Infectious Diseases

Answer 1 Viridans streptococci. Viridans streptococci are an increasing cause of blood stream infections in neutropenic patients with cancer. Risk factors include high-dose cytosine arabinoside, antimicrobial prophylaxis with fluoroquinolones or trimethoprim-sulfamethoxazole, severe neutropenia, and oral mucositis. In some patients, a toxic shock­like syndrome (eg, hypotension, rash, palmar desquamation) and rapid progression to acute respiratory distress syndrome can occur. Moreover, there is increasing resistance of viridans streptococci to penicillin and a variety of other antibiotics; hence, vancomycin is the preferred agent for empiric therapy in these situations. Although all of the other pathogens can cause serious infections, viridans streptococci is the most likely pathogen given this clinical scenario. Click here to return to the questions

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