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Best practice
Invasive pneumococcal disease
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  1. Elise Randle1,
  2. Nelly Ninis2,
  3. David Inwald3
  1. 1Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  2. 2Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
  3. 3Department of Paediatrics, St Mary's Campus, Imperial College London, London, UK
  1. Correspondence to Dr Randle, Paediatric Intensive Care Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London W2 1NY, UK; elise_randle{at}yahoo.co.uk

https://doi.org/10.1136/adc.2010.191718

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    Introduction

    Streptococcus pneumoniae, the pneumococcus, is a Gram-positive diplococcus with more than 90 serotypes determined by the polysaccharide composition of its capsule. It is carried asymptomatically in approximately 50% of people.1 It can cause both non-invasive and invasive disease. Invasive pneumococcal disease (IPD) refers to disease in which the bacterium enters a sterile site such as blood, cerebrospinal fluid (CSF), pleural fluid, joint fluid or pericardial fluid. Non-invasive disease includes otitis media, sinusitis and bronchitis. Among infectious diseases, IPD is a leading cause of morbidity and mortality in children and adults. Vaccination against pneumococcal infection was introduced into the UK routine childhood immunisation programme in 2006 with Prevenar 7 (Pfizer, Tadworth, UK), a seven-valent conjugate vaccine, replaced in 2010 with the 13-valent vaccine Prevenar 13. Pneumococcal disease continues to be a problem despite these measures.

    Invasive pneumococcal disease

    In order to make a diagnosis of IPD, pneumococcus must be isolated from a sterile site, either by culture or by detection of bacterial cell surface antigens. In the UK, all isolates from IPD, irrespective of patient age, should be referred for serotyping to the Health Protection Agency (HPA) pneumococcal reference laboratory.

    Children with pneumococcal infection often present with non-specific symptoms and signs including isolated fever. National Institute for Health and Clinical Excellence (NICE) guidance for management of feverish illness in children should be followed, including administration of antibiotics which cover IPD when serious bacterial infection is likely or suspected.2

    Certain populations of children are at increased risk of IPD. Children at particularly high risk are those with antibody deficiencies, such as X linked (Bruton's) agammaglobulinaemia, anatomic or functional asplenia, sickle cell disease, HIV infection and those with cochlear implants or CSF leak. Children with other chronic illness (eg, cardiac, pulmonary or renal disease and diabetes mellitus) and those receiving chemotherapy or steroids …

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