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Case discussion

In this video Dr Kay Roy provides a resolution for the ED case presented, and discusses the mechanisms and importance of co-infection.
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We were very surprised – but then it all kind of, in retrospect, it made more sense – when her diagnosis came back as whooping cough. So she on the syndromic panel, she tested positive for influenza A and also Bordetella pertussis. So this was very interesting, as she was a few days down the line from influenza. She didn’t need the treatment. She was, unwell enough in that she needed admission. But we were able then to ensure all the appropriate measures in terms of infection control with the whooping cough as well, and deliver her the right treatment accordingly. So it was an interesting case from that perspective. But also, it really highlights the importance of understanding co-infections, bacterial and viral.
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And we know from the previous influenza pandemic back in the 20th century when a lot of mortality did result from the bacterial superadded infections in addition to the influenza itself. And the mechanisms that can occur here does cause this increased susceptibility. In terms of the COVID pandemic, we probably haven’t seen that much bacterial co-infection. But we have certainly seen this in influenza. And if we look at the literature, again, in cases of community-acquired pneumonia, we can see that there was a lot of combination of viral and bacterial infection in a number of cases, in addition to just viral infections itself.
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So using these syndromic panels, we are able to understand a lot more globally around different kind of contributing factors or different interactions between organisms in pneumonia and other respiratory infections.
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We can see here how that actually affected the treatment as well, and the patient outcomes in these groups with both combined viral and bacterial pneumonia. So just really a short case, I think, to really think about the importance of syndromic testing in identifying all the possible organisms that may be involved, but also the timelines. In this case, this patient did have most likely flu first, followed by a bacterial infection. And we are seeing the rise now of whooping cough more widely, globally as well.

In this video, Dr Kay Roy provides a resolution for the ED case presented in the previous step and discusses the mechanisms and importance of bacterial and viral co-infections.

Case resolution

A syndromic panel was carried out, with the patient testing positive for influenza A and Bordetella pertussis so the patient was diagnosed with whooping cough. She was admitted to hospital, appropriate IPC measures were taken, and the right treatment was given accordingly.

Take-home messages

This case highlights the role syndromic testing panels play in guiding IPC strategies early on in a patient’s journey, helping to prevent the spread of infections. Additionally, it highlights the importance of understanding co-infections (bacterial and viral) when managing respiratory cases in acute units.

Now, we would like you to think about:

  • How could you integrate syndromic testing in an acute setting?

  • What do you feel are the benefits/challenges of using syndromic testing in an acute setting?

We look forward to reading your thoughts in the comments below!

References cited in the video have been provided as links in the see also section.

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Syndromic Testing and Antimicrobial Stewardship

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