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      Pneumococcal puerperal mastitis in a lactating mother

      case-report

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          Abstract

          Introduction

          A case of pneumococcal mastitis in a breast-feeding mother 6 months postpartum is described. Mastitis is usually caused by Staphylococcus aureus . A review of the literature from 1950 to March 2018 revealed only four other cases in which the causative organism was Streptococcus pneumoniae .

          Case presentation

          The nursing mother presented with high fever and the four cardinal signs of inflammation of the left breast: calor, dolor, rubor, tumour. In milk culture Streptococcus pneumoniae was isolated in numbers exceeding 10 5  c.f.u. ml −1 . The strain was of polysaccharide serotype 11 not included in Prevnar-13. Susceptibility testing showed full sensitivity to β-lactam antibiotics as well as to macrolides, lincosamides, vancomycin and tetracycline.

          Conclusion

          Streptococcus pneumoniae should be considered as a possible causative agent of puerperal mastitis.

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          Most cited references9

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          The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment

          Background The role of bacterial pathogens in lactational mastitis remains unclear. The objective of this study was to compare bacterial species in breast milk of women with mastitis and of healthy breast milk donors and to evaluate the use of antibiotic therapy, the symptoms of mastitis, number of health care contacts, occurrence of breast abscess, damaged nipples and recurrent symptoms in relation to bacterial counts. Methods In this descriptive study, breast milk from 192 women with mastitis (referred to as cases) and 466 breast milk donors (referred to as controls) was examined bacteriologically and compared using analytical statistics. Statistical analyses were also carried out to test for relationships between bacteriological content and clinical symptoms as measured on scales, prescription of antibiotics, the number of care contacts, occurrence of breast abscess and recurring symptoms. Results Five main bacterial species were found in both cases and controls: coagulase negative staphylococci (CNS), viridans streptococci, Staphylococcus aureus (S. aureus), Group B streptococci (GBS) and Enterococcus faecalis. More women with mastitis had S. aureus and GBS in their breast milk than those without symptoms, although 31% of healthy women harboured S. aureus and 10% had GBS. There were no significant correlations between bacterial counts and the symptoms of mastitis as measured on scales. There were no differences in bacterial counts between those prescribed and not prescribed antibiotics or those with and without breast abscess. GBS in breast milk was associated with increased health care contacts (p = 0.02). Women with ≥ 107 cfu/L CNS or viridans streptococci in their breast milk had increased odds for damaged nipples (p = 0.003). Conclusion Many healthy breastfeeding women have potentially pathogenic bacteria in their breast milk. Increasing bacterial counts did not affect the clinical manifestation of mastitis; thus bacterial counts in breast milk may be of limited value in the decision to treat with antibiotics as results from bacterial culture of breast milk may be difficult to interpret. These results suggest that the division of mastitis into infective or non-infective forms may not be practically feasible. Daily follow-up to measure the subsidence of symptoms can help detect those in need of antibiotics.
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            Pneumococcal disease caused by serotype 19A: review of the literature and implications for future vaccine development.

            Streptococcus pneumoniae serotype 19A is associated with all forms of pneumococcal disease and was the first reported pneumococcal serotype with high-level penicillin and multidrug resistance. While the seven-valent pneumococcal conjugate vaccine (PCV7), which contains serotype 19F, has reduced rates of disease among children and adults, the incidence of disease due to nonvaccine and increasingly drug-resistant serotypes - predominantly serotype 19A - has increased. This review summarizes the published literature to analyze the factors contributing to the emergence of serotype 19A, the diseases associated with this serotype, and the importance of including this serotype in novel pneumococcal conjugate vaccines. A recently approved 13-valent vaccine includes this serotype, and is likely to significantly reduce the burden of disease due to serotype 19A. (c) 2010 Elsevier Ltd. All rights reserved.
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              Streptococcus pneumoniae skin and soft tissue infections: characterization of causative strains and clinical illness.

              Streptococcus pneumoniae is an uncommon cause of skin and soft tissue infections, yet the incidence and clinical significance of its isolation in samples of skin or soft tissues in unselected hospital samples is poorly understood. In the present study, a review was conducted of the records of all patients with skin and soft tissue infections due to S. pneumoniae at a university hospital between January 1994 and December 2005. The isolates were identified by standard methods and were serotyped, and susceptibility testing was performed by the broth microdilution method following the guidelines of the Clinical and Laboratory Standards Institute. During the study period, 3,201 isolates of S. pneumoniae were recovered from several sources. Of these, 69 (2.2%) were from skin and soft tissue samples (69 patients). Complete information could not be obtained for 13 patients. Of the 56 patients remaining, 36 (64.3%) were infected and fulfilled the inclusion criteria. The following types of infections were observed: surgical wound infection (n = 11), burn infection (n = 7), pyomyositis (n = 6), cellulitis (n = 4), perineal or scrotal abscess (n = 3), and other (n = 5). Thirty-one (86%) patients had a favorable outcome, and 5 (13.8%) patients died. Mortality was directly attributable to S. pneumoniae infection in three of the five fatal cases. Of the 39 S. pneumoniae isolates obtained (36 from skin and soft tissues, three from blood cultures), 58.9% were penicillin nonsusceptible, 7.7% were cefotaxime nonsusceptible, and 20.5% were erythromycin resistant. The most frequent serotypes were 3, 19, 11, and 23. Of the overall number of isolates of S. pneumoniae recovered in a general institution, 2.2% involved skin and soft tissues (of which 64% were clinically significant). Mortality due to pneumococcal skin and soft tissue infections was low.
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                Author and article information

                Journal
                Access Microbiol
                Access Microbiol
                acmi
                acmi
                Access Microbiology
                Microbiology Society
                2516-8290
                2019
                24 April 2019
                24 April 2019
                : 1
                : 6
                : e000020
                Affiliations
                [1 ] departmentCentral Laboratories , IASO Gynecology, Maternity and Pediatric Hospital, IASO Group Hospitals , Athens, Greece
                [2 ] departmentMedical School , National and Kapodistrian University of Athens , Athens, Greece
                [3 ] IASO Gynecology, Maternity Hospital , Athens, Greece
                Author notes
                *Correspondence: T. Skalidis, stilemachos@ 123456yahoo.gr
                Author information
                https://orcid.org/0000-0003-0592-9591
                Article
                000020
                10.1099/acmi.0.000020
                7470298
                592e2a97-d153-4fc4-ae2a-8162b3f52965
                © 2019 The Authors

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 27 February 2019
                : 04 March 2019
                Categories
                Case Report
                Custom metadata
                0

                puerperal mastitis,pneumococcal infection,breast-feeding

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