PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Pneumococcal Infections”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 145 records · Page 8Linked to original sources
PubMed1997

Repeated invasive pneumococcal infections in young children without apparent underlying immunodeficiency.

During a 30-month interval at LeBonheur Children's Medical Center, 394 patients had a blood or cerebrospinal fluid culture positive for Streptococcus pneumoniae. Sixteen of these episodes (4%) were repeated infections; 6 of these 16 patients had sickle cell disease. Six of the remaining 10 patients had immunologic evaluations of varying completeness; no immunodeficiency was identified by these tests or on follow-up. Nine of the ten previously healthy patients with repeated pneumococcal disease were less than 2 years of age. In our experience, repeated invasive pneumococcal infections in otherwise healthy young children were relatively common (10/394, or 2.5% of patients with invasive pneumococcal infections) and did not indicate the presence of an unsuspected immunodeficiency.

Bacteremia↗
PubMed1998

Impact of antibiotic resistance on chemotherapy for pneumococcal infections.

Over the past three decades, penicillin-resistant pneumococci have emerged worldwide. In addition, penicillin-resistant strains have also decreased susceptibility to other beta-lactams (including cephalosporins) and these strains are often resistant to other antibiotic groups, making the treatment options much more difficult. Nevertheless, the present in vitro definitions of resistance to penicillin and cephalosporins in pneumococci could not be appropriated for all types of pneumococcal infections. Thus, current levels of resistance to penicillin and cephalosporin seem to have little, if any, clinical relevance in nonmeningeal infections (e.g., pneumonia or bacteremia). On the contrary, numerous clinical failures have been reported in patients with pneumococcal meningitis caused by strains with MICs > or = 0.12 microg/ml, and penicillin should never be used in pneumococcal meningitis except when the strain is known to be fully susceptible to this drug. Today, therapy for pneumococcal meningitis should mainly be selected on the basis of susceptibility to cephalosporins, and most patients may currently be treated with high-dose cefotaxime (+/-) vancomycin, depending on the levels of resistance in the patient's geographic area. In this review, we present a practical approach, based on current levels of antibiotic resistance, for treating the most prevalent pneumococcal infections. However, it should be emphasized that the most appropriate antibiotic therapy for infections caused by resistant pneumococci remains controversial, and comparative, randomized studies are urgently needed to clarify the best antibiotic therapy for these infections.

Anti-Bacterial Agents↗
PubMed1985

Pneumococcal infections among immunised and splenectomised patients in Israel.

Pneumococcal sepsis is a life-threatening complication in splenectomised patients even since the introduction of a polyvalent pneumococcal vaccine. Eight episodes of pneumococcal sepsis in seven properly vaccinated splenectomised patients are described. All but two of the causative serotypes were included in the vaccine. The fact that most of the patients were immunosuppressed may explain the failure of the vaccine in these particular patients. A survey of 59 episodes of pneumococcal bacteraemia during 1982 at the Soroka Medical Center, however, shows that 32% of the strains of pneumococci isolated were among seven types not included in the vaccine. The addition of continuous antibiotic prophylaxis in vaccinated and splenectomised patients is suggested.

Adult↗
PubMedDate not supplied

[Epidemiologic and serologic studies of pneumococcal infections with reference to the new STIKO recommendations].

Pneumococcal diseases play an important role especially for babies and toddlers (otitis media) and for older persons (pneumonia). 28% of the 481 reported cases of bacterial meningitides (without meningococcus) in Mecklenburg-Vorpommern were caused by pneumoniae streptococcus. A pneumococcus antibody study by the land register confirms the high contamination in older people. Therefore STIKO recommends since March 1998 to effect pneumococcal vaccination with every person from the age of 60 and dove as well as for children, adolescents and adults with higher risk due to a primary disease.

Adolescent↗
PubMed1977

Fulminant pneumococcal infections in 'normal' asplenic hosts.

Five asplenic persons with no other detectable underlying disease had over-whelming pneumococcemia. Four of the patients had undergoing splenectomy for trauma, and the fifth had asplenia as an isolated congenital abnormality. Including the cases presented here, there are now at least 26 reported instances of fatal or life-threatening pneumococcal infections in otherwise-normal asplenic patients. Thus, splenectomy per se is associated with an increased risk of over-whelming pneumococcemia. Although the magnitude of the risk is low, mortality associated with these infections is high. Analysis of the clinical data strongly suggests that undiagnosed febrile episodes in asplenic persons should be treated promptly with antibiotics while awaiting culture results. This strategy should be adopted regardless of the age of the patient or his general state of health. The observation that a limited number of pneumococcal serotypes, particularly type XII, appear to predominate in these cases suggests that pneumococcal vaccine might be highly efficacious in preventing overwhelming post-splenectomy pneumococcal infections in otherwise-normal hosts.

Adolescent↗
PubMed1977

Serotypes of pneumococci in pneumonia, meningitis and other pneumococcal infections.

During a five-year period, 1965 to 1969 inclusive, pneumococci from 294 patients with acute pneumococcal infections were serotyped. Pneumococci of 33 serotypes were encountered, of which types 3 and 19 were most frequent. The spectrum of infections included pneumonia, meningitis, peritonitis, otitis media and mastoiditis, wound infection and conjuctivitis. At least 17 infections were fatal, all of which, with one exception, occurred either in infants or in adults over 50 years of age. In pneumonia, type 3 pneumococcus was predominant, being isolated from 21 of 101 patients. In 67 cases of pneumococcal meningitis, most of which were in children, the commonest type was 14. If a pneumococcal vaccine is produced for use in Australia, inclusion of serotypes 1, 3, 4, 6, 9, 14, 19 and 23 should be considered. These eight types caused 52% of the cases of pneumonia and 67% of the cases of meningitis in this study.

Acute Disease↗
PubMed2004

Performance of the Binax NOW Streptococcus pneumoniae urinary antigen assay for diagnosis of pneumonia in children with underlying pulmonary diseases in the absence of acute pneumococcal infection.

The performance of the Binax NOW immunochromatographic test for detecting Streptococcus pneumoniae antigen in urine specimens from 103 children presenting underlying pulmonary diseases with no recent pneumococcal infection was assessed. Our data indicate that this assay is unlikely to be useful for discriminating between children with and without pneumococcal pneumonia.

Adolescent↗
PubMed1984

Maternal and neonatal death due to pneumococcal infection.

A 27-year-old woman died from pneumococcal meningitis associated with pneumococcal endometritis two days after being delivered of a .1.75-kg infant. The infant also had pneumococcal septicemia and died six days after birth. The pneumococcus isolated from the mother and the baby was type 8. The membranes had ruptured 21 hours before delivery, and the mother had received a salbutamol infusion in an attempt to inhibit labor with injections of betamethasone to prevent neonatal respiratory distress. This case typified the dramatic onset and lethal nature of some pneumococcal infections.

Adult↗
PubMed1993

Penicillin-resistant systemic pneumococcal infections in children: a retrospective case-control study.

OBJECTIVE: To determine whether there are any risk factors that differentiate children with systemic infections due to Streptococcus pneumoniae relatively or fully resistant (minimum inhibitory concentration > 0.1 microgram/mL) to penicillin from those children with infections due to S pneumoniae susceptible to penicillin. DESIGN: Retrospective case-control study. SETTING: A large children's hospital. PARTICIPANTS: Forty-three children with systemic penicillin-resistant S pneumoniae infections identified at Texas Children's Hospital over the 51-month period from January 1989 through March 1993. Each case had one or two controls matched only for age and date of S. pneumoniae infection. Sixty-six controls were selected from a group of 341 children with susceptible isolates. OUTCOME MEASURES: Variables compared included gender, race, diagnosis, underlying conditions, past hospitalization, geographic area of residence, antibiotic use in past month, amoxicillin-clavulanic acid use in past month, and outcome. RESULTS: Thirty-seven patients (86%) had relatively resistant isolates (minimum inhibitory concentration range 0.125 to 1.0 microgram/mL) and six patients (15%) had fully resistant isolates (minimum inhibitory concentration range 2.0 to 8.0 micrograms/mL). Thirty-three percent of the cases vs 36% of the controls had underlying conditions. Seventy-one percent of the cases vs 39% of the controls had received antibiotics in the previous month. Compared with their matched controls, the patients with penicillin-resistant systemic pneumococcal infections were more likely (P = .02) to have received a course of antibiotics within the month prior to their infection. CONCLUSION: The only identified associated risk factor in children who developed a systemic penicillin-resistant pneumococcal infection appears to have been the use of antibiotics within the month prior to their infection.

Case-Control Studies↗
PubMed2003

Antibiotic prevention of pneumococcal infections in asplenic hosts: admission of insufficiency.

Asplenic and hyposplenic patients have an increased risk for overwhelming pneumococcal infections, even several decades after splenectomy. Pneumococcal vaccination and daily oral administration of penicillin V are recommended to prevent such infections, 2-5 years after splenectomy, and for at least 5 years in children affected with sickle cell disease. In order to assess whether the infectious risk is actually known and prevented, we interviewed physicians (belonging to a general practitioner and pediatrician network) who followed patients having undergone a splenectomy and/or children with sickle cell disease under 5 years of age. We received replies from 104 physicians monitoring 152 patients replied. Potential infection risk was not known for 28% of the asplenic patients and 40% of the children with sickle cell disease. Only 75% of the asplenic patients and 36% of the children with sickle cell disease had been vaccinated against pneumococcus. Of the patients who had undergone splenectomy, 27% had been treated with an antibiotic after surgery and 60% had discontinued it, the vast majority of them during the same year. Of the children with sickle cell disease, 48% were not receiving an antibiotic. This study demonstrates that risk of infections in asplenic patients is widely misunderstood, indicating the urgent need to improve their management.

Adolescent↗
PubMed2003

Increased incidence of pneumococcal bloodstream infections.

Pneumococcal bloodstream infections in pediatric patients rose from 3.6 to 14.8 episodes per 100,000 from 1986 to the year 2000 (P < 0.001) in a population of approximately 650,000 inhabitants (16% <16 years of age). Incidence in the group <24 months of age increased from 7.4 to 78.6 episodes per 100,000 per year (P < 0.001). Overall 75% of the serogroups are included in the new heptavalent vaccine.

Adolescent↗
PubMed1986

Prophylaxis of pneumococcal infection in sickle-cell disease by the combined use of vaccination and penicillin.

Forty children homozygotes for sickle-cell disease (SCD) aged 2-5 years were enrolled in a study to assess the efficacy of pneumococcal vaccine combined with penicillin prophylaxis in preventing pneumococcal infection. The vaccine was given initially and then every 2 years as a booster. In addition to pneumococcal vaccine, 24 children were prescribed penicillin-V orally twice daily while the remaining 16 were given benzathine penicillin intramuscularly every 4 weeks in the clinic. The study period lasted for 4 years during which the clinic attendance rate of both groups was 90% and 92% respectively. The compliance with oral penicillin intake was checked by random urine testing for penicillin. The test was positive in 128 out of 320 urine samples (40%). The parenteral penicillin was given at every clinic visit and the rate of compliance was 92%. Twelve episodes of bacterial sepsis were documented: 10 of them were caused by Gram-negative organisms. The pneumococcus caused a fatal episode of septicaemia and meningitis in a child who did not comply with penicillin prophylaxis. In a retrospective search, 15 episodes of bacterial sepsis have been documented in 22 children receiving no prophylaxis for 2 years. Eight of those episodes were caused by the pneumococcus. The combination of pneumococcal vaccine with penicillin prophylaxis was effective in preventing pneumococcal sepsis in children with SCD followed up for 153 patients years.

Anemia, Sickle Cell↗
PubMed2004

Decrease of invasive pneumococcal infections in children among 8 children's hospitals in the United States after the introduction of the 7-valent pneumococcal conjugate vaccine.

OBJECTIVE: To monitor clinical and microbiologic features including antimicrobial susceptibility and serogroup distribution of invasive infections caused by Streptococcus pneumoniae among children before and after the introduction of routine administration of the 7-valent pneumococcal conjugate vaccine (PCV7). DESIGN: A 9-year (January 1, 1994 through December 31, 2002) prospective surveillance study of all invasive pneumococcal infections in children. PATIENTS: Infants and children cared for at 8 children's hospitals in the United States with culture-proven invasive infections caused by S pneumoniae. RESULTS: When compared with the mean of the years 1994 to 2000, the annual number of invasive pneumococcal infections for children < or =24 months of age declined 58% in 2001 and 66% in 2002. If only the serogroups in the PCV7 are considered, the number of cases in children < or =24 months old declined 63% and 77% in 2001 and 2002, respectively. The greatest decrease was observed for serogroup-14 isolates. The number of isolates in nonvaccine serogroups increased 28% in 2001 and 66% in 2002 for children < or =24 months old. Nonvaccine serogroup-15 and -33 isolates had the greatest increase in number. The proportion of all isolates nonsusceptible to penicillin increased yearly from 1994 to 2000, reached a plateau in 2001 at 45%, and declined to 33% in 2002. Decrease in nonsusceptibility to penicillin occurred entirely in the isolates with penicillin minimum inhibitory concentration > or =2 microg/mL. Nonsusceptibility to penicillin increased slightly among nonvaccine-serotype isolates. Most infections after at least 2 doses of PCV7 were caused by nonvaccine-serotype isolates. CONCLUSIONS: Since the introduction of the PCV7, the number of invasive pneumococcal infections caused by vaccine-serogroup isolates among 8 US children's hospitals has decreased >75% among children < or =24 months old. In addition, penicillin resistance decreased in 2002 for the first time since our surveillance began in 1993-1994. However, we have noted that replacement may be developing with serogroups 15 and 33. Furthermore, penicillin resistance seems to be increasing among nonvaccine serogroups. Surveillance must be continued to detect the emergence of changes in the distribution of serotypes as well as antibiotic susceptibility.

Child↗
PubMed1977

Prevention of pneumococcal infection by immunization with capsular polysaccharides of Streptococcus pneumoniae: current status of polyvalent vaccines.

Because of the continuing morbidity and mortality resulting from pneumococcal infection, a program was instituted to redevelop polyvalent vaccines consisting of capsular polysaccharides of Streptococcus pneumoniae. Vaccines containing 50 microgram each of the capsular polysaccharides of as many as 13 pneumococcal types have been shown to be safe, antigenic, and 78.5% effective in the prevention of type-specific putative pneumococcal pneumonia and of type-specific pneumococcal bacteremia in adults. In a population in which pneumococcal pneumonia predominated, the total incidence of radiologically confirmed pneumonia, irrespective of cause, was reduced by 54.3% by use of a tridecavalent vaccine. The efficacy of vaccine in the prevention of infection during the first two years of life is under investigation. The vaccine is recommended for those at high risk of pneumococcal infection or of a fatal outcome from such illness.

Adult↗
PubMed2003

Bacteremic pneumococcal infections in immunocompromised patients without AIDS: the impact of beta-lactam resistance on mortality.

BACKGROUND: Streptococcus pneumoniae is the leading cause of community-acquired pneumonia in the elderly, and in recent years it has arisen as an important pathogen in HIV-infected patients. However, there is a scarcity of information on clinical and therapeutic problems associated with pneumococcal infections in other immuno-compromised patients. The objective of this study was to assess the most relevant epidemiologic aspects, clinical features and prognostic factors of pneumococcal bacteremia in immunocompromised hosts without AIDS. METHODS: This was a retrospective analysis of patients with pneumococcemia, carried out in a 600-bed, university-affiliated hospital in Madrid, Spain. Two-hundred and sixty patients were evaluated retrospectively; 69 (26.5%) immunocompromised patients based on strict case definitions were compared with a group composed of 191 non-immunocompromised hosts with a variety of chronic conditions. Conventional management of pneumococcal bacteremia according to clinical standards was assessed. The MICs of penicillin and other beta-lactam antibiotics, and related mortality and hospital mortality at 30 days, were measured. RESULTS: A comparison of clinical manifestations of pneumococcemia between immunocompromised patients and non-immunocompromised patients did not show differences in the presence of fever, obtundation, type of lung involvement, frequency of primary bacteremia, or meningitis. Hospital-acquired pneumococcemia was significantly more frequent in immunocompromised patients (34.7% versus 6.8%, P<0.0001), and resistance to penicillin was also more common in pneumococcal strains isolated from these patients (37.5% versus 20%, P=0.0009). Septic shock occurred more frequently in immunocompromised patients, although the overall and related mortality were not significantly different from those found in non-immunocompromised patients (33.3% versus 22.5%, P=0.07, and 28.9% versus 20.9%, P=0.7 respectively). In the multivariate analysis, multilobar pneumonia (odds ratio (OR) 15.7; 95% CI 6.00-41.30; P<0.001), inadequate treatment (OR 12.20; 95% CI 4.10-37.20; P<0.001), obtundation (OR 5.80; 95% CI 2.20-15.00; P<0.001) and hospital-acquired bacteremia (OR 4.80; 95% CI 1.00-14.60; P<0.006) were associated with an increased risk of mortality in patients with pneumococcemia. Only multilobar pneumonia (OR 7.90; 95% CI 4.10-15.35; P<0.001) was significantly associated with an increased risk of mortality in immunocompromised patients. Patients with acute leukemia and lymphoma had a greater mortality rate than non-immunocompromised patients (53.8% related mortality, P=0.05). Analysis of these patients showed frequent inadequate empirical therapy with ceftazidime plus amikacin in the presence of beta-lactam resistance. CONCLUSIONS: Much of the burden of pneumococcal bacteremia was attributable to immunosuppressive diseases. In immunocompromised patients, pneumococcemia was frequently acquired within the hospital during the treatment of the underlying condition, and resistance to penicillin was common. Patients with acute leukemia and lymphoma who develop fever and pneumonia should be treated with drugs active against beta-lactam-resistant pneumococci, irrespective of the setting in which the infection develops.

Adolescent↗
PubMed2006

[Invasive pneumococcal infections in patients with primary immunodeficiency disorders].

The authors review the immunopathology of invasive pneumococcal infections in patients with primary immunodeficiency diseases, with particular emphasis on selective anti-polysaccharide antibody deficiency. They summarize current knowledge on the molecular mechanisms and clinical manifestations of host defense against Str. pneumoniae.

Antibodies, Bacterial↗
PubMed1995

Complement analysis in adult patients with a history of bacteremic pneumococcal infections or recurrent pneumonia.

Complement deficiencies are known to be associated with increased susceptibility to bacterial infections. In the present study we investigated 80 patients with either a history of pneumococcal bacteremic infection, or recurrent pneumonia, or both. Hemolytic screening tests for complement deficiency were performed and serum concentrations of C1q, C1s, C2, C3, C4, C4 isotypes, factor B, factor D, and properdin were determined. Complete deficiencies of single complement proteins were not found. 10 patients (12%) had a C4 isotype deficiency, but the frequency of homozygous C4A and C4B deficiency was not significantly increased. Seven patients (9%) had hypocomplementemia with low concentrations of at least 2 complement proteins. One of these patients had profound depletion of classical pathway components and findings suggesting acquired C1 esterase inhibitor deficiency. 16 patients (20%) had minor complement aberrations. A majority of the patients with hypocomplementemia suffered from other conditions associated with pneumococcal infections. However, impaired complement function could be a significant predisposing factor in some patients with invasive pneumococcal infections or recurrent pneumonia.

Acute Disease↗