Pneumococcal-13-valent-crm197-vaccine-conjugate
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Pleural empyema due to Streptococcus pneumonia following vaccine failure: case report A 25-month-old boy developed pleural empyema due to Streptococcus pneumonia following failure of pneumococcal-13-valentcrm197-vaccine-conjugate vaccine. The boy was admitted to hospital with fever for 3 days, with new onset of shortness of breath at 12 months after the booster dose. He was vaccinated with four doses of pneumococcal-13-valent-crm197-vaccine-conjugate [PCV13; dosage and route not stated]. Physical examination on admission, revealed fever of 37.8°C, tachycardia with heart rate of 184 bpm, irritability, tachypnoea (50 breaths/min) with intercostal and subcostal retractions and decreased breath sounds in the left hemithorax. His oxygen saturation was 92% (without supplemental oxygen). Laboratory tests showed Hb 11.6 g/dL, platelet count of 317.000 /mm3, peripheral WBC count of 4950 /mm3 (with lymphocytes of 42%, neutrophils of 50% and monocytes of 8%), ESR of 80 mm/hour and CRP of 270 mg/L. Chest X-ray showed consolidations on the superior of lower lobe and the base of upper lobe of the left lung. Chest ultrasound demonstrated left sided pleural effusion (14mm). A diagnostic thoracentesis was done with aspiration of the purulent fluid. Pleural fluid analysis revealed pH of 6.9, glucose of 5 mg/dL, lactate dehydrogenase of 10.631 U/L and abundant leukocytosis with neutrophils of 94%. Gram-stain of his pleural fluid was negative. The boy was started on empirical treatment with ceftriaxone, clindamycin and vancomycin. On day 2 of hospitalisation, left sided closed-tube thoracostomy drainage was performed. Owing to the presence of septations and to insufficient drainage, he was commenced on intrapleural fibrinolytic treatment with tissue plasminogen activator. After the sixth dose of tissue plasminogen activator, a total 1100mL of fluid was drained, following which the catheter was removed. His pleural fluid culture was positive for ceftriaxone susceptible and penicillin resistant S. pneumonia. He was diagnosed with pleural empyema due to Streptococcus pneumonia, following pneumococcal-13-valent-crm197-vaccine-conjugate vaccine failure. Following the diagnosis, vancomycin and clindamycin were discontinued. The isolate was later identified as serotype-1 using capsular swelling method. At follow-up, a gradual improvement in ultrasonographical and clinical findings was observed. After 14 days of hospitalisation, he was discharged on cefuroxime axetil treatment. His antibiotic treatment was completed in 4 weeks. On immunological evaluation, no pathological findings were observed. His total anti-pneumococcal antibody titer was 27 mg/L. Yasar Durmus S, et al. Pleural empyema due to streptococcus pneumoniae serotype 1 in an immunocompetent child in the 13-valent pneumococcal conjugate vaccine era. 803505840 Cocuk Enfeksiyon Dergisi 14: e79-e82, No. 2, Jun 2020. Available from: URL: http://doi.org/10.5578/ced.69082
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