1. Case Study #7 Pathogenic Bacteriology Jose Cervantes Jr. Partners: Hien Dang Evelyn Loi

2. Case Summary  70-year-old female with multiple myeloma.  treated with immunosuppressive drugs.  2-day history of dyspnea  a cough (white phlegm)  low grade fever, elevated heart rate and leukopenia  bilateral crackles with expiratory wheezes.

3. Key Information Pointing to Diagnosis  Age:  70-year-old female  History:  1 year previously was diagnosed with multiple myeloma  2-day history of dyspnea with cough producing white phlegm.  Symptoms:  Fever of 38.8 C  Elevated heart rate: 120/min  Leukopenia: 1,700 white blood cell count  Chest auscultation revealed crackles and wheezes.  Chest radiograph showed diffused pulmonary infiltrates with effusion.

4. Gram Stain Results

5. susceptible to Optochin

6. Sensitivity testing of Streptococcus

7. Classification, Gram Stain Results, and Microscopic Appearance  Family: Streptococcaceae  Genus: Streptococcus  Species: pneumoniae  Gram positive  Cocci shaped bacteria  Mucoid  Irregularly shaped colonies  α-hemolysis

8. Diseases and Pathogenesis of Disease Caused by  Diseases caused by this bacteria: - pneumonia - pneumonia - Sinusitis - Sinusitis - Otitis media - Otitis media - Bacteremia - Bacteremia - Meningitis - Meningitis

9. 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

10. Virulence factors:  Capsule- is the most important  80 different types and antibodies agaist the capsul and are type specific and protective  Leukocidan  Neuraminidase  Hyaluronidase  IgA protease

11. Therapy, Prevention and Prognosis of Patient Infected  Antimicrobial Therapy:  Penicillin,  Augmentin  erythromycin  Practice good hygiene:  Get an influenza shot each fall.  Get a pneumonococcal vaccine.  Practice good preventive measures by eating a proper diet, getting regular exercise and plenty of sleep.  Do not smoke.

12. Primary Research Article Contributing to the Understanding of the Disease Heffernan, Richard et.al, 2005, Journal of Infectious Diseases; Incidence of Invasive Streptococcus pneumoniae Infections among Persons with AIDS in an Era of Highly Active Antiretroviral Therapy, 1995-2000. 6/15/2005, Vol. 191 Issue 12, p2038-2045, 8p Experimental 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.

14. FIG. 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.

15. Take Home Message  Disease Streptococcus pneumoniae involves… Pneumonia, Sinusitis Otitis media, Bacteremia, and Meningitis  Typical symptoms  rapid breathing, rapid pulse rate,crackles and wheezes in lungs, pulmonary infiltrates with effusion. Pathogen is Streptococcus pneumoniae  Diagnostics include test  Chest auscultation and Chest radiograph  Treatment:  Penicillin, Augmentin, and erythromycin  Prognosis:   If S. pneumonia is left un treated could cause serious repercussions, however with treatment, mortally rate is really low.  Prevention :  Get an influenza shot each fall  Practice good preventive measures by eating a proper diet, getting regular exercise and plenty of sleep.  Transmission is via  spread through contact with an infected person.  Threat is  To immunocomprimised individuals (HIV ), very young, and very old people.

16. References   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.html http://www.healthscout.com/ency/1/205/main.html  http://dhs.wisconsin.gov/communicable/FactSheets/Str epPneumo.htm http://dhs.wisconsin.gov/communicable/FactSheets/Str epPneumo.htm http://dhs.wisconsin.gov/communicable/FactSheets/Str epPneumo.htm  http://www.cdc.gov/NCIDOD/DBMD/DISEASEINFO/str eppneum_t.htm