Sex: U
Vaccine: PPV, UNK
Symptoms: Alpha haemolytic streptococcal infection, Blood culture, Intensive care, Pneumonia, Streptococcus test positive
Clinical narrative: Community-Acquired Pneumonia; Streptococcus viridans; This case was reported in a literature article and described the occurrence of community acquired pneumonia in a 2-year-old patient who received Haemophilus influenzae type b vaccine for prophylaxis.   Co-suspect products included PNEUMOCOCCAL VACCINE for prophylaxis.   On an unknown date, the patient received Haemophilus influenzae type b vaccine and PNEUMOCOCCAL VACCINE. On an unknown date, unknown after receiving Haemophilus influenzae type b vaccine, the patient experienced community acquired pneumonia (serious criteria hospitalization and GSK medically significant) and streptococcus viridans group infection (serious criteria hospitalization and GSK medically significant). The subject was treated with ceftriaxone, ampicillin trihydrate (Ampicillin) and amoxicillin trihydrate (Amoxicillin). On an unknown date, the outcome of the community acquired pneumonia and streptococcus viridans group infection were unknown.   It was unknown if the reporter considered the community acquired pneumonia and streptococcus viridans group infection to be related to Haemophilus influenzae type b vaccine.  Additional details were reported as follows: This case was reported in a literature article and described the occurrence of community-acquired pneumonia (CAP) in 02-years-old patient of unspecified gender, who was vaccinated with unspecified haemophilus influenzae type b vaccine (HIB vaccine) for prophylaxis.   The patient was the part of the study and the study main objective was to identify the prevalence of bacteremia in pediatric patients hospitalized with CAP in two tertiary-level hospitals. Secondary objectives included: (1) to determine the prevalence of false-positive blood cultures, (2) to identify the microbiology and susceptibility patterns of true positive blood cultures, (3) to identify the clinical and laboratory variables associated with bacteremia in patients hospitalized with CAP, and (4) to determine the impact of blood culture results on antimicrobial therapy and length of hospital stay. [In this study, they conducted a medical record review of children and adolescent aged from two months to 18 years diagnosed with CAP between January 1, 2013, and December 31, 2017, at our two urban tertiary centers]. The patient belongs to false-positive (contaminated) blood cultures. The patient had no past medical history (PMH). Recently, the patient had not used any antibiotics (defined as any patient who self-reported antibiotics use five days before hospitalization). No information on patient's family history was provided.  On an unspecified date, the patient received unspecified haemophilus influenzae type b vaccine (HIB vaccine) and unspecified pneumococcal vaccine (PCV) (administration route and site unspecified, dosage unknown; batch number not provided).[In this study from total 464, 446 had received PCV and HIB vaccine and 264 had influenza vaccination (including influenza vaccine in the last season ). On an unspecified date in between 1st January 2013 and 31st December 2017, unknown period after vaccination, the patient had an clinical examination (such as fever/crackles/wheezes/retractions) and had hospitalization. The patient's blood culture was collected in the first 48 hours upon admission. The blood culture result showed Streptococcus viridans. The white blood cell 7x10e03/27ul and no C-reactive protein. The patient had no chest X-ray test. The patient was admitted to pediatric intensive care unit (PICU) for 13 hours, inpatient team impression it was a contaminant, but continued antibiotics. Normal Echo. However, the patient had hospital stay for 3 day and 13 hours. Initially, the patient had received Ceftriaxone one for 1 day then ampicillin for 2 days and finally amoxicillin for 7 as an outpatient. [In this study, it was unknown, whether children discharged from there two facilities may have been readmitted to other hospitals]. This case has been consider as serious due to hospitalization. The outcome of event was not reported. The author commented, "Intensive care unit (ICU) admission, toxic appearance and significantly elevated C-reactive protein (CRP) (more than 300 mg/L were associated with bacteremia. We found a significant association between PICU admission and ill appearance on presentation with a true-positive blood culture. Toxic appearance and admission or transfer to the PICU were associated with bacteremia. The prevalence of blood culture contaminants in this study was 2.6 percent. Furthermore, a positive blood culture was twice more likely to be a contaminant than a true pathogen. Despite the high likelihood of reported growth in blood culture to be a contaminant, determining the possibility of true bacteremia is still challenging for physicians and impacts negatively on patient care. In this study, five of the 10 patients with false-positive cultures had repeated cultures, even though the treating physician's impression was in favor of a contaminant organism". The author concluded, "The rate of positive blood cultures in children admitted with CAP is low, and its impact on clinical management is limited. Children that were ill-appearing, admitted to the intensive care unit, or with significantly elevated CRP levels were more likely to have bacteremia secondary to CAP. The current recommendation of obtaining a blood culture for children with moderate to severe CAP, although correct, needs to be clarified. Further studies are needed to better riskstratify children with CAP, thus providing a targeted approach for obtaining blood cultures, standardizing management, and potentially reducing the cost and length of hospital stay". This is 1 of the 6 valid cases reported in the same literature article.; Sender's Comments:  US-GLAXOSMITHKLINE-US2020GSK122173:Same reporter