Abstract • Endocarditis in a 2-year-old child was caused by a penicillin-resistant Streptococcus constellatus. Viridans streptococci in general and those associated with endocarditis in particular are usually believed to be penicillin sensitive. Although the patient did not receive prophylactic antibiotics, the child had recently been treated with an oral penicillin. Penicillin-resistant viridans streptococci are usually sensitive to the synergistic effects of penicillin and an aminoglycoside, but this organism was not. Clindamycin was ultimately shown to demonstrate admirable bactericidal activity against this patient's S constellatus. (Am J Dis Child 1982;136:42-45) References 1. Johnson DH, Rosenthal A, Nadas AS: A 40-year review of bacterial endocarditis in infancy and childhood . Circulation 1975;51:581-588.Crossref 2. Jones D: Composition and differentiation of the genus Streptococcus , in Skinner FA, Quesnel LB (eds): Streptococci . New York, Academic Press Inc, 1978, p 5. 3. Facklam RR: Physiological differentiation of viridans streptococci . J Clin Microbiol 1977;5:184-201. 4. Pulliam L, Porscher RK, Hadley WK: Biochemical properties of CO2-dependent streptococci . J Clin Microbiol 1980;12:27-31. 5. Murray HW, Gross KC, Masur H, et al: Serious infections caused by Streptococcus milleri . Am J Med 1978;64:759-764.Crossref 6. Pulliam L, Inakuchi S, Hadley WK, et al: Dextran production by viridans streptococci delays sterilization of vegetations in experimental endocarditis. Read before the 80th annual meeting of the American Society for Microbiology, Miami, May 12-16, 1980. 7. Hardie JM, Marsh PD: Streptococci and the human oral flora , in Skinner FA, Quesnel LB (eds): Streptococci . New York, Academic Press Inc, 1978, pp 183-184. 8. Rantz LA: Streptococcal meningitis: Four cases treated with sulfonamides in which the aetiologic agent was an unusual streptococcus . Ann Intern Med 1942;16:716.Crossref 9. Wheeler SM, Foley GE: A note on non-group A streptococci associated with human infection . J Bacteriol 1943;46:391. 10. Foley GE: Further observations on the occurrence of streptococci of groups other than A in human infection . N Engl J Med 1947;237:809.Crossref 11. Wort AJ: Observations on group F streptococci from human sources . J Med Microbiol 1975;8:455-457.Crossref 12. Parker MT, Ball LC: Streptococci and aerococci associated with systemic infection in man . J Med Microbiol 1976;9:275-302.Crossref 13. Bannatyne RM, Robson A: Bacteremia due to atypical streptococci belonging to Lancefield group A: Report of two cases . Am J Clin Pathol 1974;61:358-360. 14. Roberts RB, Krieger AG, Schiller NL, et al: Viridans streptococcal endocarditis: The role of various species, including pyridoxal-dependent streptococci . Rev Infect Dis 1979;1:955-966.Crossref 15. Koshi G, John L: Lancefield group F causing liver abscess and empyema . Indian J Med Res 1971;59:45-49. 16. Rogers KB: The association of acute appendicitis with infective diarrhea . Proc R Soc Med 1957;50:1025. 17. Ottens H, Winkler KC: Indifferent and hemolytic streptococci possessing group antigen F . J Gen Microbiol 1962;28:181.Crossref 18. Karchmer AW, Moellering RC Jr, Maki DG, et al: Single-antibiotic therapy for streptococcal endocarditis . JAMA 1979;241:1801-1806.Crossref 19. Malacoff RF, Frank E, Andride VT: Streptococcal endocarditis (non-enterococcal, non-group A): Single vs combination therapy . JAMA 1979;241:1807-1810.Crossref 20. Finland M: And the walls come tumbling down: More antibiotic resistance, and now the pneumococcus . N Engl J Med 1978;299:770-771.Crossref 21. David S: Penicillin-resistant streptococci . N Engl J Med 1979;300:500.Crossref 22. Parrillo JE, Borst GC, Mazur MH, et al: Endocarditis due to resistant viridans streptococci during oral penicillin chemoprophylaxis . N Engl J Med 1979;300:296-300.Crossref 23. Spencer WH, Thornsberry C, Moody MP, et al: Rheumatic fever chemoprophylaxis and penicillin-resistant gingival organisms . Ann Intern Med 1970;73:683-687.Crossref 24. Wolfe JC, Johnson WD Jr: Penicillin-sensitive streptococcal endocarditis-in-vitro and clinical observations on penicillin streptomycin therapy . Ann Intern Med 1974;81:178-181.Crossref 25. Markowitz M, Gordis L: Rheumatic recurrences and secondary prevention , in Rheumatic Fever , ed 2. Philadelphia, WB Saunders Co, 1972, p 164. 26. Pulliam L, Hadley WK: Resistance of viridans streptococci to penicillin . N Engl J Med 1979;300:1442. 27. Drucker DB, Jolly M: Prevention of bacterial endocarditis . Lancet 1969;2:1422-1423.Crossref 28. Sprunt K, Redman W, Leidy G: Penicillin resistant α streptococci in pharynx of patients given oral penicillin . Pediatrics 1968;42:957-968. 29. Resnick L: Antibiotic treatment of penicillin-sensitive streptococcal endocarditis . JAMA 1979;241:1826-1827.Crossref 30. 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American Journal of Diseases of Children – American Medical Association
Published: Jan 1, 1982
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