Streptococcus pneumoniae pneumonia: temporal evolution

Case contributed by Jack Ren

Patient Data

Age: 25
Gender: Female
X-ray

Progression of CXR during hospital admission

When patient presented to ED there was wide spread opacity across patient right lung field especially on lower lung field with positive air-bronchogram which indicate consolidation of right lower or middle lobe. There was some opacity just above the right horizontal fissure which may suggest progression of infection into right upper lobe. The right heart border was lost.

During her admission at hospital, the opacity spread to right upper lobe and started to develop opacity on left lung field and more prominent air-bronchogram which consistent with wide spread of infection across both lung.

Endotracheal tube can be seen at 2nd day of admission

CT

Chest (2 days after admission)

There is wide spread airspace consolidation mix with ground-glass opacity across both lung, more prominent and severe in right lung. There is pleural effusion in right lung. Endotracheal tube in-situ

CT

Chest (2 weeks after admission)

Compare to last CT, there is some resolve of consolidation across both lungs but presence of residual ground-glass density with fibrotic changes and emphysema which are more obvious in right lung.

There is pleural effusion in left lung. Endotracheal tube in-situ

Case Discussion

Streptococcus pneumoniae was isolated in the sputum sample and blood culture. Keep in mind that although for bacteremic pneumococcal pneumonia in adults, sputum Gram stain and cultures had sensitivities of 80% and 93%, respectively, provided an adequate specimen was produced prior to therapy. In actual clinical practice, sensitivity is lower (< 50%) due to several factors, including inadequate sputum sample, delayed processing, inability to produce sputum, and prior antimicrobial therapy.2

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Case information

rID: 29090
Case created: 3rd May 2014
Last edited: 30th Apr 2017
System: Chest
Inclusion in quiz mode: Included

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