A 23-year-old man had complained of right lower quadrant abdominal pain

A 23-year-old man had complained of right lower quadrant abdominal pain for approximately one week. Initially the pain was sharp and localized to a small area just above the right iliac crest. The pain subsided for approximately two days, but then recurred more diffusely over the lower abdomen, accompanied by cramping and mild diarrhea. The onset of fever and vomiting prompted a visit to the emergency room. His temperature was101 F, pulse was 90 per minute, and palpation of the right lower abdomen elicited severe pain. The white blood count was 23,000/mm with a distinct left shift, including 5% meta-myelocytes. Emergency surgery was performed for a large peri-appendiceal abscess. During surgery, multiple abscesses were noted in the spleen, which was removed (see image).Recovery was uneventful following five days of adjuvant clindamycin therapy.

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The answers

• Splenic Abscess Most cases of splenic abscess are the result of metastatic or contiguous infectious processes, trauma, splenic infarction, or immunosuppression.  In order to properly test what form of streptococci is present Hardy’s Rapid Anginosis ID kit should be performed. Hardy Diagnostics Rapid Anginosus ID Kit is used to detect arginine decarboxylase activity and perform the Voges-Proskauer test, in as little as four hours, to assist in the identification of the Streptococcus anginosus group (formerly milleri ). Rapid VP is also useful for differentiating coagulase-positive strains of Staphylococcus spp. The reason for using Hardy’s ID kit is because it is the quickest and easiest form of testing for this particular bacterial strand.

• There are organisms to be suspected after testing.  One organism in particular for this specific case study  is streptococcus anginous “milleri”. The Streptococcus anginosus group (also known as the S. milleri group) is a subgroup of viridans streptococci that consists of three distinct streptococcal species: S. anginosus, S. intermedius, and S. constellatus; S. constellatus has two subspecies, S. constellatus subsp constellatus and S. constellatus subsp pharyngis.The organisms were subsequently recognized as normal flora of the human oral cavity and gastrointestinal tract with the ability to cause abscesses and systemic infections. Also there are characteristics to be suspected when testing such as a carmel-like odor, preference for increased CO2 or anaerobic and is likely to produce Lancefield antigens.

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