Fulminant Streptococcal Syndrome

on Mar 25, 2020

In this case an elderly gentleman was hospitalized following a bout with influenza. While in the hospital, he developed respiratory distress and passed away. The autopsy report revealed bronchopneumonia and streptococcal sepsis.

The plaintiffs claimed that the treating physicians failed to diagnose and properly treat the pneumonia allowing it to progress over time into the fatal sepsis.

The defense argued that regular tests and examinations were performed, including numerous chest x-rays, that showed no signs of pneumonia prior to this patient’s sudden respiratory arrest. In this case, the pneumonia and systemic sepsis developed due to fulminant streptococcal syndrome that progressed so rapidly as to make intervention impossible.

Our task was to educate the lay jury on the facts of the case. This included the development of a timeline showing the substantial care administered to this patient, a presentation of the chest films showing that no pneumonia was present prior to the final events, and the creation of a series of medical illustrations to both explain pneumonia and the progression of fulminant streptococcal syndrome following influenza.

First, we had to explain pneumonia to the jury. A medical illustration was created that provided an overall depiction of the respiratory system and that offered a view into the terminal alveolus where gas exchange occurs. Utilizing two views of these air pockets at the ends of the airway, we could show the normal flow of oxygen from the air across the membranes into the surrounding vasculature, as compared to an alveolus in a pneumonia patient with fluid filling the alveolus preventing the flow of oxygen into the blood.

              Next, we utilized timelines to show the actions of the healthcare providers and to show how frequently tests were done to check if this patient had developed pneumonia. Views of the actual chest film x-rays were included to show that no pneumonia was present during the initial stages of the hospitalization.

              Finally, we had to create a series of illustrations to illustrate the development of fulminant streptococcal syndrome following influenza that occurred in this case. These illustrations showed that Group A streptococcal bacteria were already present in the oral cavity of this patient as the patient inhaled the influenza virus and the virus began to proliferate in the lining of the respiratory tract. Then we showed that this influenza strips the protective lining from the mucosa of the respiratory tract. This allows the Group A strep to invade the mucosa of the airway and creates a superhighway allowing the bacteria to rapidly spread through the airway down into the lungs. Once in the lungs, the bacteria rapidly proliferate resulting in a quick onset of pneumonia. Finally, the bacteria gain access to the circulatory system resulting in systemic sepsis that overwhelms the body since the body’s immune system had already been weakened by the influenza virus.

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