Pediatric pneumococcal infections are caused by Streptococcus pneumonia bacteria, ranging from mild to severe. There are more than 90 strains of Streptococcus pneumoniae bacteria, and the symptoms, causes, diagnosis, and treatment vary with each infection. Dr. Bornstein discusses pediatric pneumococcal infections below.
DEFINITION:
Illness caused by bacteria called Streptococcus pneumoniae
SYMPTOMS:
Depending on the site of infection, pneumococcus can cause various illnesses with multiple symptoms:
- Pneumonia
- Otitis media (ear infections)
- Sinusitis
- Pharyngitis (sore throat)
- Peritonitis (abdominal infection)
- Bacteremia (bacteria in the bloodstream)
- Sepsis
- Mastoiditis (infection of the bone behind the ear)
- Septic arthritis
- Osteomyelitis
- Endocarditis
- Brain abscess
- Meningitis
Symptoms can include:
- Fever
- Pain
- Cough
- Difficulty breathing
- Headache
- Stiff neck
- Lethargy
- Coma
Infection from this organism can, in some cases, lead to death.
CAUSES:
There are multiple strains of pneumococcal bacteria. The different bacteria, called serotypes, cause various illnesses. Many people carry the bacteria in their respiratory tract without symptoms but can transmit this to others, causing disease. Once the bacteria enter the upper respiratory tract, they can travel through the bloodstream to other body parts.
CONTAGION:
Pneumococcus is spread from person to person through respiratory droplets. The incubation period is 3-7 days.
DIAGNOSIS:
The diagnosis of pneumococcal disease is made by observation of the symptoms of the specific illness and a culture or PCR (test to find germs) showing the particular organism. Cultures or PCR are not generally taken for infections such as otitis media, sinusitis, and pneumonia. In these cases, statistics show that this is the most likely cause of these illnesses. Enough cultures have been done in studies to show that this is the case. For other infections such as bacteremia, sepsis, meningitis, osteomyelitis, septic arthritis, and mastoiditis, a culture or PCR of blood, spinal or joint fluid, or bone aspirate can show the organism. A blood culture or PCR may or may not show the pneumococcal bacteria in other pneumococcal infections such as endocarditis and brain abscess. In these cases, treatment is started assuming the pneumococcal bacteria are a likely cause.
TREATMENT:
The treatment for pneumococcal infection is the administration of antibiotics. The type of antibiotic (whether oral or intravenous) and the length of the course of treatment depends on the site of infection.
For example, the treatment of choice for otitis media is a ten-day course of oral amoxicillin. For meningitis, intravenous antibiotics with powerful medicines such as vancomycin and cefotaxime may be used until the culture or PCR is done and the sensitivities of the organism are determined. The doctor can change the treatment if the organism is sensitive to another drug. Steroids can be used to prevent complications in meningitis.
OUTCOME:
The outcome depends on the illness caused. Otitis media, pharyngitis, and sinusitis have excellent outcomes with treatment. Meningitis, bacteremia, and sepsis can have good or bad results. One child may be perfectly well after treatment, while another may suffer permanent hearing loss, deafness, developmental delay, and lifetime sequelae. In some, the illness can be deadly.
DISCUSSION:
Pneumococcal disease can be a simple or complex illness depending on the serotype of the organism and the site of infection. There is not just one pneumococcal bacteria; over ninety serotypes are causing different illnesses of different severities. In many cases, such as in otitis media and sinusitis, the child is treated with the knowledge that there is a 60% chance that the offending organism is the pneumococcus. In these milder forms of illness, an oral antibiotic will be started. If it fails, a switch to another antibiotic may be necessary. The pneumococcal bacteria show increasing resistance to otitis media (ear infections). Pneumococcal bacteria are now classified as either sensitive, intermediately resistant, or highly resistant. In some instances of otitis media, no antibiotic will provide benefit, and ventilation tubes may be necessary. In illnesses such as meningitis and bacteremia, a culture or PCR of blood or spinal fluid will show the organism, and sensitivities to antibiotics will determine the optimal course of treatment. Due to the resistance of the bacteria, these more severe illnesses require that very potent intravenous drugs be started and decreased only after a sensitivity test proves that the organism is sensitive to a different antibiotic. With the routine use of the more potent antibiotics, the bacteria will eventually become even more resistant, leaving us with few options for treatment.
The best way to combat this illness is to avoid getting it in the first place. This cannot always be accomplished, but ways to decrease the possibility of infection include:
- Vaccination
- Breastfeeding the infant and young child
- Avoiding daycare
- Avoiding exposure to cigarette smoke
- Avoiding sick individuals
For the latest AAP/CDC Vaccination Recommendations:
https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf
As time passes, the illnesses caused by pneumococcus are getting more challenging to treat. The bacteria are becoming more resistant, and antibiotic failures are becoming more frequent. Pneumococcal meningitis is the most common form of bacterial meningitis. Now, it can be prevented. There are two kinds of pneumococcal vaccines available:
- Pneumococcal conjugate vaccines (PCV13, PCV15, or PCV20)
- Pneumococcal polysaccharide vaccine (PPSV23)
According to the CDC website, all children under five should receive PCV13 or PCV15. Children 5 through 18 years old with certain medical conditions that increase their risk of pneumococcal disease should receive PCV13 or PCV15. Children 2 through 18 with certain medical conditions should also receive PPSV23. As always, speak to your child’s pediatrician to ensure your child is on schedule with their recommended vaccine schedule, and ask any questions you may have about the vaccines and illnesses they help prevent.
Written by Dr. Michael Bornstein, who has 30 years of experience as a pediatrician.
Disclaimer: The contents of this article, including text and images, are for informational purposes only and do not constitute a medical service. Always seek the advice of a physician or other qualified health professional for medical advice, diagnosis, and treatment.
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