DOCSLIB.ORG

(H1N1) Influenza

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
(H1N1) Influenza necro-yazer_Layout 1 19/01/11 11:28 AM Page 215 CMAJ Practice Cases Severe necrotizing pneumonia in a child with pandemic (H1N1) influenza Jo Yazer MD, Michael Giacomantonio MD, Noni MacDonald MD MSc, Steven Lopushinsky MD See also practice article by Udupa and colleagues, page 220 n the midst of pandemic (H1N1) 2009 in our a leukocyte count of 1.5 (normal 5.5–15.5) × Competing interests: region, a five-year-old girl with mild asthma 109/L (neutrophils 11% [normal 47%] and bands Noni MacDonald is Section Editor, Population and presented to the emergency department of a 19% [normal 5%]) and a platelet count of 92 Public Health for CMAJ I 9 children’s hospital in acute respiratory distress. (normal 217–533) × 10 /L. Results of blood tests and was not involved in the She had an 11-day history of cough, rhinorrhea were otherwise unremarkable. Venous blood gas editorial decision-making and progressive chest discomfort. She was other- had a pH level of 7.32 (normal 7.35–7.42), par- process for this article. No competing interests wise healthy, with no history of severe respira- tial pressure of carbon dioxide of 43 (normal 32– declared by the other tory illness, prior hospital admissions or immu - 43) mm Hg, a base deficit of 3.6 (normal –2 to authors. nocompromise. Outside of infrequent use of 3) mmol/L, and a bicarbonate level of 21.8 (nor- This article has been peer salbutamol, she was not taking any medications, mal 21–26) mmol/L. The initial serum creatinine reviewed. µ and her routine childhood immunizations, in - level was 43.0 (normal < 36) mol/L and the Correspondence to: cluding conjugate pneumococcal vaccine, were urea level was 6.5 (normal 2.0–7.0) mmol/L, Dr. Jo Yazer, [email protected] up to date. She had not received the pandemic with no clinical evidence of renal dysfunction. CMAJ 2011. DOI:10.1503 influenza vaccine because it was not yet avail- Given the patient’s profound increased work /cmaj.100285 able for her age group. of breathing, she was admitted to the intensive The patient had been seen previously at a care unit (ICU), where intubation was required community health centre a week into her symp- because of her continued decline over the next toms, and a chest radiograph had shown perihi lar 24 hours. Blood cultures taken on admission and peribronchial thickening but no focal con - were negative. Nasopharyngeal aspirates were solidation, atelectasis or pleural effusion. She negative on rapid respiratory viral testing, but had then been reassessed 24 hours later at an antiviral treatment for presumed pandemic influenza assessment centre and empirically (H1N1) influenza was continued given her clini- started on oseltamivir. Two days later, with the cal presentation, the prevalence of pandemic onset of vomiting, diarrhea, fever and progres- influenza in the community and the low sensitiv- sive shortness of breath, she was brought to the ity of the test in the range of only 62%.1 Viral emergency department of the children’s hospital. cultures were not done. Empiric treatment with On examination, she was in considerable dis- intravenous cefotaxime (200 mg/kg/d) and van- tress; her heart rate was 170 beats/min, her respi- comycin (40 mg/kg/d) was started in the ICU for ratory rate was 60 breaths/min and her blood broad antimicrobial coverage, including possible pressure was 117/57 mm Hg. Her oxygen satura- tions on room air were consistently 70%. On Key points auscultation, she had decreased air entry to the right side with bronchial breath sounds. Repeat • Co-infection with the pandemic (H1N1) 2009 virus and Streptococcus chest radiography showed almost complete pneumoniae is not uncommon and is potentially associated with more opacification of the right hemithorax, air bron- severe disease. chograms in the middle and lower lobes, and • With the onset of routine pneumococcal vaccination, there has been a decrease in childhood bacterial pneumonia but, conversely, there has minimal aeration to the apex. This was felt to be been an increase in severe diseases such as empyema and necrotizing in keeping with whole lung consolidation and infections. parapneumonic effusion. The left lung appeared • Conservative management of complicated pneumonia consisting of normal. antibiotics and adequate chest drainage may be sufficient treatment Blood tests done on admission showed a despite impressive radiologic images. hemoglobin level of 122 (normal 110–140) g/L, © 2011 Canadian Medical Association or its licensors CMAJ, February 8, 2011, 183(2) 215 necro-yazer_Layout 1 19/01/11 11:28 AM Page 216 Practice methicillin-resistant Staphylococcus aureus or other staphylococcal infection. When Strepto- coccus pneumoniae infection was later con- firmed, the vancomycin was discontinued and amoxicillin was started. Given the patient’s dra- matic respiratory distress and life-threatening status, off-label use of intravenous zanamivir was started. Twenty-four hours after ICU admission, our patient’s clinical status stabilized, with slow improvement over the subsequent days. Given marked clinical improvement and minimal ven - tilatory pressures, her endotracheal tube was successfully removed 10 days after admission. Radiographic imaging done on the same day showed continued aeration of the left lung but the development of a large right-sided pneuma- tocele, marked atelectasis and a mild to moderate parapneumonic effusion (Figure 1). Computed tomography (CT) done later that day showed a dramatic necrotizing process in the right middle lobe with multiple large pneumatoceles and sec- ondary compression of the right upper and lower lobes (Figure 2). The CT scan was also sugges- tive of a loculated basal pneumothorax. Sixteen days after admission, given persistent fevers, tachypnea and oxygen requirements, a right-sided chest tube was inserted to assist with drainage of the pleural space. Cultures of the pleural fluid were negative for microbial growth, Figure 1: Portable chest radiograph of a five-year-old girl with co-infection with pandemic (H1N1) 2009 virus and Streptococcus pneumoniae, showing but polymerase chain reaction analysis using multiple right pneumatoceles (bracket), opacification in the right middle lobe 16S rDNA gene sequencing was positive for (black arrow) and depression of the right hemidiaphragm (white arrow). S. pneumoniae. Serology for S. pneumoniae A B Figure 2: (A) Axial computed tomographic (CT) image showing necrosis of the right middle lobe with pneumatoceles and three pleural pockets (one air-filled, one fluid and one mixed; arrows). (B) Coronal CT image showing large pneumatoceles and necrosis of the right middle lobe (bracket). 216 CMAJ, February 8, 2011, 183(2) necro-yazer_Layout 1 19/01/11 11:28 AM Page 217 Practice immunoglobulin G antibody was also subse- Clinically, children with pneumococcal pneumo- quently found to be positive. The drained fluid nia present with fever, nonproductive cough, consisted of both pus and necrotic material, in tachypnea and fatigue.3 Radiographically, keeping with a necrotizing process. Of signifi- S. pneumoniae has a typical appearance of lobar cant concern was the development of a bron- consolidation and may also show complications chopleural fistula. Tachypnea and tachycardia such as pleural effusions and empyema.3 Necro- persisted, which created issues with mobilization tizing pneumococcal pneumonia is uncommon and nutrition. A thoracotomy was increasingly but has been described in previously healthy debated for likely lobar resection and debride- children.5 Gangrenous lung changes may result ment of devitalized tissue, but the patient began from vascular and parenchymal compromise. to gradually improve, leading to complete reso- lution of the air leak. No further surgical inter- Treatment of streptococcal pneumonia vention was required, and the chest tube was In less severe cases, suspected bacterial pneumo- removed without complication. She was dis- nia is often treated empirically because of the charged home on combination oral amoxicillin– difficulty in obtaining sputum samples for con- clavulanate (30 mg/kg/d based on the amoxi- firming a causative agent.2 When available, cillin component). At last follow-up months gram-stain, culture and susceptibility tests per- later, she continued to do well and had minimal formed on sputum samples or lung aspirates can respiratory symptoms (Figure 3). Hemagglutina- direct antibiotic therapy.2 There is limited tion inhibition and microneutralization assays research regarding the most effective antibiotic comparing serum samples collected on admis- treatment for community-acquired pneumonia. sion and one month later showed a greater than However, based on the research that has been four-fold rise in antibody titers against pandemic done, if S. pneumoniae is suspected in uncompli- (H1N1) 2009 virus (hemagglutination inhibition cated cases, treatment should be started with geometric mean titer 50.4–1140.4, microneutral- amoxicillin.3,6,7 Amoxicillin–clavulanate, ampi- ization titer 40–1280). cillin, penicillin, or intravenous cephalosporins such as cefuroxime or cefotaxime are indicated Discussion for children admitted to hospital.7 Research is also limited regarding duration of antibiotic ther- We present an instance of severe streptococcal apy; however, the British Thoracic Society sug- pneumonia in a young girl with pandemic (H1N1) influenza that was complicated by necrosis, large pneumatoceles and development of a bronchopleural fistula. Although the inci- dence of streptococcal pneumonia has decreased because of vaccination, it
Load more

Recommended publications
  • Necrotizing Pneumonia and Septic Shock: Suspecting CA-MRSA in Patients Presenting to Canadian Emergency Departments
    CASE REPORT • OBSERVATION DE CAS Necrotizing pneumonia and septic shock: suspecting CA-MRSA in patients presenting to Canadian emergency departments Joseph V. Vayalumkal, MD;* Heather Whittingham, MD;† Otto Vanderkooi, MD;‡ Thomas E. Stewart, MD;§ Donald E. Low, MD;‡ Michael Mulvey, PhD;¶ Allison McGeer, MD‡ ABSTRACT We report a case of fatal necrotizing pneumonia and sepsis caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in an otherwise well, 48-year-old Canadian man with type 2 diabetes mellitus who had travelled to Texas. Despite therapy that included in- travenous antibiotics, intravenous immune globulin and other supportive measures, the patient succumbed to his illness. Recently, CA-MRSA pneumonia has been reported in several countries. The virulence of this organism may in part be related to its ability to produce toxins, such as Panton-Valentine leukocidin. As rates of CA-MRSA increase worldwide, physicians should be aware of the potential for MRSA to cause life-threatening infections in patients presenting to Canadian emergency departments (EDs). Necrotizing pneumonia caused by MRSA must be consid- ered in the differential diagnosis of acute, severe respiratory illness. Early recognition of this syn- drome in the ED may help physicians initiate appropriate antibiotic therapy in a timely manner. Key words: necrotizing pneumonia, MRSA, community-acquired MRSA, Canada RÉSUMÉ Nous présentons un cas de septicémie et pneumonie nécrosante mortelles causées par Staphylo- coccus aureus résistant à la méthicilline d’origine communautaire (SARM-OC) chez un Canadien de 48 ans autrement bien portant mais atteint de diabète de type 2, en voyage au Texas. Malgré une thérapie à base d’antibiotiques intraveineux, d’immunoglobulines intraveineuses et d’autres mesures de soutien, le patient a succombé à la maladie.
    [Show full text]
  • Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation
    Brief Report Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation Alicia Hidron 1,2,*, William Quiceno 3, John J. Cardeño 4 , Gustavo Roncancio 1,5 and Cristian García 1,5,6 1 Department of Medicine, Division of Infectious Diseases, Universidad Pontificia Bolivariana, Medellín, Colombia; [email protected] (G.R.); [email protected] (C.G.) 2 Department of Medicine, Division of Infectious Diseases, Hospital Pablo Tobón Uribe, Medellín, Colombia 3 Department of Radiology, Hospital Pablo Tobón Uribe and Clinica Antioquia, Medellín, Colombia; [email protected] 4 Department of Medicine, Division of Infectious Diseases, IPS Universitaria, Medellín, Colombia; [email protected] 5 Department of Medicine, Division of Infectious Diseases, Clinica Cardio VID, Medellín, Colombia 6 Department of Medicine, Division of Infectious Diseases, Clinica Universitaria Bolivariana, Medellín, Colombia * Correspondence: [email protected]; Tel.: +57-44459387 Abstract: (1) Background: Few reports of necrotizing pneumonia in patients with COVID-19 have been published. We have observed an elevated incidence at two hospitals in our city, suggesting this complication is not uncommon, and may have been overlooked. (2) Methods: This article presents a retrospective, descriptive cohort study that was undertaken from 22 March 2020 to 15 June 2021 in two tertiary care hospitals in Medellín, Colombia. All adult patients admitted to the intensive care unit (ICU) for respiratory failure related to confirmed COVID-19, on invasive mechanical ventilation (IMV), with imaging or surgical findings documenting necrotizing pneumonia (NP) were included. (3) Results: Of 936 patients with COVID-19 that required IMV, 42 (4.5%) developed NP. Citation: Hidron, A.; Quiceno, W.; Cardeño, J.J.; Roncancio, G.; García, C.
    [Show full text]
  • Multiple Large Lung Cavitary Lesions Due to Streptococcus Intermedius in an Otherwise Healthy Young Male
    Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Multiple Large Lung Cavitary Lesions Due to Streptococcus Intermedius in an Otherwise Healthy Young Male. Deepika Jain MD Lehigh Valley Health Network, [email protected] Matthew iM les DO Lehigh Valley Health Network, [email protected] Andres Zirlinger MD Lehigh Valley Health Network, [email protected] Follow this and additional works at: http://scholarlyworks.lvhn.org/medicine Part of the Medical Sciences Commons Published In/Presented At Jain, D. Miles, M. Zirlinger, A. (2017, April 27). Multiple Large Lung Cavitary Lesions Due to Streptococcus Intermedius in an Otherwise Healthy Young Male. Poster Presented at: POMA's 109th Annual Clinical Assembly & Scientific eS minar, King of Prussia, PA. This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact [email protected]. Multiple Large Lung Cavitary Lesions Due to Streptococcus Intermedius in an Otherwise Healthy Young Male Deepika G Jain MD1, Matthew J Miles DO1, Andres Zirlinger MD2 1Department of Medicine, 2Pulmonary/Critical Care, Lehigh Valley Health Network, Allentown, PA • Chest x-ray revealed multiple bilateral large confluent pulmonary nodules, some of which • Pulmonary infection with S milleri may result in considerable morbidity and mortality, and is were Cavitary. characterized by a strong male predominance, non-specific symptoms (often without toxicity), BACKGROUND the presence of predisposing factors, pleural loculation, pneumothorax, and a protracted stay in • Due to the above findings on chest x ray , High resolution CT scan of the chest was done hospital most likely in immunocompromised individual.
    [Show full text]
  • IDSA/ATS Consensus Guidelines on The
    SUPPLEMENT ARTICLE Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults Lionel A. Mandell,1,a Richard G. Wunderink,2,a Antonio Anzueto,3,4 John G. Bartlett,7 G. Douglas Campbell,8 Nathan C. Dean,9,10 Scott F. Dowell,11 Thomas M. File, Jr.12,13 Daniel M. Musher,5,6 Michael S. Niederman,14,15 Antonio Torres,16 and Cynthia G. Whitney11 1McMaster University Medical School, Hamilton, Ontario, Canada; 2Northwestern University Feinberg School of Medicine, Chicago, Illinois; 3University of Texas Health Science Center and 4South Texas Veterans Health Care System, San Antonio, and 5Michael E. DeBakey Veterans Affairs Medical Center and 6Baylor College of Medicine, Houston, Texas; 7Johns Hopkins University School of Medicine, Baltimore, Maryland; 8Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi School of Medicine, Jackson; 9Division of Pulmonary and Critical Care Medicine, LDS Hospital, and 10University of Utah, Salt Lake City, Utah; 11Centers for Disease Control and Prevention, Atlanta, Georgia; 12Northeastern Ohio Universities College of Medicine, Rootstown, and 13Summa Health System, Akron, Ohio; 14State University of New York at Stony Brook, Stony Brook, and 15Department of Medicine, Winthrop University Hospital, Mineola, New York; and 16Cap de Servei de Pneumologia i Alle`rgia Respirato`ria, Institut Clı´nic del To`rax, Hospital Clı´nic de Barcelona, Facultat de Medicina, Universitat de Barcelona, Institut d’Investigacions Biome`diques August Pi i Sunyer, CIBER CB06/06/0028, Barcelona, Spain. EXECUTIVE SUMMARY priate starting point for consultation by specialists. Substantial overlap exists among the patients whom Improving the care of adult patients with community- these guidelines address and those discussed in the re- acquired pneumonia (CAP) has been the focus of many cently published guidelines for health care–associated different organizations, and several have developed pneumonia (HCAP).
    [Show full text]
  • Complicated Pneumoniae and Dissemine Infection Caused By
    Open Access Journal of Infectious Diseases and Pathogenesis CASE REPORT ISSN: 2577-7939 Complicated Pneumoniae and Dissemine Infection Caused by Streptococcus constellatus in two Children from Turkey Belet N1*, Belverenli H2, Ozlu C3 and Sarıoglu FC4 1Professor Dr., Department of Pediatric Infectious Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey 2Assistant Dr., Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey 3Pediatrist, Department of Pediatric Infectious Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey 4Radiologist, Department of Radiology, Division of Pediatric Radiology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey *Corresponding author: Belet N, Dokuz Eylül University Faculty of Medicine, Department of Pediatric Infectious Diseases, 35340, İzmir, Turkey. Tel + 90- 232-4126095, Fax +90-232-4126005, E-mail: [email protected] Citation: Belet N, Belverenli H, Ozlu C, Sarıoglu FC (2020) Complicated Pneumoniae and Dissemine Infection Caused by Streptococcus constellatus in two Children from Turkey. J Infect Dis Pathog 3: 101 Article history: Received: 14 December 2019, Accepted: 06 March 2020, Published: 09 March 2020 Abstract Streptococcus constellatus is a member of Streptococcus anginosus (SAG) group. They are members of oropharyngeal, gastrointestinal and genitourinary flora, however they can be pathogenic. These microorganisms cause pyogenic invasive infections with their tendency to abscess formation. The infections due to these organisms may be more serious than other streptococcus species. A significant number of SAG infections are polymicrobial and frequently associated with gastrointestinal flora and obligatory anaerobes. Two children who developed necrotizing pneumonia and disseminated infection due to S. constellatus were presented in this case report. Both cases were treated with long term antibiotic treatment and surgical interventions.
    [Show full text]
  • INFECTIOUS DISEASES CASE 9.4 Pneumonia
    SECTION 9 | INFECTIOUS DISEASES CASE 9.4 Pneumonia | Level 2 Dominic Chan and Jennifer Le 1. What is the subjective and objective evidence that supports the diagnosis of community-acquired pneumonia? SUBJECTIVE FINDINGS: The most common symptoms associated with pneumonia in children are fever and cough, which is present in this patient. OBJECTIVE FINDINGS: Vital sign abnormalities include a fever, pulse oximetry of 89% on room air, and an elevated WBC count with high neutrophil count. On physical exam, the patient demonstrates nasal flaring and dyspnea. The diagnosis of pneumonia is supported by this clinical presentation along with the presence of abnormal chest radiography that is consistent with pneumonia with effusion versus empyema. Signs of respiratory distress in children with pneumonia include tachypnea, dyspnea, retractions, grunting, nasal flaring, apnea, altered mental status, and pulse oximetry measuring less than 90% on room air. The patient has some of these signs of respiratory distress, warranting hospitalization for management of her pneumonia. The patient’s pneumonia is classified as community-acquired, as opposed to healthcare-associated pneumonia, due to the absence of recent exposure to healthcare facilities and antibiotic use in the past 90 days. One possible unifying diagnosis for this patient is a viral illness causing her acute gastroenteritis prior to current hospital admission with subsequent development of a superimposed lobar pneumonia. Although uncommon, children with pneumonia may have nonspecific symptoms of emesis and abdominal pain. 2. What are the most likely pathogens causing community- acquired pneumonia in this patient, and what complication associated with pneumonia is presented? Both viruses and bacteria can cause pneumonia.
    [Show full text]
  • Necrotizing Pneumonia Caused by Group C Streptococci in a Young Adult
    Necrotizing Pneumonia Caused by Group C Streptococci in a Young Adult Vikas Pathak MD, Iliana Samara Hurtado Rendon MD, and Mihai Smina MD While group C beta hemolytic streptococcal infections are uncommon in humans, group C beta hemolytic streptococcal pneumonia is exceedingly rare. To the best of our knowledge, only 2 cases of necrotizing pneumonia caused by group C beta hemolytic streptococcus have been reported in the past. Thus, we are reporting a rare case of necrotizing group C beta hemolytic streptococcal pneumonia in a young healthy adult with no risk factors. Key words: group C beta hemolytic streptococcal infection; pneumonia. [Respir Care 2012;57(3):454–456. © 2012 Daedalus Enterprises] Introduction rate of 110 beats/min, blood pressure of 110/70 mm Hg, temperature of 38.3°C, and oxygen saturation of 96% in Group C ␤-hemolytic streptococci (GCBHS) is an un- ambient air. Examination of the oral cavity was normal. common cause of infection in humans, and GCBHS pneu- Chest examination revealed crepitations in the right side monia is exceedingly rare. To the best of our knowledge, posteriorly. Other systemic examinations were normal. A only 2 cases of necrotizing pneumonia caused by GCBHS complete blood count revealed a substantial increase in the have been reported in the past.1,2 We herein report a rare white-blood-cell count (16,000 cells/mL), with a left shift case of necrotizing pneumonia caused by GCBHS in a (92% neutrophils), toxic granulations, and Do¨hle bodies. young healthy adult with no risk factors. Other laboratory findings, including basal metabolic panel, liver function tests, hemoglobin level, and coagulation tests, Case Report were all within normal limits, and his human immunode- ficiency virus (HIV) test was negative.
    [Show full text]
  • Management of Severe Community-Acquired Pneumonia Of
    Review Management of severe community-acquired Thorax: first published as 10.1136/thx.2010.142604 on 21 October 2010. Downloaded from pneumonia of children in developing and developed countries Nicola Principi, Susanna Esposito Department of Maternal and ABSTRACT Medline, Current Contents and the reference lists Paediatric Sciences, Universita` Childhood community-acquired pneumonia (CAP) is of the relevant articles. The search terms were degli Studi di Milano, common, and recent data have shown that the number of ‘community-acquired pneumonia’, ‘severe pneu- Fondazione IRCCS Ca’ Granda ’ ‘ ’ Ospedale Maggiore Policlinico, children with severe CAP is increasing worldwide. monia and complicated pneumonia . Only articles Milan, Italy Regardless of geographical area, severe cases are those written in English and related to the paediatric at the highest risk of hospitalisation, prolonged population (aged 0e18 years) were considered. Correspondence to hospitalisation and death, and therefore require prompt Given the large number of published papers, we Nicola Principi, Department of identification and the most effective treatment in order to have restricted ourselves to citing the most recent Maternal and Paediatric e Sciences, Universita` degli Studi reduce CAP-related morbidity and mortality. This review papers (2003 9) unless they were useful for back- di Milano, Fondazione IRCCS Ca’ evaluates the available data concerning the diagnosis and ground purposes. Since opportunistic agents may Granda Ospedale Maggiore treatment of severe and/or complicated cases of cause the majority of episodes in the immuno- Policlinico, Via Commenda 9, paediatric CAP in developed and developing countries. It compromised host, we will not deal with pneu- 20122 Milano, Italy; [email protected] also underlines the fact that any evidence-based monia in children with impaired host defences.
    [Show full text]
  • Lethal Necrotizing Pneumonia Caused by an ST398
    LETTERS Lethal Necrotizing bilateral pulmonary infi ltrates and References pleural effusion. S. aureus was iso- Pneumonia Caused 1. Wulf M, Voss A. MRSA in livestock an- lated by bronchoalveolar lavage fl uid imals—an epidemic waiting to happen? by an ST398 and blood culture, and staphylococ- Clin Microbiol Infect. 2008;14:519–21. Staphylococcus cal necrotizing pneumonia was diag- DOI: 10.1111/j.1469-0691.2008.01970.x nosed. Clinical features, including the 2. Smith TC, Male MJ, Harper AL, Kroeger aureus Strain JS, Tinkler GP, Moritz ED, et al. Methi- preceding infl uenza-like illness, were cillin-resistant Staphylococcus aureus To the Editor: Several recent highly consistent with those previ- (MRSA) strain ST398 is present in mid- studies have shown massive coloniza- ously reported (5). However, viral cul- western U.S. swine and swine workers. PLoS One. 2009;4:e4258. DOI: 10.1371/ tion of livestock (especially pigs) and tures and immunofl uorescence assays were negative for all common respira- journal.pone.0004258 livestock workers by methicillin-resis- 3. Fanoy E, Helmhout LC, van der Vaart WL, tant Staphylococcus aureus (MRSA) tory viruses, and, although the patient Weijdema K, van Santen-Verheuvel MG, in western Europe, Canada, and the had positive serologic test results for Thijsen SF, et al. An outbreak of non-type- able MRSA within a residential care facil- United States (1,2). Livestock MRSA infl uenza B virus, antibody titers were too low to affi rm infl uenza B infec- ity. Euro Surveill. 2009;14(1):pii=19080. isolates belong almost exclusively to 4. Chambers HF.
    [Show full text]
  • A Case of Necrotizing Pneumonia Caused by Co-Infection With
    Apr. 2018 THE JAPANESE JOURNAL OF ANTIBIOTICS 71―2 71（ 21 ） 〈Case Report〉 A case of necrotizing pneumonia caused by co-infection with inuenza B and a Panton–Valentine leucocidin negative community acquired methicillin–resistant Staphylococcus aureus strain Keiji Mouri1, Yoshihiro Kobashi1, *, Shigeki Kato1, Tetsuo Yamaguchi2 and Mikio Oka1 1 Department of Respiratory Medicine, Kawasaki Medical School 2 Department of Microbiology and Infectious Diseases, Toho University School of Medicine (Received for publication January 25, 2018) A 63-year-old woman visited our hospital complaining of fever and dyspnea. Her inflammatory response was strongly positive, with hyperglycemia, severe hypoxia, a high level of procalcitonin, and an influenza B antigen-positive result. Chest computed tomography (CT) on admission showed multiple nodules with infiltrative shadows in the bilateral lung fields, and gram-positive coccus with phagocytosis by neutrophils was observed in a sputum sample. Although treatments using sulbactam/ ampicillin (SBT/ABPC) and azithromycin (AZM) plus peramivir were initiated, the clinical effect was poor due to the delay of administration of linezolid (LZD). Because methicillin-resistant Staphylococcus aureus (MRSA) was isolated from sputum, treatments were changed to LZD plus AZM. Molecular analysis of the MRSA isolate showed as follows: multilocus sequence typing (MLST) 8, staphylococcal cassette chromosome mec (SCCmec) typeIV, spa type t1767, Panton- Valentine leucocidin (PVL)-negative, arginine catabolic mobile element (ACME)- negative, and toxic shock syndrome toxin-1 (TSST)-1-positive. Influenza B and TSST-1 produced by community acquired MRSA (CA-MRSA) may have been involved in the formation of necrotizing pneumonia in this patient. However, she improved following the administration of peramivir and LZD.
    [Show full text]
  • Streptococcus Intermedius Causing Necrotizing Pneumonia in an Immune Competent Female: a Case Report and Literature Review
    Hindawi Publishing Corporation Case Reports in Pulmonology Volume 2016, Article ID 7452161, 5 pages http://dx.doi.org/10.1155/2016/7452161 Case Report Streptococcus intermedius Causing Necrotizing Pneumonia in an Immune Competent Female: A Case Report and Literature Review Faris Hannoodi, Israa Ali, Hussam Sabbagh, and Sarwan Kumar Crittenton Hospital, 1101 W. University Drive, 2 South, Rochester, MI 48307, USA Correspondence should be addressed to Faris Hannoodi; [email protected] Received 15 April 2016; Accepted 18 October 2016 Academic Editor: Tun-Chieh Chen Copyright © 2016 Faris Hannoodi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We report a case of a 52-year-old immunocompetent Caucasian female treated for necrotizing Streptococcus intermedius pneumonia and review available literature of similar cases. Our patient presented with respiratory failure and required hospitalization and treatment in the intensive care unit. Moreover, she required surgical drainage of right lung empyema as well as decortication and resection. The review of literature revealed three cases of S. intermedius pneumonia, one of which was a mortality. Comparison of the published cases showed a highly varied prehospital course and radiological presentations, with a symptomatic phase ranging from 10 days to five months. Radiological findings varied from an isolated pleural effusion to systemic disease with the presence of brain abscesses. Immunocompetence appears to correlate well with the overall prognosis. In addition, smoking appears to be an important risk factor for S. intermedius pneumonia. In 2 (50%) of cases, pleural fluid analysis identified S.
    [Show full text]
  • Clinical Implications of Pneumococcal Serotypes: Invasive Disease Potential, Clinical Presentations, and Antibiotic Resistance
    REVIEW Infectious Diseases, Microbiology & Parasitology http://dx.doi.org/10.3346/jkms.2013.28.1.4 • J Korean Med Sci 2013; 28: 4-15 Clinical Implications of Pneumococcal Serotypes: Invasive Disease Potential, Clinical Presentations, and Antibiotic Resistance Joon Young Song,1,2 Moon H. Nahm,2,3 Streptococcus pneumoniae can asymptomatically colonize the nasopharynx and cause a and M. Allen Moseley4 diverse range of illnesses. This clinical spectrum from colonization to invasive pneumococcal disease (IPD) appears to depend on the pneumococcal capsular serotype 1 Division of Infectious Diseases, Department of rather than the genetic background. According to a literature review, serotypes 1, 4, 5, 7F, Internal Medicine, Korea University College of Medicine, Seoul, Korea; Departments of 2Pathology 8, 12F, 14, 18C, and 19A are more likely to cause IPD. Although serotypes 1 and 19A are and 3Microbiology, 4Division of Pulmonary, Allergy the predominant causes of invasive pneumococcal pneumonia, serotype 14 remains one of and Critical Care Medicine, School of Medicine, the most common etiologic agents of non-bacteremic pneumonia in adults, even after University of Alabama at Birmingham, Birmingham, 7-valent pneumococcal conjugate vaccine (PCV7) introduction. Serotypes 1, 3, and 19A Alabama, USA pneumococci are likely to cause empyema and hemolytic uremic syndrome. Serotype 1 Received: 10 September 2012 pneumococcal meningitis is prevalent in the African meningitis belt, with a high fatality Accepted: 8 November 2012 rate. In contrast to the capsule type, genotype is more closely associated with antibiotic resistance. CC320/271 strains expressing serotype 19A are multidrug-resistant (MDR) and Address for Correspondence: Joon Young Song, MD prevalent worldwide in the era of PCV7.
    [Show full text]