Case Study Pathogenic Bacteriology 2009 Case 41 Angela Augustus Case Summary 13

Case Study Pathogenic Bacteriology 2009 Case 41 Angela Augustus Case Summary 13 www.phwiki.com

Case Study Pathogenic Bacteriology 2009 Case 41 Angela Augustus Case Summary 13

Norwood, Beth, Host/Producer has reference to this Academic Journal, PHwiki organized this Journal Case Study Pathogenic Bacteriology 2009 Case 41 Angela Augustus Case Summary 13 month old HIV negative Up to date on immunizations Initial symptoms: runny nose, low grade fever Treated with Tylenol Later in the day: Seizures Lethargic, limp, unresponsive, post ictal Temperature 39oC Supple neck Blood in addition to urine cultures were taken Intravenous ceftriaxone Case Summary (cont) Next Day: No improved mental status CSF with: WBC count of 4650 cells/l (95% neutrophils) Low glucose level Elevated protein level Peripheral WBC count increased from 6,600 to 14,600 cells/ l

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Case Summary (cont) Transferred to University Hospital: Irritable, stiff neck Blood culture: positive CSF culture: negative Bacterial antigen test is consistent with blood culture Normal: Antibodies as long as Hib in addition to pneumococci Complement Immunoglobulin class in addition to subclass levels Lymphocyte function Case Study (cont) Gram Stain Choc CBA Key In as long as mation Pointing to Diagnosis DISEASE: Fever Decreased mental status Stiff neck Positive blood culture in addition to bacterial antigen test ORGANISM: Gram Stain Eliminated S. aureus in addition to S. agalactiae (Micrococcaceae in addition to Streptococcaceae) Lack of growth on CBA, growth on Choc Eliminated E. coli Normal complement in addition to lack of petechial rash Eliminated N. meningitidis

Diagnosis Meningitis caused by Haemophilus influenzae Serotype b (vaccine failure) “32% of children aged 6-59 months with confirmed type b disease had received 3 or more doses of the Hib vaccine” (Atkinson, 2008) Serotype a “No cross protection is af as long as ded to type a by immunization with Hib conjugate vaccines” (Jin, et al, 2007) As “the incidence of Hib meningitis decreased by 69% during the first year following initiation of Hib conjugate immunization the incidence of Hia meningitis increased eightfold” (Jin, et al, 2007) H. influenzae Classification: Pasteurellaceae Gram Stain: Gram negative coccobacilli Requires both X in addition to V Grows on Choc Grows poorly on CBA Ferments xylose H. aegyptius is – “The Normal Flora of Humans.” The Microbial World . 11 Jan 2009. Kenneth Todar University of Wisconsin-Madison Department of Bacteriology . 2 Mar 2009 . Pathogenesis in addition to Disease H. influenzae: Colonizes the nasopharynx Invades local tissues in addition to bloodstream to spread Human carrier, possibly transmitted by respiratory droplets Causes: Meningitis 2mo – 3 years Fever, decreased mental status, stiff neck Epiglottitis 2-4 year old boys Pneumonia Septic arthritis Cellulitis Pericarditis

Change in Epidemiology (Atkinson, 2008) An increase in vaccine use has led to a 99% decrease in Hib disease CDC hopes to eliminate Hib disease by 2010 Diagnosis of H. influenzae Diagnosis requires: Isolation in addition to culturing of MO from sterile body sites: Blood, CSF, joint, pericardial, or pleural fluid Detection of Hib specific antigen in sterile site especially after intravenous antibiotic treatment Latex agglutination Counterimmunoelectrophoresis Serotyping should also be done to identify specific type causing the disease Therapy, Prevention, in addition to Prognosis Treatment: Hospitalization in addition to 10 days of: Effective 3rd generation cephalosporin Cefotaxime Ceftriaxone Chloramphenicol with ampicillin Ampicillin resistant strains have now emerged Prognosis: 2-5% mortality rate even with appropriate antimicrobial therapy

Treatment, Prevention, in addition to Prognosis Prevention: Hib vaccine 2, 4, in addition to 6 mo old with booster at 12-15 months Safe as long as HIV patients (but immunogenicity varies) in addition to premature infants Conjugate vaccines: poorly antigenic polysaccharide binds to effective protein carrier PRP-T (ActHib) PRP-OMP (Pedvax HIB) Combination vaccines: combine two vaccines DTaP-Hib (TriHIBit) Hepatitis B-Hib (COMVAX) Childhood Immunizations http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm printable Primary Research Article Ellen Hyun-Ju Lee, et al, 2008, Haemophilus influenzae type b conjugate vaccine is highly effective in the Ug in addition to an routine immunization program: a case-control study, Tropical Medicine in addition to International Health, 13:495-502. Test Hib vaccine effectiveness in Ug in addition to a Case patients – 12 weeks to 59 mo w/ confirmed Hib disease Control groups – 3/case patient, age matched from: Neighborhood Hospital Data regarding immunizations in addition to environment were collected using: Structured questionnaires Written documentation in addition to logbooks

Primary Research Article TABLE 2 FROM ARTICLE Vaccine effectiveness increases with of doses (as high as 98.7%) Take Home Message Meningitis involves symptoms of fever, decreased mental status in addition to stiff neck Though it is caused by a variety of agents, H. influenzae is a common cause in young children (~2 mo to 3 years) Potentially transmitted through aerosols, the organism colonizes the nasopharynx in addition to infects the bloodstream Diagnosis involves culturing/ isolating the organism from sterile body sites or a positive bacterial antigen test Therapy includes a 10 day cycle of a 3rd generation cephalosporin or a combination of chloramphenicol in addition to ampicillin. Preventative measures with the Hib vaccine have led to a decreased threat. In the future, this threat may be nonexistant. References Atkinson, William , Jennifer Hamborsky, Lynne McIntyre, in addition to Charles Wolfe.Epidemiology in addition to Prevention of Vaccine-Preventable Diseases. 10th ed. Washington DC: Public Health Foundation, 2008. Jin, Zhigang, S in addition to ra Romero-Steiner, George M. Carlone, John B. Robbins, in addition to Rachel Schneerson. “Haemophilus influenzae Type a Infection in addition to Its Prevention.” Infection in addition to Immunity. 75(2007): 2650-2654. Lee, Ellen Hyun-Ju, Rosamund F. Lewis, Issa Makumbi, Adeodata Kekitiinwa, Tom D. Ediamu, monic Bazibu, Fiona Braka, Brendan Flanery, Patrick L. Zuber, in addition to Daniel R. Feikin. “Haemophilus influenzae type b conjugate vaccine is highly effective in Ug in addition to an routine immunization program: a case-control study.” Tropical Medicine in addition to International Health 13(2008): 495-502. “Recommended Immunization Schedule as long as Persons Aged 0 Through 6 Years.” Centers as long as Disease Control in addition to Prevention . 26 Feb 2009. Centers as long as Disease Control in addition to Prevention . 2 Mar 2009 . Roush, S in addition to ra W. , Lynne McIntyre, in addition to Linda M. Baldy. Manual as long as the Surveillance of Vaccine-Preventable Diseases. 4th ed. Atlanta, GA: Centers as long as Disease Control in addition to Prevention, 2008. Seehusen, M.D., Dean, Mark M. Reeves, M.D., in addition to Demitria A. Fomin, M.D. “Cerebrospinal Fluid Analysis.” American Family Physician 68(2003): 1103-1108.

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