PREVALENCE OF STREPTOCOCCUS PNEUMONIA IN PNEUMONIA PATIENTS

(A Case Study Of Unth Enugu)

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 JUSTIFICATIONPneumonia 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 OBJECTIVEThe 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).