Abstract
Pneumococcal disease has a high global morbidity and mortality. We report a case of a 63-year old female with a history of vaccination with pneumococcal polysaccharide vaccine-23 (PPSV-23) who was transferred to a tertiary care facility with fever and seizures due to an unknown etiology. The diagnosis of invasive pneumococcal disease (IPD) was based the identification of Streptococcus pneumoniae in the blood (culture; serogroup 3) and cerebrospinal fluid (antigen), and the finding of purulence under pressure at craniotomy. The pneumococcal vaccine should provide protection from IPD. The findings reported here display that IPD can overcome immunity proffered by the pneumococcal vaccine especially in patients with multiple comorbidities. This patient represents those who are under-vaccinated despite national recommendations for pneumococcal vaccination.
Highlights
Vaccination has reduced morbidity and mortality from disease
It was expanded to 23 serotypes in 1983 and is known as pneumococcal polysaccharide vaccine (PPSV-23)
The pneumococcal vaccine has been shown to reduce the rate of deaths due to invasive pneumococcal disease (IPD).[4]
Summary
Vaccination has reduced morbidity and mortality from disease. A vaccine against Streptococcus pneumoniae was developed in 1977 for 14 serotypes. An electroencephalogram showed excessive diffuse slowing of background activity, a nonspecific indicator of cerebral dysfunction This patient had multiple concurrent diagnoses on admission: pneumonia, bilateral mastoiditis, meningitis, subdural hematoma, seizure and streptococcal bacteremia. A urinary streptococcal antigen test was applied to the patient’s cerebrospinal fluid obtained from the outside hospital, which was positive Streptococcal antigen in both urine and cerebrospinal fluid are FDA-approved tests to detect the presence of pneumococcal infection.[6] A repeat MRI of the brain with contrast revealed a new fluid collection versus blood products in the left frontal and parietal sulci and overlying subdural collection (Figure 3). The day, the otolaryngologists performed bilateral myringotomies with aspiration, culture of middle ear fluid and tympanostomy tube placement She was treated with intravenous penicillin G for a total of six weeks with subsequent return to base line mental status, improved motor strength and ability to perform her activities of daily living
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