Abstract
The following review examines the bacteriological characteristics, epidemiology, pathogenicity and antimicrobial susceptibility of the “Streptococcus milleri group”. “Streptococcus milleri group” is a term for a large group of streptococci which includesStreptococcus intermedius, Streptococcus constellatus andStreptococcus anginosus. Usually considered commensals, these organisms are often associated with various pyogenic infections including cardiac, abdominal, skin and central nervous system infections. Organisms of the “Streptococcus milleri group” are often unrecognized pathogens due to the lack of uniformity in classifications and difficulties in microbiological identification. Penicillin G, cephalosporins, clindamycin and vancomycin all possess activity against these streptococci. Use of agents with poor activity may promote infections with “Streptococcus milleri group” and allow it to exhibit its pathogenicity. An understanding of these organisms may aid in their recognition and proper treatment.
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Guthof O: Über pathogene “vergrunende Streptokokken”. Streptokokken-Befunde bei dentogenen Abszessen und Infiltraten im Bereich der Mundhöhle. Zentralblatt für Bakteriologie, Parasitenkunde, Infektionskrankheiten, Hygiene 1956, 166: 553–564.
Colman G, Williams REO: Taxonomy of some human viridans streptococci. In: Wannamaker LW, Matsen JM (ed): Streptococci and streptococcal diseases: recognition, understanding, and management. Academic Press, New York, 1972, p. 281–299.
Facklam RR: Physiological differentiation of viridans streptococci. Journal of Clinical Microbiology 1977, 5: 184–201.
Facklam RR: The major differences in the American and BritishStreptococcus taxonomy schemes with special reference toStreptococcus milleri. European Journal of Clinical Microbiology 1984, 3: 91–93.
Coykendall AL, Wesbecher PM, Gustafson KB:Streptococcus milleri, Streptococcus constellatus, andStreptococcus intermedius are later synonyms ofStreptococcus anginosus. International Journal of Systematic Bacteriology 1987, 37: 222–228.
Whiley RA, Hardie JM: DNA-DNA hybridization studies and phenotypic characteristics of strains within theStreptococcus milleri group. Journal of General Microbiology 1989, 135: 2623–2633.
Whiley RA, Beighton D: Emended descriptions and recognition ofStreptococcus constellatus, Streptococcus intermedius andStreptococcus anginosus as distinct species. International Journal of Systematic Bacteriology 1991, 41: 1–5.
Skerman VBD, McGowan V, Sneath PHA: Approved lists of bacterial names. International Journal of Systematic Bacteriology 1980, 30: 225–420.
Gallis HA: Viridans and beta haemolytic (non group A, B, and D) streptococci. In: Mandell GL, Douglas RG, Bennett JE (ed): Principles and practice of infectious diseases. Churchill Livingstone, New York, 1990, p. 1563–1571.
Gossling J: Occurrence and pathogenicity of theStreptococcus milleri group. Reviews of Infectious Diseases 1988, 10: 257–285.
Kambal AM: Isolation ofStreptococcus milleri from clinical specimens. Journal of Infection 1987, 14: 217–223.
Ball LC, Parker MT: The cultural and biochemical characteristics ofStreptococcus milleri strains isolated from human sources. Journal of Hygiene 1979, 82: 63–78.
Poole PM, Wilson G: Occurrence and cultural features ofStreptococcus milleri in various body sites. Journal of Clinical Pathology 1979, 32: 764–768.
Whiley RA, Fraser H, Hardie JM, Beighton D: Phenotypic differentiation ofStreptococcus intermedius, Streptococcus constellatus andStreptococcus anginosus strains within theStreptococcus milleri Group. Journal of Clinical Microbiology 1990, 28: 1497–1501.
LePennec MP, Bernardi-Grassias L: In-vitro activity of 13 antibiotics against clinical isolates ofStreptococcus milleri. Journal of Antimicrobial Chemotherapy 1989, 24: 618–619.
Van der Auwera P: Clinical significance ofStreptococcus milleri. European Journal of Clinical Microbiology 1985, 4: 386–390.
Shlaes DM, Lerner PI, Wolinsky E, Gopalakrishna KV: Infections due to Lancefield group F and related streptococci(Streptococcus milleri, Streptococcus anginosus). Medicine 1981, 60: 197–207.
Hinnebusch CJ, Nikolai DM, Bruckner DA: Comparison of API Rapid Strep, Baxter MicroScan Rapid Pos ID panel, BBL Minitek Differential Identification system, IDS RapID STR System and Vitek GPI to conventional biochemical tests for identification of viridans streptococci. American Journal of Clinical Pathology 1991, 96: 459–463.
Ruoff KL:Streptococcus anginosus (Streptococcus milleri): The unrecognized pathogen. Clinical Microbiology Reviews 1988, 1: 102–108.
Williams BL, McCann GF, Schoenknecht FD: Bacteriology of dental abscesses of endodontic origin. Journal of Clinical Microbiology 1983, 18: 770–774.
Wickremesinghe R, Russell C: Viridans streptococci associated with periapical dental abscesses. Infection 1976, 4: 196–203.
Murray HW, Gross KC, Masur H, Roberts R: Serious infections caused byStreptococcus milleri. American Journal of Medicine 1978, 64: 759–764.
Parker MT, Ball LC: Streptococci and aerococci associated with systemic infections in man. Journal of Medical Microbiology 1976, 4: 196–203.
Admon D, Ephros MA, Gavish D, Raz R: Infection withStreptococcus milleri. Journal of Infection 1987, 14: 55–60.
Wallis DE, Venezio FR, Montoya A, Cook FV, Scanlon PJ:Streptococcus MG-intermedius endocarditis. Southern Medical Journal 1986, 79: 1313–1314.
Levandowski RA:Streptococcus milleri endocarditis complicated by myocardial abscess. Southern Medical Journal 1985, 78: 892–893.
Akashi K, Ishimaru T, Tsuda Y, Nagafuchi S, Itaya R, Hayashi J, Sawae Y, Kawachi Y, Niho Y: Purulent pericarditis caused byStreptococcus milleri. Archives of Internal Medicine 1988, 148: 2446–2447.
Koepke JA: Meningitis due toStreptococcus anginosus (Lancefield group F). Journal of the American Medical Association 1965, 193: 739–740.
DeLouvois J: Bacteriologic examination of pus from abscess of central nervous systems. Journal of Clinical Pathology 1980, 33: 66–71.
Ghosh K, Duncan R, Kennedy PG: Acute spinal epidural abscess caused byStreptococcus milleri. Journal of Infection 1988, 16: 303–304.
Gelfand MS, Bakhtian BJ, Simmons BP: Spinal sepsis due toStreptococcus milleri: two cases and review. Reviews of Infectious Diseases 1991, 13: 559–563.
Hatoff D: Perineal Crohn's disease complicated by pyogenic liver abscess during metronidazole therapy. Gastroenterology 1983, 85: 194–195.
Madden NP, Hart CA:Streptococcus milleri in appendicitis in children. Journal of Pediatric Surgery 1985, 20: 6–7.
Reed TMS, Davidson AI:Streptococcus milleri liver abscess. Lancet 1976, ii: 648–649.
Brasitus TA, Cleri DJ, Szabo K:Streptococcus MG-intermedius (Streptococcus milleri) hepatic abscess in two patients with regional enteritis. Southern Medical Journal 1983, 76: 1297–1298.
Gillon JCM, Eykyn SJ, Phillips I: Microbiology of pyogenic liver abscess. British Medical Journal 1981, 282: 819–821.
Chua D, Reinhart HH, Sobel JD: Liver abscess caused byStreptococcus milleri. Reviews of Infectious Diseases 1989, 11: 197–202.
Gelfand MS, Hodgkiss T, Simmons BP: Multiple hepatic abscesses caused byStreptococcus milleri in association with an intrauterine device. Reviews of Infectious Diseases 1989, 11: 983–987.
Miller SD, Mauff AC, Koornhof HJ:Streptococcus milleri causing infection in man. South African Medical Journal 1983, 63: 684–686.
Cox RA, Chen K, Coykendall AL, Wesbecher P, Herson VC: Fatal infection in neonates of 26 weeks gestation due toStreptococcus milleri: report of two cases. Journal of Clinical Pathology 1987, 40: 190–193.
Highet AS, Warren RE, Staughton RCD, Roberts SOB:Streptococcus milleri causing treatable infection in perineal hidradenitis suppurativa. British Journal of Dermatology 1980, 103: 375–382.
Müller F, Von Graevenitz A, Ferber T:Streptococcus milleri subcutaneous abscesses in drug addicts. Infection 1987, 55: 201.
Houston BD, Crouch ME, Finch RG:Streptococcus MG-intermedius (Streptococcus milleri) septic arthritis in a patient with rheumatoid arthritis. Journal of Rheumatology 1980, 7: 89–92.
Lever AML, Owen T, Forsey I: Pneumoarthropathy in septic arthritis caused byStreptococcus milleri. British Journal of Medicine 1982, 285: 24.
Brook MG, Lucas RE, Pain AK: Clinical features and management of two cases ofStreptococcus milleri chest infection. Scandinavian Journal of Infectious Diseases 1988, 20: 345–346.
Witt DJ, Craven DE, McCabe WR: Bacterial infections in adult patients with the acquired immune deficiency syndrome (AIDS) and AIDS-related complex. American Journal of Medicine 1987, 82: 900–906.
Whiley RA, Beighton D, Winstanley TG, Fraser HY, Hardie JM:Streptococcus intermedius, Streptococcus constellatus, andStreptococcus anginosus (theStreptococcus miller group): association with different body sites and clinical infections. Journal of Clinical Microbiology 1992, 30: 243–244.
Brook I, Walker RI: Interaction between penicillin, clindamycin, or metronidazole and gentamicin against species of clostridia and anaerobic and facultatively anaerobic gram-positive cocci. Journal of Antimicrobial Chemotherapy 1985, 15: 31–37.
Tillotson GS, Ganguli LA: Antibiotic susceptibilities of clinical strains ofStreptococcus milleri and related streptococci. Journal of Antimicrobial Chemotherapy 1984, 14: 557–560.
Bourgalt A, Wilson WR, Washington JA: Antimicrobial susceptibilities of species of viridans streptococci. Journal of Infectious Diseases 1979, 140: 316–321.
Pulliam LRK, Porschen RK, Hadley WK: Biochemical properties of CO2 dependent streptococci. Journal of Clinical Microbiology 1980, 12: 27–31.
Marshall R, Kaufman AK: Production of deoxyribonuclease, ribonuclease, coagulase, and hemolysins by anaerobic gram-positive cocci. Journal of Clinical Microbiology 1981, 13: 787–788.
Steffen EK, Hentges DJ: Hydrolytic enzymes of anaerobic bacteria isolated from human infections. Journal of Clinical Microbiology 1981, 14: 153–156.
Arala-Chaves MP, Higerd TB, Porto MT, Munoz J, Goust JM, Fudenberg HH, Loadholt CB: Evidence for the synthesis and release of strongly immunosuppressive noncytotoxic substances byStreptococcus intermedius. Journal of Clinical Investigation 1979, 64: 871–883.
Wilcox MD, Knox KW: Surface-associated properties ofStreptococcus milleri group strains and their potential relation to pathogenesis. Journal of Medical Microbiology 1990, 31: 259–270.
Brook I, Walker RI: The role of encapsulation in the pathogenesis of anaerobic gram-positive cocci. Canadian Journal of Microbiology 1985, 31: 176–180.
Tresadern JC, Farrand RJ, Irving MH:Streptococcus milleri and surgical sepsis. Annals of the Royal College of Surgeons of England 1983, 65: 78–79.
Onderdonk AB, Cisneros R: Comparison of clindamycin and metronidazole for the treatment of experimental intra-abdominal sepsis produced byBacteroides fragilis andStreptococcus intermedius. Current Therapeutic Research, Clinical and Experimental 1985, 38: 893–898.
Phillips I, Warren C, Harrison JM, Sharples P, Ball LC, Parker MT: Antibiotic susceptibilities of streptococci from mouth and blood of patients treated with penicillin or lincomycin and clindamycin. Journal of Medical Microbiology 1976, 9: 393–404.
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Piscitelli, S.C., Shwed, J., Schreckenberger, P. et al. Streptococcus milleri group: Renewed interest in an elusive pathogen. Eur. J. Clin. Microbiol. Infect. Dis. 11, 491–498 (1992). https://doi.org/10.1007/BF01960802
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DOI: https://doi.org/10.1007/BF01960802