Vol. 7(20), pp. 1205-1207, 29 May, 2013 DOI 10.5897/AJPP12.377 ISSN 1996-0816 © 2013 Academic Journals http://www.academicjournals.org/AJPP African Journal of Pharmacy and Pharmacology Case Report An invasive pneumococcal disease during the influenza pandemic successfully treated with ampicillin Camelia Gubavu 1 , Liana-Catalina Gavriliu 1,2 and Gabriel-Adrian Popescu 1,2 * 1 “Matei Bals” Infectious Diseases Institute, Bucharest, Romania. 2 Carol Davila University of Medicine, Bucharest, Romania. Accepted 23 April, 2013 We described the case of a 35-year-old man with a history of pulmonary tuberculosis, presented with invasive pneumococcal disease during the influenza pandemic. The patient recovered with ampicillin monotherapy; the differentials and the antibiotic choice for a fully penicillin susceptible strain of Streptococcus pneumoniae were discussed. Key words: Streptococcus pneumonia bacteremia, bacterial superinfection, antimicrobial monotherapy, ampicillin. INTRODUCTION Streptococcus pneumoniae is a major bacterial pathogen and a predominant cause of community-acquired pneumonia, acute exacerbations of chronic bronchitis, meningitis, sinusitis and bacteremia in adults from both developed and developing countries, mainly because of its ability to colonize the nasopharynx of healthy people (5 to 10%). (Musher, 2010). Nasopharyngeal carriage in adults is more common in asthmatic patients, in smokers, and in patients with recurrent respiratory infections. (Lynch and Zhanel, 2009) Risk factors for developing invasive pneumococcal di- sease (IPD) are extreme ages (less than 2 years or more than 65 year-old), immunocompromised status and winter months (Lynch and Zhanel, 2009). In immunocompetent hosts, the incidence of IPD is higher among those who are suffering from: alcohol abuse, diabetes mellitus, asthma, recent viral infection, congestive heart failure, exposure to cigarette smoke, splenectomy or functional asplenia (Kyaw et al., 2005). Mortality rates for bacteremic pneumococcal pneumonia vary from 10 to 30% in adults and are higher in patients with comorbidities. Factors associated with unfavorable outcome include age more than 65 years, shock, alcohol abuse, multilobar involvement and some capsular subtypes of S. pneumoniae (Lynch and Zhanel, 2009). CASE REPORT A 35-year-old man was admitted in March, 2010 with fever, dyspnea, dry cough, chills, right sided chest pain, jaundice and abdominal pain, which started three days before admission. He had a history of diabetes mellitus, pulmonary tuberculosis, alcohol abuse and he was a heavy smoker. On physical examination, the patient appeared ill, with jaundice. He had fever (38.6°C), a respiratory rate of 23 breaths per minute, the oxygen saturation was 93% in ambient air and the blood pressure was normal. Crackles were heard in the right lung base and the abdomen was tender. Chest radiography showed right alveolar infiltrate (Figure 1). Laboratory tests showed inflammation (C-reactive protein = 342 mg/dl, procalcitonin = 2.47 ng/ml), pancytopenia (white blood cell *Corresponding author. E-mail: gabrielp9@yahoo.com. Tel: + 40213186100.