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Infective Endocarditis (IE) is associated with severe complications including cardiac failure, septic embolisation to distant organs, and significant mortality, if not promptly diagnosed and treated. It is therefore pertinent to perform diagnostic echocardiography in patients who have clinical suspicion of IE as it can reveal size and location of vegetations along with the extent of infection in the surrounding tissue and aid in confirming a therapeutic response. Vegetations in IE usually involve the valves but rarely may be located in the ventricles. Left atrial mural vegetation is a very rare condition. The common pathogen causing IE is Staphylococcus Aureus seen in more than half of the cases. Streptococcus Viridans is a less virulent organism, found as a part of normal oral, respiratory, gastrointestinal and genital bacterial flora but has the potential to cause invasive bacteremia and infections. A 20-year-old female presented with fever, palpitations, and shortness of breath on exertion for last 4 months. She then had developed sudden onset left sided body weakness and facial weakness. She had an ill-sustained heaving apex beat with grade 4 pan-systolic murmur at mitral area. There was upper motor left-sided uncrossed hemiplegia. Transesophageal echocardiography revealed anterior mitral leaflet vegetation along with 2 vegetations attached to the posterior left atrial wall and the jet of mitral valve regurgitation was directed to the posterior wall of the left atrium towards the vegetations. Blood cultures revealed gram-positive Streptococcus Viridians sensitive to vancomycin which was continued. MRI Brain revealed hypodense T1WS and hyperdense T2WS/FLAIR area in the right lentiform nucleus. The final diagnosis was Infective Endocarditis with left atrial mural vegetations due to Streptococcus Viridians, complicated by septic embolisation causing stroke. At 6-week follow up, she was clinically asymptomatic and a repeat echocardiography demonstrated resolution of the vegetations.

Aim: The aim was to compare the efficacy of various herbal disinfectants on irreversible hydrocolloid impressions and to investigate the effectiveness of three herbal disinfectants and a chemical disinfectant against particular pathogens. Settings and Design: In vitro -a comparative study. Materials and Methods: The following methodology was followed to achieve the objectives. Four maxillary impressions were made for each selected patient with irreversible hydrocolloid impression material. The predisinfection swabs were taken from impression sites of teeth 17, 13, 27, and 23 (FDI system of tooth numbering). The impressions were immersed in all four different disinfectants such as 2% glutaraldehyde, Aloe vera solution, 50% neem oil, and apple vinegar solution, then the postdisinfection swabs were taken from the same sites 17,13,27,23 and then cultured onto sheep blood agar and examined for growth, and colony forming units (CFUs) of Streptococcus viridans, Streptococcus mutans, Streptococcus sanguis, and Actinomyces viscosus. The comparative analysis was done for the predisinfection and postdisinfection values in each study group. Statistical Analysis Used: Descriptive analysis, Kruskal Wallis test, Mann Whitney post hoc test, Wilcoxon signed rank test. Results: The results revealed that the mean CFUs of S. viridans, S. mutans, S. sanguis, and A. viscosus during postdisinfection samples were statistically significant when compared to predisinfection samples. Multiple comparison of the mean CFUs of all 4 microorganisms in the control group and in 50% Neem oil group was significantly lesser compared to A. vera and Apple Vinegar group. Conclusion: CFUs of S. viridans, S. mutans, S. sanguis, and A. viscosus significantly decreased in the 50% neem oil group as well as the control group. As a result, 50% Neem oil was a viable option for disinfecting alginate impressions. [ABSTRACT FROM AUTHOR]

Abstract Background Granulomatous hypophysitis is a rare disease that presents with chronic inflammation of the pituitary gland. In this study, we reported a case of granulomatous hypophysitis associated with a pituitary abscess. Case presentation A 39-year-old woman presented with a 2-year history of infertility. For the past six months, she has suffered from amenorrhea, decreased libido, headaches, and vertigo. She was referred to our hospital with a suspected diagnosis of nonfunctioning pituitary adenoma based on her presentation and brain MRI findings. She underwent trans-sphenoidal surgery (TSS). Direct observation during surgery revealed drainage of malodor pus and pituitary gland abscess. The histopathological evaluation also showed granulomatous hypophysitis and neutrophilic microabscess formation. The patient was initially treated with high doses of ceftriaxone (2 g twice daily) and metronidazole (500 mg (mg) four times per day). Also, the patient received cortisol replacement therapy after the operation. After obtaining the antibiogram and culture results, the treatment regimen was continued for 4 weeks postoperatively, followed by amoxicillin-clavulanate (500/125 mg three times daily) for a total duration of 12 weeks. Conclusion The patient recovered uneventfully and the postoperative MRI was normal without any remnant lesions.

IntroductionInfective endocarditis is an infection of the endothelial surfaces of the heart. It is more prevalent in adults but its incidence in the pediatric population has been on the rise. The most important factor remains congenital heart disease and the most isolated pathogen is viridans group streptococcus.MethodsIn this manuscript, we present a 20-year experience of a major referral tertiary care center in diagnosing and treating pediatric patients with endocarditis. A retrospective analysis of records of patients who were diagnosed with infective endocarditis under the age of 18 years is presented in this study. Variables relating to the demographic, imaging, microbiologic and pathologic data are described. Outcomes relating to complications and need for surgical repair are also portrayed.ResultsA total of 70 pediatric patients were diagnosed with endocarditis in this time interval. The medical records of 65 patients were comprehensively reviewed, however the remaining 5 patients had severely missing data. Of the 65 patients, 55.4% were males, and the mean age at diagnosis was 7.12 years. More than half of the population (58.5%) had vegetation evident on echocardiography. The pulmonary valve was the most commonly affected (50%), followed by the mitral valve and tricuspid valves (15.6%). Most patients received empiric treatment with vancomycin and gentamicin. Viridans group streptococcus was the most frequently isolated organism (23.4%).ConclusionAmong pediatric patients diagnosed with endocarditis in this study, data pertaining to valve involvement and microbiologic information was consistent with the published literature. The incidence of complications and the need for surgical repair are not significantly correlated with demographic and clinical variables.

Background: Brain abscess (BA) is a rare but life-threatening infection. Early identification of the pathogen is helpful to improve the outcomes. This study aimed to describe the clinical and radiological features of patients with BA caused by different organisms. Methods: A retrospective, observational study of patients with known etiologic diagnosis of BA in Huashan Hospital Affiliated to Fudan University in China between January 2015 and December 2020 was conducted. Data on patient demographics, clinical and radiological presenting features, microbiological results, surgical treatment, and outcomes were collected. Results: Sixty-five patients (49 male, 16 female) with primary BAs were included. Frequent clinical presentations included headache (64.6%), fever (49.2%) and confusion (27.3%). Streptococcus viridans was associated with thicker wall of abscesses (6.94 ± 8.43 mm for S. viridans versus 3.66 ± 1.74 mm for other organisms, P = 0.031) and larger oedema (89.40 ± 15.70 mm for S. viridans versus 74.72 ± 19.70 mm for other organisms, P = 0.023). The independent factor associated with poor outcome identified by multivariate analysis was confusion (Odds ratio 6.215, 95% confidence interval 1.406–27.466; P = 0.016). Conclusions: Patients with BAs caused by Streptococcus species had nonspecific clinical signs, but specific radiological features, which might be helpful for early diagnosis.

Background: Granulomatous hypophysitis is a rare disease that presents with chronic inflammation of the pituitary gland. In this study, we reported a case of granulomatous hypophysitis associated with a pituitary abscess. Case presentation: A 39-year-old woman presented with a 2-year history of infertility. For the past six months, she has suffered from amenorrhea, decreased libido, headaches, and vertigo. She was referred to our hospital with a suspected diagnosis of nonfunctioning pituitary adenoma based on her presentation and brain MRI findings. She underwent trans-sphenoidal surgery (TSS). Direct observation during surgery revealed drainage of malodor pus and pituitary gland abscess. The histopathological evaluation also showed granulomatous hypophysitis and neutrophilic microabscess formation. The patient was initially treated with high doses of ceftriaxone (2 g twice daily) and metronidazole (500 mg (mg) four times per day). Also, the patient received cortisol replacement therapy after the operation. After obtaining the antibiogram and culture results, the treatment regimen was continued for 4 weeks postoperatively, followed by amoxicillin-clavulanate (500/125 mg three times daily) for a total duration of 12 weeks. Conclusion: The patient recovered uneventfully and the postoperative MRI was normal without any remnant lesions. [ABSTRACT FROM AUTHOR]

Streptococcus viridans is more commonly known as an infectious agent in endocarditis, however, little is known about its infectious potential in other organs or systems, where it has shown high mortality. The recognition of Streptococcus viridans as an abscess-producing agent in other locations, such as the liver or lungs, will allow timely diagnosis using different imaging methods, reducing serious consequences for the patient and hospitalization times. We present the case of a 33-year-old male patient with no chronic degenerative history, who started symptoms 7 months prior to admission, with intermittent fever, fatigue, asthenia, anorexia and weight loss, on physical examination he presented pain at the medium and deep palpation in the right hypochondrium, in the laboratory panel I present striking neutrophilia, in the tomography of the thorax and abdomen a cavernous lesion in the lung and complicated hepatic cysts are shown, to which percutaneous drainage guided by ultrasound is performed, with sending of cultured samples with a positive result for Streptococcus viridans. Thus, allowing treatment to be provided to the patient, thereby achieving remission of the disease. [ABSTRACT FROM AUTHOR]

Introduction: Streptococcus viridans is the most common facultative anaerobic bacteria which can cause pulp and root canal infections in oral cavity. This Gram-positive bacterium can cause pulp necrosis, an indication for root canal treatment. One of the important steps in root canal treatment is root canal irrigation and a good root canal irrigant has a maximum antibacterial effect with minimum toxicity effect. Chitosan is a natural ingredient from shrimp shells. Chitosan has high antibacterial activity against many pathogenic microorganisms and has been used as an antibacterial agent to eliminate Streptococcus viridans. Methods: Streptococcus viridans was grown in a tube which contained BHIB medium and 2% chitosan suspension in each sample group with the concentration of 0.0156%; 0.03125%; .0625%; 0.125%; 0.25%; 0.5%; 1%; 2%. Positive control (BHIB medium and Streptococcus viridans bacteria), 2% acetic acid solution control (2% acetic acid solution and Streptococcus viridans), and negative control (BHIB medium) were made to ensure that there was not any antibacterial effect on the medium. Each tube was incubated at 37°C for 24 hours. The number of living colonies were calculated and compared with the positive control to determine the antibacterial activity, MIC, and MBC. Results: In this study, the percentage of the living colonies in the sample groups with chitosan concentration of 0.125%; 0.0625%; 0.03125% were 0%; 7.2%; 16.4%, respectively. Conclusion: Chitosan has an antibacterial activity with 0.0625% MIC and 0.0125% MBC against Streptococcus viridans. [ABSTRACT FROM AUTHOR]

Abstract Background Streptococcus tigurinus was recently described as a new streptococcal species within the viridans group streptococci (VGS). The objectives of the present work were to analyse the clinical and microbiological characteristics of S. tigurinus isolated from patients with bacteraemias, to determine the prevalence of S. tigurinus among VGS endocarditis in Spain, and to compare the clinical characteristics and outcomes of endocarditis caused by S. tigurinus and other VGS. Methods Retrospective nationwide study, performed between 2008 and 2016 in 9 Spanish hospitals from 7 different provinces comprising 237 cases of infective endocarditis. Streptococcal isolates were identified by sequencing fragments of their 16S rRNA, sodA and groEL genes. Clinical data of patients with streptococcal endocarditis were prospectively collected according to a pre-established protocol. Results Patients with endocarditis represented 7/9 (77.8%) and 26/86 (30.2%) of the bacteraemias caused by S. tigurinus and other VGS, respectively (p

Purpose: To evaluate the effectiveness of prophylactic systemic moxifloxacin in a rabbit model of Streptococcus viridans (S. viridans) endophthalmitis.Methods: Animals (n=60) were divided into three groups. Intravenous moxifloxacin, vancomycin, normal saline was administered to 20 animals in each group and two hours later, 104 colony-forming units (CFU) of S. salivarius were intravitreally injected into the left eye. Intravenous antibiotics injection was repeated on days 1, 2, and 3 after inoculation. The clinical features, bacterial culture from vitreous aspirates of 10 eyes from each group were evaluated on days 1, 3, 5, and 7. On day 7, eyes for clinical feature examination were enucleated for histopathologic examination.Results: Clinical scores and log10CFU/ml values were lower in moxifloxacin group on all examination days. Histopathologic examination showed less inflammation and relatively well-preserved retina in the moxifloxacin group.Conclusions: Systemic moxifloxacin may have a prophyactic effect for S. viridans endophthalmitis after intraocular procedure. [ABSTRACT FROM AUTHOR]

Bacteremia caused by Streptococcus viridans may be fulminant in neutropenic patients. The clinical signs of streptococcal bacteremiain neutropenic patients are obvious, but non-specific, and are characterized by fever, pulmonary symptoms (pneumonia, respiratory distress syndrome) in 20–25 % of cases, hemodynamic instability (about 30 % of cases), rash and followed desquamation, in rare cases – neurological disorders (encephalopathy). Perhaps the main difference from other bacteremia in immunocompromised patients is approximately 10 times higher risk of rapid (during the first two days) development of acute lung injury with hypoxemia often requiring oxygen subsidies and respiratory support. Frequency, clinical characteristics and outcomes of streptococcal bacteremia, as well as the spectrum of antibiotics sensitivity was retrospective analyzed in this study. From 2003 to 2009 in children with various oncological and hematological diseases and febrile neutropenia 265 microorganisms were isolated from blood cultures, including Gram-positive in 113 (42 %) patients. Strains of Streptococcus viridans, isolated at least once from blood (central venous catheter and / or peripheral veins), are included in analysis. Streptococcus viridans were isolated from the blood of 20 patients, accounting for 7.5 % of the total number of bacteremia and 17.7 % of gram-ositive bacteremia. Patients with acute myeloid leukemia (AML) accounted for 45 % of all patients with streptococcal bacteremia, but the incidence of streptococcal bacteremia in AML patients was 8.7 % and did not differ from patients with other diagnoses. 11 (55 %) from 20 patients have mucositis at diagnosis of bacteremia, in 14 patients (70 %) prior chemotherapy included high dose of cytosine arabinoside. All patients with streptococcal bacteremia have severe neutropenia (median 70 cells / mkl) and characterized by fever (100 %), septic shock (8 patients, 40 %) and RDS (7 patients, 35 %) required high doses of steroids (7 patients; 100 %) and ALV (2 patients; 10 %). All patients survived. In 13 (65 %) patients primary empirical therapy contained antibiotics effective against Streptococcus viridans. All strains were susceptible to vancomycin, linezolid and levofloxacin; 90 % and 95 % of strains – to ceftriaxone and cefepime, respectively; 80 % – to penicillin; 50 % – to oxacillin and 35 % – to trimethoprim / sulfomethoxazol.

Background: Antimicrobial agents serve as an effective adjunct with mechanical means in plaque control. Chlorhexidine has been the gold standard in the field of dentistry, but these days a growing number of dentists are embracing the philosophy that natural agents are better for children′s oral health, and the focus is shifted toward biogenic agents for oral hygiene maintenance in children. Aim: The aim was to evaluate antimicrobial and plaque inhibitory potential of herbal and probiotic rinses against Streptococcus viridans with commonly used antimicrobial agent like 0.2% chlorhexidine digluconate. Materials and Methods: A randomized clinical trial was conducted on 60 subjects aged between 6 and 14 years and were divided into three groups comprising 20 subjects in each group. Three oral rinses were administered twice daily for a period of 1 week. Estimation of plaque scores and S. viridans counts was done before and after intervention, and the results were statistically analyzed. Results: The change in mean plaque index in Groups A, B, and C was 0.28 ± 0.16, 1.37 ± 0.43, and 0.60 ± 0.35 respectively. Furthermore, change in mean log 10 colony forming unit (CFU)/ml of S. viridans in Groups A, B, and C was 0.13 ± 0.06, 0.53 ± 0.17, and 0.22 ± 0.06 CFU/ml, respectively. Conclusion: Based on observations done during the course of study herbal rinse proved equally effective as 0.2% chlorhexidine digluconate in reducing S. viridans counts and plaque accumulation after 1 week of intervention, whereas probiotic rinse was least effective. However, long-term clinical trial with larger sample size needs to be undertaken, especially to evaluate beneficial effects of biogenic agents such as herbal and probiotic rinses.

OBJECTIVE: Procalcytonin is a useful marker of bacterial infections. Several studies have reported elevated serum levels of PCT in patients with infective endocarditis (IE) and/or other infections sustained by cocci. We report a rare case of IE attributed to Streptococcus viridans in whom levels of PCT were normal. CASE REPORT: A 67 years-old male was admitted to the Emergency Department for a 25- day history of recurring night fever. Upon admission, patient underwent blood test, including PCT, showing normal levels, e×cept for a slight increased creatinine concentration (1.6 mg/dl). CBC showed WBC levels of 10.24 × 10⋀9/l with neutrophil concentration of 8.64 × 10⋀9/l. Three blood culture were performed, and all of them were positive for Streptococcus viridans (S. oralis). Dosage of PCT was then repeated two times within the ne×t 2 days after the admission, with negative results. An echocardiogram was performed, showing a lesion of the left anterior aortic leaflet. This finding was confirmed by a transoesophageal echocardiogram. The patient was then treated with G penicillin (6 million of Units quid) for 3 weeks; during the course of antibiotic therapy fever disappeared and blood cultures become negative. CONCLUSIONS: In the literature there are just few data about the association between PCT levels and endocarditis and sepsis but there are not etiological differentiations particularly for those sustained by Streptococcus viridans. Only one study suggests that a Streptococcus viridans infection could reduce 'PCT accuracy in diagnosis oh endocarditis. So, our observation although come from a single case, could merits, further investigation. [ABSTRACT FROM AUTHOR]

Cutaneous polyarteritis nodosa ( CPAN) is a chronic, indolent, single organ arteritis that generally presents with lower extremity nodules and/or livedo racemosa, accompanied by malaise and arthralgias. CPAN is often triggered by infection, commonly Group A streptococcal species, and is considered an autoimmune reaction. Scarring from surgery and obliterative lymphangiitis from bacterial cellulitis are the causes of lymphedema. Lymphedematous skin is predisposed to autoimmune disorders. Herein we report a 53-year-old woman who developed CPAN restricted to a localized area of the right upper arm-shoulder that had undergone multiple surgeries, complicated by episodes of Streptococcus viridans cellulitis. Clinically, a 15 cm diameter plaque exhibited violaceous, reticulate margins, subtle papules and nodules and central livedo racemosa. Biopsy showed numerous foci of arteritis in active, subacute and reparative stages. In addition, a broad zone of fibrosis replaced the deep dermis-subcutis zone and harbored numerous dilated lymphatic vessels scar lymphedema. Treatment consisted of high potency topical corticosteroids under occlusion; remission after 3 months therapy and follow-up. CPAN primarily affects the lower legs, a region of frequently affected by phlebolymphedema. This report of CPAN localized to an area of scar lymphedema underscores the importance of lymphatic function in the pathogenesis of CPAN. [ABSTRACT FROM AUTHOR]

Introduction: Infective endocarditis is an infection of the endothelial surfaces of the heart. It is more prevalent in adults but its incidence in the pediatric population has been on the rise. The most important factor remains congenital heart disease and the most isolated pathogen is viridans group streptococcus., Methods: In this manuscript, we present a 20-year experience of a major referral tertiary care center in diagnosing and treating pediatric patients with endocarditis. A retrospective analysis of records of patients who were diagnosed with infective endocarditis under the age of 18 years is presented in this study. Variables relating to the demographic, imaging, microbiologic and pathologic data are described. Outcomes relating to complications and need for surgical repair are also portrayed., Results: A total of 70 pediatric patients were diagnosed with endocarditis in this time interval. The medical records of 65 patients were comprehensively reviewed, however the remaining 5 patients had severely missing data. Of the 65 patients, 55.4% were males, and the mean age at diagnosis was 7.12 years. More than half of the population (58.5%) had vegetation evident on echocardiography. The pulmonary valve was the most commonly affected (50%), followed by the mitral valve and tricuspid valves (15.6%). Most patients received empiric treatment with vancomycin and gentamicin. Viridans group streptococcus was the most frequently isolated organism (23.4%)., Conclusion: Among pediatric patients diagnosed with endocarditis in this study, data pertaining to valve involvement and microbiologic information was consistent with the published literature. The incidence of complications and the need for surgical repair are not significantly correlated with demographic and clinical variables., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Rashed, Fakhri, Zareef, Abdul Halim, Ahmed, Dbaibo, El-Rassi, Bitar and Arabi.)

Background: Oral ulceration often becomes the main reason for the patients to see a dentist. Therapy of the oral ulceration is by giving the palliative therapy with topical antiseptic. Nowadays, there are many researches concerning with the traditional medicines as alternative therapy. One of them is Piper betle linn which contains the antiseptic agent. Purpose: This research is aimed to observe the sensitivity difference of Streptococcus viridans on 35% Piper betle linn extract and 10%povidone iodine. Methods: This laboratory research was conducted by the post test only design with random complete design. The research sampel is Streptococcus viridans culture that was scrapped from the ulcer of the recurrent aphthous stomatitis patient, then it was replicated by using the Federer theory. Results: Inhibitory zone of 35% Piper betle linn extract is bigger than 10% povidone iodine. Conclusion: Streptococcus viridans are more sensitive to 35% Piper bittle linn extract than 10% povidone iodine. 35% Piper betle linn extract has more antibacterial effect than 10% povidone iodine.Latar belakang: Ulserasi rongga mulut seringkali menjadi alasan utama bagi pasien untuk memeriksakan diri ke dokter gigi. Terapi ulserasi rongga mulut adalah pemberian terapi paliatif kepada penderita, seperti: pemberian obat topikal yang mengandung antiseptik. Saat ini banyak penelitian dalam pengembangan obat tradisional yang dapat dijadikan sebagai obat alternatif. Salah satu diantaranya adalah daun sirih yang mengandung zat antiseptik. Tujuan: Penelitian ini bertujuan mengetahui perbedaan sensitivitas Streptococcus viridans terhadap ekstrak daun sirih 35% jika dibandingkan dengan povidone iodine 10%. Metode: Penelitian laboratoris yang dilakukan dengan post test only design dengan rancangan acak lengkap. Sampel penelitian adalah kultur Streptococcus viridans yang diambil melalui swab dari hapusan ulser pada pasien yang menderita stomatitis aftosa rekuren, kemudian dilakukan replikasi dengan rumus Federer. Hasil: Zona hambat ekstrak daun sirih 35% lebih besar daripada zona hambat povidone iodine 10%. Kesimpulan: Streptococcus viridans lebih sensitif terhadap ekstrak daun sirih 35%. Ekstrak daun sirih 35% memiliki efek daya antibakteri yang lebih tinggi jika dibandingkan dengan povidone iodine 10%.

Calcium hydroxide had been used as the intra-canal dressing in endodontic treatment due to its high alkaline and antimicrobial capacity. It can also dissolve the necrotic tissue, prevent dental root resorbtion and regenerate a new hard tissue. The aim of this study was to determine the concentration of calcium hydroxide which had the highest antimicrobial effect on Streptococcus viridans. Samples were divided into 5 groups; each group consisted of 8 samples with different concentration of calcium hydroxide. Group I: 50%, group II: 55, Group III: 60%, Group IV: 65%, Group V: 70%. The antimicrobial testing was performed using diffusion method against Streptococcus viridans. The result of susceptibility test was showed by the inhibition zone diameter which measured with caliper (in millimeter). We analyzed the data using One-Way ANOVA test with significant difference 0.05 and subsequently LSD test. The study showed that calcium hydroxide with concentration 60% has the highest antimicrobial effect.

Background: Brain abscess (BA) is a rare but life-threatening infection. Early identification of the pathogen is helpful to improve the outcomes. This study aimed to describe the clinical and radiological features of patients with BA caused by different organisms., Methods: A retrospective, observational study of patients with known etiologic diagnosis of BA in Huashan Hospital Affiliated to Fudan University in China between January 2015 and December 2020 was conducted. Data on patient demographics, clinical and radiological presenting features, microbiological results, surgical treatment, and outcomes were collected., Results: Sixty-five patients (49 male, 16 female) with primary BAs were included. Frequent clinical presentations included headache (64.6%), fever (49.2%) and confusion (27.3%). Streptococcus viridans was associated with thicker wall of abscesses (6.94 ± 8.43 mm for S. viridans versus 3.66 ± 1.74 mm for other organisms, P  = 0.031) and larger oedema (89.40 ± 15.70 mm for S. viridans versus 74.72 ± 19.70 mm for other organisms, P  = 0.023). The independent factor associated with poor outcome identified by multivariate analysis was confusion (Odds ratio 6.215, 95% confidence interval 1.406-27.466; P  = 0.016)., Conclusions: Patients with BAs caused by Streptococcus species had nonspecific clinical signs, but specific radiological features, which might be helpful for early diagnosis., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Endocarditis is an infectious disease, caused in most cases by bacteria from other parts of the body or introduced into the body during medical maneuvers, being called infective endocarditis (IE). Although it is an uncommon disease, IE is among the first life-threatening infections. Damaged or artificial heart valves, congenital or other heart defects and increasing percentage of cardiac devices represent various risk factors, most often flaged for developing this disease. Among the etiologic agents, Staphylococcus aureus is the pathogen most frequently isolated in bacterial endocarditis. The germs of Streptococcus viridans group from normal oral flora, skin, respiratory and gastrointestinal tract are causing approximately 50-60% of subacute IE, as well as enterococci in IE cases. Other pathogens isolated from cases of IE are coagulase-negative staphylococci, beta-hemolytic streptococci, gram-negative group HACEK, Pseudomonas aeruginosa, Corynebacterium spp., Legionella spp., and fungi (Candida spp., e.g., Aspergillus spp.) etc. IE types are described according to various causes and their causative agents: the native valve IE, prosthetic valve IE (artificial), IE by intravenous administration of illegal drugs through the use of cardiac devices, nosocomial IE. Penetration of the pathogen into the bloodstream (bacteremia), followed by adherence at the level of damaged areas in parietal endocardial, the heart valves, subvalvular apparatus or a blood vessel, forming lesions vegetating and ulcerative necrotic, represent the steps in a complex process in IE development. Classic signs and symptoms of IE are fever, chills, weight loss, heart murmur, vascular and immunological phenomena as well. Diagnosis is based on clinical manifestations, laboratory investigations, imaging techniques and microbiological investigations, most of them being the base of the modified Dukes criteria to facilitate the diagnosis of this disease. Treatment of IE requires eradication of the infection and the treatment of complications, which involves antibiotics and surgery to remove infected material and draining abscesses. Also, prevention measures are an important chapter in the management of infective endocarditis. [ABSTRACT FROM AUTHOR]

Peritonitis is a disease caused by bacterial strains that have become increasingly resistant to many antibiotics. The development of alternative therapeutic compounds is the focus of extensive research, so novel nanoparticles (NPs) with activity against antibiotic‐resistant bacteria should be developed. In this study, the antibacterial activity of quaternary ammonium polyethyleneimine (QA‐PEI) NPs was evaluated against Streptococcus viridans, Stenotrophomonas maltophilia and Escherichia coli. To appraise the antibacterial activity, minimal inhibitory concentration (MIC), minimal bactericidal concentration and bactericidal assays were utilised with different concentrations (1.56–100 µg/ml) of QA‐PEI NPs. Moreover, 3‐[4,5‐dimethylthiazol‐2‐yl]‐2,5‐diphenyl tetrazolium bromide (MTT) and annexin V/propidium iodide toxicity assays were performed in cell cultures. MICs for S. maltophilia and E. coli isolates were 12.5 and 25 µg/ml, respectively, whereas the MIC for S. viridans was 100 µg/ml. Furthermore, the growth curve assays revealed that these QA‐PEI NPs at a concentration of 12.5 µg/ml significantly inhibited bacterial growth for the bacterial isolates studied. On the other hand, QA‐PEI NPs lacked significant toxicity for cells when used at concentrations up to 50 μg/ml for 48 h. The present findings reveal the potential therapeutic value of this QA‐PEI NPs as alternative antibacterial agents for peritonitis, especially against Gram‐negative bacteria. [ABSTRACT FROM AUTHOR]

Background and purpose: Some complications such as infective endocarditis may develop following dental procedures. Preventing infective endocarditis is possible by identifying and eliminating the underlying risk factors. This study was designed to investigate the risk factors for infective endocarditis. Materials and methods: In a cross sectional study we investigated 60 patients with infective endocarditis attending Rajaie Heart Center and Imam Khomeini Hospital, Tehran. All parameters were recorded including the type of endocarditis, history of cardiac diseases, cardiac surgery, infective endocarditis, intravenous drug abuse, any kind of systemic disease, and microorganisms in blood cultures. Other information including oral health behavior, history of dental procedures and DMFT index were also recorded. Data was analyzed using descriptive statistics. Results: The mean age of patients was 16.8 ± 42.9 years and 70% had heart diseases. Other factors including cardiac surgery, intravenous drug abuse, history of endocarditis, and other surgical procedures were also observed. Systemic diseases were found in 50%. In 36.7% no risk factor was found for increased risk of endocarditis. Dental treatments were reported in 73.3% of the patients. The mean DMFT score was 36.6 ± 4.12. In the past 6 months 16.7% had dental procedures that required antibiotic prophylaxis. Conclusion: The low age of patients, high number of patients without underlying risk factors and poor oral hygiene are amongst the important issues that require further investigation. [ABSTRACT FROM AUTHOR]

Although many patients with infective endocarditis (IE) complain of joint, muscle, and back pain, infections at these sights are rare. The incidence of spinal abscess in cervical spine complicating endocarditis is very rare. Although the surgical management is the mainstay of treatment, conservative treatment can get success in selected patients. We report a patient with cervical epidural abscess due to Streptococcus viridans endocarditis. Both epidural abscess and IE were managed conservatively with intravenous antibiotics for 8 weeks, with recovery. It is important to remind spinal epidural abscess can occur in those patients with bacterial endocarditis. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial agents serve as an effective adjunct with mechanical means in plaque control. Chlorhexidine has been the gold standard in the field of dentistry, but these days a growing number of dentists are embracing the philosophy that natural agents are better for children's oral health, and the focus is shifted toward biogenic agents for oral hygiene maintenance in children. Aim: The aim was to evaluate antimicrobial and plaque inhibitory potential of herbal and probiotic rinses against Streptococcus viridans with commonly used antimicrobial agent like 0.2% chlorhexidine digluconate. Materials and Methods: A randomized clinical trial was conducted on 60 subjects aged between 6 and 14 years and were divided into three groups comprising 20 subjects in each group. Three oral rinses were administered twice daily for a period of 1 week. Estimation of plaque scores and S. viridans counts was done before and after intervention, and the results were statistically analyzed. Results: The change in mean plaque index in Groups A, B, and C was 0.28 ± 0.16, 1.37 ± 0.43, and 0.60 ± 0.35 respectively. Furthermore, change in mean log10 colony forming unit (CFU)/ml of S. viridans in Groups A, B, and C was 0.13 ± 0.06, 0.53 ± 0.17, and 0.22 ± 0.06 CFU/ml, respectively. Conclusion: Based on observations done during the course of study herbal rinse proved equally effective as 0.2% chlorhexidine digluconate in reducing S. viridans counts and plaque accumulation after 1 week of intervention, whereas probiotic rinse was least effective. However, long-term clinical trial with larger sample size needs to be undertaken, especially to evaluate beneficial effects of biogenic agents such as herbal and probiotic rinses. [ABSTRACT FROM AUTHOR]