ABSTRACT
The prevalence of
streptococcus pneumonia in pneumonia patients using university of Nigeria
Teaching Hospital (UNTH) Enugu as a case study was carried out based on the
fact of the pneumonia is one of the commonest afflictions of the aged people
and children worldwide. A total of 50 samples were collected. 12 (24%) of the
sample were from sputum while 38 (76%) were from nasopharyned swabs from
children who can not produce sputum using sterilized disposable swab sticks. 12
(24%) of the patients were adults and 38 (76%) were children under the age of
the. 29 (58%) of the patients were made while 21 (42%) were female. The media
used for isolation of bacteria were blood agar and chocolate agar plates. This
was followed by their appropriate biochemical tests 5 different organisms were
isolated. They streptococcus pneumonia’s 13 (26%) staphylococcus 17 (34%)
streptococcus viridian’s 3(6%) other staphylococcus species 6(12%) mixed growth
of staphylococcus aureus and streptococcus specie 1(2%) and non –significant
growth of staphylococci and streptococci 10(20%). This study shows that the
frequency of staphylococcus aureus is prater than streptococcus pneumonia’s
which was earlier regarded as the most common pathogen that cause pneumonia.
CHAPTER
ONE
1.0
INTRODUCTION
Bacterial an
something cause severe infection in children the elderly and other people with
weakened immune system is people that are more susceptible to infection because
of an overal impairment of the immune response example Hiv infection chronic
resease advanced aged and or function of defense mechanisms (example smoking
chronic obstructive pulmonary disease (copd) tumours inhaled toxins and
aspiration (Stephen 2002).
The trachea, bronchi
and lungs are normally free from communal and potentially pathogenic bacteria,
but when their reference are upset they are liable to be invaded by organization
from the throat or nose (fraser, 1996) one of the commonest infection of the
lower respiratory tract is pneumonia (Jawetz, et ,2001).
1.1
PATHOPHYSIOLOGY OF BACTERIAL PNEUMONIA
It is known that the
inflammation of the lengs is called pneumonia it is pneumonia’s that result in
the filling of alveoli with pus and fluid is called pneumonia (Naster et al
2001). Macrophages are numerous in the long issues and reality move into the
alveoli and air ways to engaful infection agents, thus helping to prevent pneumonia
from developing but when there is upset of the defense mechanism, causative
agents are then likely to enviable the host (Yolande and Broduem 1987).
Pneumonia is an
infection caused by different bacterial like streptococcus pneumonia,
staphylococcus aureus, pneumococci etc. and in several case can lead to death
for instance, William henry Harrison, the with president of the united states,
contracted pneumonia during his inauguration in 1841 and ride after being in
office for only 31 days. Other notable persons to succumb to pneumonia include
sir Francis bacon in 1626, who died after staffing chikens with now while
conducting freezing experimente and Thomas stonewal Jackson in 1863, whose arm
required amputation after he was shot by one of his own sentries (Stephen
2002). Pneumonia is prevalent in cold weather and during raing season.
1.2
CLASSIFICATION OF PNEUMONIA
Pneumonia can be
classified into three
-Acute, hospital
–acquired
– Acute, community
–acquired
– Chronic pneumonia
(Inglis 1996)
a). ACUTE COMMUNITY
ACQUIRED: this is defined as pneumonia whose onset occurs either prior to or
immediately after mission to hospital. It is one of the classics of pneumonia
that cause death worldwide (Fraser, 1996).
Patients with acute
pneumonia usually have cough, chest signs and fever. The cough may or may not
be productive of purulent sputum (Stephen, 2002). The most important
consequence of actuate pneumonia is improvement of respiratory function, which
should be assessed as a first priority ( Frasch and concopcion, 2000).
b. ACUTE HOSPTAL
ACQUIRED: This type of pneumonia affects smoker, patient with prior chest
disense or following operation (especially thoracis and upper abdominal) and
ventillated critically patient (inglis, 1996). The last group have the highest
relative risk (Ross, 1994).
c. CHRONIC PNEUMONIA:
This have a more insidious onset and prolong course than actuate pneumonia.
There is no single symptom complex, so the diagnosis is often bused on
radiological finding (Frasch and cocaplion, 2002). Cough may productive of
parnlent sputum occasionally blood stained.
1.3
CAUSES OF PNEUMONIA
Cause for the
development of pneumonia are extrinsic or intrinsic and various bacteria
causative against exist (Nester et al 2001).
Extrinsic factor
include exposure to a causative agent pulmonary irratante, or direct pulmonary
injury, while intrinsic factor are related to the host.
In most cause, the
primary infection is casued by qa virus eg Rhinovirus, Adanovirus etc. but
there is often a secondary infection with a bacteria pathogen from the upper
respiratory tract, most ommon is streptococcus pneumonia Gawatz et al, 2001)
the streptococcus pneumonia also know as pnumococcus appears to be the primary
cause of many cases of pneumonia, particularly ldorar and bronche pneumonia
with Homophiles influenza as a frequent co- pathogen (Fraser, 1996) but often
these pneumonic infection are triggered by a proceeding viral infection of the
upper respiratory tract such as common cold (Wisconsin, 2003).
Other secondary
invaders of the lower respiratory tract that can cause pneumonia are
staphylococcus aureus, which may cause fatal pneumonia after streptococcus
pneumonia (Staphen, 2002). Haemophilus influenza, Kiabsiella pneumonia etc
Jawetz at al 2001).
1.4
JUSTIFICATION
Pneumonia infection
is one of the major cause of death world wide and the infection is increasing
rapidly in Enugu metropolis with streptococcus pneumoniae as the major pathogen
(Okafor 1992). Therefore there is need to find out if this virulent organism is
actually the primary bacterium that causes premnonia in Enugu metropolis.
Although, many persons carry these bacteria harmlessly in their threat, mouth
and nasopharyux and these are likely to contaminate the sputum as it is
expected through the throat and mouth so as the commensal in nasopharynx which
can equally contaminate the nasopharyueal swab (Ross, 1994).
1.5
AIMS AND OBJECTIVE
The aims and
objective of this work are:
1. To isolate
bacterial pathogens form pneumonia patients.
2. To ascertain the
prevalence of streptococcus pneumonia in pneumonia patient using UNTH as a cast
study.
3. To determine the
aga group and sex that are more susceptible to this infection.
1.6
HYPOTHESIS
Ho streptococcus
pneumonia’s causes pneumonia
H1¬ streptococcus
does not cause pneumonia
H2 Streptococcus
Pneumoniae have insight relationship on sex and age
1.7
STATEMENT OF PROBLEM
Streptococcus
pneumoniae is regarded as the commonest cause of pneumonia both in children and
adults. Other bacteria have also been implicated as the cause of disease in
severe case pneumonia can lead 15 death.
1.8
DIAGNOSIS
In pneumonia patients
streptococcus pneumoniae and other organisms (Causative pathogens) are
diagnosed when they are grown from cultures of sterile fluids such as sputum
from adult and nasopherynged swab as in case of children who are unable to
produce sputum the clinical presentation varies from the mildly to extremely
ill patients (Wisconsin 2003). Straptococcue pneumonia and other causative
bacteria can be isolated from specimens when cultured on blood agar and
chocolate agar plates. Media have been described which facilitate the isolation
of small numbers of pneumococci from sputum heavily contaminated with secondary
invaders form throat and mouth commensals of 5% horse blood is affective
incubation should be in 5-10 % coq (Gilks, 1997) .
A list of biochemical
tests are used in identify the presence of these bacteria. Catalase optochin
sensitive test and bile solubility test for streptococcus pneumonia’s congulase
test for staphylococcus aureus satellition test for Haemophilus influenza and
citrate utilization for Klebsiella pneumoniae (Cheesbrough 1984).