Case StudyCase Study#7#7

Pathogenic BacteriologyPathogenic Bacteriology

Jose Cervantes Jr. Jose Cervantes Jr. Partners:Partners:Hien DangHien DangEvelyn LoiEvelyn Loi

Case SummaryCase Summary

70-year-old female with multiple myeloma. 70-year-old female with multiple myeloma.

treated with immunosuppressive drugs.treated with immunosuppressive drugs.

2-day history of dyspnea 2-day history of dyspnea

a cough (white phlegm) a cough (white phlegm)

low grade fever, elevated heart rate and low grade fever, elevated heart rate and leukopenialeukopenia

bilateral crackles with expiratory wheezes. bilateral crackles with expiratory wheezes.

Key Information Pointing Key Information Pointing to Diagnosisto Diagnosis

Age:Age: 70-year-old female 70-year-old female

History:History: 1 year previously was diagnosed with multiple myeloma1 year previously was diagnosed with multiple myeloma 2-day history of dyspnea with cough producing white phlegm.2-day history of dyspnea with cough producing white phlegm.

Symptoms:Symptoms: Fever of 38.8 CFever of 38.8 C Elevated heart rate: 120/minElevated heart rate: 120/min Leukopenia: 1,700 white blood cell countLeukopenia: 1,700 white blood cell count Chest auscultation revealed crackles and wheezes.Chest auscultation revealed crackles and wheezes. Chest radiograph showed diffused pulmonary infiltrates with Chest radiograph showed diffused pulmonary infiltrates with

effusion.effusion.

Gram Stain ResultsGram Stain Results

susceptible to Optochinsusceptible to Optochin

Sensitivity testing of Sensitivity testing of Streptococcus Streptococcus

Classification, Gram Stain Results, Classification, Gram Stain Results, and Microscopic Appearanceand Microscopic Appearance

Family: Family: StreptococcaceaeStreptococcaceae Genus: Genus: StreptococcusStreptococcus Species: Species: pneumoniaepneumoniae Gram positive Gram positive Cocci shaped bacteriaCocci shaped bacteria

MucoidMucoid Irregularly shaped coloniesIrregularly shaped colonies αα-hemolysis-hemolysis

Diseases and Pathogenesis Diseases and Pathogenesis of Disease Caused byof Disease Caused by

Diseases caused by this bacteria:Diseases caused by this bacteria:

- pneumonia - pneumonia

- Sinusitis- Sinusitis

- Otitis media- Otitis media

- Bacteremia- Bacteremia

- Meningitis- Meningitis

Diagnosis,Isolation, and Identification

Biochemical Testing Optochin Test 

Is the only Strep. that is susceptible

Bile Solubility Test   bacteria will lyse and the area become clear

Virulence factors:Virulence factors:

Capsule- is the most importantCapsule- is the most important 80 different types and antibodies agaist the 80 different types and antibodies agaist the

capsul and are type specific and protectivecapsul and are type specific and protective

LeukocidanLeukocidan NeuraminidaseNeuraminidase HyaluronidaseHyaluronidase IgA proteaseIgA protease

Therapy, Prevention and Therapy, Prevention and Prognosis of Patient Prognosis of Patient InfectedInfected

Antimicrobial Therapy:Antimicrobial Therapy: Penicillin, Penicillin, AugmentinAugmentin erythromycinerythromycin

Practice good hygiene:Practice good hygiene: Get an influenza shot each fall. Get an influenza shot each fall. Get a pneumonococcal vaccine. Get a pneumonococcal vaccine. Practice good preventive measures by eating a proper diet, Practice good preventive measures by eating a proper diet,

getting regular exercise and plenty of sleep. getting regular exercise and plenty of sleep. Do not smoke. Do not smoke.

Primary Research Article Primary Research Article Contributing to the Understanding Contributing to the Understanding

of the Diseaseof the DiseaseHeffernan, Richard et.al, 2005, Heffernan, Richard et.al, 2005, Journal of Infectious DiseasesJournal of Infectious Diseases; ;

Incidence of Invasive Streptococcus pneumoniae Infections Incidence of Invasive Streptococcus pneumoniae Infections among Persons with AIDS in an Era of Highly Active among Persons with AIDS in an Era of Highly Active Antiretroviral Therapy, 1995-2000.Antiretroviral Therapy, 1995-2000. 6/15/2005, Vol. 191 Issue 6/15/2005, Vol. 191 Issue 12, p2038-2045, 8p 12, p2038-2045, 8p

Experimental set upExperimental set up: : used time-trend analysis of annual invasive pneumococcal disease

incidence rates from a population based, active surveillance system. Annual incidence rates were calculated for 5 July–June periods by

use of data from San Francisco county, Baltimore, and Connecticut. The numerators were the numbers of invasive Streptococcus

pneumoniae infections among persons 18–64 years of age with AIDS; the denominators were the numbers of persons living with AIDS, estimated on the basis of AIDS surveillance data.

FIG. 1FIG. 1

(July 1995–June 1996) to 467 cases/100,000 persons living with AIDS (July 1999–June 2000).

The annual percentage changes in incidence were 34%, 29%, 8%, and 1%. Declines were similar by surveillance area, sex, and race/ethnicity.

Conclusion: In the United States, invasive pneumococcal disease incidence

declined sharply across a range of subgroups living with AIDS during the period after widespread introduction of HAART(highly active antiretroviral therapy). Despite these gains,persons with AIDS remain at high risk for invasive pneumococcal disease.

Take Home MessageTake Home Message Disease Disease Streptococcus pneumoniaeStreptococcus pneumoniae involves… involves…

Pneumonia, Sinusitis Otitis media, Bacteremia, and MeningitisPneumonia, Sinusitis Otitis media, Bacteremia, and Meningitis Typical symptoms Typical symptoms

rapid breathing, rapid pulse rate,crackles and wheezes in lungs, pulmonary infiltrates with rapid breathing, rapid pulse rate,crackles and wheezes in lungs, pulmonary infiltrates with effusion.effusion.

Pathogen is Pathogen is Streptococcus pneumoniaeStreptococcus pneumoniae Diagnostics include testDiagnostics include test

Chest auscultation and Chest radiographChest auscultation and Chest radiograph

Treatment:Treatment: Penicillin, Augmentin, and erythromycin Penicillin, Augmentin, and erythromycin

Prognosis:Prognosis: If S. pneumonia is left un treated could cause serious repercussions, however with treatment,

mortally rate is really low. PreventionPrevention::

Get an influenza shot each fall Get an influenza shot each fall Practice good preventive measures by eating a proper diet, getting regular exercise and plenty of sleep. Practice good preventive measures by eating a proper diet, getting regular exercise and plenty of sleep.

Transmission is viaTransmission is via spread through contact with an infected person.spread through contact with an infected person.

Threat isThreat is To immunocomprimised individuals (HIV ), very young, and very old people. To immunocomprimised individuals (HIV ), very young, and very old people.

ReferencesReferences

Heffernan, R. et.al, Journal of Infectious Diseases; 6/15/2005, Vol. 191 Issue 12, p2038-2045, 8p Incidence of Invasive Streptococcus pneumoniae Infections among Persons with AIDS in an Era of Highly Active Antiretroviral Therapy, 1995-2000.

McQueen, Nancy. 2009. Streptococcus Lecture. California State University Los Angeles.

http://www.healthscout.com/ency/1/205/main.htmlhttp://www.healthscout.com/ency/1/205/main.html http://dhs.wisconsin.gov/communicable/FactSheets/Strhttp://dhs.wisconsin.gov/communicable/FactSheets/Str

epPneumo.htmepPneumo.htm http://www.cdc.gov/NCIDOD/DBMD/DISEASEINFO/http://www.cdc.gov/NCIDOD/DBMD/DISEASEINFO/

streppneum_t.htmstreppneum_t.htm