Streptococcus pneumoniae: An Unusual Pathogen Seen In High Vaginal Swab

Abstract

Streptococcus pneumoniae are Gram positive lanceolate diplococci. In some individuals they are present as normal commensals of the nasopharynx. They cause pneumonia, otitis media, sinusitis, bronchitis and bacterial meningitis. Infection may be exogenous or endogenous in origin. S.pneumoniae however are not a part of the normal vaginal flora. We present a case of a 19 year old primigravida of 25 weeks amenorrhea, who presented with a history of cough since 3 days, abdominal pain since a day and spotting per vagina. She had a previous history of IgA nephropathy, and underwent dialysis and was on oral steroids. S. pneumoniae was isolated from the high vaginal swab culture. As it may predispose to neonatal sepsis, she was started on IV Cefazolin. Due to severe pregnancy induced hypertension and premature rupture of membrane an elective caesarean section was done and a preterm low birth weight live female child was delivered. As the baby had an acute respiratory distress syndrome, feed intolerance, and a raised C- Reactive protein, she was put on a ventilator and given antibiotics. This signifies that S. pneumoniae can be a resident vaginal flora especially in patients with predisposing factors. Patients with high risk of S.pneumoniae infection should be screened and vaccinated to reduce morbidity and mortality outcome for both mother and child.