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Section 3. Summaries of Infectious Diseases
Pneumococcal Infections 1
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Pneumococcus is the most common bacterial cause of acute otitis media and of invasive bacterial infections in children. Many children with bacteremia have no identifiable primary focus of infection. Pneumococci also are a common cause of sinusitis, community-acquired pneumonia, and conjunctivitis. Pneumococci and meningococci are the 2 most common causes of bacterial meningitis in infants and young children. Pneumococcus occasionally causes endocarditis, osteomyelitis, pericarditis, pyogenic arthritis, soft tissue infection, and early-onset neonatal septicemia.
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ETIOLOGY: Streptococcus pneumoniae (pneumococci) are lancet-shaped, grampositive diplococci. Ninety pneumococcal serotypes have been identified. Serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F (Danish serotyping system) cause most invasive childhood pneumococcal infections in the United States and are the 7 types contained in the licensed heptavalent pneumococcal conjugate vaccine. Serotypes 6B, 9V, 14, 19A, 19F, and 23F are the most common isolates associated with resistance to penicillin.
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EPIDEMIOLOGY: Pneumococci are ubiquitous, with many people having colonization in their upper respiratory tracts. Transmission is from person to person, presumably by respiratory droplet contact. The period of communicability is unknown and may be as long as the organism is present in respiratory tract secretions but probably is less than 24 hours after effective antimicrobial therapy is begun. Among young children who acquire a new pneumococcal serotype in the nasopharynx, illness (eg, otitis media) occurs in approximately 15%, usually within 1 month of acquisition. Viral upper respiratory tract infections, including influenza, may predispose to pneumococcal infections. Pneumococcal infections are most prevalent during winter months; most common in infants, young children, and the elderly; and more common in black individuals and some American Indian populations than in other racial
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