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Appendices

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Section 3. Summaries of Infectious Diseases

Pneumococcal Infections 188

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS

Before routine use of heptavalent pneumococcal conjugate vaccine (PCV7), Streptococcus pneumoniae was the most common bacterial cause of invasive bacterial infections in children, including febrile bacteremia. Pneumococci also are a common cause of acute otitis media, sinusitis, community-acquired pneumonia, empyema, and conjunctivitis. Pneumococcus and meningococcus are the 2 most common causes of bacterial meningitis in infants and young children in the United States. Pneumococcus occasionally causes periorbital cellulitis, endocarditis, osteomyelitis, pericarditis, peritonitis, pyogenic arthritis, soft tissue infection, and neonatal septicemia. Pneumococcus also is associated with hemolytic-uremic syndrome, usually in the course of complicated invasive disease (eg, pneumonia with empyema).


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ETIOLOGY

S pneumoniae organisms (pneumococci) are lancet-shaped, gram-positive catalase-negative diplococci. At least 90 pneumococcal serotypes have been identified on the basis of the polysaccharide capsule. Before implementation of routine immunization in infants with heptavalent pneumococcal conjugate vaccine (PCV7) in 2000, serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F (Danish serotyping system) caused most invasive childhood pneumococcal infections in the United States; these 7 types are contained in PCV7. Serotypes 6A, 6B, 9V, 14, 19A, 19F, and 23F also were the most common serotypes associated with resistance to penicillin. Serotype 19A is the most common cause of invasive disease in PCV7-immunized children.


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EPIDEMIOLOGY

Pneumococci are ubiquitous, with many people having transient colonization of their upper respiratory tract. In children, nasopharyngeal carriage rates range from 21% to 59%. Transmission is from person to person 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 . . . [Go to Full Text]


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