Case Study Pathogenic Bacteriology 2009 Case Summary Key In as long as mation Pointing to Diagnosis The Diagnosis as long as Case 51 Diagnosis

Case Study Pathogenic Bacteriology 2009 Case Summary Key In as long as mation Pointing to Diagnosis The Diagnosis as long as Case 51 Diagnosis www.phwiki.com

Case Study Pathogenic Bacteriology 2009 Case Summary Key In as long as mation Pointing to Diagnosis The Diagnosis as long as Case 51 Diagnosis

Wheaton, Karen, Host/Producer has reference to this Academic Journal, PHwiki organized this Journal Case Study Pathogenic Bacteriology 2009 Case 51 Anthony Obisesan Tania Guevara Edmund yeo Case Summary A 53 year-old man with non-insulin-dependent diabetes in addition to hypertension presents symptoms of fever, chills, in addition to a cough with green sputum. Gram stain, blood culture, biochemical test, chest x-ray were per as long as med to identify the causative agent. Streptococcus Pneumoniae was isolated in addition to identified. This organism is by far the most common cause of bacterial pneumonia, particularly in the elderly. Key In as long as mation Pointing to Diagnosis Degree of resistance to host: Age: 53 year old Gender: Male Physical Health: Mellitus diabetes in addition to Hypertension, 2 packs of cigarettes daily as long as 40 years. Symptoms: fatigue, fever, chills, dyspnea, left-sided pleuritic chest pain, in addition to cough with green sputum. Gram Staining in addition to blood culture to role out other organism

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The Diagnosis as long as Case 51 Based on the patient’s symptoms (green sputum) in addition to findings from physical examination (crackles in lung fields) Pneumonia is suspected. Chest X-ray: Chest X-ray is typically used as long as diagnosis in hospitals Right lower lobe, left lingular, in addition to left lower lobe infiltrates Computed tomography of chest (lung window) shows two large cavities with air fluid level. After 4 weeks in hospital, multiple cavities with air-fluid level are seen in right lung One week into admission, there is segmental infiltrate within right upper lobe. Diagnosis Blood Culture: Significant in ruling out other gram (+) organism that cause pneumonia such as staph. aureus, in addition to strep. agalactiae an important cause of pneumonia (especially in new borns). Gram stain: Strep Pneumoniae present & Normal Respiratory Flora High white blood cell count indicates the presence of an infection or inflammation. staining: Gram (+) Catalase (+) Coagulase (-) Staph Epidermidis Present, NF in upper respiratory tract. Classification,Gram Stain Results, in addition to Microscopic Appearance of Streptococcus Pneumoniae Classification: Streptococcus – a major cause of human infections. They are untypable in the Lancefield classification which is based on the antigenicity of a carbohydrate which is soluble in dilute acid in addition to called the C carbohydrate. They can, however, be subdivided into more than 80 serological types on the basis of antigenic differences in their capsular polysaccharide. For pneumococcal pneumonia, 23 types are the cause of 90% of the case Morphology in addition to General Characteristics: a gram (+), apha-hemolytic diplococcus, aerotolerant anaerobe. Gram Stain Results: Gram positive diplococcus Streptococcus pneumoniae Gram-stain of blood broth culture. CDC

Diseases in addition to Pathogenesis of Disease Caused by Streptococcus Pneumoniae Diseases: Lobar Pneumonia, meningitis, Otitis media, Septicemia, endocarditis in addition to so on. In the elderly or in other individuals whose ciliary activity or respiratory drainage is likely to be impaired the organism can reach its pathogenic site in the lung in addition to cause serious disease. Those most susceptible would be the bedridden, heavy smokers, alcoholics, or individuals who had suffered a recent respiratory viral infection or toxic damage to the mucociliary escalator Transmission: Person to person by direct inoculation from shared respiratory equipment has been documented, other medical equipment might be cause to infection, in addition to transmission via HCW Pathogenesis Virulence Factors: The capsule of the pneumococci is its most potent virulence factor. The antiphagocytic properties of the capsule allow the pneumococci to grow in the lung. This results in an inflammatory response in which fluid accumulates in the lung. Other virulence factors include: the cell wall; choline-binding proteins; pneumococcal surface proteins A in addition to C (PspA in addition to PspC); the LPXTG-anchored neuraminidase proteins; hyaluronate lyase (Hyl); pneumococcal adhesion in addition to virulence A (PavA); enolase (Eno); pneumolysin; autolysin A (LytA); in addition to the metal-binding proteins pneumococcal surface antigen A (PsaA), pneumococcal iron acquisition A (PiaA) in addition to pneumococcal iron uptake A (PiuA). Common Disease & Symptoms caused by Streptococcus Pneumoniae Septicemia Pneumonia

Diagnosis/Isolation/Identification/ of Streptococcus Pneumoniae Isolation: Isolation can be done on Columbia Blood Agar (CBA) Identification: Gram staining; Pneumococci are differentiated in the laboratory from other alpha hemolytic streptococci by virtue of their sensitivity to optichin. This is usually tested by means of an impregnated disc, the P disk, placed on a lawn of the bacteria on a blood agar plate, in addition to sensitivity demonstrated by a zone of no growth around the disc. Test as long as Bile solubility also Therapy, Prevention in addition to Prognosis of Patient Infected with Streptococcus Pneumoniae Prevention: Vaccination is recommended as long as individuals over 10 years of age who are at risk; i.e., those with sickle cell disease, splenic malfunction, congestive heart failure, alcoholism, diabetes, confinement in a nursing home. Sterilized hospital equipment in addition to the use of personal safety equipment (gloves, gowns etc) by healthcare worker will reduce transmission. Between 5 in addition to 10 million people get pneumonia in the United States each year, in addition to more than 1 million people are hospitalized due to the condition. As a result, pneumonia is the third most frequent cause of hospitalizations (births are first, in addition to heart disease is second). About 500,000 children are hospitalized as long as respiratory infections each year, in addition to a third of them have pneumonia. Although the majority of pneumonias respond well to treatment, the infection kills 40,000 – 70,000 people each year. A recent disturbing finding is that about 25% of isolates of S. pneumoniae are now resistant to one or more antibiotics. The penicillin resistance in this organism is usually not due to beta lactamase, but rather to mutations in penicillin binding proteins. Sensitivity testing is necessary Primary Research Article Contributing to the Underst in addition to ing of the Disease caused by Streptococcus Pneumoniae Kwan, S.K. et al, 2009, “Changes of serotype in addition to genotype in Streptococcus pneumoniae isolates from a Korean hospital in 2007”, Diagnostic Microbiology in addition to Infectious Disease, vol 63: 271 – 278. Experimental set up: Capsular quellung method: To determine serotypes of Strep. pneumoniae (154 isolates) from sputum, blood, tracheal aspirate, nasal swab, in addition to pus. 104 were invasive In vitro susceptibility testing was per as long as med by broth microdilution (MIC). 8 antimicrobial agents were tested: penicillin, erythromycin, amoxixillin-clavulanate, levofloxacin, ciprofloxacin, clarithromycin, clindamycin in addition to trimethoprim-sulfamethoxazole. Multilocus sequence typing was per as long as med to determine the genotypes of all isolates. Erythromycin-resistant genes in isolates were determined by duplex PCR method.

Findings New serotypes found Antimicrobial Resistance in isolates between 1998-2000 in addition to 2007 Conclusion Conclusion: Helpful in as long as mation on local vaccine serotype expansion or replacement in Korea Emergence of new serotypes with time Resistance to antimicrobials Changes in serotype in addition to genotype in Streptococcus pneumoniae is unfavorable to preventing pneumoniae especially in hospital patients. With these changes, resistant serotypes emerge in addition to are a major threat to human lives. Take Home Message Pneumonia is a common illness which occurs in all age groups, in addition to is a leading cause of death among the elderly in addition to people who are chronically in addition to terminally ill Typical symptoms are fatigue, fever, chills, dyspnea, left-sided pleuritic chest pain, in addition to cough with green sputum. Pathogen is Streptococus pneumoniae, a gram (+), apha-hemolytic diplococcus, aerotolerant anaerobe Diagnostics include test gram staining, optochin susceptibility & bile solubilty, blood culture, in addition to X-ray Therapy is based on vaccination, vaccination to prevent certain strains are available Prognosis: with treatment, pneumonia can be cleared within two to four weeks. The eventual outcome of an episode depends on how ill the person is when he or she is first diagnosed Prevention is via vaccination as long as individuals over 10 years of age who are at risk; i.e., those with sickle cell disease, splenic malfunction, congestive heart failure, alcoholism, diabetes, confinement in a nursing home.Sterilized hospital equipment in addition to the use of personal safety equipment (gloves, gowns etc) by healthcare worker will reduce transmission Transmission is via Person to person by direct inoculation from shared respiratory equipment has been documented, other medical equipment might be cause to infection, in addition to transmission via HCW Threat is Changes in serotype in addition to genotype in Streptococcus pneumoniae is unfavorable to preventing pneumoniae especially in hospital patients. With these changes, resistant serotypes emerge in addition to are a major threat to human lives

References Kwan, S.K. et al, 2009, “Changes of serotype in addition to genotype in Streptococcus pneumoniae isolates from a Korean hospital in 2007”, Diagnostic Microbiology in addition to Infectious Disease, vol 63: 271 – 278. http://www.cdc.gov/ncidod/biotech/strep/strepindex.htm accessed on March 11, 2008 Point Spread

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Wheaton, Karen Host/Producer

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