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Abstract

Introduction:

Invasive pneumococcal disease is an uncommon and notifiable disease in Singapore. It is often associated with significant morbidity and mortality. We report a rare case of invasive pneumococcal bacteraemia due to parotitis in a patient with systemic sclerosis and secondary Sjögren’s syndrome. We also present a retrospective review of bacteraemia cases in Singapore General Hospital from January 2011 to April 2016.

Case presentation:

A 59-year-old Malay lady with a history of systemic sclerosis with secondary Sjögren’s syndrome presented with fever and left parotid gland swelling. Clinical examination revealed poor salivary pooling and left parotid swelling without fluctuance. Ultrasound of the left parotid gland confirmed acute parotitis without evidence of abscess or sialolithiasis. Blood cultures were positive for . She was diagnosed to have invasive pneumococcal bacteraemia secondary to acute parotitis, and treated with intravenous benzylpenicillin with clearance of bacteraemia after 3 days. Upon discharge, her antibiotics were changed to intravenous ceftriaxone to facilitate outpatient parenteral antibiotic therapy for another 2 weeks. She responded favourably to antibiotics at follow-up, with no complications from the bacteraemia. A review of the microbiological records of the Singapore General Hospital revealed 116 cases of pneumococcal bacteraemia, most (80.3 %) of which were due to pneumonia. None were due to parotitis.

Conclusion:

parotitis and subsequent bacteraemia is rare. Prompt recognition of the disease and appropriate use of antibiotics are important. This case highlights that close communication between healthcare workers (microbiologist, rheumatologist and infectious disease specialist) is essential in ensuring good clinical outcomes in patients with a potentially fatal disease.

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2016-09-01
2020-10-01
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References

  1. Assen S. V., Agmon-Levin N., Elkayam O., Cervera R., Doran M. F., Dougados M., Emery P., Geborek P., Ioannidis J. P. et al. 2011; EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis70:414–422 [CrossRef][PubMed]
    [Google Scholar]
  2. Blanche P., Sicard D.. 1996; Pneumococcal parotitis in human immunodeficiency virus infection. Rev Med Interne17:1044[PubMed][CrossRef]
    [Google Scholar]
  3. Bonten M. J., Huijts S. M., Bolkenbaas M., Webber C., Patterson S., Gault S., van Werkhoven C. H., van Deursen A. M., Sanders E. A. et al. 2015; Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults. N Engl J Med372:1114–1125 [CrossRef][PubMed]
    [Google Scholar]
  4. Brook I.. 2003; Acute bacterial suppurative parotitis: microbiology and management. J Craniofac Surg14:37–40 [CrossRef][PubMed]
    [Google Scholar]
  5. CDC 2010; Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb Mortal Wkly Rep59:1102–1106[PubMed]
    [Google Scholar]
  6. CDC 2012; Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine for adults with immunocompromising conditions: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep61:816–819[PubMed]
    [Google Scholar]
  7. CLSI 2016; Performance Standards for Antimicrobial Susceptibility Testing; 26th Informational Supplement M100-S26. Wayne, PA: Clinical and Laboratory Standards Institute;
  8. Elkayam O., Paran D., Caspi D., Litinsky I., Yaron M., Charboneau D., Rubins J. B.. 2002; Immunogenicity and safety of pneumococcal vaccination in patients with rheumatoid arthritis or systemic lupus erythematosus. Clin Infect Dis34:147–153 [CrossRef][PubMed]
    [Google Scholar]
  9. Gentile J. H., Sparo M. D., Mercapide M. E., Luna C. M.. 2003; Adult bacteremic pneumococcal pneumonia acquired in the community. A prospective study on 101 patients. Medicina63:9–14[PubMed]
    [Google Scholar]
  10. Gomez-Rodrigo J., Mendelson J., Black M., Dascal A.. 1990; Streptococcus pneumoniae acute suppurative parotitis in a patient with Sjögren's syndrome. J Otolaryngol19:195–196[PubMed]
    [Google Scholar]
  11. Hanekom W. A., Chadwick E. G., Yogev R.. 1995; Pneumococcal parotitis in a human immunodeficiency virus-infected child. Pediatr Infect Dis J14:1113–1114[PubMed][CrossRef]
    [Google Scholar]
  12. Jackson L. A., Neuzil K. M., Yu O., Benson P., Barlow W. E., Adams A. L., Hanson C. A., Mahoney L. D., Shay D. K. et al. 2003; Effectiveness of pneumococcal polysaccharide vaccine in older adults. N Engl J Med348:1747–1755 [CrossRef][PubMed]
    [Google Scholar]
  13. Kataria A., Multz A. S.. 2009; Pneumococcal bacteremia presenting as acute parotitis and sepsis. Case Rep Med2009:627170 [CrossRef][PubMed]
    [Google Scholar]
  14. Kobayashi M., Bennett N. M., Gierke R., Almendares O., Moore M. R., Whitney C. G., Pilishvili T.. 2015; Intervals between PCV13 and PPSV23 vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep64:944–947 [CrossRef][PubMed]
    [Google Scholar]
  15. Mathews S. A., Kurien B. T., Scofield R. H.. 2008; Oral manifestations of Sjögren's syndrome. J Dent Res87:308–318 [CrossRef][PubMed]
    [Google Scholar]
  16. Mercado U., Acosta H., Diaz-Molina R.. 2009; Antibody response to pneumococcal polysaccharide vaccine in systemic sclerosis. J Rheumatol36:1549–1550 [CrossRef][PubMed]
    [Google Scholar]
  17. Moberley S., Holden J., Tatham D. P., Andrews R. M.. 2013; Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev1:CD000422 [CrossRef][PubMed]
    [Google Scholar]
  18. Stellbrink H.-J., Albrecht H., Greten H.. 1994; Pneumococcal parotitis and cervical lymph node abscesses in an HIV-infected patient. Clin Investig72:1037–1040 [CrossRef]
    [Google Scholar]
  19. Vinasco L. G., Bares S., Sandkovsky U.. 2015; Acute suppurative parotitis caused by Streptococcus pneumoniae in an HIV-infected man. BMJ Case Reports2015:bcr-2014-209082[CrossRef]
    [Google Scholar]
  20. Westra J., Rondaan C., van Assen S., Bijl M.. 2015; Vaccination of patients with autoimmune inflammatory rheumatic diseases. Nat Rev Rheumatol11:135–145 [CrossRef][PubMed]
    [Google Scholar]
  21. Wotton C. J., Goldacre M. J.. 2012; Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses. J Epidemiol Community Health66:1177–1181 [CrossRef][PubMed]
    [Google Scholar]
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