Question

The patient is an 18 – day – old female who at presentation was brought to the emergency department by her mother after a three – day bout of coughing. Her mother also reported that her daughter had been “spitting up” more than usual and had episodes of tachypnea. During the initial exam, a rapid respiratory syncytial (RSV) test was obtained with negative results. A review of systems was notable only for a nonproductive cough. Her pulse was 168 beats/min, her respiratory rate was 32 inspirations per minute, and oxygen saturation was 92-95% on room air. Her complete blood count was significant for a white blood cell count of 15,300 cells/µl with an absolute lymphocyte count of 10,900 cells/µl. The mother had a chronic cough of 4 weeks duration but had been afebrile. Six weeks before the patient’s admission, her 10 – year – old brother also had a prolonged coughing illness that responded to breathing treatments and inhaled steroids. After initial examination, the child was admitted to the hospital. Her initial hospital course was uneventful, and she was discharged after 2 days. However, she was readmitted the following day with worsening respiratory symptoms. Over the next several days, she had increasing difficulty breathing, tachypnea up to 100 breaths per minute, and oxygen saturations in the low 80s during coughing episodes. She was admitted to the pediatric intensive care unit for respiratory support. She had an extremely complicated and prolonged intensive care unit course that included pulmonary hypertension, acute respiratory distress syndrome, and health care – associated pneumonia. After a 10 – week hospital stay, she was eventually discharged to return home, where her recovery was uneventful.

1. Nucleic acid amplification testing (NAAT) was performed on a nasopharyngeal swab. The amplified DNA was positive for a bacterial agent. What was the agent infecting this patient? What findings in this case support this conclusion?

2. Why is NAAT used for diagnosis for this pathogen?

3. Describe the clinical course of this disease. Why is the patient at increased risk for health care – associated pneumonia?

4. Why didn’t the patient respond to the antimicrobial she was given?

5. A vaccine exists to prevent infections of this pathogen. Explain why and how this patient was infected. What does this case tell you about the vaccine?

6. Vaccine strategies for preventing infections with this organism have recently changed. What changes in the vaccine are making better prevention possible? What groups of individuals should receive this new vaccine?

7. What type of isolation precautions should have been used while the patient was in the hospital?

Answer 1

Answer 1: Mycoplasma pneumoniae is the main agent which infect the respiratory organ.

Answer 2: NAAT have significant sensitivity and turnaround time advantages over traditional methods, potentially returning same-day results.

Answer 3: Pneumonia is an infection of the lungs. It is a serious illness that can affect people of any age, but it is most common and most dangerous in very young children, people older than 65, and in those with underlying medical problems such as heart disease, diabetes, and chronic lung disease. Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.

A number of antibiotic treatment regimens exist for treatment of CAP. The choice of which antibiotic to use is based upon several factors, including the person's underlying medical problems and the likelihood of being infected with a bacterium that is resistant to specific drugs.

People with certain underlying medical problems and those who have used antibiotics in the past three months have a higher risk of infection with drug-resistant bacteria.

Answer 4:Antimicrobial drug use for outpatients with community-acquired pneumonia, or given as first adi, but her infection has become more worse so, antibacterial drugs needed.