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This clinical case presents an unusual case of Lemierre's syndrome (LS) in a young woman of 38-year-old. She arrived in the Emergency Department with a high fever and pharyngology resistant to antibiotic therapy with clarithromycin, ceftriaxone, and cortisone for two weeks. At the blood sampling, there is a marked leucocytosis, and the advice of the otolaryngologist is required given the strong pain in the throat. Due to the tonsillar abscess, a neck CT with a contrast medium is necessary for the otolaryngologist's opinion. The CT shows thrombosis of the jugular vein and left subclavian, with thickening of soft perivascular tissues; these findings suggest Lemierre's syndrome: a septic thrombophlebitis of the jugular vein that occurs as a complication of a peritonsillar abscess. The diagnostic process is then completed with a chest HR-CT, which reveals lung density and excavation areas suggesting tuberculosis. Blood culture reveals the presence of Veillonella Parvula (an anaerobic gram-negative coccus), sputum culture reveals the presence of some colonies of Enterobacter cloacae complex, real-time PCR examination on sputum reveals the presence of Streptococcus Pneumoniae and the borderline presence of rhinovirus. Microbiologists, after these results and neck and chest CT with a contrast agent, agree with the diagnosis of suspected LS at an early stage: a septic dissemination fortunately limited only to the neck and lungs region.
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Lemierre's syndrome (LS) is a rare disorder that manifests as septic internal jugular thrombophlebitis following a recent oropharyngeal infection. This article details a unique case of LS, where the patient presented to the emergency room with complaints of vomiting, headache, diplopia, and left eye pain. Due to a history of sore throat, headache, neck pain, fever, and nausea five days prior to admission, the patient was initially treated with amoxicillin/clavulanate for suspected tonsillitis. A positive meningeal sign and elevated temperature were observed during the clinical examination. Lumbar puncture (LP) was deferred based on imaging indicating potential increased intracranial pressure (ICP). Nevertheless, the patient received vancomycin, ceftriaxone, and dexamethasone as an initial course of treatment for presumed bacterial meningitis. Significant improvement was observed within the first four days of admission, with no subsequent episodes of fever, nausea, or headache. However, upon discontinuation of corticosteroid therapy, the patient experienced severe headaches and frequent vomiting. An urgent brain CT scan confirmed the extension of the left internal jugular vein (IJV) thrombosis to the ipsilateral sigmoid sinuses. Metronidazole and anticoagulant medication were initiated upon LS diagnosis. There is a paucity of discussions on corticosteroid use in LS, with no definitive statistics in the current literature. This case underscores the importance of recognizing and effectively managing interconnected clinical manifestations.
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Background: Descending necrotizing mediastinitis (DNM) is an acute life-threatening infection that originates in the oropharyngeal region. It is an uncommon disease with a mortality rate of about 20-40%. This high mortality is mainly attributed to delays in diagnosis and treatment and poor drainage of the mediastinum. We highlight key points that may help reduce mortality. Case Description: We analyze a retrospective case series of seven patients diagnosed with DNM between March 2019 and July 2022 at Hospital de la Santa Creu i Sant Pau. The primary oropharyngeal infection was peritonsillar abscess in three cases and odontogenic abscess in four. All patients showed symptoms of severe cervical infection and symptoms suggestive of mediastinitis. A cervicothoracic computed tomography (CT) scan confirmed the presence of cervical and mediastinal collections and emphysema in all cases. All patients were simultaneously evaluated by the otorhinolaryngology and thoracic surgery teams. Broad-spectrum antibiotic therapy was instituted pending culture. All the patients underwent urgent surgery, consisting of cervicotomy to control the cervical focus and unilateral or bilateral video-assisted thoracoscopic debridement and drain of the pleural cavities and mediastinum. Regarding the outcomes, no patients died, one patient (14.2%) underwent transcervical mediastino-thoracoscopy drainage only. In six patients (85.8%) we performed a combined transcervical and transthoracic approach. Reoperation was required in 3 (43%) cases. The parameter that indicated a poor clinical evolution in these patients was an increase in C-reactive protein and the infection extension on the cervicothoracic CT scan. The follow-up was 30 days from last surgery; there were no losses. Conclusions: Based on our experience, the key points that can help reduce the high mortality associated with DNM are a rapid multidisciplinary assessment and a combined surgical procedure, considering the minimally invasive approach as the first option to drain the pleural cavities and mediastinum.
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Chlamydia trachomatis and Neisseria gonorrhoeae are two of the most often reported bacterial infections in the United States. The rectum and oropharynx are important anatomic sites of infection and can contribute to ongoing transmission. Nucleic acid amplification tests (NAATs) are the mainstays for the detection of C. trachomatis and N. gonorrhoeae infections owing to their high sensitivity and specificity. Several NAATs have been evaluated for testing in rectal and pharyngeal infections. A few assays recently received clearance by the Food and Drug Administration, including one point-of-care test. Those assays can be used for testing in symptomatic individuals, as well as for asymptomatic screening in certain patient populations. Routine screening for C. trachomatis in pharyngeal specimens is not recommended by the Centers for Disease Control and Prevention, though it is often performed due to the use of multiplex assays. While expanding the types of settings for screening and using self-collected rectal and pharyngeal specimens can help to increase access and uptake of testing, additional research is needed to determine the potential benefits and costs associated with increased screening for rectal and pharyngeal C. trachomatis and N. gonorrhoeae infections on a population level.
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Infecciones por Chlamydia , Gonorrea , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/genética , Pruebas Diagnósticas de Rutina , Gonorrea/diagnóstico , Gonorrea/microbiología , Humanos , Neisseria gonorrhoeae/genética , Técnicas de Amplificación de Ácido Nucleico , Recto/microbiología , Sensibilidad y EspecificidadRESUMEN
Research using nucleic acid amplification tests (NAATs) have repeatedly found rectal and oropharyngeal infections with Chlamydia trachomatis and Neisseria gonorrhoeae to be common and potentially more difficult to treat than genital infections. Unfortunately, public health and patient care efforts have been hampered by the lack of FDA-cleared NAATs with claims for anorectal or oropharyngeal samples. At the time of the initiation of this study, no commercially available assays had these claims. We formed a novel partnership among academic institutions and diagnostic manufacturers to address this public health need. From May 2018 through August 2019, we recruited 1108 women, 1256 men, and 26 transgender persons each of whom provided 3 anal and 3 oropharyngeal swab specimens. The 3 anal swabs were pooled into a single transport tube as were the 3 oropharyngeal swabs. The performance of each of three study assays was estimated by comparison to the composite result and relative to one another. Percent positivity for chlamydia was 5.9 and 1.2% from anal and oropharyngeal specimens, respectively, compared to 4.2 and 4.1% for gonorrhea. Sensitivity for chlamydia detection ranged from 81.0 to 95.1% and 82.8 to 100% for anal and oropharyngeal specimens, respectively. Gonorrhea sensitivity ranged from 85.9 to 99.0% and 74.0 to 100% for anal and oropharyngeal samples, respectively. Specificity estimates were ≥ 98.9% for all assays, organisms, and sample types. Although there was heterogeneity between sensitivity estimates, these assays offer better ability to detect extragenital infections than culture and potential solutions for providing appropriate sexual health care for populations in which these infections are of concern.
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Infecciones por Chlamydia , Gonorrea , Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/genética , Femenino , Gonorrea/diagnóstico , Humanos , Masculino , Neisseria gonorrhoeae/genética , Técnicas de Amplificación de Ácido Nucleico , Sensibilidad y EspecificidadRESUMEN
Lemierre's syndrome (LS) is a potentially fatal complication of oropharyngeal infection, resulting in contiguous suppurative thrombosis of the internal jugular vein (IJV) and septic emboli. It is most commonly associated with Fusobacterium necrophorum (F. necrophorum), though other pathogens have also been implicated in its pathogenesis. The incidence of LS had so significantly decreased that it was referred to as "the forgotten disease." However, cases of LS have shown a resurgence, which may be partly attributed to an overreliance on a negative group A beta-hemolytic streptococcal rapid antigen detection test (RADT), commonly referred to as "rapid strep test." Clinicians must maintain a very high index of suspicion for LS in patients with persistent sequelae from tonsillopharyngitis who have a negative RADT.
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Oral infection by Human Papillomavirus (HPV) has recently gained great attention because of its involvement in the development of a subset of head and neck squamous cell carcinoma. The role of specific Alpha-HPVs in this regard has been well established, whereas the contribution of other genera is under investigation. Despite their traditional classification as "cutaneous" types, Beta and Gamma HPVs are frequently detected in oral samples. Due to the lack of a standardized protocol, a large variety of methodologies have been used for oral sample collection, DNA extraction, HPV detection and genotyping. Laboratory procedures influence the evaluation of oral HPV prevalence, which largely varies also according to the population characteristics, e.g., age, gender, sexual behavior, Human Immunodeficiency Virus (HIV) status. Nevertheless, oral infection by Beta and Gamma HPVs seems to be even more common than Alpha-HPVs. The latter is 5-7% in the general population, and increases up to 30% approximately in HIV-infected men who have sex with men. Despite major advances in the evaluation of oral HPV prevalence, its natural history is still little understood, especially for Beta and Gamma HPVs. The latest technologies, such as Next Generation Sequencing (NGS), can be exploited to gain new insights into oral HPV, and to improve the identification of novel HPV types.
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Lemierre's syndrome is, presently, a very rare condition, but a life-threatening one. The syndrome was first described in 1936 by Andre Lemierre and comprises an oropharyngeal infection (most commonly associated with anaerobic bacteria Fusobacterium necrophorum), internal jugular vein thrombophlebitis and, possibly, secondary septic metastasis (common sites are lungs or brain). We describe such a rare case diagnosed at our Infectious Diseases Department in September 2019.
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Síndrome de Lemierre , Sepsis , Tromboflebitis , Fusobacterium necrophorum , Humanos , Venas Yugulares/diagnóstico por imagen , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/tratamiento farmacológico , Tromboflebitis/diagnóstico , Tromboflebitis/tratamiento farmacológicoRESUMEN
INTRODUCTION: Lemierre's syndrome is a rare and potentially fatal entity characterized by the spread of an oropharyngeal infection, with secondary suppurative thrombophlebitis of the internal jugular vein and septic emboli. PRESENTATION OF CASE: We discuss the case of a 52-year-old male who developed Lemierre's syndrome following peritonsillar abscess. He presented with submandibular and submental swelling extending into the neck. His management included; incision and drainage of the abscesses; and prolonged anticoagulant therapy. CONCLUSION: The incidence of Lemierre's disease appears to be increasing, perhaps due to ignorance of the disease by many clinicians, and diagnosis is often delayed with potentially fatal consequences.
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BACKGROUND/AIM: The incidence of human papilloma virus (HPV)-related head and neck squamous cell carcinoma (HNSCC) has been increasing in the last decades. Analysis of oral brushing or rinsing samples for screening or stratification could potentially improve screening and prevention. PATIENTS AND METHODS: Oral brushes and mouthwashes were taken from 20 patients with HPV-associated HNSCC before definite therapy. HPV genotyping was performed for the detection of 14 high-risk HPV subtypes and correlated to DNA isolated from tumor tissue. RESULTS: Ten of 20 patients were tested HPV positive by using either method. There was a significant correlation between macroscopic visibility of tumor and positive HPV detection (p<0.001) and HPV detection and tumor size (p<0.001). HPV was detected in all macroscopically visible tumors. Half of the HPV cases who had macroscopically invisible tumors were missed by both methods. CONCLUSION: Both techniques are limited in the detection of macroscopically non-visible and small tumors. Therefore, the application of these techniques for screening or diagnosis of HNSCC is not recommended.
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Neoplasias Orofaríngeas/genética , Papillomaviridae/genética , Infecciones por Papillomavirus/genética , Carcinoma de Células Escamosas de Cabeza y Cuello/genética , Anciano , ADN Viral/genética , ADN Viral/aislamiento & purificación , Femenino , Genotipo , Papillomavirus Humano 16/aislamiento & purificación , Papillomavirus Humano 16/patogenicidad , Humanos , Masculino , Persona de Mediana Edad , Antisépticos Bucales/análisis , Neoplasias Orofaríngeas/patología , Neoplasias Orofaríngeas/virología , Papillomaviridae/aislamiento & purificación , Papillomaviridae/patogenicidad , Infecciones por Papillomavirus/patología , Infecciones por Papillomavirus/virología , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/virologíaRESUMEN
BACKGROUND: Lemierre's syndrome is classically precipitated by oropharyngeal infections that progress to suppurative internal jugular vein thrombophlebitis via direct extension. Metastatic pneumonia from septic emboli is nearly universal and bacterial seeding frequently results in disseminated septic foci. Fusobacterium necrophorum is the most commonly reported etiologic agent, though methicillin-resistant Staphylococcus aureus (MRSA) is an emerging pathogen and a myriad of oropharyngeal flora must be covered until blood cultures return. Prompt identification is paramount to minimizing morbidity. Empiric treatment with antibiotics exhibiting predominantly anaerobic activity has been standard, but now may be insufficient, given an evolving microbial landscape. Anticoagulation continues to be debated. CASE REPORT: We describe an uncommon presentation of Lemierre's syndrome in a diabetic patient secondary to MRSA, where the only identifiable source of entry was atraumatic post-auricular cellulitis. Why Should an Emergency Physician Be Aware of This? Given the evolving landscape of organisms implicated in septic internal jugular thrombophlebitis, empiric treatment should entail consideration of MRSA. Patients at an elevated risk include those who are undomiciled or incarcerated, injection drug users, human immunodeficiency virus-positive, and have recently been hospitalized or completed a course of antibiotics. The existing evidence evaluating empiric anticoagulation is low-powered and retrospective and would benefit from randomized controlled trials. Although it does not appear valuable for most, those with thrombus extension, persistent bacteremia, or central venous thrombosis may benefit.
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Venas Yugulares/anomalías , Síndrome de Lemierre/etiología , Staphylococcus aureus Resistente a Meticilina/patogenicidad , Tromboflebitis/complicaciones , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Femenino , Humanos , Venas Yugulares/fisiopatología , Síndrome de Lemierre/fisiopatología , Imagen por Resonancia Magnética/métodos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Persona de Mediana Edad , Tromboflebitis/diagnóstico , Tromboflebitis/fisiopatologíaRESUMEN
Lemierre's syndrome is a rare and severe sepsis that can rapidly lead to a life-threatening condition in the absence of early management. This syndrome described at the beginning of the 20th century combines oropharyngeal infection complicated with septic thrombosis of the internal jugular vein and septic emboli predominantly pulmonary. Fusobacterium necrophorum, anaerobic germ, Gram negative bacillus is the main germ in this "necrobacillosis". The diagnosis is should be confirmed precociously with cervicothoracic CT-scan, reference exam, and bacteriological examinations (especially in atypical forms). Its management consists of an emergency antibiotic treatment, combining a third-generation cephalosporin or a betalactam with metronidazole, anticoagulant therapy to be reserved for high-risk situations related to thrombosis. Surgical treatment may be required.
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Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , Fusobacterium necrophorum/aislamiento & purificación , Síndrome de Lemierre/diagnóstico , Adulto , Femenino , Humanos , Síndrome de Lemierre/terapia , Tomografía Computarizada por Rayos XRESUMEN
Lemierre syndrome (LS) is a rare life-threatening disease that is often caused by an acute oropharyngeal infection with a secondary thrombophlebitis of the internal jugular vein. LS rarely manifests as cranial nerve palsy. To the best of our knowledge, this is the second case report of LS associated with recurrent laryngeal nerve palsy. A 66-year-old female presented to a dental clinic with gingivitis and sore throat. Due to moderate periodontitis, her left first upper molar was extracted. A few days later, she subsequently developed a coarse voice and occipital headaches, and was referred to an otolaryngologist. She was diagnosed with left recurrent laryngeal nerve palsy and subsequent left-sided otitis media, and was referred to us for persistent headaches. She intermittently presented with high-grade fever and complained of salty taste disturbance. Her head magnetic resonance imaging (MRI) revealed left mastoiditis, thrombosis in the left transverse and sigmoid sinus, and left internal jugular vein. Her laboratory tests revealed an elevated white blood cell count, levels of C-reactive protein, and D-dimer. No endogenous coagulopathy was confirmed. Although, blood and cerebrospinal fluid culture grew no microorganisms, respectively, the empirically determined antibiotic therapy was initiated. In a week, the patient defervesced and had no headaches despite persistent thrombosis. Early diagnosis and an immediate antibiotic treatment are crucial for LS patients. Anticoagulation therapy was not needed for our patient and is still controversial for LS.
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BACKGROUND: Although the natural history of cervical and oral infection by human papillomavirus (HPV) has been intensely investigated, the ability of this virus to infect oral and genital mucosae in the same individual and its potential of communicability are still unclear. OBJECTIVES: This study aimed at assessing the presence of oropharyngeal HPV infection in women with cervical lesions and in their current sexual partners in a Brazilian population. METHODS: It included a total of 65 patients, 43 women and 22 male partners. Medical history and the sociobehavioral profile were assessed through interviews that included the association of oropharyngeal HPV and the sexual behavior of patients, and also extra and intra-oral examinations were performed. Brushing was used to collect cells from the oropharyngeal mucosa. HPV DNA was checked through nested PCR with primers PGMY09/11 and GP5+/6+, and Pappilocheck to genotyping. RESULTS: Oropharyngeal HPV infection was detected in four of 65 (6.15%) cases, with one of 43 (2.3%) women, and three of 22 (13.6%) male partners. Clinically no patient showed HPV-related oral lesions. Pappilocheck assay showed the absence of HPV genotype commonly found in cervical mucosa. Moreover, there was no correlation between the presence of oropharyngeal HPV and sexual behavior risk factors. CONCLUSIONS: The results suggest that the presence of cervical lesions does not lead to HPV oropharyngeal infection. It also highlights the low rate of HPV infection in the oropharyngeal mucosa of women with cervical lesions and their partners in a researched sample.
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Enfermedades de la Boca/virología , Orofaringe/virología , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/virología , Parejas Sexuales , Displasia del Cuello del Útero/virología , Neoplasias del Cuello Uterino/virología , Adulto , Brasil/epidemiología , ADN Viral/genética , ADN Viral/aislamiento & purificación , Transmisión de Enfermedad Infecciosa , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Boca/epidemiología , Enfermedades de la Boca/patología , Orofaringe/patología , Papillomaviridae/genética , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/patología , Infecciones por Papillomavirus/transmisión , Reacción en Cadena de la Polimerasa , Prevalencia , Factores de Riesgo , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/patología , Adulto Joven , Displasia del Cuello del Útero/epidemiología , Displasia del Cuello del Útero/patologíaAsunto(s)
Antibacterianos/administración & dosificación , Farmacorresistencia Bacteriana/efectos de los fármacos , Fiebre/etiología , Hipotensión/etiología , Síndrome de Lemierre/diagnóstico , Adolescente , Progresión de la Enfermedad , Femenino , Fiebre/diagnóstico , Fiebre/tratamiento farmacológico , Humanos , Hipotensión/diagnóstico , Hipotensión/tratamiento farmacológico , Unidades de Cuidado Intensivo Pediátrico , Síndrome de Lemierre/complicaciones , Síndrome de Lemierre/tratamiento farmacológico , Resultado del TratamientoRESUMEN
BACKGROUND: Lemierre syndrome is a rare but serious illness that associates throat infection and thrombosis of the internal jugular vein (IJV) or one of its tributaries with subsequent distant septic emboli. The purpose of our study was to review the pathogenesis, clinical presentation, and treatment of this disease. METHODS: Patients with confirmed Lemierre syndrome were included in our retrospective monocentric study. All patients had bacteriologic analyses as well as radiologic imaging. RESULTS: There were 11 patients in our study (from 1998-2012). Fusobacterium necrophorum was responsible for the infection in 45% of cases. Surgical drainage of pharyngeal, cervical, or mediastinal abscesses was carried out in 8 cases. All patients received broad-spectrum antibiotics. Six patients were admitted to the intensive care unit (ICU). One patient (9%) died. CONCLUSION: Treatment with broad-spectrum antibiotics is the primary choice of treatment of Lemierre syndrome. Surgery is indicated in case of abscess formation.
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Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/terapia , Absceso/etiología , Absceso/terapia , Adolescente , Adulto , Anciano , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Antibacterianos/uso terapéutico , Anticoagulantes/uso terapéutico , Ceftriaxona/uso terapéutico , Celulitis (Flemón)/etiología , Celulitis (Flemón)/terapia , Drenaje , Femenino , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación/estadística & datos numéricos , Masculino , Mediastinitis/etiología , Mediastinitis/terapia , Metronidazol/uso terapéutico , Persona de Mediana Edad , Estudios Retrospectivos , Tonsilitis/etiología , Tonsilitis/terapia , Adulto JovenRESUMEN
Lemierre's syndrome is a rare condition characterized by septic thrombophlebitis of the internal jugular vein and metastatic abscesses following oropharyngeal infection. Though classically caused by Fusobacterium necrophorum, a number of other causative organisms have been reported in literature. We report a case of Lemierre's syndrome following parapharyngeal abscess due to staphylococcus aureus which progressed to septic shock.
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Lemierre syndrome is characterized by a history of recent oropharyngeal infection, clinical or radiological evidence of internal jugular vein thrombosis, and isolation of pathogens, mainly Fusobacterium necrophorum. Septic emboli resulting from infected thrombophlebitis of the internal jugular vein leads to metastatic infections involving lung, liver, kidney, bone and central nervous system. Before the advent of antibiotics, the disease used to be common, incurring a high mortality rate. The disease is less frequently seen nowadays, but it is still a life-threatening disease, requiring a high index of suspicion and prompt treatment. We report a case of Lemierre syndrome, which showed oropharyngeal infection, and internal jugular vein thrombosis.
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Antibacterianos , Sistema Nervioso Central , Fusobacterium necrophorum , Venas Yugulares , Riñón , Síndrome de Lemierre , Hígado , Pulmón , Tromboflebitis , TrombosisRESUMEN
Descending necrotizing mediastinitis (DNM) is a serious, life threatening complication that can occur from a common odontogenic infection. Even with advancements in antibiotics, diagnostic imaging, and surgical management, the mortality rate remains between 20 and 40%. It is imperative that the practitioner taking care of patients with odontogenic infections be sensitized to this potentially fatal complication. We report the successful management of a case of mediastinitis complicating an odontogenic infection in a 39-year-old male.
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BACKGROUND: Antimicrobial resistance of Streptococcus pneumoniae presents a challenge to the clinicians in developing countries, particularly against the acute respiratory tract infections, including pneumonia. The present study was to evaluate the carriage rate and the antimicrobial resistance of S. pneumoniae isolated from children at a day-care center. METHODS: Oropharyngeal swabs were done every month for one year in 64 children at a day-care center in Seoul, Korea. Minimum inhibitory concentrations (MICs) of 9 antimicrobial agents (penicillin, ceftriaxone, cefuroxime, erythromycin, chloramphenicol, tetracycline, vancomycin, ciprofloxacin, cefpirome) were determined by agar-dilution method. RESULTS: The ages of the children ranged from 13 to 60 months (mean: 31 months). The overall carriage- rate of pneumococci was 26%, which was highest in December (46%) and lowest in July (3%). A total number of 105 strains of S. pneumoniae were isolated from 404 throat swabs and 68 strains among these were available for MIC tests. Only 8 (12%) strains were susceptible to penicillin, while 50 (73%) were intermediate and 10 (15%) were resistant. The isolates also exhibited high rates of resistance to other beta- lactams (53% and 21% were resistant to cefuroxime and ceftriaxone, respectively). The resistance rates to the other antimicrobial agents were also remarkable; 90% and 88% were resistant to erythromycin and tetracycline, respectively. However, 75% of isolates were susceptible to chloramphenicol and 100% were susceptible to vancomycin. CONCLUSION: There was a high rate of pharyngeal carriage of penicillin-resistant S. pneumoniae among children attending day-care center. Surveillance of pharyngeal cultures may provide useful information the treatment guideline of pneumococcal infections.