BACKGROUND:Streptococcus pneumoniae(S.pneumoniae)is a common pathogen that causes bacterial pneumonia.However,with increasing bacterial resistance,there is an urgent need to develop new drugs to treat S.pneumoniae inf...BACKGROUND:Streptococcus pneumoniae(S.pneumoniae)is a common pathogen that causes bacterial pneumonia.However,with increasing bacterial resistance,there is an urgent need to develop new drugs to treat S.pneumoniae infections.Nanodefensin with a 14-carbon saturated fatty acid(ND-C14)is a novel nanoantimicrobial peptide designed by modifying myristic acid at the C-terminus of humanα-defensin 5(HD5)via an amide bond.However,it is unclear whether ND-C14 is effective against lung infections caused by S.pneumoniae.METHODS:In vitro,three groups were established,including the control group,and the HD5 and ND-C14 treatment groups.A virtual colony-count assay was used to evaluate the antibacterial activity of HD5 and ND-C14 against S.pneumoniae.The morphological changes of S.pneumoniae treated with HD5 or ND-C14 were observed by scanning electron microscopy.In vivo,mice were divided into sham,vehicle,and ND-C14 treatment groups.Mice in the sham group were treated with 25μL of phosphate-buffered saline(PBS).Mice in the vehicle and ND-C14 treatment groups were treated with intratracheal instillation of 25μL of bacterial suspension with 2×108 CFU/mL(total bacterial count:5×10^(6) CFU),and then the mice were given 25μL PBS or intratracheally injected with 25μL of ND-C14(including 20μg or 50μg),respectively.Survival rates were evaluated in the vehicle and ND-C14 treatment groups.Bacterial burden in the blood and bronchoalveolar lavage fluid were counted.The lung histology of the mice was assessed.A propidium iodide uptake assay was used to clarify the destructive eff ect of ND-C14 against S.pneumoniae.RESULTS:Compared with HD5,ND-C14 had a better bactericidal eff ect against S.pneumoniae because of its stronger ability to destroy the membrane structure of S.pneumoniae in vitro.In vivo,ND-C14 significantly delayed the death time and improved the survival rate of mice infected with S.pneumoniae.ND-C14 reduced bacterial burden and lung tissue injury.Moreover,ND-C14 had a membrane permeation eff ect on S.pneumoniae,and its destructive ability increased with increasing ND-C14 concentration.CONCLUSION:The ND-C14 may improve bactericidal eff ects on S.pneumoniae both in vitro and in vivo.展开更多
Rationale:Acute otitis media is a common disease in early childhood,and is usually caused by Streptococcus pneumoniae(S.pneumoniae).Acute mastoiditis is a complication of acute otitis media and can involve not only th...Rationale:Acute otitis media is a common disease in early childhood,and is usually caused by Streptococcus pneumoniae(S.pneumoniae).Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone(acute coalescent mastoiditis).In addition,the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells,leading to subperiosteal abscesses.Patient’s Concern:A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis(swelling and redness of the skin).Diagnosis:Bilateral acute coalescent mastoiditis caused by S.pneumoniae infection.The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides.Interventions:The patient underwent intravenous antibiotic therapy and surgical treatment.Outcomes:The patient was discharged 14 days after hospitalization with an improved condition.Lessons:Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications,sometimes serious and even life-threatening.Complications are prevalent in children under 2 years,in whom the disease progresses more rapidly and severely.The vaccination with a 13-valent vaccine may not result in sufficient immunity against S.pneumoniae,a predominant pathogen in children affected by acute coalescent mastoiditis.展开更多
Co-infections of the central nervous system (CNS) caused by bacterial and viral pathogens are considered to be rare. Herpes simplex virus type-1 (HSV-1) reactivation following Streptococcus pneumoniae infection is wel...Co-infections of the central nervous system (CNS) caused by bacterial and viral pathogens are considered to be rare. Herpes simplex virus type-1 (HSV-1) reactivation following Streptococcus pneumoniae infection is well described but most cases are related to oral or cutaneous lesions or in respiratory samples. HSV-1 CNS reactivation after Streptococcus pneumoniae meningitis is a very rare event and may have significant morbidity and mortality. In this case report, we describe a 71-year-old female patient that presented with a history of abdominal pain and confusion/disorientation that had tonic-clonic seizures while in the Emergency Department. The diagnostic work-up confirmed CNS co-infection caused by Streptococcus pneumoniae and HSV-1. Of note, beyond age, the patient had no known risk factors for both entities and recovered fully after antibiotic and antiviral therapy. This case underlines that clinicians must be aware of CNS co-infection despite being a rare diagnosis. This should be suspected particularly in patients who present an unusual clinical course of CNS infection.展开更多
A prospective and analytical study was carried out from January 2017 to Decem-ber 2022, at the National Laboratory of Clinical Biology and Public Health (LNBCSP) in Bangui. 352 samples of cerebrospinal fluid (CSF) wer...A prospective and analytical study was carried out from January 2017 to Decem-ber 2022, at the National Laboratory of Clinical Biology and Public Health (LNBCSP) in Bangui. 352 samples of cerebrospinal fluid (CSF) were confirmed out of 2065, coming from the four hospitals in Bangui. This study aimed to evalu-ate the evolution of antibiotic sensitivity to strains of Streptococcus pneumoniae. CSF had been collected from patients who presented with meningeal syndromes. Based on the leukocyte count (White blood cells ≥ 5 mm3), an aliquot was trans-ferred to trans-isolate medium and sent to the LNBCSP for confirmatory testing, culture and determination of antibiotic sensitivity. The antibiotic sensitivity of Streptococcus pneumoniae strains was tested according to the methods recom-mended by the Antibiogram Committee of the French Society of Microbiology. The data collected was entered into Excel 2010 to be analyzed with Epi Info 7.2. Ficher’s exact test, chi2 at the 5% threshold (p < 0.05) was used to compare pro-portions and analyze associations between variables. The average sensitivity rate to β-lactams was 74.43%. The sensitivity rate of Fluoroquinolones was 54.54%. That of levofloxacin was 87%. The average rate of sensitivity to β-lactams for the age group under 5 years old was 79.25%. That of fluoroquinolones was 52.59%. Levofloxacin had 90.37%. The average sensitivity rate to β-lactams for the age group over 5 years old was 76.03%. Fluoroquinolones had 45.16%. Levofloxacin had 69.58%. The average sensitivity rate to β-lactams for males was 76.68%. Fluoroquinolones had 54.26%. That of levofloxacin was 83.40%. The sensitivity rate to β-lactams for females was 74.41%. That of fluoroquinolones was 51.16%. Levofloxacin had 67.44%. Cyclins had 28.68%. The study noted an association between age and sensitivity (p < 0.05;CI [1.05-2.57]). Strains of Streptococcus pneumoniae were always detected in the CSF. The average rate of sensitivity to macrolides was 36.93%;aminoglycosides 28.69%;phenicols 63.35%;sulfona-mides 39.2%. These results could suggest a reduced sensitivity to β lactams. .展开更多
Objective:To determine the antimicrobial susceptibility and serotypes of Neisseria(N.)meningitidis and Streptococcus(S.)pneumoniae in Sri Lankan patients.Methods:We retrospectively analyzed 11 blood culture specimens ...Objective:To determine the antimicrobial susceptibility and serotypes of Neisseria(N.)meningitidis and Streptococcus(S.)pneumoniae in Sri Lankan patients.Methods:We retrospectively analyzed 11 blood culture specimens from suspected patients with invasive meningococcal disease and 26 S.pneumoniae clinical isolates.We tested 6 antimicrobials against N.meningitidis and 12 antimicrobials against S.pneumoniae.Meningococcal serogroup was determined by realtime PCR and Quellung serotyping was used for pneumococcal analysis.Results:N.meningitidis serogroup B was the most common in this study.Intermediate-susceptibility to penicillin was seen in 75.0%(6/8)of strains.Susceptibility to ciprofloxacin,levofloxacin and cotrimoxazole was 62.5%(5/8),62.5%(5/8)and 87.5%(7/8),respectively.Excellent susceptibility was seen in cefotaxime and meropenem.In S.pneumoniae,the most common serotype was 19F in both invasive and non-invasive pneumococcal diseases.The majority of strains showed multidrug resistance.Penicillin non-susceptibility in non-meningeal strains were 13.6%and all meningeal strains were penicillin resistant.Erythromycin was highly resistant in both groups.Amoxicillin showed excellent susceptibility in non-invasive pneumococcal diseases strains.Linezolid,levofloxacin and vancomycin showed 100.0%susceptibility in all pneumococcal isolates.Conclusions:Implementation of vaccines should be considered,especially for children and high-risk populations.This may contribute to reducing pneumococcal and meningococcal invasive disease burden and help prevent emergence of antimicrobial resistant strains.展开更多
Objectives: This study focuses on the antibiotic susceptibility pattern and distribution of the ermB and mefA virulence genes among the Streptococcus pneumoniae due to an increase in erythromycin resistance in S. pneu...Objectives: This study focuses on the antibiotic susceptibility pattern and distribution of the ermB and mefA virulence genes among the Streptococcus pneumoniae due to an increase in erythromycin resistance in S. pneumoniae worldwide. Methodology: We investigated 255 clinical isolates collected from 2005-2010 to determine the serotype distribution and resistance to erythromycin in comparison to penicillin, clindamycin, clarithromycin, azithromycin, and trimethoprim sulfamethoxazole. Multiplex PCR was carried out to detect erythromycin resistance genes (ermB and mefA). Results: There were 146 (57.3%) isolates resistant to erythromycin. MIC<sub>90</sub> for erythromycin is at >256 mg/L and MIC<sub>50</sub> is at 16 mg/L. The ermB gene was detected in 25.3% of the erythromycin-resistant isolates and mefA gene was detected in 50.7% of the isolates. The four most common serotypes encountered are 19F, 19A, 23F and 14. The serotype distribution among the erythromycin resistant isolates was 19F (42.0%) followed by serotype 19A (11.3%), serotype 23F (9.2%) and serogroup 14 (7.0%). Conclusion: In conclusion, there is a significant rise in erythromycin resistance among the Malaysian pneumococcal isolates. The emergence of serotype 19A together with increasing prevalence of resistance to macrolide warrants for a more extensive surveillance study.展开更多
Objective: To analyze the causes of childhood pneumonia Streptococcus pneumoniae resistance and clinical characteristics, and provide a basis for better and timely clinical therapy, and medication to reduce blind-ness...Objective: To analyze the causes of childhood pneumonia Streptococcus pneumoniae resistance and clinical characteristics, and provide a basis for better and timely clinical therapy, and medication to reduce blind-ness. Methods: MIC method in our hospital 114 under 2020 pediatric pneumococcal respiratory infection in children with lower respiratory tract specimens were isolated antimicrobial susceptibility testing, and analyzed retrospectively. Results: 84 male children, 30 female children, the largest of which 9 years old, the youngest two months, infants less than 1 year old, 90 people;suffering from bronchial pneumonia, 90 cases, 21 cases of pneumonia, wheezing, 3 cases of bronchitis, the average length of stay for about a week;improved in 79 cases, 33 cases were cured, 2 cases transferred to higher level hospitals. All children with throat congestion, swollen tonsils, lung breath sounds rough, smell and moist rales. 114 penicillin-resistant Streptococcus pneumoniae was 64.9%, erythromycin 97.4%, clindamycin 86.8%, tetracycline 87.7%, trimethoprim-sulfamethoxazole 82.5%, amoxicillin 21.9%, cefotaxime 49.1%, chloramphenicol 10.5%, was not found to levofloxacin and van-comycin. Conclusion: Penicillin, erythromycin, and clindamycin are not as pneumococcal pneumonia in children experience preferred medi-cation in children less than one year old child could easily cause lung chain Streptococcus pneumoniae. Therefore, the antimicrobial resistance of Streptococcus pneumoniae analysis provides a reference for experi-enced clinicians to adjust medication.展开更多
To assess the prevalence, the antimicrobials resistance and to identify risk factors of nasopharyngeal colonization by Streptococcus pneumoniae in children with sickle cell disease (SCD) using prophylactic penicillin ...To assess the prevalence, the antimicrobials resistance and to identify risk factors of nasopharyngeal colonization by Streptococcus pneumoniae in children with sickle cell disease (SCD) using prophylactic penicillin and immunized with 7-valent pneumococcal conjugate vaccine. A total of 424 swabs were collected from the nasopharynx in 216 children with SCD and 109 samples from the control group, both from 2 to 60 months age range. Isolation and identification of pneumococci followed standard procedures. Minimum inhibitory concentration (MIC) for penicillin was determined by the E-test method. Prevalence of nasopharyngeal colonization by pneumococci in children with SCD was 17%, and 11% in the control group. The risk factors for increased colonization in children with SCD were the presence of more than five people at home, daycare/school attendance and low prophylaxis compliance. The prevalence of strains with penicillin resistance was 57.5% in patients with SCD and 25% in the control group. Conclusions: Prevalence of pneumococci nasopharyngeal colonization was similar among the study groups. Prophylactic use of penicillin may have increased the prevalence of resistant strains. The vaccine did not decrease the colonization with penicillin resistant strains.展开更多
Aim: To study how immunity to Streptococcus pneumoniae normally develops in healthy children. Methods: Ninety two healthy children at 3 - 5, 7 - 9 and 13 - 15 years of age were recruited. No one of the children had pr...Aim: To study how immunity to Streptococcus pneumoniae normally develops in healthy children. Methods: Ninety two healthy children at 3 - 5, 7 - 9 and 13 - 15 years of age were recruited. No one of the children had previously been given pneumococcal vaccine. Serum was analysed for pooled antigens of the 23 most common pneumococcal polysaccharides with ELISA technique, and results are given in opitical density (OD). A three-level semi-quantitative system was used to assess degree of immunity to Streptococcus pneumoniae . Cut-off levels were OD ≤ 0.7 and OD ≥ 1.3, separating low, intermediate and high degree of immunity. Results: Median values for OD differed significantly between the groups, with OD 0.91, 1.18 and 1.10 respectively (p = 0.004). Levels were lower in the youngest age group, but from age 7-9 years, levels were similar trough out childhood. Twenty six percent of the children in the youngest age-group had a low degree of protection (OD ≤ 0.7) to Streptococcus pneumoniae . Such low levels were uncommon from 7 - 9 years of age, found in only 13% of the children. Conclusion: Protective antibodies to Streptococcus pneumoniae develops mainly during the preschool period. Thereafter, levels are stable throughout childhood up to the age of 15 years.展开更多
Background Streptococcus pneumoniae,as a respiratory tract common pathogen,can cause invasive disease and sepsis.This study aimed to investigate the association of factors with clinical outcomes in sepsis with strepto...Background Streptococcus pneumoniae,as a respiratory tract common pathogen,can cause invasive disease and sepsis.This study aimed to investigate the association of factors with clinical outcomes in sepsis with streptococcus pneumoniae infection based on MIMIC-IV database.Methods The sepsis patients with streptococcus pneumoniae infection were included.Different variables between the survivor group and the non-survivor group were analyzed.Multivariable logistic regression was applied to identify the factors which were associated with clinical outcomes.Results A total of 80 sepsis patients with streptococcus pneumoniae infection were included.The in-hospital mortality was 23.75%(n=19).Significant differences were found in heart rate,white blood cell,RDW,MCV and hematocrit between the survivor group and the non-survivor group.The area under the ROC curve of hematocrit was 0.758 with a sensitivity of 73.7%and a specificity of 72.1%.The cut-off value of hematocrit was 30.8%.Conclusions Hematocrit level was identified to be negatively associated with in-hospital mortality in sepsis with streptococcus pneumoniae infection.展开更多
Introduction: Burkina Faso experiences regular cases of Streptococcus pneumoniae meningitis. As part of the strategy to reduce cases of meningitis, the 13-valent pneumococcal conjugate vaccine (PCV-13) has been introd...Introduction: Burkina Faso experiences regular cases of Streptococcus pneumoniae meningitis. As part of the strategy to reduce cases of meningitis, the 13-valent pneumococcal conjugate vaccine (PCV-13) has been introduced in the Expanded Programme on Immunisation (EPI). Despite these efforts, there are some cases of pneumococcal meningitis including both vaccine and non-vaccine serotypes. The objective of this study was to describe the pneumococcal sequence types (ST) circulating in Burkina Faso before the introduction of the 13-valent pneumococcal conjugate vaccine (PCV-13). Methods: It was a descriptive cross-sectional study that took place from 27th October 2013 to 7th January 2014. S. pneumoniae strains were collected in Burkina Faso and Multi Locus Sequence Typing (MLST) was performed at the Pneumococcal Laboratory at the Centers for Disease Control and Prevention (CDC) in the USA (United States of America). MLST consists of 4 steps: amplification, purification, sequencing and interpretative reading of the results. The amplification used 7 primers consisting of sequences of aroe, gdh, gki, recP, spi, xpt, ddl genes. Results: Of 37 strains tested, 10 serotypes were identified. Serotype 1 was prevalent in 48.7% (18/37) followed by serotype 25F in 10.8% (4/37). Serotypes 5 and 12F/12A/12B/44/46 were 8.1% (3/37) each. Serotype 1 contained 5 STs including ST303 24.3% (9/37), ST217 8.1% (3/37) and ST618 8.1% (3/37);followed by serotype 25F with ST105 10.8% (4/37), serotype 5 with ST289 8.1% (3/37) and serogroup 12F/12A/12B/44/46 with ST 989 8.1% (3/37). Conclusion: Pneumococci are characterised by their great variability both in number of serotypes and in ST within the same serotype. Thus, 10 serotypes have been identified. Also, within serotype 1, 5 different STs have been described. These data indicate the complexity of the pneumococcus which is strongly involved in purulent bacterial meningitis at national level. This requires continuous surveillance of pneumococcal meningitis through laboratory capacity building.展开更多
A 22-year-old man underwent bilateral laser in situ keratomileusis and developed Streptococcus pneumoniae keratitis after surgery.This complication occurred one day after the procedure in both eyes.Topical and systemi...A 22-year-old man underwent bilateral laser in situ keratomileusis and developed Streptococcus pneumoniae keratitis after surgery.This complication occurred one day after the procedure in both eyes.Topical and systemic antibiotics were promptly administered.Bacterial culture was performed following corneal flap lift and scraping of the lesions.Afterwards,the therapeutic regimen was readjusted according to the culture results.Streptococcus pneumoniae was identified from the culture.Three months after the surgery,corrected distance visual acuity achieved 20/20 in both eyes.Streptococcus pneumoniae can affect the cornea following LASIK.As prompt treatment is crucial,we recommend,for acute and subacute cases,systemic and topical application of vancomycin or moxifloxacin before the culture results come out.展开更多
Objective To establish and modify quantitative real-time polymerase chain reaction(qPCR)-based serotyping assays to distinguish 97 pneumococcal serotypes.Methods A database of capsular polysaccharide(cps)loci sequence...Objective To establish and modify quantitative real-time polymerase chain reaction(qPCR)-based serotyping assays to distinguish 97 pneumococcal serotypes.Methods A database of capsular polysaccharide(cps)loci sequences was generated,covering 97 pneumococcal serotypes.Bioinformatics analyses were performed to identify the cps loci structure and target genes related to different pneumococcal serotypes with specific SNPs.A total of 27 novel qPCR serotyping assay primers and probes were established based on qPCR,while 27 recombinant plasmids containing serotype-specific DNA sequence fragments were constructed as reference target sequences to examine the specificity and sensitivity of the qPCR assay.A panel of pneumococcal reference strains was employed to evaluate the capability of pneumococcal serotyping.Results A total of 97 pneumococcal serotyping assays based on qPCR were established and modified,which included 64 serotypes previously reported as well as an additional 33 serotypes.Twenty-seven novel qPCR serotyping target sequences were implemented in the pneumococcal qPCR serotyping system.A total of 97 pneumococcal serotypes,which included 52 individual serotypes and 45 serotypes belonging to 20 serogroups,could not be identified as individual serotypes.The sensitivity of qPCR assays based on 27 target sequences was 1–100 copies/μL.The specificity of the qPCR assays was 100%,which were tested by a panel of 90 serotypes of the pneumococcal reference strains.Conclusion A total of 27 novel qPCR assays were established and modified to analyze 97pneumococcal serotypes.展开更多
BACKGROUND Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people.Herein,we report a patient misdiagnosed with subdural effusion,who was eventually diagnosed with chronic subdu...BACKGROUND Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people.Herein,we report a patient misdiagnosed with subdural effusion,who was eventually diagnosed with chronic subdural empyema(SDE)caused by Streptococcus pneumoniae.CASE SUMMARY A 63-year-old man was brought to our emergency room with a headache,vomiting,and disturbed consciousness.Computed tomography(CT)revealed a bilateral subdural effusion at the top left side of the frontal lobe.Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis,which improved after anti-infective therapy.However,the patient then presented with acute cognitive dysfunction and right limb paralysis.Repeat CT showed an increase in left frontoparietal subdural effusion,disappearance of the left lateral ventricle,and a shift of the midline to the right.Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae.His condition improved after adequate drainage and antibiotic treatment.CONCLUSION Patients with unexplained subdural effusion,especially asymmetric subdural effusion with intracranial infection,should be assessed for chronic SDE.Early surgical treatment may be beneficial.展开更多
BACKGROUND Bacterial meningitis(BM)is a common central nervous system inflammatory disease.BM may cause serious complications,and early diagnosis is essential to improve the prognosis of affected patients.CASE SUMMARY...BACKGROUND Bacterial meningitis(BM)is a common central nervous system inflammatory disease.BM may cause serious complications,and early diagnosis is essential to improve the prognosis of affected patients.CASE SUMMARY A 37-year-old man was hospitalized with purulent meningitis because of worsening headache for 12 h,accompanied by vomiting,fever,and rhinorrhea.Head computed tomography showed a lesion in the left frontal lobe.Infectious disease screening showed positivity for hepatitis B surface antigen,hepatitis B e antigen,and hepatitis B core antigen.Cerebrospinal fluid(CSF)leak was suspected based on clinical history.Streptococcus pneumoniae(S.pneumoniae)was detected in CSF by metagenomic next-generation sequencing(mNGS)technology,confirming the diagnosis of purulent BM.After treatment,multiplex PCR indicated the presence of hepatitis B virus(HBV)DNA and absence of S.pneumoniae DNA in CSF samples.CONCLUSION We report a rare case of HBV in the CSF of a patient with purulent BM.Multiplex PCR is more sensitive than mNGS for detecting HBV DNA.展开更多
Background: Acute otitis media (AOM) is an inflammatory disease of the middle ear causing significantmorbidity in early childhood. A pilot study was undertaken to identify the role of various risk factorsSouth Indian ...Background: Acute otitis media (AOM) is an inflammatory disease of the middle ear causing significantmorbidity in early childhood. A pilot study was undertaken to identify the role of various risk factorsSouth Indian children with AOM, especially the role of nasopharyngeal otopathogens.Methodology: A prospective case control pilot study was conducted in children aged below six years,presenting to a single tertiary care from 2018 to 2019. Fifty cases with AOM and 45 age and gendermatched controls were recruited. Two nasopharyngeal swabs were collected, one was processed forbacterial culture. The other swab was processed according to the CDC recommended broth enrichmentmethod to identify carriage of S. pneumoniae. Subsequent serotyping was done by Quellung method andconventional sequential multiplex PCR.Result: Otalgia was the major presentation seen in 92% of the children with AOM. None of the clinical anddemographic characteristics were found to be statistically significant between the cases and controls. Themost common otopathogen was S. pneumoniae (55%) followed by H. influenza (29%). The commonS. pneumoniae serotypes encountered were 11A and 19F.Nasopharyngeal colonization with S. pneumoniae[OR 6.57, p < 0.003] and H. influenzae [OR14.18, p < 0.003] were significant risk factors for AOM inchildren. The risk increased with co-colonization (OR 13.89,p < 0.003).Conclusion: This study strengthens the significant association between nasopharyngeal colonization ofotopathogens and AOM as a risk factor that is enhanced by co-colonization.S. pneumoniae was the mainotopathogen in this population, serotypes 11A and 19F being the most common.展开更多
BACKGROUND The occurrence of Streptococcus pneumoniae-associated hemolytic uremic syndrome(SP-HUS)is increasing.Thomsen-Friedenreich antigen activation is highly involved in the pathogenesis of SP-HUS,and T-antibody-n...BACKGROUND The occurrence of Streptococcus pneumoniae-associated hemolytic uremic syndrome(SP-HUS)is increasing.Thomsen-Friedenreich antigen activation is highly involved in the pathogenesis of SP-HUS,and T-antibody-negative plasma exchange(PE)may be effective in the treatment of severe cases of SP-HUS.CASE SUMMARY We retrospectively reviewed two pediatric patients with SP-HUS.Both clinical features and laboratory examination results of the children were described.Tantibody-negative PE was performed in both cases.Both children made a full recovery after repeated PE and remained well at a 2 year follow-up.CONCLUSION Streptococcal pneumonia continues to be an uncommon but important cause of HUS.The successful treatment of the presented cases suggests that T-antibodynegative PE may benefit patients with SP-HUS.展开更多
AIM:To investigate the 7-valent pneumococcalconjugate vaccine(PCV7)effectiveness.METHODS:A systematic literature review of studies which evaluated the effectiveness of PCV7 vaccine was performed searching the keyword&...AIM:To investigate the 7-valent pneumococcalconjugate vaccine(PCV7)effectiveness.METHODS:A systematic literature review of studies which evaluated the effectiveness of PCV7 vaccine was performed searching the keyword"heptavalent pneumococcal conjugate vaccine"in PubM ed and Scopus until March 16,2013.The selection of potential eligible articles was done by two researchers independently on the basis of abstract and title and only post-marketing studies were included in the systematic review.Data extraction was carried out by two researchers with respect to invasive pneumococcal diseases due to both all and vaccine serotypes in pre-vaccine and postvaccine periods in children less than 5 years.Results of studies which were considered suitable for meta-analysis were combined by means of relative risk(RR)with95%CI.Vaccine effectiveness was calculated as(1-RR)×100.Heterogeneity was assessed by I2 and a random effects model was used to combine data in the case of heterogeneity.RevM an 5 was used to pool data.RESULTS:On the whole,757 eligible papers were identified from the literature search in PubM ed and Scopus.Of them,62 were finally considered in the systematic review and 38 were included in the meta-analysis.In all post-marketing studies included in the systematic review the incidence of invasive pneumococcal diseases due to vaccine serotypes declined significantly with the exception of few studies showing stability or a slight,but not significant,increase.Furthermore most of studies highlighted also a reduction in the incidence of invasive pneumococcal diseases due to all serotypes.With regards to meta-analysis,a random effects model was used to combine data because of the high heterogeneity.Data combination showed that the effectiveness of PCV7in reducing invasive pneumococcal diseases due to vaccine serotypes and to all serotypes was 84%(95%CI:74%-90%)and 53%(95%CI:46%-59%)respectively.These results are confirmatory with respect to the efficacy of PCV7 against invasive pneumococcal diseasesdue to vaccine serotypes.CONCLUSION:PCV7 implementation determines a significant decrease of invasive pneumococcal diseases.展开更多
BACKGROUND Asplenia,the lack of a spleen,can be congenital and increases susceptibility to severe infections caused by encapsulated bacteria,such as Streptococcus pneumoniae(S.pneumoniae).We report two cases of severe...BACKGROUND Asplenia,the lack of a spleen,can be congenital and increases susceptibility to severe infections caused by encapsulated bacteria,such as Streptococcus pneumoniae(S.pneumoniae).We report two cases of severe pneumococcal infection in two asplenic family members living in the same household.CASE SUMMARY Patient 1,a 38-year-old man with a history of congenital hepatitis B infection and hypospadias,was brought to our emergency department with complaints of cyanosis,cough,and edema of his limbs.He was clinically diagnosed as hyposplenic with overwhelming pneumococcal sepsis.He was admitted to the intensive care unit and was administered antibiotics and catecholaminergic therapy but died 2 h after admission.Patient 2,a 63-year-old woman with a history of type 2 diabetes,was brought to our emergency department one month after admission of Patient 1.She was diagnosed as asplenic with overwhelming pneumococcal sepsis.History-taking revealed that she was the mother of Patient 1 and the two had lived in the same household.She was admitted to the intensive care unit and was rapidly provided antibiotics and catecholaminergic intervention but died one day after admission.CONCLUSION Pneumococcal bacteremia caused by virulent S.pneumoniae may be transmitted within households.All residents of households where individuals with pneumococcal bacteremia are living should be educated about the risk of transmissibility.Family members of patients with congenital asplenia/hyposplenia,all family members should be examined to assess their splenic function.展开更多
基金supported by the National Natural Science Foundation of China(82072148)Zhejiang Provincial Basic Public Welfare Research Program of Zhejiang Province(LGF21H150002)+1 种基金Zhejiang Medicine and Health Science and Technology Project(2022RC245&2023KY255)Ningbo Municipal Natural Science Foundation(2023J134).
文摘BACKGROUND:Streptococcus pneumoniae(S.pneumoniae)is a common pathogen that causes bacterial pneumonia.However,with increasing bacterial resistance,there is an urgent need to develop new drugs to treat S.pneumoniae infections.Nanodefensin with a 14-carbon saturated fatty acid(ND-C14)is a novel nanoantimicrobial peptide designed by modifying myristic acid at the C-terminus of humanα-defensin 5(HD5)via an amide bond.However,it is unclear whether ND-C14 is effective against lung infections caused by S.pneumoniae.METHODS:In vitro,three groups were established,including the control group,and the HD5 and ND-C14 treatment groups.A virtual colony-count assay was used to evaluate the antibacterial activity of HD5 and ND-C14 against S.pneumoniae.The morphological changes of S.pneumoniae treated with HD5 or ND-C14 were observed by scanning electron microscopy.In vivo,mice were divided into sham,vehicle,and ND-C14 treatment groups.Mice in the sham group were treated with 25μL of phosphate-buffered saline(PBS).Mice in the vehicle and ND-C14 treatment groups were treated with intratracheal instillation of 25μL of bacterial suspension with 2×108 CFU/mL(total bacterial count:5×10^(6) CFU),and then the mice were given 25μL PBS or intratracheally injected with 25μL of ND-C14(including 20μg or 50μg),respectively.Survival rates were evaluated in the vehicle and ND-C14 treatment groups.Bacterial burden in the blood and bronchoalveolar lavage fluid were counted.The lung histology of the mice was assessed.A propidium iodide uptake assay was used to clarify the destructive eff ect of ND-C14 against S.pneumoniae.RESULTS:Compared with HD5,ND-C14 had a better bactericidal eff ect against S.pneumoniae because of its stronger ability to destroy the membrane structure of S.pneumoniae in vitro.In vivo,ND-C14 significantly delayed the death time and improved the survival rate of mice infected with S.pneumoniae.ND-C14 reduced bacterial burden and lung tissue injury.Moreover,ND-C14 had a membrane permeation eff ect on S.pneumoniae,and its destructive ability increased with increasing ND-C14 concentration.CONCLUSION:The ND-C14 may improve bactericidal eff ects on S.pneumoniae both in vitro and in vivo.
文摘Rationale:Acute otitis media is a common disease in early childhood,and is usually caused by Streptococcus pneumoniae(S.pneumoniae).Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone(acute coalescent mastoiditis).In addition,the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells,leading to subperiosteal abscesses.Patient’s Concern:A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis(swelling and redness of the skin).Diagnosis:Bilateral acute coalescent mastoiditis caused by S.pneumoniae infection.The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides.Interventions:The patient underwent intravenous antibiotic therapy and surgical treatment.Outcomes:The patient was discharged 14 days after hospitalization with an improved condition.Lessons:Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications,sometimes serious and even life-threatening.Complications are prevalent in children under 2 years,in whom the disease progresses more rapidly and severely.The vaccination with a 13-valent vaccine may not result in sufficient immunity against S.pneumoniae,a predominant pathogen in children affected by acute coalescent mastoiditis.
文摘Co-infections of the central nervous system (CNS) caused by bacterial and viral pathogens are considered to be rare. Herpes simplex virus type-1 (HSV-1) reactivation following Streptococcus pneumoniae infection is well described but most cases are related to oral or cutaneous lesions or in respiratory samples. HSV-1 CNS reactivation after Streptococcus pneumoniae meningitis is a very rare event and may have significant morbidity and mortality. In this case report, we describe a 71-year-old female patient that presented with a history of abdominal pain and confusion/disorientation that had tonic-clonic seizures while in the Emergency Department. The diagnostic work-up confirmed CNS co-infection caused by Streptococcus pneumoniae and HSV-1. Of note, beyond age, the patient had no known risk factors for both entities and recovered fully after antibiotic and antiviral therapy. This case underlines that clinicians must be aware of CNS co-infection despite being a rare diagnosis. This should be suspected particularly in patients who present an unusual clinical course of CNS infection.
文摘A prospective and analytical study was carried out from January 2017 to Decem-ber 2022, at the National Laboratory of Clinical Biology and Public Health (LNBCSP) in Bangui. 352 samples of cerebrospinal fluid (CSF) were confirmed out of 2065, coming from the four hospitals in Bangui. This study aimed to evalu-ate the evolution of antibiotic sensitivity to strains of Streptococcus pneumoniae. CSF had been collected from patients who presented with meningeal syndromes. Based on the leukocyte count (White blood cells ≥ 5 mm3), an aliquot was trans-ferred to trans-isolate medium and sent to the LNBCSP for confirmatory testing, culture and determination of antibiotic sensitivity. The antibiotic sensitivity of Streptococcus pneumoniae strains was tested according to the methods recom-mended by the Antibiogram Committee of the French Society of Microbiology. The data collected was entered into Excel 2010 to be analyzed with Epi Info 7.2. Ficher’s exact test, chi2 at the 5% threshold (p < 0.05) was used to compare pro-portions and analyze associations between variables. The average sensitivity rate to β-lactams was 74.43%. The sensitivity rate of Fluoroquinolones was 54.54%. That of levofloxacin was 87%. The average rate of sensitivity to β-lactams for the age group under 5 years old was 79.25%. That of fluoroquinolones was 52.59%. Levofloxacin had 90.37%. The average sensitivity rate to β-lactams for the age group over 5 years old was 76.03%. Fluoroquinolones had 45.16%. Levofloxacin had 69.58%. The average sensitivity rate to β-lactams for males was 76.68%. Fluoroquinolones had 54.26%. That of levofloxacin was 83.40%. The sensitivity rate to β-lactams for females was 74.41%. That of fluoroquinolones was 51.16%. Levofloxacin had 67.44%. Cyclins had 28.68%. The study noted an association between age and sensitivity (p < 0.05;CI [1.05-2.57]). Strains of Streptococcus pneumoniae were always detected in the CSF. The average rate of sensitivity to macrolides was 36.93%;aminoglycosides 28.69%;phenicols 63.35%;sulfona-mides 39.2%. These results could suggest a reduced sensitivity to β lactams. .
文摘Objective:To determine the antimicrobial susceptibility and serotypes of Neisseria(N.)meningitidis and Streptococcus(S.)pneumoniae in Sri Lankan patients.Methods:We retrospectively analyzed 11 blood culture specimens from suspected patients with invasive meningococcal disease and 26 S.pneumoniae clinical isolates.We tested 6 antimicrobials against N.meningitidis and 12 antimicrobials against S.pneumoniae.Meningococcal serogroup was determined by realtime PCR and Quellung serotyping was used for pneumococcal analysis.Results:N.meningitidis serogroup B was the most common in this study.Intermediate-susceptibility to penicillin was seen in 75.0%(6/8)of strains.Susceptibility to ciprofloxacin,levofloxacin and cotrimoxazole was 62.5%(5/8),62.5%(5/8)and 87.5%(7/8),respectively.Excellent susceptibility was seen in cefotaxime and meropenem.In S.pneumoniae,the most common serotype was 19F in both invasive and non-invasive pneumococcal diseases.The majority of strains showed multidrug resistance.Penicillin non-susceptibility in non-meningeal strains were 13.6%and all meningeal strains were penicillin resistant.Erythromycin was highly resistant in both groups.Amoxicillin showed excellent susceptibility in non-invasive pneumococcal diseases strains.Linezolid,levofloxacin and vancomycin showed 100.0%susceptibility in all pneumococcal isolates.Conclusions:Implementation of vaccines should be considered,especially for children and high-risk populations.This may contribute to reducing pneumococcal and meningococcal invasive disease burden and help prevent emergence of antimicrobial resistant strains.
文摘Objectives: This study focuses on the antibiotic susceptibility pattern and distribution of the ermB and mefA virulence genes among the Streptococcus pneumoniae due to an increase in erythromycin resistance in S. pneumoniae worldwide. Methodology: We investigated 255 clinical isolates collected from 2005-2010 to determine the serotype distribution and resistance to erythromycin in comparison to penicillin, clindamycin, clarithromycin, azithromycin, and trimethoprim sulfamethoxazole. Multiplex PCR was carried out to detect erythromycin resistance genes (ermB and mefA). Results: There were 146 (57.3%) isolates resistant to erythromycin. MIC<sub>90</sub> for erythromycin is at >256 mg/L and MIC<sub>50</sub> is at 16 mg/L. The ermB gene was detected in 25.3% of the erythromycin-resistant isolates and mefA gene was detected in 50.7% of the isolates. The four most common serotypes encountered are 19F, 19A, 23F and 14. The serotype distribution among the erythromycin resistant isolates was 19F (42.0%) followed by serotype 19A (11.3%), serotype 23F (9.2%) and serogroup 14 (7.0%). Conclusion: In conclusion, there is a significant rise in erythromycin resistance among the Malaysian pneumococcal isolates. The emergence of serotype 19A together with increasing prevalence of resistance to macrolide warrants for a more extensive surveillance study.
文摘Objective: To analyze the causes of childhood pneumonia Streptococcus pneumoniae resistance and clinical characteristics, and provide a basis for better and timely clinical therapy, and medication to reduce blind-ness. Methods: MIC method in our hospital 114 under 2020 pediatric pneumococcal respiratory infection in children with lower respiratory tract specimens were isolated antimicrobial susceptibility testing, and analyzed retrospectively. Results: 84 male children, 30 female children, the largest of which 9 years old, the youngest two months, infants less than 1 year old, 90 people;suffering from bronchial pneumonia, 90 cases, 21 cases of pneumonia, wheezing, 3 cases of bronchitis, the average length of stay for about a week;improved in 79 cases, 33 cases were cured, 2 cases transferred to higher level hospitals. All children with throat congestion, swollen tonsils, lung breath sounds rough, smell and moist rales. 114 penicillin-resistant Streptococcus pneumoniae was 64.9%, erythromycin 97.4%, clindamycin 86.8%, tetracycline 87.7%, trimethoprim-sulfamethoxazole 82.5%, amoxicillin 21.9%, cefotaxime 49.1%, chloramphenicol 10.5%, was not found to levofloxacin and van-comycin. Conclusion: Penicillin, erythromycin, and clindamycin are not as pneumococcal pneumonia in children experience preferred medi-cation in children less than one year old child could easily cause lung chain Streptococcus pneumoniae. Therefore, the antimicrobial resistance of Streptococcus pneumoniae analysis provides a reference for experi-enced clinicians to adjust medication.
文摘To assess the prevalence, the antimicrobials resistance and to identify risk factors of nasopharyngeal colonization by Streptococcus pneumoniae in children with sickle cell disease (SCD) using prophylactic penicillin and immunized with 7-valent pneumococcal conjugate vaccine. A total of 424 swabs were collected from the nasopharynx in 216 children with SCD and 109 samples from the control group, both from 2 to 60 months age range. Isolation and identification of pneumococci followed standard procedures. Minimum inhibitory concentration (MIC) for penicillin was determined by the E-test method. Prevalence of nasopharyngeal colonization by pneumococci in children with SCD was 17%, and 11% in the control group. The risk factors for increased colonization in children with SCD were the presence of more than five people at home, daycare/school attendance and low prophylaxis compliance. The prevalence of strains with penicillin resistance was 57.5% in patients with SCD and 25% in the control group. Conclusions: Prevalence of pneumococci nasopharyngeal colonization was similar among the study groups. Prophylactic use of penicillin may have increased the prevalence of resistant strains. The vaccine did not decrease the colonization with penicillin resistant strains.
基金supported by grants from Stiftelsen Samariten,Sachsska Barnsjukhuset,Sodersjukhuset,Stockholm,Sweden.
文摘Aim: To study how immunity to Streptococcus pneumoniae normally develops in healthy children. Methods: Ninety two healthy children at 3 - 5, 7 - 9 and 13 - 15 years of age were recruited. No one of the children had previously been given pneumococcal vaccine. Serum was analysed for pooled antigens of the 23 most common pneumococcal polysaccharides with ELISA technique, and results are given in opitical density (OD). A three-level semi-quantitative system was used to assess degree of immunity to Streptococcus pneumoniae . Cut-off levels were OD ≤ 0.7 and OD ≥ 1.3, separating low, intermediate and high degree of immunity. Results: Median values for OD differed significantly between the groups, with OD 0.91, 1.18 and 1.10 respectively (p = 0.004). Levels were lower in the youngest age group, but from age 7-9 years, levels were similar trough out childhood. Twenty six percent of the children in the youngest age-group had a low degree of protection (OD ≤ 0.7) to Streptococcus pneumoniae . Such low levels were uncommon from 7 - 9 years of age, found in only 13% of the children. Conclusion: Protective antibodies to Streptococcus pneumoniae develops mainly during the preschool period. Thereafter, levels are stable throughout childhood up to the age of 15 years.
文摘Background Streptococcus pneumoniae,as a respiratory tract common pathogen,can cause invasive disease and sepsis.This study aimed to investigate the association of factors with clinical outcomes in sepsis with streptococcus pneumoniae infection based on MIMIC-IV database.Methods The sepsis patients with streptococcus pneumoniae infection were included.Different variables between the survivor group and the non-survivor group were analyzed.Multivariable logistic regression was applied to identify the factors which were associated with clinical outcomes.Results A total of 80 sepsis patients with streptococcus pneumoniae infection were included.The in-hospital mortality was 23.75%(n=19).Significant differences were found in heart rate,white blood cell,RDW,MCV and hematocrit between the survivor group and the non-survivor group.The area under the ROC curve of hematocrit was 0.758 with a sensitivity of 73.7%and a specificity of 72.1%.The cut-off value of hematocrit was 30.8%.Conclusions Hematocrit level was identified to be negatively associated with in-hospital mortality in sepsis with streptococcus pneumoniae infection.
文摘Introduction: Burkina Faso experiences regular cases of Streptococcus pneumoniae meningitis. As part of the strategy to reduce cases of meningitis, the 13-valent pneumococcal conjugate vaccine (PCV-13) has been introduced in the Expanded Programme on Immunisation (EPI). Despite these efforts, there are some cases of pneumococcal meningitis including both vaccine and non-vaccine serotypes. The objective of this study was to describe the pneumococcal sequence types (ST) circulating in Burkina Faso before the introduction of the 13-valent pneumococcal conjugate vaccine (PCV-13). Methods: It was a descriptive cross-sectional study that took place from 27th October 2013 to 7th January 2014. S. pneumoniae strains were collected in Burkina Faso and Multi Locus Sequence Typing (MLST) was performed at the Pneumococcal Laboratory at the Centers for Disease Control and Prevention (CDC) in the USA (United States of America). MLST consists of 4 steps: amplification, purification, sequencing and interpretative reading of the results. The amplification used 7 primers consisting of sequences of aroe, gdh, gki, recP, spi, xpt, ddl genes. Results: Of 37 strains tested, 10 serotypes were identified. Serotype 1 was prevalent in 48.7% (18/37) followed by serotype 25F in 10.8% (4/37). Serotypes 5 and 12F/12A/12B/44/46 were 8.1% (3/37) each. Serotype 1 contained 5 STs including ST303 24.3% (9/37), ST217 8.1% (3/37) and ST618 8.1% (3/37);followed by serotype 25F with ST105 10.8% (4/37), serotype 5 with ST289 8.1% (3/37) and serogroup 12F/12A/12B/44/46 with ST 989 8.1% (3/37). Conclusion: Pneumococci are characterised by their great variability both in number of serotypes and in ST within the same serotype. Thus, 10 serotypes have been identified. Also, within serotype 1, 5 different STs have been described. These data indicate the complexity of the pneumococcus which is strongly involved in purulent bacterial meningitis at national level. This requires continuous surveillance of pneumococcal meningitis through laboratory capacity building.
基金Supported by Shanghai Leading Academic Discipline Project (S30205)
文摘A 22-year-old man underwent bilateral laser in situ keratomileusis and developed Streptococcus pneumoniae keratitis after surgery.This complication occurred one day after the procedure in both eyes.Topical and systemic antibiotics were promptly administered.Bacterial culture was performed following corneal flap lift and scraping of the lesions.Afterwards,the therapeutic regimen was readjusted according to the culture results.Streptococcus pneumoniae was identified from the culture.Three months after the surgery,corrected distance visual acuity achieved 20/20 in both eyes.Streptococcus pneumoniae can affect the cornea following LASIK.As prompt treatment is crucial,we recommend,for acute and subacute cases,systemic and topical application of vancomycin or moxifloxacin before the culture results come out.
基金supported by a grant from Beijing Municipal Natural Science Foundation [L212011]National Institute for Communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention [131031102000210003&102393230020020000002]。
文摘Objective To establish and modify quantitative real-time polymerase chain reaction(qPCR)-based serotyping assays to distinguish 97 pneumococcal serotypes.Methods A database of capsular polysaccharide(cps)loci sequences was generated,covering 97 pneumococcal serotypes.Bioinformatics analyses were performed to identify the cps loci structure and target genes related to different pneumococcal serotypes with specific SNPs.A total of 27 novel qPCR serotyping assay primers and probes were established based on qPCR,while 27 recombinant plasmids containing serotype-specific DNA sequence fragments were constructed as reference target sequences to examine the specificity and sensitivity of the qPCR assay.A panel of pneumococcal reference strains was employed to evaluate the capability of pneumococcal serotyping.Results A total of 97 pneumococcal serotyping assays based on qPCR were established and modified,which included 64 serotypes previously reported as well as an additional 33 serotypes.Twenty-seven novel qPCR serotyping target sequences were implemented in the pneumococcal qPCR serotyping system.A total of 97 pneumococcal serotypes,which included 52 individual serotypes and 45 serotypes belonging to 20 serogroups,could not be identified as individual serotypes.The sensitivity of qPCR assays based on 27 target sequences was 1–100 copies/μL.The specificity of the qPCR assays was 100%,which were tested by a panel of 90 serotypes of the pneumococcal reference strains.Conclusion A total of 27 novel qPCR assays were established and modified to analyze 97pneumococcal serotypes.
基金Supported by Sichuan Provincial Health and Family Planning Commission,China,No.17PJ088.
文摘BACKGROUND Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people.Herein,we report a patient misdiagnosed with subdural effusion,who was eventually diagnosed with chronic subdural empyema(SDE)caused by Streptococcus pneumoniae.CASE SUMMARY A 63-year-old man was brought to our emergency room with a headache,vomiting,and disturbed consciousness.Computed tomography(CT)revealed a bilateral subdural effusion at the top left side of the frontal lobe.Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis,which improved after anti-infective therapy.However,the patient then presented with acute cognitive dysfunction and right limb paralysis.Repeat CT showed an increase in left frontoparietal subdural effusion,disappearance of the left lateral ventricle,and a shift of the midline to the right.Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae.His condition improved after adequate drainage and antibiotic treatment.CONCLUSION Patients with unexplained subdural effusion,especially asymmetric subdural effusion with intracranial infection,should be assessed for chronic SDE.Early surgical treatment may be beneficial.
文摘BACKGROUND Bacterial meningitis(BM)is a common central nervous system inflammatory disease.BM may cause serious complications,and early diagnosis is essential to improve the prognosis of affected patients.CASE SUMMARY A 37-year-old man was hospitalized with purulent meningitis because of worsening headache for 12 h,accompanied by vomiting,fever,and rhinorrhea.Head computed tomography showed a lesion in the left frontal lobe.Infectious disease screening showed positivity for hepatitis B surface antigen,hepatitis B e antigen,and hepatitis B core antigen.Cerebrospinal fluid(CSF)leak was suspected based on clinical history.Streptococcus pneumoniae(S.pneumoniae)was detected in CSF by metagenomic next-generation sequencing(mNGS)technology,confirming the diagnosis of purulent BM.After treatment,multiplex PCR indicated the presence of hepatitis B virus(HBV)DNA and absence of S.pneumoniae DNA in CSF samples.CONCLUSION We report a rare case of HBV in the CSF of a patient with purulent BM.Multiplex PCR is more sensitive than mNGS for detecting HBV DNA.
基金The study was approved by our institutional review board (IRBNo10947/17) and all the subjects provided informed consent.
文摘Background: Acute otitis media (AOM) is an inflammatory disease of the middle ear causing significantmorbidity in early childhood. A pilot study was undertaken to identify the role of various risk factorsSouth Indian children with AOM, especially the role of nasopharyngeal otopathogens.Methodology: A prospective case control pilot study was conducted in children aged below six years,presenting to a single tertiary care from 2018 to 2019. Fifty cases with AOM and 45 age and gendermatched controls were recruited. Two nasopharyngeal swabs were collected, one was processed forbacterial culture. The other swab was processed according to the CDC recommended broth enrichmentmethod to identify carriage of S. pneumoniae. Subsequent serotyping was done by Quellung method andconventional sequential multiplex PCR.Result: Otalgia was the major presentation seen in 92% of the children with AOM. None of the clinical anddemographic characteristics were found to be statistically significant between the cases and controls. Themost common otopathogen was S. pneumoniae (55%) followed by H. influenza (29%). The commonS. pneumoniae serotypes encountered were 11A and 19F.Nasopharyngeal colonization with S. pneumoniae[OR 6.57, p < 0.003] and H. influenzae [OR14.18, p < 0.003] were significant risk factors for AOM inchildren. The risk increased with co-colonization (OR 13.89,p < 0.003).Conclusion: This study strengthens the significant association between nasopharyngeal colonization ofotopathogens and AOM as a risk factor that is enhanced by co-colonization.S. pneumoniae was the mainotopathogen in this population, serotypes 11A and 19F being the most common.
文摘BACKGROUND The occurrence of Streptococcus pneumoniae-associated hemolytic uremic syndrome(SP-HUS)is increasing.Thomsen-Friedenreich antigen activation is highly involved in the pathogenesis of SP-HUS,and T-antibody-negative plasma exchange(PE)may be effective in the treatment of severe cases of SP-HUS.CASE SUMMARY We retrospectively reviewed two pediatric patients with SP-HUS.Both clinical features and laboratory examination results of the children were described.Tantibody-negative PE was performed in both cases.Both children made a full recovery after repeated PE and remained well at a 2 year follow-up.CONCLUSION Streptococcal pneumonia continues to be an uncommon but important cause of HUS.The successful treatment of the presented cases suggests that T-antibodynegative PE may benefit patients with SP-HUS.
文摘AIM:To investigate the 7-valent pneumococcalconjugate vaccine(PCV7)effectiveness.METHODS:A systematic literature review of studies which evaluated the effectiveness of PCV7 vaccine was performed searching the keyword"heptavalent pneumococcal conjugate vaccine"in PubM ed and Scopus until March 16,2013.The selection of potential eligible articles was done by two researchers independently on the basis of abstract and title and only post-marketing studies were included in the systematic review.Data extraction was carried out by two researchers with respect to invasive pneumococcal diseases due to both all and vaccine serotypes in pre-vaccine and postvaccine periods in children less than 5 years.Results of studies which were considered suitable for meta-analysis were combined by means of relative risk(RR)with95%CI.Vaccine effectiveness was calculated as(1-RR)×100.Heterogeneity was assessed by I2 and a random effects model was used to combine data in the case of heterogeneity.RevM an 5 was used to pool data.RESULTS:On the whole,757 eligible papers were identified from the literature search in PubM ed and Scopus.Of them,62 were finally considered in the systematic review and 38 were included in the meta-analysis.In all post-marketing studies included in the systematic review the incidence of invasive pneumococcal diseases due to vaccine serotypes declined significantly with the exception of few studies showing stability or a slight,but not significant,increase.Furthermore most of studies highlighted also a reduction in the incidence of invasive pneumococcal diseases due to all serotypes.With regards to meta-analysis,a random effects model was used to combine data because of the high heterogeneity.Data combination showed that the effectiveness of PCV7in reducing invasive pneumococcal diseases due to vaccine serotypes and to all serotypes was 84%(95%CI:74%-90%)and 53%(95%CI:46%-59%)respectively.These results are confirmatory with respect to the efficacy of PCV7 against invasive pneumococcal diseasesdue to vaccine serotypes.CONCLUSION:PCV7 implementation determines a significant decrease of invasive pneumococcal diseases.
文摘BACKGROUND Asplenia,the lack of a spleen,can be congenital and increases susceptibility to severe infections caused by encapsulated bacteria,such as Streptococcus pneumoniae(S.pneumoniae).We report two cases of severe pneumococcal infection in two asplenic family members living in the same household.CASE SUMMARY Patient 1,a 38-year-old man with a history of congenital hepatitis B infection and hypospadias,was brought to our emergency department with complaints of cyanosis,cough,and edema of his limbs.He was clinically diagnosed as hyposplenic with overwhelming pneumococcal sepsis.He was admitted to the intensive care unit and was administered antibiotics and catecholaminergic therapy but died 2 h after admission.Patient 2,a 63-year-old woman with a history of type 2 diabetes,was brought to our emergency department one month after admission of Patient 1.She was diagnosed as asplenic with overwhelming pneumococcal sepsis.History-taking revealed that she was the mother of Patient 1 and the two had lived in the same household.She was admitted to the intensive care unit and was rapidly provided antibiotics and catecholaminergic intervention but died one day after admission.CONCLUSION Pneumococcal bacteremia caused by virulent S.pneumoniae may be transmitted within households.All residents of households where individuals with pneumococcal bacteremia are living should be educated about the risk of transmissibility.Family members of patients with congenital asplenia/hyposplenia,all family members should be examined to assess their splenic function.
