A 78-year-old man presented to the emergency department with a probable upper respiratory infection with cough, expectoration and respiratory distress.
The patient's history included degenerative arthropathy, being a former smoker (30 cigarettes per day for up to two years) and excessive drinker.
Physical examination revealed: axillary T° 38.5 °C, conserved consciousness, well oriented, collaborating.
He had no respiratory distress with O administration, asthenical habit, without impressing the examination of a serious compromise in his general condition.
The left costal wall showed a painful tumour measuring 3 cmx with inflammatory signs (heat and erythema), not adhered to deep planes.
Rhythmic heart sounds.
Conserved pulmonary vesicular murmur.
No organomegaly or tender points were described in the abdominal examination.
Respiratory failure (arterial pH 7.48; p02 54 rnrnHg; pC02 35 mrnHg, Saturation 02: 4%, HCC03: 27) and complete blood count with neutrophils (87.42%).
ESR 106 mm/h.
Persistent respiratory failure was finally admitted to the hospital.
A chest X-ray showed minimal left pleural effusion, although consolidation could not be ruled out.
Left rib cage X-ray showed no signs of bone involvement, but showed an increase in soft tissues adjacent to the cranial nerve.
No sputum sample was available for microbiological study due to the absence of expectoration of the patient.
The hemocultives (unchanged in BacT/Alert® (BioMerieux) for a period of 5 days) were negative.
Seizures for Legionella Streptococcus pneumoniae (BINAXNOW, INVERNESS) in urine were negative.
Puncture of the abscess was performed, visualizing Gram-positive cocci grouped into chains.
The collection was later surgically drained obtaining 100 cc of purulent material, resulting in G. morbillorum.
After 14 days with intravenous antibiotic treatment (1 g every 8 hours amoxicillin/clavulanic acid), the patient was discharged with oral therapy (875/125 mg every 8 h), to complete a total of 3 weeks of treatment.
At present, after one year, the patient is asymptomatic.
Microbiological study.
Colonies were obtained in blood agar Columbia, chocolate agar and anaerobic blood agar; negative colonies were obtained in the anaerolytical medium, catalase, with better growth in the culture medium.
Microorganisms were identified as G. morbillorum and G. haemolysans by API 20 Strep system (CAPI System, BioMérieux).
The certainty in the identification of G. morbillorum based on PYRA substrate is 3 0% and with the LAP substrate (Zyme A+Zyme B) 86%.
Susceptibility to the following antimicrobial agents ß-lactams was determined by agar dilution with CLSF recommendations: penicillin, amoxicillin, amoxicillin/clavulanic acid, cefuroxime and glucopenic acid vancomycin ceftriaxone.
In the absence of defined cut-off values for Gemella sp, those established by the CLSI for Streptococcus α -agonist were used, considering the similarities between both bacterial groups.
To determine the MIC of amoxicillin, amoxicillin/clavulanic acid and cefuroxime, the breakpoints defined by CLSI for Streptococcus pneumoniae were used.
