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Beneath the surface: a case report on nonencapsulated Streptococcus pneumoniae-associated invasive disease in an
Jonathan Zintgraff1, Nahuel Sanchez Eluchans1, Paula Gagetti2
1Servicio de Bacteriología Clínica, Departamento de Bacteriología, INEI-ANLIS "Dr. Carlos G. Malbrán", Ciudad Autónoma de Buenos Aires, Argentina.
Background:
Streptococcus pneumoniae, a prominent human pathogen linked to various systemic diseases, includes non-typeable pneumococci marked by the absence of a detectable capsule. However, the majority of invasive infections are attributed to encapsulated strains. This case report details the first documented instance of invasive disease caused by non-typeable S. pneumoniae in Argentina since 2017.
Case Presentation:
A 19-year-old woman presented with haemorrhagic injuries attributed to chronic oral mucosa irritation. Subsequent hospitalization revealed bone marrow aplasia, leading to antibiotic, antifungal, antiviral, and immunosuppressive treatments, culminating in her discharge. Two weeks later, she was readmitted with sepsis related to a respiratory focus, exhibiting a negative COVID-PCR test. After ten days, ICU admission revealed additional infections: positive COVID-PCR test, fungal sinusitis, and S. pneumoniae bacteremia. Targeted treatments led to improvement, and the patient was subsequently discharged.
S Pneumoniae Characterization:
Verification of the capsule's absence utilized traditional methods such as the Quellung reaction, transmission electron microscopy, molecular assays, and Whole Genome Sequencing (WGS). The isolate, identified as ST18335, displayed genetic features and antibiotic resistance patterns, concordant between WGS and the agar dilution method. It demonstrated non-susceptibility to penicillin and cefotaxime, based on meningitis breakpoints, as well as meropenem and cotrimoxazole.
Conclusion:
This case underscores the clinical significance of non-typeable S. pneumoniae, emphasizing the necessity for a comprehensive approach to identification and characterization. The findings contribute to ongoing discussions regarding the challenges posed by non-typeable strains in vaccine development, understanding clinical impacts, and addressing antibiotic resistance. As the pneumococcal epidemiological landscape evolves, this case serves as a valuable addition to the evolving knowledge surrounding non-typeable S. pneumoniae, highlighting the continued need for surveillance and research in infectious diseases.
Insights
This case report details the first invasive non-typeable Streptococcus pneumoniae infection in Argentina since 2017. The study highlights the challenges of identifying and treating these encapsulated-deficient bacterial strains, emphasizing antibiotic resistance.
Area of Science:
- Infectious Diseases
- Microbiology
- Genomics
Background:
- Non-typeable Streptococcus pneumoniae (NT-SP) lack a capsule, differentiating them from encapsulated strains that cause most invasive pneumococcal diseases.
- While encapsulated strains dominate invasive infections, NT-SP are increasingly recognized as significant pathogens.
Observation:
- A 19-year-old woman presented with bone marrow aplasia and sepsis, later diagnosed with co-infections including NT-SP bacteremia.
- The NT-SP isolate (ST18335) was confirmed via Quellung reaction, electron microscopy, molecular assays, and Whole Genome Sequencing (WGS).
Findings:
- WGS revealed genetic features and antibiotic resistance patterns consistent with agar dilution methods.
- The NT-SP isolate exhibited non-susceptibility to penicillin, cefotaxime, meropenem, and cotrimoxazole.
Implications:
- This case highlights the critical need for advanced diagnostics and characterization of NT-SP.
- Understanding NT-SP epidemiology and antibiotic resistance is crucial for vaccine development and effective treatment strategies.
- The findings underscore the evolving challenges posed by NT-SP in clinical settings and public health surveillance.
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