Serotype 15C Streptococcus pneumoniae with Third Cranial Nerve Palsy: Unusual Serotype and Presentation

@#We present a unique case of pneumococcal meningitis caused by serotype 15C, a non-vaccine serotype, which is long thought to be non-virulent. Our patient is a young lady with a known case of plaque psoriasis, presented with sudden onset of left oculomotor nerve palsy and severe headache two days prior to admission. The clinical features were initially mimicking of brain tumour and brain aneurysm. The diagnosis of pneumococcal meningitis was confirmed by the bacterial antigen test and genome detection using multiplex PCR from the CSF. The blood culture also grew Streptococcus pneumoniae. Serotyping was performed on the isolate using Neufeld's Quellung method and it was identified as serotype 15C. Psoriatic skin disease was identified as a potential source of this invasive infection.

Occurrence of virulent genes among environmental isolates of Legionella pneumophila serogroup 1 strains from various parts of peninsular Malaysia

Legionella pneumophila are intracellular pathogens, associated with human disease, attributed to the presence and absence of certain virulent genes. In this study, virulent gene loci (lvh and rtxA regions) associated with human disease were determined. Thirty-three cooling tower water isolates, isolated between 2004 to 2006, were analyzed for the presence of these genes by PCR method. Results showed that 19 of 33 (57.5%) of the L. pneumophila serogroup 1 isolates have both the genes. Six (18.2%) of the isolates have only the lvh gene and 2 (6.1%) of the isolates have only the rtxA gene. However, both genes were absent in 6 (18.2%) of the L. pneumophila isolates. The result of our study provides some insight into the presence of the disease causing L. pneumophila serogroup 1 in the environment. Molecular epidemiological studies will provide better understanding of the prevalence of the disease in Malaysia.