INVESTIGADORES
MOLLERACH Marta Eugenia
congresos y reuniones científicas
Título:
Group B streptococcal necrotizing pneumonia in a diabetic adult patient.
Autor/es:
PACHA A; LUNA CIAN R; BONOFIGLIO L; SOLARI M; SUAREZ M; VIGLIAROLO L; TERSIGNI C; MOLLERACH M; LOPARDO H
Lugar:
Buenos Aires
Reunión:
Simposio; XIX Lancefield International Symposium on Streptococci & Streptococcal Diseases; 2014
Institución organizadora:
Lancefield Society
Resumen:
Group B streptococcal (GBS)invasive diseases have significantly increased during the past two decades. Pneumonia is most often encountered in elderly persons than in younger adults. Diabetes mellitus is a risk factor to develop GBS infections as a whole. Objective.The aim of this presentation is to describe a case of necrotizing pneumonia in a younger (≤65 years of age) diabetic male patient. Case report. A 48 y-o man with dyspnea, nonproductive cough, fever (39ºC), and loss of weight was admitted at the emergency room of the hospital. He referred to suffer from a right-side back pain since one month ago. The blood pressure was 110/80 mm Hg, the pulse was 120, and respiration frequency was 36/min. The serum potassium was 4.1 mEq/dL. An empyema was seen in the right lower lobe by chest radiography and computer axial tomography. He was taken to the operating room where decortication and atypical lung resection were performed. An empyema and lung necrosis were found. Samples of pleural fluid an biopsy were obtained and three drainage tubes were left. GBS was isolated from the pleural fluid. According with Vitek results it was susceptible to ampicillin (MIC = 0.25 μg/mL), erythromycin(MIC = 0.25 μg/mL), clindamycin (MIC = 0.25 μg/mL) and vancomycin(MIC = 0.5 μg/mL) but resistant to tretracycline (≥16 μg/mL). The patient firstly received ceftazidime (2g/8h iv.) + clindamycin (300 mg c/8h) during 18 days and then he was discharged home and orally treated with amoxicillin clavulanic acid /1g c/12h). Discussion. Pneumonia due to GBS almost exclusively occurs in older debilitated adults with central nervous system dysfunction. It is often associated with health care and results in high case-fatality rate. The present case, however, occurred in a 48 y-o diabetic man who survived after appropriate treatment. Though concomitant organisms are frequently found, GBS was the unique causal agent in this case. Conclusions. We present this case to highlight the necrotizing nature of pneumonia and the success of the antimicrobial treatment. As in cases of invasive infection by Streptococcus pyogenes clindamycin may prevent GBS shock toxic syndrome, providing that GBS may also produce pyrogenic toxins.