Streptococcus pneumoniae bacteraemia in a young man with pandemic influenza A (H1N1) 2009.

Dear Editor, The contributory role of bacterial infection to severe infl uenza illness during a pandemic is not entirely clear. The post-mortem samples of those who died between 1918 and 1919, the pre-antibiotic era, exhibited severe changes indicative of bacterial pneumonia; these are less well substantiated in the subsequent 2 pandemics in the 1950s and 1960s. Although primary viral pneumonia seems predominant in the current infl uenza pandemic, it is important not to overlook secondary bacterial infection. We report a confi rmed case of 2009 pandemic infl uenza A (H1N1) infection in a young male, who had secondary Streptococcus pneumoniae bacteraemia and probable bacterial pneumonia. In April 2009, 2 alarming reports were published by the US Centers for Disease Control and Prevention (CDC). One report described 2 cases of swine infl uenza in children living in neighbouring countries in California, who had no direct contact with pigs; the other described an outbreak in a school in New York City. Following that, the World Health Organization (WHO) sent out its fi rst alert to the world on the emergence of a novel infl uenza virus. The virus was subsequently named as 2009 pandemic infl uenza A (H1N1). In Singapore, the virus was fi rst detected on 26 May 2009, in a returning student from New York City. Local transmission of cases soon emerged, despite strict containment measures.1 The initial local cases described by Liang et al2 included mainly young returning travellers with no pre-existing medical illness. Secondary bacterial infection was not detected in the fi rst 10 local cases. We report the fi rst local case of bacteraemia involving a young foreign worker and discuss the role of bacterial infection in infl uenza pandemics.