# Mycobacterium tuberculosis, Streptococcus pneumoniae, and Staphylococcus aureus Co-infection in a Two-Year-Old Immunocompetent Patient: A Case Report

## TL;DR

A two-year-old child with a strong immune system developed a rare co-infection of tuberculosis and two bacteria in a low-tuberculosis area.

## Contribution

This is the first reported case of tuberculosis, Streptococcus, and Staphylococcus co-infection in an immunocompetent child in a low-prevalence region.

## Key findings

- The child had necrotic pleuropneumonia caused by three pathogens: Mycobacterium tuberculosis, Streptococcus pneumoniae, and Staphylococcus aureus.
- No prior contact with tuberculosis was identified, and the infection occurred in a low-prevalence setting.
- The case highlights the possibility of bacterial superinfection complicating tuberculosis in immunocompetent individuals.

## Abstract

Co-infections in pulmonary tuberculosis are rare among immunocompetent children in settings with low tuberculosis prevalence. We present a case of a two-year-old immunocompetent child with necrotic pleuropneumonia caused by Mycobacterium tuberculosis, Streptococcus pneumoniae, and Staphylococcus aureus co-infection in a low tuberculosis prevalence setting.

A 24-month-old boy presented with a five-day history of cough, followed by three days of high fever and dyspnea. Initial laboratory inflammatory markers were elevated. Chest ultrasound, radiography, and CT scan revealed necrotic changes in the right upper lobe with bullae, pleural effusion, and subcutaneous emphysema. Initial therapeutic procedures included the evacuation of 140 mL of hemorrhagic content from the pleural space. Microbiological analysis revealed Streptococcus pneumoniae type 3 from pleural effusion and Staphylococcus aureus from blood culture. Antimicrobial therapy included ceftriaxone and clindamycin for six weeks. Following flexible bronchoscopy, microbiological culture from aspirated material detected Mycobacterium tuberculosis. Anamnesis did not clarify any prior contact with a tuberculosis-infected individual.

This case represents an example of Streptococcus and Staphylococcus superinfection on evolving pulmonary tuberculosis. To our knowledge, no literature is currently available indicating the co-existence of tuberculosis, streptococcal, and staphylococcal pulmonary infection in an immunocompetent patient in a population with low tuberculosis prevalence.