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Mesturino MA, Bitetti C, Clemente A, Krzysztofiak A, Lancella L, Lombardi R, Cursi L, Boccuzzi E, Musolino AM, Villani A. Aggregatibacter actinomycetemcomitans infection in a 15-year-old boy with pulmonary empyema: a case report and review of literature. Ital J Pediatr 2023; 49:42. [PMID: 37004059 PMCID: PMC10066016 DOI: 10.1186/s13052-023-01429-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/10/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Aggregatibacter actinomycetemcomitans (Aa), previously known as Actinobacillus actinomycetemcomitans, is a slow-growing Gram-negative coccobacillus, member of the HACEK group of bacteria colonizing oral flora. Besides causing infectious diseases in the oral cavity such as dental caries and periodontitis, it is responsible for severe extra-oral infections secondary to hematogenous spread or aspiration, such as endocarditis, soft tissue abscesses and osteomyelitis. The diagnosis depends on prolonged bacterial culture of biological material obtained through biopsy. Aa is susceptible to most antibiotics but complete eradication often requires a long term treatment. CASE PRESENTATION We report the case of a 15-year-old previously healthy boy diagnosed with both pulmonary empyema and subphrenic chest wall abscess caused by Aa. He was admitted to our Pediatric Emergency department for evaluation of a right mass associated with marked asthenia and dry cough. After radiological findings etiological diagnosis was made by culture of fluid drainage of pleural empyema. He started empirical antibiotic therapy with intravenous piperacillin/tazobactam, whose sensibility was confirmed by the antibiogram, then, for occurrance of hepatopathy it was switched to ciprofloxacin: the patient almost completely recovered after 6-month therapy. CONCLUSIONS Extra-oral infections caused by Aa are extremely rare, especially in children, and not well described yet. To our knowledge, there is only another similar case described in literature. However, the case described in our manuscript represents the only one presenting with pulmonary empyema without involvement of lung parenchyma in children. We also conducted a brief review of published cases of Aa infection in the pediatric population. This case report reminds us the importance of an accurate inspection of the oral cavity during the examination of pediatric patients.
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Affiliation(s)
- Maria Alessia Mesturino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy.
| | - Carol Bitetti
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Anna Clemente
- Department of Maternal, Infantile, and Urological Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Andrzej Krzysztofiak
- Infectious Diseases and Immunoinfectivology Unit, University Hospital Pediatric Department, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Laura Lancella
- Infectious Diseases and Immunoinfectivology Unit, University Hospital Pediatric Department, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Roberta Lombardi
- Unit of Emergency Radiology, Department of Diagnostic Imaging, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Laura Cursi
- Infectious Diseases and Immunoinfectivology Unit, University Hospital Pediatric Department, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Elena Boccuzzi
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Anna Maria Musolino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Alberto Villani
- Unit of General Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
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Benhaïm-Mattout E, Cano A, Di Meglio C, Bosdure E, Chabrol B, Dubus J. A rare chest tumor in a 7-year old girl with a neurodegenerative disease. Respir Med Case Rep 2022; 37:101648. [PMID: 35433248 PMCID: PMC9006848 DOI: 10.1016/j.rmcr.2022.101648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/21/2021] [Accepted: 03/30/2022] [Indexed: 11/29/2022] Open
Abstract
We report the case of a 7-year-old girl with a history of San Filippo disease who presented with gingivitis and painful chest tumefaction. Microbiology of this tumefaction identified Aggregatibacter actinomycetemcomitans (AA), a slowly growing, commensal, Gram negative bacillus that is a very unusual cause of thoracic infection. We discuss this case in the light of available literature of pediatric cases of AA thoracic infection. Conclusion: a tumor-like chest mass in a patient with multiple disabilities should evoke an invasive AA infection.
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Affiliation(s)
- E. Benhaïm-Mattout
- Service de Spécialités Pédiatriques et Médecine Infantile, CHU Timone-Enfants, 13385, Marseille Cedex 5, France
| | - A. Cano
- Service de Spécialités Pédiatriques et Médecine Infantile, CHU Timone-Enfants, 13385, Marseille Cedex 5, France
- Centre de référence des maladies héréditaires du métabolisme, CHU Timone-Enfants, 13385, Marseille Cedex 5, France
| | - C. Di Meglio
- Service de Spécialités Pédiatriques et Médecine Infantile, CHU Timone-Enfants, 13385, Marseille Cedex 5, France
- Centre de référence des maladies héréditaires du métabolisme, CHU Timone-Enfants, 13385, Marseille Cedex 5, France
| | - E. Bosdure
- Service de Spécialités Pédiatriques et Médecine Infantile, CHU Timone-Enfants, 13385, Marseille Cedex 5, France
| | - B. Chabrol
- Service de Spécialités Pédiatriques et Médecine Infantile, CHU Timone-Enfants, 13385, Marseille Cedex 5, France
- Centre de référence des maladies héréditaires du métabolisme, CHU Timone-Enfants, 13385, Marseille Cedex 5, France
| | - J.C. Dubus
- Service de Spécialités Pédiatriques et Médecine Infantile, CHU Timone-Enfants, 13385, Marseille Cedex 5, France
- Aix-Marseille Université, AP-HM, IRD, MEPHI, IHU-Méditerranée Infection, 13005, Marseille, France
- Corresponding author. CHU Timone-Enfants, 264 rue Saint-Pierre, 13385, Marseille Cedex 5, France.
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