18258107 Visualization

Here, we describe another case in a 60 Age - year Age - old Age man Sex from San Personal_background Francisco Personal_background who had consumed Activity raw Activity pork Activity while traveling Activity in the Philippines Nonbiological_location .
In June Date 2003 Date , this man became ill Sign_symptom with fever Sign_symptom , diaphoresis Sign_symptom , headache Sign_symptom , nausea Sign_symptom , and anorexia Sign_symptom .
He had just returned Activity from a 7 Duration - month Duration vacation Activity in the Philippines Nonbiological_location .
Three Date days Date after Date symptoms Date onset Date , his physician prescribed doxycycline Medication .
Symptoms Sign_symptom continued Sign_symptom and he was admitted Clinical_event to a local Nonbiological_location hospital Nonbiological_location 5 Date days Date later Date with a fever Sign_symptom of 38.9°C Lab_value , nuchal Sign_symptom rigidity Sign_symptom , headache Sign_symptom , and general malaise Sign_symptom .
The patient described no History recent History contact History with History sick History persons History ; past History medical History history History was History unremarkable History .
On physical Diagnostic_procedure examination Diagnostic_procedure , he was somnolent Sign_symptom but fully Sign_symptom oriented Sign_symptom , with no focal Sign_symptom findings Sign_symptom on neurologic Diagnostic_procedure examination Diagnostic_procedure and only slight Severity nuchal Sign_symptom rigidity Sign_symptom .
He had a leukocyte Diagnostic_procedure count Diagnostic_procedure of 21,000/mm3 Lab_value , including 16,400/mm3 Lab_value neutrophils Diagnostic_procedure .
Cerebrospinal Biological_structure fluid Biological_structure ( CSF Biological_structure ) showed leukocyte Diagnostic_procedure count Diagnostic_procedure of 487/μL Lab_value with 80% Lab_value polymorphonuclear Lab_value cells Lab_value and 18% Lab_value lymphocytes Lab_value , and glucose Diagnostic_procedure and protein Diagnostic_procedure levels <20 Lab_value mg/dL Lab_value and <167 Lab_value mg/dL Lab_value , respectively.
Gram Diagnostic_procedure stain Diagnostic_procedure of CSF Biological_structure showed gram Sign_symptom - positive Sign_symptom cocci Sign_symptom in Sign_symptom pairs Sign_symptom (Figure).
Empiric therapy ( ceftriaxone Medication , vancomycin Medication , and ampicillin Medication ) for bacterial Disease_disorder meningitis Disease_disorder was begun.
Computed Diagnostic_procedure tomographic Diagnostic_procedure scan Diagnostic_procedure of the head Biological_structure showed only sinusitis Sign_symptom ; findings of chest Biological_structure radiograph Diagnostic_procedure and transesophageal Diagnostic_procedure echocardiogram Diagnostic_procedure were negative Lab_value .
On hospital Date day Date 2 Date , blood Diagnostic_procedure cultures Diagnostic_procedure grew gram Sign_symptom - positive Sign_symptom cocci Sign_symptom in pairs Detailed_description and chains Detailed_description .
The organism Sign_symptom was catalase Diagnostic_procedure - negative Lab_value , bile Diagnostic_procedure esculin Diagnostic_procedure - negative Lab_value , and pyrrolidonyl Diagnostic_procedure aminopeptidase Diagnostic_procedure - negative Lab_value , consistent with Streptococcus Sign_symptom spp Sign_symptom .
A latex Diagnostic_procedure agglutination Diagnostic_procedure test Diagnostic_procedure did not detect Streptococcus Sign_symptom pneumoniae Sign_symptom antigen Sign_symptom .
Antimicrobial Diagnostic_procedure susceptibility Diagnostic_procedure testing Diagnostic_procedure showed that the isolate Coreference was sensitive Sign_symptom to Sign_symptom penicillin Sign_symptom (MIC Sign_symptom = Sign_symptom 0.03), Sign_symptom ceftriaxone, Sign_symptom and Sign_symptom vancomycin Sign_symptom but resistant Sign_symptom to Sign_symptom tetracycline Sign_symptom and Sign_symptom clindamycin Sign_symptom .
Antimicrobial Medication therapy Medication was changed to penicillin Medication G Medication , 24 Dosage million Dosage units Dosage intravenously Administration per Frequency day Frequency .
On hospital Date day Date 5 Date , the patient complained of hearing Sign_symptom loss Sign_symptom in his left Biological_structure ear Biological_structure .
Results of nasopharyngeal Diagnostic_procedure endoscopy Diagnostic_procedure were negative Lab_value .
By hospital Date day Date 7 Date , the organism Coreference was identified by the API Diagnostic_procedure 20 Diagnostic_procedure Strep Diagnostic_procedure System Diagnostic_procedure (bioMerieux, Marcy l’Etoile, France), as S. Sign_symptom suis Sign_symptom serotype Sign_symptom 2 Sign_symptom .
The patient subsequently stated that he was a butcher Occupation with a culinary Detailed_description preference Detailed_description for Detailed_description partially Detailed_description cooked Detailed_description pork, Detailed_description which he had eaten Activity in the Philippines Nonbiological_location until Date the Date week Date prior Date to Date onset Date of Date symptoms Date .
On hospital Date day Date 9 Date , a formal Diagnostic_procedure audiology Diagnostic_procedure evaluation Diagnostic_procedure showed severe Severity bilateral Sign_symptom sensorineural Sign_symptom high Sign_symptom - frequency Sign_symptom hearing Sign_symptom loss Sign_symptom (– 70 Lab_value dB Lab_value ).
The patient completed a 10 Duration - day Duration course Duration of parenteral Medication antimicrobial Medication drugs Medication and was discharged Clinical_event on continued Detailed_description oral Medication therapy Medication with close followup.
Two Date months Date after Date discharge Date , the patient reported much Sign_symptom improved Sign_symptom hearing Sign_symptom without other sequelae Sign_symptom .