Peptostreptococcus Spp In Cervical

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Infectious CL can be either acute unilateral or bilateral, and chronic (subacute). Because of the high frequency of CL in children, most microbiological studies were done in this age group. The most common causes of bilateral CL in children are viruses. However, the adenitis appears and resolves quickly without treatment. The most common viruses are EB, cytomegalovirus, herpes simplex, adeno virus, enterovirus, roseola, and rubella. Other pathogens include Mycoplasma pneumoniae and Corynobacterium diphtheria. The most common bacterial organisms causing acute unilateral infection associated with facial trauma or impetigo are S. aureus and GABHS (66-70). Other rare aerobic pathogens are S. pneumoniae and gram-negative rods. Other causes include Bartonella henselae, Francisella tularensis, Pasteurella multocida, Yersinia pestis, Actinoba-cillus actinomycetemcomitans, Burkholderia gladioli, M. tuberculosis, and non-TB Mycobacterium spp. (71-73). The presence of dental or periodontal disease suggests anaerobic bacteria (67,74). Adenitis in newborns is often related to Group B streptococci (75). Many of the investigations that attempted to evaluate the etiology of CL failed to use methodologies for the recovery of anaerobic bacteria (66,68-70). This probably accounted for the many sterile cultures obtained in these studies. Anaerobes such as AGNB (68) and Peptostreptococcus spp. (66,76) occasionally have been isolated.

Several reports described the recovery of anaerobes from cervical adenitis. Barton and Feigin (68) who studied 74 children, isolated four Peptostreptococcus spp. However, the microbiological techniques used in that study probably were not optimal for the recovery of anaerobes. Bradford and Plotkin (76) have reported the recovery of anaerobes from two children, one with alpha-hemolytic streptococci, Bacteroides spp., and Peptostreptococcus spp. and the other with Bacteroides spp.

Three studies that employed methodologies for recovery of anaerobes demonstrated the importance of these organisms in CL (67,74,77). Brook (67) studied 53 children who presented with CL (Table 4). Bacterial growth was noted in 45 children (85%). A total of 66 bacterial isolates (35 aerobes and 31 anaerobes) were recovered. Aerobes alone were recovered from 27 aspirates (60%), anaerobes alone from eight aspirates (18%), and mixed aerobic and anaerobic bacteria from nine specimens (20%). BLPB were recovered in 15 of the 45 (33%) specimens. Only 15% of the cultures in this study showed no bacterial growth. The large number of sterile

TABLE 4 Bacterial Isolates Recovered from 45 Aspirates Obtained from Children with Cervical Lymphadenitis

Aerobic and facultative isolates

No.

Anaerobic isolates

No.

Gram-positive cocci

Gram-positive cocci

Alpha-hemolytic streptococci

4

Peptostreptococcus spp.

9

Group A beta-hemolytic streptococci

8

Gram-negative cocci

Group C streptococci

2

Veillonella parvula

2

Staphylococcus aureus

14

Gram-positive bacilli

Staphylococcus epidermidis

3

Propionibacterium acnes

5

Gram-negative bacilli

Bifidobacterium spp.

2

Klebsiella pneumoniae

1

Lactobacillus sp.

1

Escherichia coli

2

Gram-negative bacilli

Mycobacterium scrofulaceum

1

Fusobacterium nucleatum

4

Total

35

Bacteroides spp.

2

Prevotella melaninogenica

3

Prevotella oris-buccae

1

Bacteroides ureolyticus

1

Porphyromonas asaccharolyticus

1

Total

31

Source: From Ref. 67.

Source: From Ref. 67.

lymph node cultures in past studies (24% to 35%) may be related to the failure of isolation of fastidious organisms.

Roberts and Linsey (74), who recovered organisms in 35 nodes, grew mycobacterial species in 22 cultures and bacteria in 11 cultures, five of which were anaerobic.

Brook et al. reported the microbiology of needle aspirates from 40 inflamed cervical lymph glands in adults (77). Forty-two bacterial, 11 mycobacterial and six fungal isolates were isolated. Aerobes only were recovered in 11 (27.5%), anaerobes alone in five (12.5%) and mixed aerobic and anaerobic bacteria in seven (17.5%). Mycobacterium spp. were recovered in 11 (27.5%) and fungi in six (15%). The recovery of anaerobes was associated with dental infection. Eighteen aerobic bacteria were isolated and the predominant ones were S. aureus (8 isolates) and GABHS (4). Twenty-four anaerobic bacteria were recovered and the predominant ones were: Prevotella spp. (6), Peptostreptococcus spp. (5), Propionibacterium acnes (4) and Fusobacterium spp. (3).

Most of the time, anaerobes were recovered as part of a polymicrobial infection in all of the above studies (67,74,77). Recovery of these organisms is not surprising because anaerobic bacteria outnumber aerobic organisms in the oropharynx by 10:1 and frequently are recovered from infection adjacent to the oral cavity (4).

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