streptococcus minor was described in 2004 as a new species isolated from the tonsils of dogs , cats and cattle as well as from the intestinal tract of dogs .
although staphylococci and streptococci are commonly involved genera in bite - infected wounds , no cases of human infection by s.  minor have been reported in the literature . here
a 51-year - old woman was admitted for a dog bite injury to her right hand .
the patient s medical history revealed a urinary bladder cancer 3 years ago , currently in remission .
she presented with inflammation , redness , heat and pus production at the bite wounds ( fig .  1 ) .
clinically , the patient was afebrile ( temperature 36.6c ) , and no signs of systemic infection were observed .
biologic investigations revealed an inflammatory syndrome with a c - reactive protein value of 46  mg / l ( normal value , < 5  mg / l ) associated with a light leukocytosis of 10.880 cells/l ( normal range , 4 to 10    10 cells/l ) .
urgent surgery was proposed but was refused by the patient despite warnings of the risk of sepsis and necrosis .
the wounds were washed with povidone  iodine , and intravenous empiric antibiotic therapy was initiated ( cefazolin 2  g / d ) .
one set of peripheral blood cultures ( including aerobic and anaerobic conditions ) was performed , and no growth was observed after 5 days of incubation .
aerobic culture from pus wounds after 48 hours on columbia agar ( becton dickinson , franklin lakes , nj , usa ) yielded a pure growth of unpigmented , regular , translucent and -hemolytic colonies of gram - positive streptococcus .
identification as streptococcus minor was achieved using matrix - assisted laser desorption / ionization time - of - flight mass spectrometry ( maldi - tof ms ; bruker daltonics , bremen , germany ) , with an excellent score of 2.428 .
sequencing of 16s rrna gene ( 96ga3730 xl ; thermo fisher scientific life sciences , waltham , ma , usa ) confirmed the identification of s.  minor with 100% of identity and demonstrated the usefulness of maldi - tof ms for identifying this organism . the antimicrobial testing showed susceptibility to penicillin , clindamycin , erythromycin and trimethoprim  sulfamethoxazole .
the patient left the hospital the same day and received 10 days of oral antimicrobial therapy with amoxicillin  clavulanate acid at 850/125  mg three times a day . under this antibiotic regimen ,
five days later , patient examination revealed no clinical signs of infection or radiologic signs of bone injury .
infections caused by s.  minor are probably underestimated because of the organism s facultative anaerobic nature , requiring a co2-enhanced atmosphere , and the difficulty in identifying to the species level -hemolytic streptococci with current laboratory techniques . moreover , in contrast to other streptococci generally identified in zoonotic infection , such as streptococcus canis ( group g ) involved in several cases of septicaemia and one case of infective endocarditis , , s.  minor does not react with lancefield groups a , c , d , f or g antisera .
although the pathogenicity of this organism is still unknown , this case suggests that s.  minor can lead to serious local infections .
this study also demonstrates the usefulness of maldi - tof ms for identifying this organism . to our knowledge
s.  minor has never been isolated from humans but is part of the commensal flora from dogs , suggesting strong causality .
unfortunately , in this case , the dog bite had occurred a while ago , and the dog was not available for further testing in order to compare the homology of both the patient s and dog s isolate strains and to confirm the origin and the pathogenicity of s.  minor .
further investigation on the oral dog flora and on s.  minor s virulence factors is necessary to confirm its implication and elucidate its pathogenic mechanisms .
 we report the first case of human infection caused by streptococcus minor in a 51-year - old immunocompetent woman admitted for dog bite injuries . at present , the role of streptococcus minor in bite wound infections is unknown . 
 further studies on virulence factors are needed to elucidate its pathogenicity mechanisms . 
Introduction
Case presentation
Discussion
Conflict of Interest