Streptococcus pneumoniae can commonly cause otitis media, sinusitis, pneumonia, or meningitis; however, these infections less frequently can develop into invasive pneumococcal disease (IPD). Vaccination for the prevention of pneumococcal disease has significantly decreased complications from severe infections, including pneumonia, meningitis, and IPD, in patients with certain risk factors. In this case study, we describe a unique presentation of disseminated S. pneumoniae meningitis and bacteremia in a patient who initially presented with acute otitis media (AOM). Due to the patient's multiple comorbidities of obesity, tobacco use, pre-diabetes, coronary artery disease, and lack of pneumococcal vaccination, their AOM rapidly progressed to life-threatening, an invasive pneumococcal infection which was successfully treated with timely initiation of antibiotics. In addition to discussing the patient's clinical course and treatment regimen, we will review pertinent updates to the pneumococcal vaccination guidelines for high-risk patients and their efficacy in preventing severe disease.

Purpose: Obesity is a national epidemic resulting in significant morbidity and mortality. Weight loss as modest as 5% of body weight significantly reduces the risk of hypertension, diabetes, and cardiovascular disease. The primary aim of this pilot study was to test the efficacy of a text messaging intervention in a primary care setting to motivate overweight patients to lose weight and reduce their waist circumference.Methods: A total of 128 adult primary care patients who were overweight and classified as abdominally obese via waist circumference measurement were randomized to enhanced care (EC, n = 62) or standard care (SC, n = 66). Patients assigned to both groups met with the physician, and the SC group received a standard clinic brochure on weight loss. In addition to the brochure, the EC group met with a research assistant to discuss the risks of abdominal obesity and resources to lose weight in addition to receiving 3 motivational text messages per week for 12 weeks and 2 phone calls to check in on their progress. At baseline, three, and six months, all patients had a survey administered and weight, waist circumference, and blood pressure were obtained.Results: In the EC group, 50% (n = 16) reported reading all of the text messages, 31% (n = 10) found the text messages helpful, and 84% (n = 26) reported using the diet and physical activity resources provided. The average weight loss at six months was 4.3 pounds in the SC group and 3 pounds in the EC group (p = 0.17). The average reduction in waist circumference at six months was 0.5 inches in the SC group and 1.2 inches in the EC group (p = 0.15). The most commonly reported diet change was reducing calories, with 28% (n = 17) and 36% (n = 18) reporting a low-calorie diet at three and six months, respectively. At six months, 26% (n = 13) reported engaging in cardiovascular exercise like jogging, aerobics, or swimming, while 24% (n = 12) reported engaging in some form of weightlifting as a change from baseline.

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