title: The Streptococcus milleri group in chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  S. anginosus, constellatus and intermedius, also known as the Streptococcus milleri group (SMG) are three streptococcal species more frequently detected in cases of invasive disease, abscesses and empyema in particular. Recent research suggests they play a role in exacerbations of cystic fibrosis (CF). Owing to poor recovery on standard culture media and difficult differentiation from non-pathogenic streptococci, SMG may be underdiagnosed in routine settings. We aimed to establish the incidence of SMG in chronic obstructive pulmonary disease (COPD) patients compared to CF patients and to examine possible links of SMG to exacerbations that plays a key role in progression of COPD.
  
  
  METHODS
  Altogether, 90 respiratory tract samples of patients suffering from CF or COPD were examined during the period from July 2012 to December 2013. Semi-selective McKay agar was used for primary cultivation of SMG and MALDI TOF MS was used for species identification that was confirmed by biochemical profiling and specific PCR.
  
  
  RESULTS
  We confirmed the presence of SMG in CF (17.6% incidence in adult patients) and newly established its presence in COPD (10.3% incidence). In COPD, SMG was detected in 4 cases of acute exacerbations, where no other bacterial pathogen was detected. In 3/4 cases, increased CRP level indicated bacterial infection as a cause of the exacerbation and in all 3 cases, patients recovered during antibiotic treatment.
  
  
  CONCLUSIONS
  Our data indicate SMG may act as opportunist pathogens able to cause exacerbations in COPD.
authors.affiliation: Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
authors.forename: Lucie
authors.initials: L
authors.lastname: Navratilova
authors.affiliation: State Veterinary Institute in Olomouc, Jakoubka ze Stribra 1, Olomouc, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Bardon
authors.affiliation: Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
authors.forename: Radko
authors.initials: R
authors.lastname: Novotny
authors.affiliation: Department of Respiratory Medicine, University Hospital Olomouc, Czech Republic.
authors.forename: Jaromir
authors.initials: J
authors.lastname: Zatloukal
authors.affiliation: Department of Respiratory Medicine, University Hospital Olomouc, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Jakubec
authors.affiliation: Department of Respiratory Medicine, University Hospital Olomouc, Czech Republic.
authors.forename: Vitezslav
authors.initials: V
authors.lastname: Kolek
authors.affiliation: Department of Pediatrics, University Hospital Olomouc, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Zapalka
authors.affiliation: Department of Pediatrics, University Hospital Olomouc, Czech Republic.
authors.forename: Frantisek
authors.initials: F
authors.lastname: Kopriva
authors.affiliation: Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
authors.forename: Petra
authors.initials: P
authors.lastname: Prochazkova
authors.affiliation: Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.|Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
authors.forename: Vladislav
authors.initials: V
authors.lastname: Raclavsky
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003550:Cystic Fibrosis / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000382:microbiology; D029424:Pulmonary Disease, Chronic Obstructive; D012141:Respiratory Tract Infections / Q000382:microbiology*; D013183:Sputum / Q000382:microbiology; D013290:Streptococcal Infections / Q000382:microbiology*; D034364:Streptococcus milleri Group / Q000302:isolation & purification*
keywords: Streptococcus anginosus; Streptococcus constellatus; Streptococcus intermedius; Streptococcus milleri group; chronic obstructive pulmonary disease; cystic fibrosis