Clinical Profile of Invasive Pneumococcal Disease in Patan Hospital, Nepal

Abstract

Background Pneumococcal infection is one of the leading causes of pneumonia, meningitis and septicemia in developing countries. It accounts for one million deaths each year in children. Objectives The objective of this study is to see the clinical profile of invasive pneumococcal disease, antibiotics sensitivity pattern and prevalent serotypes in children admitted at Patan Hospital. Methods This is a retrospective analytical study conducted in the department of Paediatrics, Patan hospital. The lab data of those children who grew pneumococci in their blood, cerebrospinal fluid or body fluids over a period of 3 years (January 2007 to Dec 2009) were collected and the case files were then studied. Results Out of 42 cases of invasive pneumococcal diseases studied admitted diagnoses included pneumonia, febrile seizure, bacteremia or septicemia, meningitis, acute gastroenteritis and glomerulonephritis. Twenty seven of them were children under five. The male to female ratio was 1.7:1. On investigation 64%, 52% and 5% of the patients had leucocytosis, anaemia, and leucopenia respectively. Twenty six of them had radiological changes suggestive of pneumonia. Streptococcus pneumoniae grew in 38 blood samples, 5 cerebrospinal fluid and 3 pleural fluids. Almost all of these isolates were sensitive to penicillin, cefotaxime, amoxycillin, choloramphenicol, erythromycin and ofloxacin and resistant to cotrimoxazole and gentamicin.Pneumococcal serotypes found in our study were 1, 14, 5, 23B, 6B, 8, 9A, 9V, 10A, 15 and 23F (11 serotypes). ConclusionsPenicillin is still the most effective antibiotic for streptococcal infection in our study. Of the pneumococcal serotypes identified; 36% were covered by the 7-valent pneumococcal conjugate vaccine, 54% each by PCV-10 and PCV-13, and 72% by the e 23 valent vaccines.http://dx.doi.org/10.3126/kumj.v9i1.6262 Kathmandu Univ Med J 2011;9(1):45-9

Radiographically Confirmed Community-Acquired Pneumonia in Pediatric Patients Prior to Pneumococcal Vaccination in Nepal

“…Other Nepalese studies have also demonstrated the effectiveness of penicillin in pneumococcal infections. 6,7 The National Committee on Immunization Practice (NCIP) of Nepal recommends three doses of PCV 10 vaccine containing serotypes 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F, at 6 and 10 weeks and then at 9 months, based on prevalence and serologic test results. 12 A 2014 systematic review supported the three-dose schedules recommended by the WHO and found it to be effective in reducing clinical as well as radiologically confirmed pneumonia.…”

“…3,4 The few previous studies of pneumonia in Nepal have focused on description of the antibiotic sensitivity patterns and serotypes of pneumococci in tertiary care centers within the capital city. [5][6][7] Research on community-acquired pneumonia (CAP) in other regions of the country is lacking. Pneumococcal conjugate vaccination (PCV) has demonstrated efficacy against various serotypes of Streptococcus pneumoniae and is now part of routine immunization schedule in many countries.…”

Antibiotic Use and Treatment Outcomes among Children with Community-Acquired Pneumonia Admitted to a Tertiary Care Public Hospital in Nepal

“…In Nepal, pneumonia accounted for 10% of all childhood acute respiratory infections (ARI) in 2017 with an annual incidence of 66 cases per 1000 under-five children [ 4 ]. Previous studies from tertiary care settings in Nepal show that most of the pneumonia in under-five children were viral in origin and those with bacterial etiology were sensitive to the penicillin group of antibiotics [ 5 , 6 ].…”

Persistence of Immunity Following 2-Dose Priming with a 10-Valent Pneumococcal Conjugate Vaccine at 6 and 10 Weeks or 6 and 14 Weeks of Age in Nepalese Toddlers

“…[3][4][5] Long-term surveillance of invasive pneumococcal disease (IPD) at Patan Hospital, Nepal has shown pneumococcal serotypes 1, 5 and 14 to be the cause of the majority of IPD. 6 All of these serotypes are covered by available PCVs. 7,8 The incidence of childhood pneumococcal pneumonia is high up to the age of 5 years.…”