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Complicated Thoracic Empyema of Serotype 23F Streptococcus pneumoniae in an Adult Patient

ACTA MEDICA INDONESIANA · Vol. 57 No. 4 (2025)

ISSN
2338-2732, 0125-9326
Published
2025-12-23
Publisher
The Indonesian Society of Internal Medicine
Language
eng
License
creativecommons.org/licenses/by/4.0

Abstract

We report a case of thoracic empyema in a 61-year-old male patient, a heavy smoker with malignancy undergoing chemotherapy. The patient’s clinical symptoms included shortness of breath, productive cough, fever, and chest pain. This patient had never received antibiotics before. Streptococcus pneumoniae was isolated from a bedside culture of empyema fluid collected through thoracentesis. The empyema fluid was cultured on chocolate agar plates and in aerobic and anaerobic culture bottles. The isolate was identified as serotype 23F, a vaccine strain with sequence type 17532. The isolate was resistant to chloramphenicol, tetracycline, and cotrimoxazole. The patient clinically improved with the administration of combined intravenous ceftriaxone and levofloxacin antibiotics, along with chest tube drainage via thoracostomy. This is the first report of thoracic empyema caused by S. pneumoniae in an adult in Indonesia. Serotype 23F is multi-resistant with low invasiveness, typically causing infections in patients with underlying health conditions. The pneumococcal conjugate vaccine covers it; thus, it usually occurs in areas with low vaccine coverage. Our findings support the importance of improving adult pneumococcal vaccination coverage in Indonesia.

Keywords

Collaboration network of the authors

40 authors · 101 co-authorship links · 1 across different organisations · showing the 40 most connected

Hover or tap a name to highlight its co-authors. Double-click to open the author's page.

  • Universitas Halu Oleo
  • Cenderawasih University
  • Hasanuddin University
  • Affiliation unknown
  • Different organisations
  • Same organisation
  • Affiliation unknown
  • Thicker line = more joint articles · bigger circle = more articles
Show as table
Co-authorOrganisationJoint articles
Suharty RoslanUniversitas Halu Oleo4
La Ode Monto BautoUniversitas Halu Oleo3
Muhammad RusliUniversitas Halu Oleo3
Bahtiar BahtiarUniversitas Halu Oleo3
Sulsalman MoitaUniversitas Halu Oleo2
Juhaepa JuhaepaUniversitas Halu Oleo2
Muhammad ArsyadUniversitas Halu Oleo2
Antonius OktavianCenderawasih University2
Wisnu TafrojiAffiliation unknown2
Sumarlin SumarlinUniversitas Halu Oleo1
Dewi AnggrainiAffiliation unknown1
Rahman TandiAffiliation unknown1
Ratnawati RatnawatiHasanuddin University1
Marliana MarlianaAffiliation unknown1
Rety Reka MerlinsAffiliation unknown1
Iksan Mail SyahAffiliation unknown1
Keli SartikaAffiliation unknown1
Sarman SarmanUniversitas Halu Oleo1
Usnia UsniaAffiliation unknown1
Ardi YusufAffiliation unknown1
Angga SaputraAffiliation unknown1
Nirmawati NirmawatiAffiliation unknown1
Orin OrinAffiliation unknown1
Amnia AmniaAffiliation unknown1
Alimuddin AlimuddinAffiliation unknown1
La AlimanAffiliation unknown1
Tahrun KokoUniversitas Halu Oleo1
Hj. Suharty RoslanAffiliation unknown1
Wa SarianaAffiliation unknown1
Ilham IlhamAffiliation unknown1
Susianti SusiantiAffiliation unknown1

Affiliations come from OpenAlex; journal OAI-PMH metadata carries none. Authors without an OpenAlex ID are matched by name, which can merge or split people.

Metadata source: OAI-PMH (metadata jurnal) http://www.actamedindones.org/index.php/ijim/oai, first harvested 8 Nov 2026, last seen 8 Nov 2026.
Original metadata (oai_dc) 
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	<dc:title xml:lang="en-US">Complicated Thoracic Empyema of Serotype 23F Streptococcus pneumoniae in an Adult Patient</dc:title>
	<dc:creator>Yovi, Indra</dc:creator>
	<dc:creator>Safari, Dodi</dc:creator>
	<dc:creator>Syah, Nur Afrainin</dc:creator>
	<dc:creator>Anggraini, Dewi</dc:creator>
	<dc:creator>Sarassari, Rosantia</dc:creator>
	<dc:creator>Maladan, Yustinus</dc:creator>
	<dc:creator>Azzahrah, Ayummi</dc:creator>
	<dc:creator>Pelawi, Nicholas Gilbert</dc:creator>
	<dc:creator>Elliyanti, Aisyah</dc:creator>
	<dc:subject xml:lang="en-US">pulmonology</dc:subject>
	<dc:subject xml:lang="en-US">infection</dc:subject>
	<dc:subject xml:lang="en-US">Streptococcus pneumonia</dc:subject>
	<dc:subject xml:lang="en-US">Thoracic empyema</dc:subject>
	<dc:subject xml:lang="en-US">adult patient</dc:subject>
	<dc:subject xml:lang="en-US">Serotype 23F</dc:subject>
	<dc:description xml:lang="en-US">We report a case of thoracic empyema in a 61-year-old male patient, a heavy smoker with malignancy undergoing chemotherapy. The patient’s clinical symptoms included shortness of breath, productive cough, fever, and chest pain. This patient had never received antibiotics before. Streptococcus pneumoniae was isolated from a bedside culture of empyema fluid collected through thoracentesis. The empyema fluid was cultured on chocolate agar plates and in aerobic and anaerobic culture bottles. The isolate was identified as serotype 23F, a vaccine strain with sequence type 17532. The isolate was resistant to chloramphenicol, tetracycline, and cotrimoxazole. The patient clinically improved with the administration of combined intravenous ceftriaxone and levofloxacin antibiotics, along with chest tube drainage via thoracostomy. This is the first report of thoracic empyema caused by S. pneumoniae in an adult in Indonesia. Serotype 23F is multi-resistant with low invasiveness, typically causing infections in patients with underlying health conditions. The pneumococcal conjugate vaccine covers it; thus, it usually occurs in areas with low vaccine coverage. Our findings support the importance of improving adult pneumococcal vaccination coverage in Indonesia.</dc:description>
	<dc:publisher xml:lang="en-US">The Indonesian Society of Internal Medicine</dc:publisher>
	<dc:date>2025-12-23</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>http://www.actamedindones.org/index.php/ijim/article/view/2902</dc:identifier>
	<dc:source xml:lang="en-US">Acta Medica Indonesiana; Vol. 57 No. 4 (2025): Acta Medica Indonesiana; 503</dc:source>
	<dc:source>2338-2732</dc:source>
	<dc:source>0125-9326</dc:source>
	<dc:language>eng</dc:language>
	<dc:relation>http://www.actamedindones.org/index.php/ijim/article/view/2902/833</dc:relation>
	<dc:rights xml:lang="en-US">Copyright (c) 2025 Indra Yovi, Aisyah Elliyanti, Dodi Safari, Nur Afrainin, Dewi Anggraini, Rosantia Sarassari, Yustinus Maladan, Ayummi Azzahrah, Nicholas Gilbert Pelawi</dc:rights>
	<dc:rights xml:lang="en-US">https://creativecommons.org/licenses/by/4.0</dc:rights>
</oai_dc:dc>