection of 114 clinical Streptococcus milleri group (SMG) strains at the Ryukyu University Hospital obtained in 1999 and 2000, was identified and tested for susceptibility to 12 antibiotics. The percentage of strains with intermediate susceptibility to penicillin G was relatively high (14%). Cefaclor and cefotiam, with a MIC 90 of 2 microg/ml, were less active than cefotaxime. Strains nonsusceptible to erythromycin, clindamycin, and azithromycin were found with a frequency of 8%, 5%, and 4%, respectively. Almost all of the SMG strains were susceptible to fluoroquinolones (except for 1% of the strains nonsusceptible to levofloxacin), and sitafloxacin (DU-6859a) was the most active agent among the 12 tested antibiotics.

Anti-Bacterial Agents↗
PubMed2005

Head and neck infections caused by Streptococcus milleri group: an analysis of 17 cases.

BACKGROUND: Streptococcus milleri group (SMG) is a common inhabitant of the mouth and gastrointestinal tract, and can be an aggressive pathogen causing abscess formation at various sites in the body. However, it has rarely been listed as a cause of head and neck infections. OBJECTIVES: The present study was performed to evaluate the clinical significance of SMG by reviewing the microbiology and clinical records of patients with SMG in head and neck infections retrospectively. STUDY DESIGN: A retrospective review of all patients diagnosed as having SMG bacterial infections at Onomichi General Hospital, Hiroshima, between the years 2001 and 2002 was performed; 17 patients developed head and neck infections with SMG. Here, we describe the clinical features and management of SMG in head and neck infection. RESULTS: The patient population consisted of 12 males and 5 females with a median age of 62 years (age range, 8-78 years). The sites of infection were as follows: maxillary sinus (n=6), peritonsillar region (n=4), subcutaneous (n=3), submandibular space-retropharyngeal space (n=1), deep neck-mediastinum (n=1), parapharyngeal space (n=1), submandibular space (n=1), tonsil (n=1), parotid gland (n=1), and masseter muscle (n=1). Ten cases (59%) were of suppurative diseases. Six cases (35%) had mixed SMG with anaerobe infection. Three cases showed deteriorating clinical courses, and all three of these cases were culture-positive for SMG with anaerobes. In addition, one deteriorating case showed gas gangrene regardless of repeated surgical debridement and intravenous antibiotic therapy; hyperbaric oxygen therapy improved this patient's condition. CONCLUSION: It is important to recognize SMG as a pathogen in head and neck infection. In addition, the care should be taken with infectious diseases caused by SMG with anaerobes as the patient's clinical course can deteriorate rapidly.

Adolescent↗
PubMed1992

Detection of diacetyl (caramel odor) in presumptive identification of the "Streptococcus milleri" group.

The caramel odor associated with the "Streptococcus milleri" group was shown to be attributable to the formation of the metabolite diacetyl. Levels of diacetyl in the 22- to 200-mg/liter range were produced by 68 strains of the "S. milleri" group; apart from one strain of Streptococcus mutans, all 92 other strains of streptococci belonging to 12 species produced < 13 mg of diacetyl per liter. Quantitation of diacetyl levels from cultures of streptococci is suggested as a rapid presumptive test for the "S. milleri" group.

Candy↗
PubMed1993

Haemagglutinating activities of oral strains of Streptococcus milleri group.

Of a total 148 strains of Streptococcus milleri group, 66 agglutinated sheep erythrocytes. The haemagglutinating strains were confined to serotypes g, h, i, j or were untypeable, and had no Lancefield group antigens (A to G and K), all of which have been shown to belong to Streptococcus intermedius. Cell surface hydrophobicity did not significantly differ even between the agglutinating and non-agglutinating S. intermedius strains. The haemagglutinating activity of strain 0813-1 (serotype i) was partially sensitive to heat (100 degrees C, 30 min) or trypsin (1 mg/ml, 30 min) treatment, but completely lost after the heat and subsequent trypsin treatments. Only L-arginine, L-lysine (100 mM), mucin, and fetuin (1 mg/ml) partially inhibited the haemagglutination with native bacterial cells but completely inhibited that with heated cells, whereas none was inhibitory in the reaction with trypsin-treated cells. The results suggest that at least two haemagglutinins are involved in the agglutination of the S. intermedius strain and that the heat-stable but trypsin-sensitive haemagglutinin recognizes the receptors on the erythrocyte surface which contain L-arginine and L-lysine at the reactive site.

Amino Acids↗
PubMed1993

Albumin-binding proteins on the surface of the Streptococcus milleri group and characterization of the albumin receptor of Streptococcus intermedius C5.

Members of the Streptococcus milleri group (SMG) that react with Lancefield group C antisera were shown to bind large amounts of albumin although there was no direct relation between these two properties as polyclonal antisera to Lancefield group C antigen did not prevent the binding of albumin. There was a specificity for albumin binding, with albumin from man, monkeys, cat, dog and mouse being bound to a greater degree than albumin from cow, horse, goat or rabbit. Gold-labelled albumin was shown to be located close to the surface of strains by transmission electron microscopy. A cell-surface protein of M(r) 24,000, which was liberated by lysozyme treatment of cells, was shown to be the cell-surface receptor on Streptococcus intermedius C5. The receptor was physically dissimilar from protein G, an albumin- and IgG-binding protein of 'large-colony' Lancefield group C and G streptococci.

Animals↗
PubMed2004

Distribution and characterization of hemolytic activity by an oral anaerobe from the Streptococcus milleri group.

Some oral anaerobes from the Streptococcus milleri strain group were found to secrete human specific hemolytic toxin, which was detected when bacteria were cultured in Todd-Hewitt broth and Brain Heart Infusion broth. The toxin elicited by the Streptococcus intermedius strain was partially fractionated by ammonium sulfate precipitation. Preincubation with glutathione or cysteine showed significant inhibiting effects; however, no effects were seen with dithiothreitol or beta-mercaptoethanol, and cholesterol was a weak inhibitor. Five kinds of protease inhibitor had no effect on the hemolytic activity, and rabbit preimmune and immune sera against the bacterial cells showed weak inhibition at a similar level. Digestion with trypsin, chymotrypsin, proteinase-K, subtilisin and pronase-P brought about a rise in activity, followed by a decrease during long-term incubation. Other enzymes tested showed no effects. Further, the presence of the intermedilysin gene in the portion with hemolytic activity was not identified by polymerase chain reaction.

Adult↗