A case of bacteremia and pneumonia caused by Streptococcus equi subspecies equi infection in a 70-year-old female following horse exposure in rural Wyoming.

BACKGROUND: The occurrence of zoonotic infections following an animal exposure continues to be an important consideration for all patients, especially those within agricultural communities. Streptococcus equi subspecies equi (S. equi subsp. equi) is a bacteria known to cause a common infection called 'Strangles' in horses. This article highlights a new case of pneumonia and bacteremia in a patient caused by S. equi subsp. equi following strangles exposure in a horse. Rarely has there been reported horse to human transmission of subsp. equi. CASE PRESENTATION: A 70-year-old woman attended a rural emergency department with complaints of dry heaving, fever, chills, shakes, and nausea and presented with a cough. She had undergone a screening colonoscopy two days prior with no other significant medical history. The patient had computed tomography (CT) evidence of a pneumonia and positive blood cultures growing S. equi subsp. equi consistent with bacteremia. The patient later disclosed the recent passing of her horse following its sudden illness six days prior to her emergency department presentation. She had cuddled and kissed the horse prior to its death. The patient was treated with IV lactated ringers during the initial evaluation and admission and also received IV piperacillin-tazobactam 4.5 g every eight hours intravenously during her hospital stay. She was transitioned to an oral antibiotic on discharge. Subsequent blood cultures drawn the day after discharge were negative for S. equi subsp. equi, indicating successful treatment of her bacteremia. CONCLUSIONS: This report discusses an atypical presentation of S. equi subsp. equi infection in an otherwise healthy individual, manifesting as early sepsis, pneumonia, and bacteremia. The patient likely developed this infection following direct contact exposure to her horse who had died from presumed strangles a few days prior to her symptom onset. This case highlights the importance of investigating potential exposures to S. equi subsp. equi in rural areas, areas where farming and ranching are prevalent, particularly among individuals working with horses. It is especially important to acknowledge high risk populations such as immunocompromised individuals with signs and symptoms of meningitis or bacteremia.

Acid Reflux or Posterior Myocardial Infarction: One ECG Away From a Missed Diagnosis.

Health care professionals and hospitals have made tremendous advances in detecting, diagnosing, and treating posterior myocardial infarction over many decades. Electrocardiogram (ECG) alone is used to make a timely diagnosis of ST-segment elevation myocardial infarction in the emergency department. The typical signs of myocardial infarction, left-sided chest discomfort with radiation to the jaw or left arm, rule out a wide range of patient presentations with ST-segment elevation myocardial infarction. This variation in clinical symptoms is exacerbated by the fact that most ECG monitors lack algorithms that account for posterior myocardial infarction interpretation. Therefore, health care practitioners must exercise caution when dismissing nondiagnostic and faint ECG abnormalities as normal or unimportant.