NEWS & EVENTS

Case of the Month - December 2014



Carin Erasmus
Infection Control Society of Southern Africa (ICSSA)

An infant who had been discharged from the neo-natal intensive care unit (NNICU) was re-admitted to the paediatric unit, within 21 days, with respiratory distress. He was one of a twin and born prematurely (Case 2,Table 1). Five days after his re-admission, the infant had to be transferred back to the NNICU. He was unstable and required oxygen, and the radiological findings were compatible with Pneumocystis pneumonia (PCP). An induced sputum sample was positive by PCR for Pneumocystis jiroveci.

The hospital was informed by the Paediatrician that another premature infant (case 1), had been re-admitted to a NNICU in another hospital with PCP. This led to heightened vigilance and testing of neonates in the unit. Over the next 2 months, a cluster of 7 premature infants were diagnosed with PCP (Table 1) and from July - October, another cluster of 4 cases occurred.



Table 1

Case Date of Birth / Admission Date Date Lab Results Positive for PCP First Admission Diagnosis Co-Morbidities Discharge Date Re-Admission Date Days from Discharge to Infection
Case 1 25/11/2013 Prematurity, respiratory distress syndrome of newborn, dependence on respirator Premature, immune-compromised 16/02/2014 27/02/2014 11
Case 2 (twin of case 3) 01/11/2013 02/03/2014 Prematurity, respiratory distress syndrome of newborn, dependence on respirator, low birth weight Premature, immune-compromised 07/02/2014 28/02/2014 21
Case 3 01/11/2013 02/03/2014 Prematurity, respiratory distress syndrome of newborn, dependence on respirator, low birth weight Premature, immune-compromised, NEC 07/02/2014 01/03/2014 22
Case 4 09/01/2014 20/05/2014 Prematurity, respiratory distress syndrome of newborn, dependence on respirator, low birth weight Premature, immune-compromised 06/03/2014 Tested positive whilst in facility 62
Case 5 02/12/2013 13/03/2014 Prematurity, respiratory distress syndrome of newborn, dependence on respirator, low birth weight Premature, immune-compromised 05/04/2014 Tested positive whilst in facility 100
Case 6 02/12/2013 Prematurity, respiratory distress syndrome of newborn, dependence on respirator, low birth weight Premature, immune-compromised 22/02/2014 25/03/2014 31
Case 7 27/01/2014 29/03/2014 Prematurity, respiratory distress syndrome of newborn, dependence on respirator, low birth weight Premature, immune-compromised 09/03/2014 27/03/2014 18
Case 8 23/04/2014 19/07/2014 Prematurity, respiratory distress syndrome of newborn, dependence on respirator, low birth weight Premature, immune-compromised 22/06/2014 21/07/2014 29
Case 9 28/05/2014 25/08/2014 Respiratory distress syndrome of newborn, pre-term infant Premature, immune-compromised 18/06/2014 25/08/2014 64
Case 10 28/05/2014 25/8/14 Respiratory distress syndrome of newborn, pre-term infant Premature, immune-compromised 18/06/2014 25/08/2014 64
Case 11 26/04/2014 22/10/2014 Prematurity, respiratory distress syndrome of newborn, dependence on respirator, low birth weight Premature, immune-compromised 04/07/2014 22/10/2014 109


Of the 11 infants, 9 were discharged apparently well and re-admitted to a health care facility, requiring additional oxygen within time periods of 11 to 109 days after birth. The remaining 2 infants remained in the NNICU for 62 and 100 days respectively before being diagnosed with PCP in the Unit after they too, required supplemental oxygen.

Question 1: What is the significance to neonates of P. jiroveci colonisation in the human host?

Continue to Answer 1

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