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• W4387249987 abstract "SESSION TITLE: Chest Infections Case Report Posters 21 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Streptococcus pneumoniae peritonitis is poorly described, accounting for 4.3% of culture-positive SBP in case series. Here we present the case of persistent and severe Streptococcus pneumoniae peritonitis diagnosed by 16s rDNA sequencing in a 33-year-old female. CASE PRESENTATION: A 33-year-old female from Micronesia with ESRD secondary to IgA nephropathy was admitted to the hospital with dyspnea and hypotension. She was admitted to the ICU with septic shock. On physical exam, she was in moderate respiratory distress. Her vital signs showed a temperature of 36.5 F, heart rate of 106 bpm, respiratory rate of 22, blood pressure of 95/64 mmHg, and oxygen saturation of 90% on room air. She was tachycardic and had 2+ edema in the lower extremities bilaterally. Her lung exam was positive for bilateral rhonchi and decreased air sounds on the right lung. Her laboratory was significant for WBC of 27.75 10^3/cmm, hemoglobin of 9.8 gm/dl, Hematocrit of 30%, and platelet count of 71.7 10^3/cmm. pH on Venous blood gas was 7.24, PCO2 was 53 mmHg, and Bicarbonate was 21 mMol/L. Lactic acid was 6.3 mg/dL. Computed tomography showed bilateral multifocal consolidations, predominantly in a perihilar distribution. Small left, trace right pleural effusions with partial left lower lobe atelectasis, moderate ascites, and anasarca. Bedside abdominal ultrasound showed complex loculated peritoneal fluid collection. Her blood cultures were positive for Penicillin-sensitive Streptococcus pneumoniae. On day 4 of her hospital stay, abdominal distension and pain were noticed on the exam, and abdominal ultrasound showed moderate ascites; paracentesis was performed, showing grossly purulent ascites. Ascites fluid analysis revealed a total WBC count of 29,399 cells/cmm, 92% polymorphonuclear, and albumin 1.5 gm/dL. Her ascites culture remained negative. Pleural fluid revealed an exudative pleural effusion with glucose <10 mg/dl, LDH of 9,749 Units/L, WBC of 23,466/cmm, 93% polymorphonuclear. ADA level in the peritoneal fluid was 62.3 units/liter and 69.8 units/liter in the pleural fluid. Due to her persistent purulent peritoneal fluid accumulation despite repeated therapeutic paracentesis and antibiotic therapy, bacterial sequencing 16s PCR (performed by the University of Washington MC Montlake Dept of Lab Medicine) was performed. It was positive for Streptococcus pneumoniae after seventeen days of appropriate antimicrobial therapy. DISCUSSION: Invasive Pneumococcal Disease is a significant cause of pneumonia, meningitis, and pleural effusion in children and adults, but it is not well-recognized as a cause of peritonitis. The utility Broad-Range PCR (16S PCR) in SBP has been described, with a sensitivity of 100% and specificity of 91.5% in a study of 106 patients with suspected SBP. Culture-independent methods can aid in diagnosing culture-negative parapneumonic effusions and culture-negative peritonitis. PCR testing can be positive in up to 70% of the patients with culture-negative parapneumonic effusions. CONCLUSIONS: Streptococcus pneumoniae must be considered as a cause of persistent neutrocytic peritonitis. Multiple factors, including the pressure of early administration of antimicrobial therapy and lack of sensitivity with traditional microbiology methods, make DNA sequencing an attractive way of diagnosing bacterial processes when traditional means have failed. This can reduce uncertainties, aid in antibiotic stewardship, and likely translate into better patient outcomes. REFERENCE #1: Kim T, Hong SI, Park SY, et al. Clinical Features and Outcomes of Spontaneous Bacterial Peritonitis Caused by Streptococcus pneumoniae. Medicine (Baltimore). 2016;95(22):e3796. doi:10.1097/MD.0000000000003796 REFERENCE #2: Identification of Bacterial Pathogens in Ascitic Fluids from Patients with Suspected Spontaneous Bacterial Peritonitis by Use of Broad-Range PCR (16S PCR) Coupled with High-Resolution Melt Analysis. doi:10.1128/JCM.00345-12 REFERENCE #3: Pizzutti K, Perez VP, Barbiero C, d'Azevedo PA, Fischer GB, Dias C. Identifying pneumococci in parapneumonic pleural effusion: Is there a role for culture-independent methods? Pediatr Pulmonol. 2020;55(2):484-489. doi:10.1002/ppul.24568 DISCLOSURES: No relevant relationships by Tawakalitou A Alabi No relevant relationships by Jennifer Girard No relevant relationships by Luis Lantigua Tatem No disclosure on file for Kinner Patel No relevant relationships by Christopher Richardson" @default.
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• W4387249987 date "2023-10-01" @default.
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• W4387249987 title "PERSISTENT PURULENT NEUTROCYTIC PERITONITIS: THE UTILITY OF DNA SEQUENCING" @default.
• W4387249987 doi "https://doi.org/10.1016/j.chest.2023.07.723" @default.
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