Unexpected etiology of a pleural empyema in a patient with chronic lymphocytic leukemia (CLL): Capnocytophaga ochracea

Polymicrobial empyema in a patient with lung adenocarcinomacontaining Capnocytophaga sputigena

A man in his 60s with advanced COPD and lung adenocarcinoma presented with sepsis and acute hypoxaemic respiratory failure. Imaging revealed bilateral pleural effusions, and he was found to have a polymicrobial empyema which included Capnocytophaga sputigena Despite appropriate treatment, he continued to deteriorate and ultimately died of sepsis. Capnocytophaga species, typically benign constituents of the oral microbiota, rarely can instigate pleuropulmonary infections, especially in immunocompromised individuals. We highlight the difficulty in the identification and the optimal antimicrobial treatment of Capnocytophaga in the setting of growing antibiotic resistance.

Empyema Caused by Mixed Infection with Streptococcus intermedius and Streptococcus constellatus in a Patient with Previous Surgery for Oral Carcinoma: A Case Report

Background

The incidence of community-acquired empyema caused by the Streptococcus anginosus group (SAG) has been on the rise in the 2020s. To the best of our knowledge, while empyema caused individually by either strain has been reported, there are no reports on empyema caused by concurrent infection with these two strains. Here, we report for the first time empyema caused by concurrent infection with Streptococcus intermedius and Streptococcus constellatus (both SAG species) in a postoperative patient who had been treated for floor of the mouth carcinoma.

Case Presentation

A 61-year-old male patient who had undergone surgical treatment for floor of the mouth carcinoma 2 year earlier suddenly presented with left-sided chest pain. Chest computed tomography (CT) revealed encapsulated pleural effusion on the left side, which was diagnosed as empyema. Metagenomic next-generation sequencing(mNGS) of the pleural fluid sample indicated mixed infection caused by Streptococcus intermedius and Streptococcus constellatus. The patient's condition improved about 5 weeks after treatment with thoracic fluid drainage and cephalosporin antibiotics.

Conclusion

This case highlights the possibility of concurrent infection with two SAG strains in patients with empyema. Currently, it is unclear whether there is a definitive relationship between a surgical history of carcinoma of the floor of the mouth and empyema caused by infection with SAG strains. This case could, perhaps, serve as a reference for future related research on the topic.

Gemella morbillorum- and Capnocytophaga sp.-Related Mycotic Thoracic Aortic Aneurysm and Mediastinal Abscess: An Unusual Case Report, a Treatment Challenge, and a Review of Literature

A thoracic mycotic aortic aneurysm is an uncommon entity that can complicate mediastinal abscesses. Gemella morbillorum and Capnocytophaga sp. are oral bacteria that are very rarely encountered in this setting, especially when occurring together and with other organisms, posing a difficult treatment challenge per the available guidelines and sensitivities. We present in detail this interesting case of a multi-organism mediastinal abscess and thoracic mycotic aortic aneurysm after a previous esophagogastroduodenoscopic procedure in a 51-year-old female with known achalasia who presented with upper abdominal pain, including a successful surgical and antibiotic treatment regimen and a literature review of the involved topics.