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Chapter 8 : Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children

Authors: Shabir A. Madhi1, Stephen I. Pelton2
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Affiliations: 1: Respiratory and Meningeal Pathogens Research Unit, Medical Research Council/University of the Witwatersrand, and Dept. of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Bertsham, Gauteng, South Africa; 2: Pediatrics and Epidemiology, Boston University Schools of Medicine and Public Health, Maxwell Finland Laboratory for Infectious Diseases, Boston, MA 02118
Content Type: Monograph
Publication Year: 2008

Category: Bacterial Pathogenesis; Immunology

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Abstract:

Invasive pneumococcal disease (IPD) in children persists as a major cause of morbidity and mortality throughout the world, despite the introduction of antimicrobial therapy. Following colonization, invasive disease may result from dissemination from a respiratory focus, such as in the case of acute otitis media, sinusitis, or pneumonia, or from dissemination from an unidentified focus to the central nervous system, pleural space, periorbital tissue, bone, or joint. The major clinical syndromes are reflective of the pathogenesis as either (i) bacteremia with or without focal complications or (ii) contiguous spread from the nasopharynx to mucosal surfaces of the lung and middle ear, resulting in pneumonia and acute otitis media, respectively. A temperature greater than 39ºC at follow-up is the best correlate of whether a given child is likely to have persistent bacteremia or a new focus of infection. Complications such as meningitis, pneumonia, cellulitis, or periorbital cellulitis are most common. The role of compared to that of other bacterial pathogens, especially and , has been reported in numerous cross-sectional studies globally. Friedland and Klugman observed that 80% of children with penicillin-nonsusceptible strains causing pneumococcal meningitis had an unsatisfactory outcome when treated with chloramphenicol compared to 33% of children with penicillin-susceptible types of pneumococcal disease. Preventative measures such as vaccination will contribute substantially toward attaining the United Nations millennium goal of reducing childhood mortality by two-thirds in 2015 compared to 1990 levels.

Citation: Madhi S, Pelton S. 2008. Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children, p 95-116. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch8
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Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children
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Citation: Madhi S, Pelton S. 2008. Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children, p 95-116. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch8
/content/10.1128/9781555815820.ch08.ch08fig01
Figure 1
Incidence of IPD in various high- and low-risk populations. Data are from reference .
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10.1128/9781555815820/f0096-01.gif
Image of Figure 1
Figure 1

Incidence of IPD in various high- and low-risk populations. Data are from reference .

Citation: Madhi S, Pelton S. 2008. Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children, p 95-116. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch8
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Figure 2
Distribution of ages of infants and toddlers in The Gambia (1996) (a), among the U.S. White Mountain Apache population (1992) (b), and among generally healthy children in California (1996) ( ) (c) at the onset of IPD.
10.1128/9781555815820/f0097-01_thmb.gif
10.1128/9781555815820/f0097-01.gif
Image of Figure 2
Figure 2

Distribution of ages of infants and toddlers in The Gambia (1996) (a), among the U.S. White Mountain Apache population (1992) (b), and among generally healthy children in California (1996) ( ) (c) at the onset of IPD.

Citation: Madhi S, Pelton S. 2008. Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children, p 95-116. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch8
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Tables

Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children
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Citation: Madhi S, Pelton S. 2008. Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children, p 95-116. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch8
/content/10.1128/9781555815820.ch08.ch08tab01
Table 1
Selected studies demonstrating the clinical presentation of IPD in children
Generic image for table
Table 1

Selected studies demonstrating the clinical presentation of IPD in children

Citation: Madhi S, Pelton S. 2008. Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children, p 95-116. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch8
/content/10.1128/9781555815820.ch08.ch08tab02
Table 2
Proportion of purulent bacterial meningitis cases due to and outcome in children prior to introduction of Hib and conjugate vaccines (unless specified otherwise) in studies from Africa
Generic image for table
Table 2

Proportion of purulent bacterial meningitis cases due to and outcome in children prior to introduction of Hib and conjugate vaccines (unless specified otherwise) in studies from Africa

Citation: Madhi S, Pelton S. 2008. Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children, p 95-116. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch8
/content/10.1128/9781555815820.ch08.ch08tab03
Table 3
Selected studies showing the incidence rates of pneumococcal meningitis in children ≤24 months of age (unless otherwise specified) not immunized with a conjugate pneumococcal vaccine
Generic image for table
Table 3

Selected studies showing the incidence rates of pneumococcal meningitis in children ≤24 months of age (unless otherwise specified) not immunized with a conjugate pneumococcal vaccine

Citation: Madhi S, Pelton S. 2008. Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children, p 95-116. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch8
/content/10.1128/9781555815820.ch08.ch08tab04
Table 4
Bacterial isolates from lung aspirate studies performed since 1970 among children who had not received antibiotics prior to the procedure and had no mentioned underlying illness
Generic image for table
Table 4

Bacterial isolates from lung aspirate studies performed since 1970 among children who had not received antibiotics prior to the procedure and had no mentioned underlying illness

Citation: Madhi S, Pelton S. 2008. Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children, p 95-116. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch8
/content/10.1128/9781555815820.ch08.ch08tab05
Table 5
Etiology of pneumonia based on findings from lung aspirate studies
Generic image for table
Table 5

Etiology of pneumonia based on findings from lung aspirate studies

Citation: Madhi S, Pelton S. 2008. Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children, p 95-116. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch8

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