Epidemiology, Diagnosis, and Treatment of Serious Pneumococcal Infections in Children

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 Streptococcus pneumoniae compared to that of other bacterial pathogens, especially Haemophilus influenzae and Neisseria meningitidis, 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.