Osteomyelitis caused by Streptococcus intermedius in immunocompetent adults - a case report and systematic literature review

Abstract

Hematogenous osteomyelitis caused by Streptococcus intermedius is rare, particularly in immunocompetent adults. The aim of this paper is to provide an overview of the clinical presentation, prognosis as well as treatment of this disease, with the focus on immunocompetent adults. Six medical literature libraries were searched to identify studies reporting on Streptococcus intermedius induced hematogenous osteomyelitis in immunocompetent adults. In addition, we presented a case of a 44-year-old man from our institution that is illustrative for this disease. Four case reports describing four patients were identified by this systematic literature review. Hence, the data of five patients (including our case) were assessed. The most common presenting symptom was localised pain, followed by fever. Portal entries were found in two patients (general periodontitis and necrotic dentition). The localisations of osteomyelitis were diverse: femoral (two patients), lumbar spine (two patients), and the iliac bone (one patient). Treatment strategies varied strongly, but antibiotics (penicillins) were administered in each case, and two patients underwent surgical debridement. Follow-up ranged from 2 weeks to more than 6 months; one patient died from septic shock. Only a very limited number of immunocompetent adults with Streptococcus intermedius induced hematogenous osteomyelitis have been described. Based on the available data, we summarised the clinical presentation, prognosis as well as treatment of hematogenous osteomyelitis caused by Streptococcus intermedius in this patient population.

Keywords: Hematogenous; Immunocompetent; Infectious diseases; Osteomyelitis; Streptococcus intermedius.

Fig. 1

MRI scan (number 1) of both femurs (left) and a close-up of the left femur (right) showing a periosteal lesion in the left musculus vastus intermedius and a permeative process of the left femoral diaphysis

Fig. 2

MRI scan (number 2) of both femurs (left) and a close-up of the left femur (right) showing a parosteal lesion, oedema, and enhancement of the musculus vastus intermedius (28 × 11 × 140 mm) including general oedema in the surrounding musculature and permeative process of the left femoral diaphysis

Fig. 3

Ultrasound of the left femur showing abscesses near the musculus vastus lateralis (8.0 × 3.3 × 1.7 cm) and musculus intermedius (6.0 × 2.7 × 1.3 cm)

Fig. 4

Flowchart of study selection and inclusion process