Abstract
Childhood pneumococcal infection is a growing concern among paediatricians especially, in countries where there is no routine vaccination program against Streptococcal pneumoniae. The disease is associated with significant morbidity and mortality in young children particularly those who are under the age of two years. Its main virulent factors include polysaccharide capsule, autolysin, pneumolysin, choline-binding Protein A, the higher chance for genetic transformation, and the presence of pilli that facilitate enhanced binding of bacteria to host cellular surfaces. More severe and invasive pneumococcal infections are seen in children with immunodeficiencies, hypofunctional spleen, malnutrition, chronic lung disease and nephrotic syndrome. The disease spectrum includes a range of manifestations from trivial upper respiratory tract infections to severe invasive pneumococcal disease (PD). The basis of diagnosis is the isolation of bacteria in the culture of body fluids including blood. Antibiotics are best guided by sensitivity patterns and the emergence of resistance is a growing concern.
Highlights
BackgroundPneumococcal disease (PD) is caused by a gram-positive bacterium, Streptococcus pneumoniae, known as Pneumococcus
Before introducing the vaccine PCV7, there was a high prevalence of globally invasive pneumococcal disease (IPD)
Bacteremia might occur in conjunction with meningitis, pneumonia, and septic arthritis and occur concurrently with a localized disease such as acute otitis media or without any focal lesions
Summary
Pneumococcal disease (PD) is caused by a gram-positive bacterium, Streptococcus pneumoniae, known as Pneumococcus. PD is the major cause of morbidity and mortality under five years in the world, according to the World Health Organization, but mortality has been high in developing countries [1] Though it colonises 20%-40% of healthy children's nose and throat, it is a leading cause of bacterial pneumonia, meningitis, and sepsis in children at present [1,2]. Non-vaccine pneumococcal serotypes, especially 19A, have increased serious and invasive infection incidence. Because of this reason, 13-valent pneumococcal conjugate (PCV13) was introduced, and PCV13 contains additional six serotypes (1, 3, 5, 6A, 7F & 19A) compared to PCV7. A study done in California before introducing the Pneumococcal vaccine revealed a high incidence of IPD, especially among young children below two years [13]. Congenital or acquired humoral immunodeficiency Impaired phagocytosis or defective clearance of organism Abnormal innate immune response Hypofunction of the spleen (sickle cell disease) Absent spleen (congenital or surgical removal) Human immunodeficiency virus (HIV) Nephrotic syndrome Chronic lung disease Haematological malignancies 2 Acute infections Overwhelming viral infection especially influenza which damages the especially respiratory epithelium 3 Cochlear implants 4 Malnutrition 5 Chronic inhalation of smoke 6 Cerebrospinal fluid leakage 7 Certain racial and ethnic groups (Native Alaskan, Black, American Indian population and Australian Aborigines) 8 Attendance in group child care 9 Crowded living conditions
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