title: An unusual case of thoracic empyema caused byGranulicatella elegans(nutritionally variant streptococci) in a patient with pulmonary tuberculosis and human immunodeficiency virus infection.
abstract: BACKGROUND
  Nutritionally variant streptococci (NVS) are an infrequent cause of human infection withGranulicatella elegansbeing the least encountered species in clinical specimens. The most common infection caused by NVS is infective endocarditis.
  
  
  METHODS
  We report an unusual case of thoracic empyema due toG. elegansin a patient with pulmonary tuberculosis (TB) and human immunodeficiency virus infection. The patient responded favourably to drainage and penicillin.
  
  
  CONCLUSIONS
  This case illustrates that even though TB is responsible for the majority of pleural effusions in this setting, other rare opportunistic bacteria may cause infection in susceptible patients. Therefore, microbiological investigations should be performed in all patients presenting with pleural effusion.
authors.affiliation: Department of Medical Microbiology, University of Kwazulu-Natal, 800 Bellair Road, Mayville, Durban, South Africa; National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, South Africa.
authors.forename: Nomonde R
authors.initials: NR
authors.lastname: Mvelase
authors.affiliation: National Health Laboratory Service , 1 Modderfontein Road, Sandringham, Johannesburg , South Africa.
authors.forename: Kanitha
authors.initials: K
authors.lastname: Marajh
authors.affiliation: Respiratory and Meningeal Pathogens Reference Unit, National Institute for Communicable Diseases, a division of the National Health Laboratory Service , 1 Modderfontein Road, Sandringham, Johannesburg , South Africa.
authors.forename: Olga
authors.initials: O
authors.lastname: Hattingh
authors.affiliation: Department of Medical Microbiology, University of Kwazulu-Natal, 800 Bellair Road, Mayville, Durban, South Africa; National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, South Africa.
authors.forename: Koleka P
authors.initials: KP
authors.lastname: Mlisana
keywords: Granulicatella elegans; Penicillin; Thoracic empyema; pulmonary tuberculosis