Streptococcal infections in patients with chronic granulomatous disease: case report and review of the literature

We thank Nourani and Challapalli for their interest in our report on streptococcal infections in patients with chronic granulomatous disease (CGD) [1]. They add to a growing literature with their report of a case of Streptococcus constellatus lymphadenitis and pneumonia in a boy with CGD. Similar to our case, they identified a member of the Streptococcus anginosus group causing infection in CGD, an infection that is not supposed to happen in this disease. Hydrogen peroxide testing would have been interesting but likely negative, since no S. intermedius strains and few of S. constellatus strains produce it [2]. This report further highlights the importance of direct cultures from patients with primary immune deficiencies, since the recovery of a S. constellatus from sputum would have been difficult to interpret. It also points out that our understanding of immune defects is evolving, driven by precisely these valuable clinical observations and reports.