#idboardreview 40 M presents with fever, chills, abd pain. CT liver abscess s/p I&D, microaerophilic catalase negative, gram positive cocci. Diagnosis? #medEd #idmedEd 
Streptococcus anginosus liver abscess. S. anginosus group has 3 species: S constellatus, S intermedius & S. anginosus.
S anginosus or S milleri Gp are commensal flora of oropharynx snd GI track.
S anginosus gp cause periodontal abscess, CNS abscess, lung abscess/empyema, liver abscess, peritonitis, cholangitis & appendicitis. S. constellatus is more likely to cause deep abscesses, S. intermedius: liver & brain abscess & S. anginosus: bacteraemia & polymicrobial abscess
A buttery, butterscotch-like smell is useful for identifying the S. anginosus group when present but is not a sufficiently sensitive screening test.
Majority of strains PenicillinG MIC ≤0.125 with occasional strain MIC>1 (9% w/MIC>4). Tx penicillin G or ceftriaxone can be used. If black am allergy: Vanc or clinda. Empirically penicillin w/gent can be used. AG, macrolides are resistant.
Interesting case of strep anginosus refractory to I&D and abx caused by stuck 🐠 bone academic.oup.com/cid/article/41…
