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Unknown #5 The infant with seizures
S. aureus• Thomas Rohan• Jeanette Daniels• Kristina Arcena
Pathogen Id: Staphylococcus aureusDiagnosis: Acute Bacterial Meningitis.
Diagnosis Information Sheet• Patient name: Jaden Hallens• Date of Birth: 05/22/11• Weight: 3.9 kg• Height: 20.5 in• Vital signs: Temperature: 103.6 Pulse: 154 Respiration: 43 B/P: 141/91 Oxygen level: 94
Signs and Symptoms
• Irritability• High pitched cry• Vomiting• Fever• Bulging anterior frontonals • Lethargic
Day 1 and Day 2• Gram stain resulted bacilli rod; di-bacilli
observed and cocci.• Secondary gram stain resulted Gram (-)
rods and cocci. • Suspect a pathogen that causes
Meningitis deduced from infants signs and symptoms.
• Blood agar test’s inconclusive due to incorrect incubation temperatures of test environment. Kristina initiates new series of testing on unknown # 5 organism. Thomas observes results and orders next series
• of testing.
Secondary organism identified.Escherichia coli identified
from isolating the organisms.
• FTM: Facultative anaerobe.
• Motility: (+)• Catalase: (+)• EMB :black w/ Green
metallic sheen. Indicative of E. coli
• HEA: yellow/orange• TSI: yellow slant/yellow
butt
Unknown #5 Results.• Macromorphology: Creamy-tan • Indicative of
Staphylococcus aureus.
• FTM: (-)• Catalase: (+)• MSA:
Colorless/yellow colonies
Unknown #5 Results.• Hemolysis: Alpha
Prime Beta Hemolysis.
• Motility: non motile.• Novo-bio:
susceptable.
Results after isolation:• Oxidase: (-)• TGA :Black colonies.• Catalase :(+)• Coagulase:(+)• Motility: Non motile• Staphylococcus
aureus presenting more evidence as possible unknown #5 pathogen.
Unknown identified as S. aureus• Coagualase: (+)• Causative agent for
infant Meningitis• Sensitivity tests show
appropriate resistance and sensitivity for Staphylococcus aureus as the pathogen.
Diagnosis: Acute bacterial Meningitis
• Mode of transmission: Nosocomial introduction of pathogen caused during surgical repair of diaphragmatic hernia after caesarian birth.
Infant mortality rate 20-40%
Treatment • Metastatic spread of pathogen has occurred. MSSA:
superiority of beta-lactoms makes a clear favorite over using vancomycin.
• Prefered treatment: 2g IV oxacillin or nafcillin q4h.• Brain abscess, subdural empyema & epidural abscess-
requires urgent neurosurgical consult for drainage.
• Duration of therapy: 28 days is standard course of therapy.
• MRSA (Methicillian-resistant Staphylococcus aureus) “super-bug”-resistant evolved to beta-lactam anti-biotics which include the penicillins-methicillin, dicloxacillin,nafcillin,oxacillin as well as caphalosporins.
Treatment continued.
• •Meningitis• ◦MSSA: nafcillin or oxacillin 2g IV q4h.• ◦MRSA: • ■Preferred: vancomycin 15-20 mg/kg IV 12h (consider loading dose;
guidelines recommend 25-30 mg/kg, although we favor 20-25 mg/kg, particularly in patients with any baseline renal dysfunction). Strive for trough level ~20 µg/mL.
• ■Alternatives: • ◦Linezolid 600mg IV q12h (limited data for meningitis but has good CNS
penetration).• ◦TMP/SMX 5mg/kg (trimethoprim component) q8-12h.• ■Some add rifampin 600mg PO/IV q24 or 300-450mg IV/PO q12h.• ■Refractory infection: consider intrathecal vancomycin, 5-20mg daily.• ◦Duration: 14d.• ◦CNS shunt infection: remove device. Replace only when CSF cultures
repeatedly sterile.• •Brain abscess, subdural empyema, epidural abscess• ◦Consult neurosurgery urgently for drainage.• ◦Duration: 4-6 wks.
If treatment and precautions are followed infant should recover.
If treatment fails the infant expires due to brain lesions from cerebral
pressure from swollen brain.