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September - December 2002: 
Volume 15, Issue 3

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Group A streptococcal bacteremia: A case report
Abstract
We present a case of a thirty years old intravenous drug user (IVDU), who was admitted to the hospital due to temperature of 38°C, cough, blood in sputum and a chest pain. Clinical examination revealed a small degree of spleenomegaly and absence of cardiac murmurs. He was started treatment with Vancomycin 1gr x 2, Ampicillin 2 gr x 6 and Amikacin 500 gr x 2 daily. Laboratory testing was normal, except blood cultures which revealed a group A streptococcus. Echocardiography is missing because the patient left the hospital without permission the next day following his admission. GAS bacteremia is responsible for only 1,07% of all bacteremias. There is a significant increase of its incidence, in the third decade of life, concerning young IVDU patients, free of underlying diseases, as a consequence of IV drug use, under non aseptic conditions. Its clinical characteristics are similar to those of the patient presented. In fact, it is a benign disease of low mortality, a long period of evolution before diagnosis, often associated with septic pulmonary embolism, developing due to septic thrombophlebitis. Characteristically, there is an absence of cardiac murmurs and endocardial lesions in echocardiogram, while underlying endocarditis is only present in 6,5% of cases. In the case presented, the possibility of an underlying endocarditis has not been determined, because of lack of echocardiogram. Anyhow, the isolation of GAS, as a cause of bacteremia is definitely of particular interest. Pneumon 2002, 15(3):323-326.