Pneumococcal Pneumonia In Children Research Articles

Radiographically confirmed pneumonia in Malawian children and associated pneumococcal carriage after introduction of the 13-valent pneumococcal conjugate vaccine

BackgroundThe 13-valent pneumococcal conjugate vaccine (PCV-13) was introduced in Malawi in 2011 with an expected impact of reducing pneumococcal pneumonia in children. We aimed to describe clinical characteristics and nasopharyngeal (NP) carriage of pneumococcus by serotype in children hospitalized with primary end-point pneumonia (PEP) between 2013 and 19 after the introduction of PCV-13.MethodsWe conducted a secondary analysis of children aged under-5-years hospitalized with acute respiratory illness (ARI) in Malawi. Chest radiographs conducted at admission were read by two independent clinicians according to WHO criteria for PEP, and a third reviewer resolved discordant diagnoses. NP swab specimens were processed and Streptococcus pneumoniae growth was serotyped. Multivariable regression analysis was conducted to assess the association between clinical characteristics, NP serotypes, and PEP.ResultsWe had complete radiographic and NP serotype data for 500 children, of which 54 isolates were vaccine-type (VT) (10.8%), 165 were non-VT (NVT; 33.0%), and 281 had no pneumococcal growth (56.2%). Among these, 176 (35.2%) had PEP on chest x-ray. Among those with PEP, pneumococcal carriage was documented in 43.8% of cases, and VT serotypes accounted for 10.8%. For children with PEP, we found no association between clinical characteristics and carrying either VT, NVT, or no pneumococcus.ConclusionCarriage of S. pneumoniae remains high among children hospitalized with ARI in Malawi, but children with VT carriage were no more likely to have PEP than children carrying no pneumococcus or those with NVT carriage. There were no differences in clinical characteristics between those carrying VT, NVT, or no pneumococcus.

Children with Pneumonia Caused by <i>Streptococcus pneumoniae</i> Resistance Analysis and Clinical Features

Objective: To analyze the causes of childhood pneumonia Streptococcus pneumoniae resistance and clinical characteristics, and provide a basis for better and timely clinical therapy, and medication to reduce blindness. Methods: MIC method in our hospital 114 under 2020 pediatric pneumococcal respiratory infection in children with lower respiratory tract specimens were isolated antimicrobial susceptibility testing, and analyzed retrospectively. Results: 84 male children, 30 female children, the largest of which 9 years old, the youngest two months, infants less than 1 year old, 90 people; suffering from bronchial pneumonia, 90 cases, 21 cases of pneumonia, wheezing, 3 cases of bronchitis, the average length of stay for about a week; improved in 79 cases, 33 cases were cured, 2 cases transferred to higher level hospitals. All children with throat congestion, swollen tonsils, lung breath sounds rough, smell and moist rales. 114 penicillin-resistant streptococcus pneumoniae was 64.9%, erythromycin 97.4%, clindamycin 86.8%, tetracycline 87.7%, trimethoprim-sulfamethoxazole 82.5%, amoxicillin 21.9%, cefotaxime 49.1%, chloramphenicol 10.5%, was not found to levofloxacin and vancomycin. Conclusion: Penicillin, erythromycin, and clindamycin are not as pneumococcal pneumonia in children experience preferred medication in children less than one year old child could easily cause lung chain streptococcus pneumonia. Therefore, the antimicrobial resistance of Streptococcus pneumoniae analysis provides a reference for experienced clinicians to adjust medication.

1176. Experience with PCV10 Implementation in Colombia and More Severe Course of Pneumococcal Pneumonia in children: A Multicenter Study, 2008 – 2019 (Neumocolombia Network)

BackgroundPneumococcal conjugate vaccines (PCV) have decreased pneumonia in children. Colombia introduced massive vaccination with PCV10 in 2012.MethodsPneumococcal pneumonia cases from 10 hospitals part of an active surveillance network for invasive pneumococcal disease were included. Two periods were compared, pre-PCV10: 2008-2012 and post-PCV10: 2014-2019. The objective was to compare characteristics and outcomes before and after PCV10.Results370 cases were included. Serotype 1(15, 11.2%) and 14 (33, 24.6%) were the most frequent in Pre-PCV10, with only 4(3%) 19A and 1(0.7%) serotype 3. Post-PCV10, serotype 1 decreased to 6(3.1%), 14 to 15(7.8%), while 19A increased to 58(30.2%), serotype 3 to 32(16.7%) and 6A to 7(3.6%) (p = < 0.001), (Graph 1). Complicated pneumonia (CN) also increased (13.4% to 31,8%) (p< 0,001). Pre-PVC10, 44% of CN were due to PCV10 serotypes; with no PCV13 serotypes cases. Post-vaccine period, PCV10 explained only 8.2% and PCV13 60.6%(p < 0.001) of CN. Comparing PICU requirement among predominant serotypes on each period; 23.5% of serotypes 14 and 27.2% of serotypes 1 were admitted, while 59.4% of serotypes 3, 56.9 % of 19A and 42.8% of 6A required PICU. The median of hospitalization increased from 8(5.5-15) to 12 (7-22) days (p < 0.001), as well as the frequency of PICU, 32.8% to 51.6 %, (p = 0.001). Penicillin prescription was similar (17.2% -15.7%), with decrease in ampicillin use (28.4% - 3.6%) and increase ampicillin-sulbactam (0.7% to 24%), and ceftriaxone / clindamycin (0.7% to 5.7%) in post-PCV10. The duration of empirical antibiotic treatment was 7(4-11) and increased to 10(6-17) (p = < 0.001). Lethality showed a slight, non-significant increase between periods 7.5% vs. 9.9% (p = 0.57). (Table1)Graph 1. Serotype distribution 2008 - 2019 Year 2012, PCV10 introduced 2 + 1 schedule.Table 1. Outcomes in the Pre-PCV10 and Post-PCV10 Period ConclusionPCV10 significantly decreased vaccine serotypes, with increase in PCV13 serotypes. 19A, 3 and 6A the predominant serotypes had greater severity including PICU admission, CN and more resistance, with an increase in the use of broad-spectrum antibiotics and longer hospitalization. The current data support national and regional evidence on the importance of replacing PCV10 to a higher valence that include 19A, as PCV13, with the aim of reducing the circulation, particularly of this serotype. Disclosures Ivan Felipe Gutiérrez Tobar, n/a, Pfizer and MSD (Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer)Pfizer and MSD (Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Cristina Mariño Drews, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Sandra Beltran, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Aura Lucia Leal Castro, MD, Pfizer and MSD (Research Grant or Support, Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Aura Lucia Leal Castro, n/a, Pfizer and MSD (Research Grant or Support, Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Jaime alberto Patiño-Niño, n/a, Pfizer (Research Grant or Support, Speaker’s Bureau, Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Martha Isabel Alvarez-Olmos, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Rocio Barrero Barreto, n/a, Pfizer and MSD (Other Financial or Material Support, Has received support from Pfizer and MSD for participation in congresses and has received conference payments from Pfizer) Fabio Espinosa, n/a, MSD (Research Grant or Support, Other Financial or Material Support, Has received support from MSD for other research.) Nicolas Ramos, n/a, Pfizer (Other Financial or Material Support, Has received support from Pfizer for participation in congresses) Vivian Marcela Moreno Mejia, n/a, Pfizer (Research Grant or Support)

1480. Incidence of Non-Invasive Pneumococcal Pneumonia in Children in the United States before and after Introduction Pneumococcal Conjugate Vaccines (PCV7 and PCV13) during 1998-2018

BackgroundPneumonia causes significant pediatric morbidity, mortality, and healthcare resource utilization. S. pneumoniae is a leading cause of bacterial pneumonia in children. Merck is developing V114, an investigational 15-valent PCV that contains PCV13 serotypes as well as 22F and 33F. To demonstrate the potential value of V114, it is important to estimate the remaining burden associated with pneumococcal pneumonia (PP). This study was to estimate incidence rates (IRs) of non-invasive PP before and after PCV7 and PCV13 introduction in children in the US.MethodsPP-related claims in children < 18 years were identified in the IBM MarketScan® Commercial database (1998-2018) using pneumococcal specific ICD9/10 codes. Claims with any invasive pneumococcal disease ICD9/10 codes were excluded. An episode could comprise one or more claims. Episodes with any inpatient stays were categorized as inpatient, and as outpatient otherwise. Age-stratified (< 2, 2-4, and 5-17 years) IRs were episodes per 100,000 patient-years (PYs) during the pre-PCV7 (1998-1999), early and late PCV7 (2001-2005, 2006-2009), and early and late PCV13 (2011-2013, 2014-2018) periods.ResultsInpatient and outpatient PP IRs decreased steadily in children < 2 years (146.8, 117.9, 102.0, 67.8, and 32.2 per 100,000 PYs for pre-PCV7, early and late PCV7, and early and late PCV13 periods, respectively; Figure 1). In children 2-4 years, IRs increased slightly from 88.6 to 90.0 per 100,000 PYs from the pre-PCV7 to early PCV7 period, then declined to 83.9 and 30.8 per 100,000 PYs in the late PCV7 and late PCV13 periods, respectively (Figure 2). In children 5-17 years, IRs declined from 35.3 to 34.2 per 100,000 PYs from the pre-PCV7 to early PCV7 period, stabilized at 34.1 per 100,000 PYs in the late PCV7 period, followed by a steeper decline to 12.5 per 100,000 PYs in the late PCV13 period (Figure 3). The majority of episodes were outpatient in all three age groups.Figure 1. Non-invasive pneumococcal pneumonia incidence in children <2 years, episodes per 100,000 patient-years (1998 - 2018) Figure 2. Non-invasive pneumococcal pneumonia incidence in children 2 - 4 years, episodes per 100,000 patient-years (1998 - 2018) Figure 3. Non-invasive pneumococcal pneumonia incidence in children 5 - 17 years, episodes per 100,000 patient-years (1998 - 2018) ConclusionIn children < 2 years, IRs of non-invasive PP decreased after introduction of PCV7 and PCV13. Following introduction of PCV 7 and PCV13, there remains a residual burden of non-invasive PP in children in the US. The impact of future PCVs on PP will depend on the proportion of PP caused by S. pneumoniae and vaccine-type serotypes.DisclosuresTianyan Hu, PhD, Merck (Employee, Shareholder) Yan Song, PhD, Merck (Consultant) Nicolae Done, PhD, Merck & Co., Inc. (Consultant) Qing liu, PhD, Merck (Consultant) James Signorovitch, PhD, Merck & Co., Inc. (Consultant) Tanaz Petigara, PhD, Merck & Co., Inc. (Employee, Shareholder)

Assessment of an Antibody-in-Lymphocyte Supernatant Assay for the Etiological Diagnosis of Pneumococcal Pneumonia in Children.

New diagnostic tests for the etiology of childhood pneumonia are needed. We evaluated the antibody-in-lymphocyte supernatant (ALS) assay to detect immunoglobulin (Ig) G secretion from ex vivo peripheral blood mononuclear cell (PBMC) culture, as a potential diagnostic test for pneumococcal pneumonia. We enrolled 348 children with pneumonia admitted to Patan Hospital, Kathmandu, Nepal between December 2015 and September 2016. PBMCs sampled from participants were incubated for 48 h before harvesting of cell culture supernatant (ALS). We used a fluorescence-based multiplexed immunoassay to measure the concentration of IgG in ALS against five conserved pneumococcal protein antigens. Of children with pneumonia, 68 had a confirmed etiological diagnosis: 12 children had pneumococcal pneumonia (defined as blood or pleural fluid culture-confirmed; or plasma CRP concentration ≥60 mg/l and nasopharyngeal carriage of serotype 1 pneumococci), and 56 children had non-pneumococcal pneumonia. Children with non-pneumococcal pneumonia had either a bacterial pathogen isolated from blood (six children); or C-reactive protein <60 mg/l, absence of radiographic consolidation and detection of a pathogenic virus by multiplex PCR (respiratory syncytial virus, influenza viruses, or parainfluenza viruses; 23 children). Concentrations of ALS IgG to all five pneumococcal proteins were significantly higher in children with pneumococcal pneumonia than in children with non-pneumococcal pneumonia. The concentration of IgG in ALS to the best-performing antigen discriminated between children with pneumococcal and non-pneumococcal pneumonia with a sensitivity of 1.0 (95% CI 0.73–1.0), specificity of 0.66 (95% CI 0.52–0.78) and area under the receiver-operating characteristic curve (AUROCC) 0.85 (95% CI 0.75–0.94). Children with pneumococcal pneumonia were older than children with non-pneumococcal pneumonia (median 5.6 and 2.0 years, respectively, p < 0.001). When the analysis was limited to children ≥2 years of age, assay of IgG ALS to pneumococcal proteins was unable to discriminate between children with pneumococcal pneumonia and non-pneumococcal pneumonia (AUROCC 0.67, 95% CI 0.47–0.88). This method detected spontaneous secretion of IgG to pneumococcal protein antigens from cultured PBMCs. However, when stratified by age group, assay of IgG in ALS to pneumococcal proteins showed limited utility as a test to discriminate between pneumococcal and non-pneumococcal pneumonia in children.

Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network.

Following the introduction of 7-valent pneumococcal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumococcal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, parapneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015. Three-hundred seventy-one children were included. Subjects had a median age of four years, and 188/370 (50.8%) required a chest tube. Admission rates changed markedly during this time period. The number of admissions per year rose most sharply between 2009 and 2012, corresponding to the period following introduction of PCV7 and then the occurrence of pandemic influenza A (H1N1). In children who likely received PCV13, the incidence of PCOMP returned to approximately pre-PCV7 levels. In contrast, rates of PCOMP in older children (who would not have received PCV13) remained elevated during the post-PCV13 time period. While rates of PCOMP, particularly in older children, remain elevated following the introduction of PCV13, this might be expected to resolve with more widespread vaccine coverage with PCV13 and herd immunity.

A Pneumococcal Protein Array as a Platform to Discover Serodiagnostic Antigens Against Infection

Pneumonia is one of the most common and severe diseases associated with Streptococcus pneumoniae infections in children and adults. Etiological diagnosis of pneumococcal pneumonia in children is generally challenging because of limitations of diagnostic tests and interference with nasopharyngeal colonizing strains. Serological assays have recently gained interest to overcome some problems found with current diagnostic tests in pediatric pneumococcal pneumonia. To provide insight into this field, we have developed a protein array to screen the antibody response to many antigens simultaneously. Proteins were selected by experimental identification from a collection of 24 highly prevalent pediatric clinical isolates in Spain, using a proteomics approach consisting of "shaving" the cell surface with proteases and further LC/MS/MS analysis. Ninety-five proteins were recombinantly produced and printed on an array. We probed it with a collection of sera from children with pneumococcal pneumonia. From the set of the most seroprevalent antigens, we obtained a clear discriminant response for a group of three proteins (PblB, PulA, and PrtA) in children under 4 years old. We validated the results by ELISA and an immunostrip assay showed the translation to easy-to-use, affordable tests. Thus, the protein array here developed presents a tool for broad use in serodiagnostics.

Proteomics-driven design of a multiplex bead-based platform to assess natural IgG antibodies to pneumococcal protein antigens in children

Pneumococcal surface proteins are potential candidates for the development of protein-based vaccines and serological assays. The objective of the study was to develop a multiple bead-based immunoassay using Luminex xMAP® technology for the quantitation of natural antibodies against Streptococcus pneumoniae proteins and the characterization of the acute serum response following pneumococcal pneumonia in children. Sixty-four recombinantly produced pneumococcal proteins, which were selected based on their proteomic experimental identification by “shaving” live cells with trypsin followed by LC/MS/MS analysis, were coupled to fluorescent SeroMAP® beads and anti-pneumococcal specific IgG levels were determined in sera. Multiplex assay was validated through comparison of IgG levels to 14 randomly chosen pneumococcal antigens by using multiplex and singleplex assays. Acute serum IgG levels against RrgB were significantly lower in children ≤4years old with pneumococcal pneumonia than those in controls. In addition, there was a small trend toward slightly lower antibody levels for PrsA, RrgC and RrgB in pneumonia patients of the all age group.

Empyema and bacteremic pneumococcal pneumonia in children under five years of age

We compared bacteremic pneumococcal pneumonia (BPP) and pneumococcal empyema (PE), in terms of clinical, radiological, and laboratory findings, in under-fives. A cross-sectional nested cohort study, involving under-fives (102 with PE and 128 with BPP), was conducted at 12 centers in Argentina, Brazil, and the Dominican Republic. Among those with PE, mean age was higher; disease duration was longer; and tachypnea, dyspnea, and high leukocyte counts were more common. Among those with BPP, fever and lethargy were more common. It seems that children with PE can be distinguished from those with BPP on the basis of clinical and laboratory findings. Because both conditions are associated with high rates of morbidity and mortality, prompt diagnosis is crucial.

Cost of hospitalizing children with invasive pneumococcal pneumonia

BackgroundAlthough invasive pneumococcal pneumonia remains responsible for a significant number of child hospitalizations, specific data on hospital resource utilization and related costs are limited. ObjectivesTo assess the cost of hospitalizing children with invasive pneumococcal pneumonia and identify the cost determinants of the disease. Patients and methodsEconomic evaluation based on an observational study of all children <18 years of age with culture-proved invasive pneumococcal pneumonia admitted to a referral hospital in Barcelona (Spain) during the period January 2001–December 2011. Analysis included demographic, microbiological, epidemiological and clinical variables. ResultsA total of 135 children were included in the study (median age 3.3 years). PCV13 serotypes were detected in 132 (97.8%) cases. Median hospital cost was €4533 (€4078–5435, 95% CI). Median length of stay was 11.0 days (10.6–13.0 days, 95% CI). Variables significantly associated with increased cost in the multivariate analysis were complicated pneumonia (≥2 and 1 complication) versus non-complicated pneumonia (€4919 and €2822 vs. €1399), performance of surgery versus no surgery (€4849 vs. €1435), intensive care versus no intensive care (€6488 vs. €3862) and identification of non-PCV7 serotypes versus PCV7 serotypes (€4656 vs. €1470). ConclusionInvasive pneumococcal pneumonia in children makes substantial demands on hospital health care and financial resources that could be mitigated with universal PCV13 childhood immunization programmes and early management of complications.

Reply to: “The application of urinary antigen test score in pneumococcal pneumonia in children”

Reply to: “The application of urinary antigen test score in pneumococcal pneumonia in children”

Thoracoscopic pericardiotomy for management of purulent pneumococcal pericarditis in a child

Purulent pericarditis is an extremely rare complication of pneumococcal pneumonia in children that may result in to cardiac tamponade. While image-guided pericardiocentesis is the treatment of choice for such a condition, it may fail in the presence of thick pus; loculations and thoracoscopic pericardiotomy are useful procedures for such situations. Herein, we report such a case involving a 6-year-old boy who presented with purulent pneumococcal pericarditis that was managed with thoracoscopic pericardiotomy and who recovered well. Thoracoscopic pericardiotomy is a safe procedure that allows effective drainage under vision, pericardial biopsy for diagnosis, and a simultaneous opportunity to perform thoracoscopic pleural drainage.

Complicated pneumococcal pneumonia in children at a university hospital in São Paulo (Brazil)

Physical examination, laboratory studies, radiographic data (including chest CT scan), abdominal ultrasound, diagnostic thoracentesis established the diagnostic: 1. S. pneumoniae: Pneumonia of the RUL and RLL, complicated with pleural empyema. 2. D-Hemolytic Uremic Syndrome (HUS) (mediated by neuraminidases) 3. Hypocomplement C3, C4. Differential diagnostic was difficult: sepsis with pleural pulmonary and renal determination, parenchymal malformations were discussed. The treatment included: fluid therapy with monitor electrolyte and hydration status, platelets transfusion, packed RBC, IV immunoglobulines, albumin replacement, plasma infusion, diuretics and IV antibiotics (doses adjusted for glomerular clearance) for 7 weeks: meropenem, ertapenem, zyvoxid, ciprofloxacin, clindamycin. She didn’t need dialysis, or mechanical ventilation. Pulmonary outcome was good, with total recovery; after 3 months chest CT was normal. Renal outcome was good, with no recurrence. We discuss the severity of lung damage with a lot of pneumatoceles, but without pneumothorax or chronic empyema – that progressively resolved with antibiotic therapy in a child of 2 years that was vaccinated. It is the first case in our experience that associates HUS. We couldn’t explain this evolution on a genetic deficiency of the immune system (normal IgG, IgM, IgA, normal MBL), except complement C3, C4 decreased during the acute episode. We couldn’t determine the pneumococcal serotype, but it is possible to be 19A, the most frequent serotype that determine empyema or SHU, according to the studies from North America and Australia, serotype that is not present in 10 valent vaccine.

Contribution of vaccines to our understanding of pneumococcal disease

Pneumonia is the leading cause of mortality in children in developing countries and is also the leading infectious cause of death in adults. The most important cause of pneumonia is the Gram-positive bacterial pathogen, Streptococcus pneumoniae, also known as the pneumococcus. It has thus become the leading vaccine-preventable cause of death and is a successful and diverse human pathogen. The development of conjugate pneumococcal vaccines has made possible the prevention of pneumococcal disease in infants, but has also elucidated aspects of pneumococcal biology in a number of ways. Use of the vaccine as a probe has increased our understanding of the burden of pneumococcal disease in children globally. Vaccination has also elucidated the clinical spectrum of vaccine-preventable pneumococcal infections; the identification of a biological niche for multiple pneumococcal serotypes in carriage and the differential invasiveness of pneumococcal serotypes; the impact of pneumococcal transmission among children on disease burden in adults; the role of carriage as a precursor to pneumonia; the plasticity of a naturally transformable pathogen to respond to selective pressure through capsular switching and the accumulation of antibiotic-resistance determinants; and the role of pneumococcal infections in hospitalization and mortality associated with respiratory viral infections, including both seasonal and pandemic influenza. Finally, there has been a recent demonstration that pneumococcal pneumonia in children may be an important cause of hospitalization for those with underlying tuberculosis.

A new urinary antigen test score correlates with severity of pneumococcal pneumonia in children

Streptococcus pneumoniae is the most common bacterial cause of community-acquired pneumonia in children. This study was designed to determine whether a newly designed urinary antigen test score correlated with severity of pneumococcal pneumonia in children. We recruited 119 children hospitalized with pneumonia diagnosed by positive urinary pneumococcal antigen test at the National Cheng Kung University Hospital from 2002 through 2007. The urinary antigen reactivity score was determined by the rate of the reaction time and intensity of the pneumococcal antigen-antibody band. The children were stratified into three groups according to total score: group I, 8; group II, 5-7; and group III, 2-4. Disease severity was based on clinical presentation and radiological and laboratory findings. Patients in group I had significantly more respiratory distress (p=0.01), oxygen desaturation (p=0.04), febrile days (p=0.03), pulmonary complications (p=0.01), and bacteremia (p=0.01), greater requirement for intensive care (p=0.004), longer hospital stays (p<0.001), and lower white blood cell counts (p=0.01) than patients in group II or III. A new urinary pneumococcal antigen test score correlated well with the severity of pneumococcal pneumonia in children. It might provide helpful diagnostic and prognostic information.

Community‐Acquired Bacteremic Pneumococcal Pneumonia in Children: Diagnosis and Serotyping by Real‐Time Polymerase Chain Reaction Using Blood Samples

The aim of this study was to use real-time polymerase chain reaction (RT-PCR) on blood samples to diagnose and serotype pneumococcal infection in a large cohort of Italian children hospitalized for community-acquired pneumonia. We conducted an observational study from April 2007 through June 2009 of children aged 0-16 years with a diagnosis of community-acquired pneumonia admitted to 83 pediatric hospitals in Italy. Seven hundred fifty-three children were studied. RT-PCR found pneumococcal infection in 80 (10.6%) of 753 patients. In 292 patients, culture and RT-PCR were simultaneously performed. Streptococcus pneumoniae was identified in 47 of 292 patients; 45 (15.4%) tested positive by RT-PCR and 11 (3.8%) tested positive by culture. RT-PCR was significantly more sensitive than culture in revealing bacteremic pneumonia (odds ratio, 30.6; 95% confidence interval, 5.8-97.5; P<.001). Complicated pneumonia was found in 162 (21.5%) of 753 children; 152 (93.8%) of these 162 had parapneumonic effusion, and 51 (33.6%) had empyema. Children with complicated pneumonia were significantly older. Pneumococcal bacteremia was found by RT-PCR to occur significantly more frequently in children with complications (38 [23.5%] of 162) than in children with uncomplicated pneumonia (44 [7.4%] of 591; odds ratio, 3.8; 95% confidence interval, 2.30-6.30; P<.001). RT-PCR allowed serotyping from blood in 92.5% of patients. More than two-thirds of the pneumonia cases were due to nonpneumococcal conjugate vaccine 7 serotypes. Serotype 1 was the most frequent serotype (26 [32.5%] of 80) and was significantly associated with complications (50.0% in patients with complicated pneumonia vs 18.2% in patients with uncomplicated pneumonia; odds ratio, 4.5, 95% confidence interval, 1.48-14.03; P=.005) and older age. Serotype 19A was second in frequency (15.0%) and was significantly associated with younger age. RT-PCR allows diagnosis and serotyping of pneumococcal bacteremic community-acquired pneumonia in children and is an important tool for evaluating serotype distribution in culture-negative samples.

Pneumococcal conjugate vaccines in the prevention of childhood pneumonia

Lower respiratory tract infections are among the most important causes of childhood mortality worldwide, more than 2 million children die due to pneumonia every year. A number of infections caused by the main pathogens related to pneumonia can be prevented through vaccination ( S. pneumoniae, H. influenzae type-b, morbilli, pertussis, influenza). In the last decade, after the introduction of the 7-valent pneumococcal conjugated vaccine (PCV), the epidemiological background of childhood pneumonia has changed. Recently, several studies have been performed to collect data and evidences about the efficacy of PCV against noninvasive pneumococcal diseases (e.g. pneumonia, otitis media). These investigations showed 10-50% decrease of all pneumonia cases, 10-30% decrease of radiologically diagnosed pneumonia, and 50-70% decrease of the incidence of pneumococcal pneumonia in children. The aim of this review was to determine the role of the PCV in the prevention of childhood pneumonia according to the medical literature, and to summarize the efforts of global organizations (WHO, UNICEF, GAVI) in the fight against pneumonia in children.

Bilateral postpneumococcal pneumatoceles in a one year 7 month old boy: case report and review of literature

We report on a one year and 7 months old boy who presented clinically with ascending pneumococcal pneumonia. He was successfully treated with beta-lactam antibiotics. On the control chest radiogram two bilateral pneumatoceles were seen during the resolution of pneumococcal pneumonia. The bilateral cystic lesions seen on the control chest X-ray prompted us to present our case as interesting, as well as to review the literature on this issue. However, there is no previous report of bilateral pneumatocele as an isolated complication, without any signs of empyema and/or effusion in pneumococcal pneumonia in children.

Necrotizing pneumococcal pneumonia in children: The role of pulmonary gangrene

Little is known about the mechanism of necrotizing pneumonia caused by Streptococcus pneumoniae in children. Pulmonary gangrene secondary to vascular thrombosis was reported in adults with necrotizing pneumococcal pneumonia. We conducted a retrospective study of 15 children with a diagnosis of necrotizing pneumococcal pneumonia at National Taiwan University Hospital to explore its association with pulmonary gangrene, based on evidence from chest computed tomography, serial chest radiographic patterns, and pathologic results. S. pneumoniae serotype 14 was the prevalent pneumococcal serotype. Overall, 63.6% of isolates were not susceptible to penicillin. One child with pneumonia caused by S. pneumoniae serotype 3 complicated by hemolytic uremic syndrome had a rapidly fatal course. An autopsy in this patient documented lung necrosis and pulmonary gangrene. Radiographic follow-up was performed during the clinical course in 9 patients, and showed no evidence of pulmonary gangrene. Four children had no radiographic follow-up. The relationship between pulmonary gangrene and necrotizing pneumonia was unclear in the remaining one. In conclusion, necrotizing pneumococcal pneumonia may be infrequently associated with pulmonary gangrene in children.

Review of antibiotic resistance, antibiotic treatment and prevention of pneumococcal pneumonia.

Streptococcus pneumoniae is one of the most common pathogens causing lower respiratory and other serious invasive infections in children. Over the past 15 years antibiotic resistance among pneumococcal isolates has continued to increase and clearly has impacted the management of pneumococcal infections. In this review the frequency and mechanisms by which S. pneumoniae evade the actions of antibiotics, the antimicrobial approach to treating pneumococcal pneumonia in children in the era of antibiotic resistance and strategies to prevent invasive pneumococcal infections are discussed.