title: Community-acquired bacteremic Streptomyces atratus pneumonia in animmunocompetent adult: a case report.
abstract: BACKGROUND
  Streptomyces spp. are aerobic, Gram-positive bacteria of the order Actinomycetales, known for their ability to produce antimicrobial molecules such as streptomycin. Pneumonia due to Streptomyces is considered to be rare and limited to immunocompromised patients. Streptomyces spp. are only rarely associated with invasive systemic infections. To our knowledge, we report the first documented case of community-acquired Streptomyces atratus bacteremic pneumonia in an immunocompetent patient.
  
  
  METHODS
  We describe a case of Streptomyces atratus bacteremic pneumonia in an otherwise healthy, 77-year-old Spanish man. Streptomyces identified by 16S ribosomal RNA sequencing grew in multiple blood cultures and bronchoalveolar lavage cultures. The infection resolved completely after treatment with imipenem and amoxicillin/clavulanic acid for 2 months.
  
  
  CONCLUSIONS
  The majority of cases reported in the literature make reference to the difficulty of determining the pathogenic role of Streptomyces spp. Usually considered a contaminant, the pathogenic role of Streptomyces spp. is easier to confirm when the species is isolated from a catheter tip and, in the case of blood cultures, in more than one sample with a high count of colonies. To our knowledge, we report the first documented case of Streptomyces atratus bacteremic pneumonia in an immunocompetent patient. As the experience is limited, further studies are needed to better understand the interpretation of the isolates of the genus Streptomyces; the predisposing factors for infection; and the course, treatment, and evolution of these infections.
authors.affiliation: Hospital Universitario Central de Asturias (HUCA), Instituto Nacional de Silicosis (INS), Área del Pulmón, Facultad de Medicina, Universidad de Oviedo, Avenida Roma s/n, Oviedo, Asturias, 33011, Spain. arizamiguel@hotmail.com.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Ariza-Prota
authors.affiliation: Hospital Universitario Central de Asturias (HUCA), Instituto Nacional de Silicosis (INS), Área del Pulmón, Facultad de Medicina, Universidad de Oviedo, Avenida Roma s/n, Oviedo, Asturias, 33011, Spain. ana_pando@hotmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Pando-Sandoval
authors.affiliation: Hospital Universitario Central de Asturias (HUCA), Instituto Nacional de Silicosis (INS), Área del Pulmón, Facultad de Medicina, Universidad de Oviedo, Avenida Roma s/n, Oviedo, Asturias, 33011, Spain. davidfolevazquez@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Fole-Vázquez
authors.affiliation: Hospital Universitario Central de Asturias (HUCA), Instituto Nacional de Silicosis (INS), Área del Pulmón, Facultad de Medicina, Universidad de Oviedo, Avenida Roma s/n, Oviedo, Asturias, 33011, Spain. mgclemen@gmail.com.
authors.forename: Marta
authors.initials: M
authors.lastname: García-Clemente
authors.affiliation: Hospital Universitario Central de Asturias (HUCA), Instituto Nacional de Silicosis (INS), Área del Pulmón, Facultad de Medicina, Universidad de Oviedo, Avenida Roma s/n, Oviedo, Asturias, 33011, Spain. terebudino@telecable.es.
authors.forename: Teresa
authors.initials: T
authors.lastname: Budiño
authors.affiliation: Hospital Universitario Central de Asturias (HUCA), Instituto Nacional de Silicosis (INS), Área del Pulmón, Facultad de Medicina, Universidad de Oviedo, Avenida Roma s/n, Oviedo, Asturias, 33011, Spain. pcasan@ins.es.
authors.forename: Pere
authors.initials: P
authors.lastname: Casan
mesh_terms: D000193:Actinomycetales Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology; D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D017714:Community-Acquired Infections; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage*; D007121:Immunocompetence; D064704:Levofloxacin / Q000008:administration & dosage*; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology; D017422:Sequence Analysis, DNA; D013302:Streptomyces / Q000302:isolation & purification*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015378:Imipenem; D019980:Amoxicillin-Potassium Clavulanate Combination