Invasive Pneumococcal Disease in a Patient With COVID-19: A Case Report

Ayad, Sarah; Alyacoub, Ramez; Gergis, Kirolos; Grossman, Daniel; Salamera, Julius

doi:10.7759/cureus.13559

Cited by 5 publications

(6 citation statements)

References 13 publications

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“…COVID-19 is known to cause severe respiratory distress and multi-organ failure through inflammatory cytokines. Increased expression of ACE2 receptors, particularly in the lungs, also provide a route of entry for systemic manifestations [ 1 ]. Binding of ACE2 receptors and damage to the blood-brain barrier can lead to nervous system involvement, namely, meningoencephalitis [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes systemic manifestations through inflammatory cytokines and binding of angiotensin-converting enzyme 2 (ACE2) receptors in tissues [ 1 ]. Similar to other viral respiratory tract infections, evidence suggests that COVID-19 compromises immune defense, increasing the risks of associated infections [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Invasive Pneumococcal Disease and COVID-19 With Acute Otitis Media and a Tegmen Tympani Defect

Gaudin,

Thayalakulasingam

2023

Cureus

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Streptococcus pneumoniae is a leading cause of otitis media, pneumonia, sinusitis, and meningitis. This encapsulated, gram-positive bacterium colonizes the nasopharynx. Major risk factors, including age, hyposplenism, and immunosuppression, predispose to serious infections. Viral infections are known to increase the risk of secondary bacterial infections as the initial immune response can compromise defenses against bacteria. Coronavirus disease 2019 (COVID-19) similarly poses a risk for secondary bacterial infections and coinfections, such as invasive pneumococcal disease (IPD). Still, temporal relationships between IPD and COVID-19 are not fully understood. IPD may also be a complication of untreated acute otitis media. COVID-19 and pneumococcal bacteremia, a form of IPD, have both been shown to damage the blood-brain barrier and gain access to the central nervous system, resulting in deep infections, namely, meningitis and encephalitis. Presented here is the case of a 70-year-old female partially vaccinated against pneumococcal disease, who was initially evaluated for an elevated temperature, acute encephalopathy, and COVID-19. Further investigation confirmed IPD in the form of bacteremia and meningitis. The patient had a protracted disease course complicated by sick sinus syndrome and altered mental status, which led to the identification of otitis media and a right tegmen tympani defect. Emergent implantation of a single-chamber temporary pacemaker and myringotomy with tube placement was performed. Lumbar puncture showed evidence of meningitis. Antibiotic therapy eventually narrowed to ceftriaxone and continued for a total of six weeks. The presence of comorbidities, history of incomplete pneumococcal vaccination series, and concomitant infection with COVID-19 may explain the development of IPD and other complications seen in this case. Furthermore, tegmen tympani defects and damage to the blood-brain barrier can serve as a route for otogenic intracranial sepsis and meningitis. This case serves to reinforce the importance of pneumococcal vaccination and the high clinical suspicion necessary for the prompt diagnosis and treatment of IPD. However, despite vaccination, IPD remains a life-threatening disease due to poor antibiotic penetration in the central nervous system and overlapping presentations with coinfections, such as COVID-19.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Invasive Pneumococcal Disease and COVID-19 With Acute Otitis Media and a Tegmen Tympani Defect

Gaudin,

Thayalakulasingam

2023

Cureus

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“…Though the Austrian triad is an interesting and specific presentation of IPD, the disease process can vary greatly depending on the patient population, risk factors, and infectious source. The following Table 2 summarizes several additional case reports detailing other known presentations, treatments, and outcomes of IPD in adults [8][9][10][11]. To help decrease the prevalence of IPD and its various complications, the PPSV23 vaccine was developed as a capsular polysaccharide vaccine that was initially approved in 1983.…”

Section: Discussionmentioning

confidence: 99%

Invasive Pneumococcal Disease Secondary to Acute Otitis Media in a High-Risk Patient: A Case Report and Review of Recent Changes to Pneumococcal Immunization Guidelines

Gregory¹,

Chohrach²,

Iyengar³

2022

Cureus

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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.

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“…Also, miliary TB was reported in COVID-19 patients (AlKhateeb et al, 2020;Bouaré et al, 2020;Elziny et al, 2021). Several other studies described pulmonary and extrapulmonary TB cases, with the former being the most prevalent (AlKhateeb et al, 2020;Cao et al, 2020;Goussard et al, 2020a,b;He et al, 2020;Liu C. et al, 2020;Sarma et al, 2020;Sasson et al, 2020;Singh et al, 2020;Yao et al, 2020;Yousaf et al, 2020;Ayad et al, 2021;Musso et al, 2021).…”

Section: Pulmonary and Extrapulmonary Tuberculosis In Covid-19mentioning

confidence: 95%

Mycobacterium tuberculosis and SARS-CoV-2 Coinfections: A Review

et al. 2022

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BackgroundTuberculosis (TB) is still one of the most important causes of death worldwide. The lack of timely attention on TB diagnosis and treatment during the coronavirus disease 2019 (COVID-19) pandemic is a potential threat to health issues and may have severe consequences for patients and health systems. There is not much information on the management of TB during this period. Here, we reviewed the current literature to evaluate the rate of Mycobacterium tuberculosis and severe acute respiratory syndrome coronavirus 2 coinfections and interactions between these infectious agents.MethodsSeveral databases, including Web of Science, Scopus, and MEDLINE (via PubMed), were searched for original articles addressing TB and COVID-19 diseases published from December 2019 to April 2021.ResultsOf 3,879 articles, 57 articles were included in this study, and among 106,033 patients affected by COVID-19, 891 also had TB. Overall, investigators found a consistent increase in C-reactive protein, D-dimer (especially in patients with severe clinical manifestation), erythrocyte sedimentation rate, lactate dehydrogenase, alanine aminotransferase, and a reduction of lymphocytes. The respiratory symptoms of TB/COVID-19 patients were similar to those of TB patients, but the risk of developing pulmonary TB increased in COVID-19 patients. Also, the mortality rate in TB/COVID-19 patients was higher than that in patients affected only by COVID-19 or TB.ConclusionSome reports indicated worsening respiratory symptoms and even activation of latent TB after COVID-19 or vice versa. It seems that both active and previously treated TB constituted a risk factor for COVID-19 in terms of severity and mortality, regardless of other underlying diseases and patient status. Health systems should not neglect TB during this era of the ongoing COVID-19 pandemic by setting up appropriate diagnostic and clinical management algorithms.

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Invasive Pneumococcal Disease in a Patient With COVID-19: A Case Report

Cited by 5 publications

References 13 publications

Invasive Pneumococcal Disease and COVID-19 With Acute Otitis Media and a Tegmen Tympani Defect

Invasive Pneumococcal Disease and COVID-19 With Acute Otitis Media and a Tegmen Tympani Defect

Invasive Pneumococcal Disease Secondary to Acute Otitis Media in a High-Risk Patient: A Case Report and Review of Recent Changes to Pneumococcal Immunization Guidelines

Mycobacterium tuberculosis and SARS-CoV-2 Coinfections: A Review

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