Pneumococcemia in children – a retrospective study before universal pneumococcal vaccinations

Abstract

Aim. To evaluate the incidence and characteristics of blood culture-positive occult pneumococcemia compared with blood culture-positive pneumococcal pneumonia in children.Methods. In years [2001][2002][2003][2004][2005][2006][2007][2008][2009][2010] 105 children with positive blood cultures for Streptococcus pneumoniae were identified from hospital electronic files. The patient cards were retrospectively charted for clinical and laboratory data, and 38 patients had and 67 had not penumonia.Results. The annual incidence of pneumococcemia was, on average, 29.0/10,000 at 0-12 months, 5.3/10,000 at 13-24 months and 1.9/10,000 at 2-4 years of ages, with no increasing or decreasing trend. The incidence of bacteremic pneumococcal pneumonia increased (p=0.022) during the study period. The duration of fever before hospitalization (<24 hours 73.9% vs. 25.0%, p=0.022) and the duration of intravenous antibiotics, usually G-penicillin (median 72 vs. 96 hours, p=0.021) was shorter in pneumococcemia patients. On admission, blood leukocyte count was higher in pneumococcemia (mean 26.6 vs. 21.9 x10E9/L, p=0.012), but serum CRP was higher in pneumonia (median 160 vs. 67.4 mg/L, p<0.001). The serotypes 6B and 14 caused 53.2% of pneumococcemia cases. Conclusion.The incidence of pneumococcemia was highest in 1-to-2-year-old children, and typical for pneumococcemia was rapid onset of fever, high blood leukocyte count and a modestly elevated CRP on admission.Key notes. The incidence of pneumococcemia was highest in 1-2 years old children, with no increasing trend during the study period. Instead, the incidence of bacteremic pneumococcal pneumonia increased significantly. Currently available 7-valent, 10-valent and 13-valent vaccines would have covered 77.4%, 82.3% and 90.3% of pneumococcemia cases, respectively.

Pneumococcal vaccinations effectively prevent blood culture‐negative infections that resemble occult pneumococcal bacteraemia or bacteraemic pneumococcal pneumonia at one to 36 months of age

“…The vast majority of patients were treated with intravenous penicillin, and in most cases, the response was excellent, as is the case in blood culture-positive pneumococcaemia (1,13). Nearly all patients recovered within 48 hours of starting of intravenous penicillin and the duration of both intravenous antibiotics and hospitalisation were less than two days, as also seen in noncomplicated bacterial pneumonia (29).…”

“…In our previous retrospective population‐based study covering the years 2001–2010, all children hospitalised for blood culture‐positive pneumococcaemia were less than six years old . The mean blood leucocyte count was 26.6 × 10E9/L (SD 8.3).…”

“…The mean blood leucocyte count was 26.6 × 10E9/L (SD 8.3). The highest age‐specific incidence of pneumococcaemia was 5.3/10 000 at 13–24 months of age . Universal pneumococcal vaccinations of Finnish infants were started with 10‐valent vaccine in 2010.…”

Langerhans cell histiocytosis in children – a disease with many faces. Recent advances in pathogenesis, diagnostic examinations and treatment

“…Skin lesions are the second most-common clinical manifestation of LCH (30–60%) [ 17 , 33 ], which is particularly frequent in infants [ 17 ] and the most common presentation of “non-self-regressive” cutaneous LCH in neonates and young infants [ 45 ]. However, an isolated cutaneous form of the disease is rare (the number of described cases does not exceed 12% of all patients with LCH), typically concerns only male infants and has a good prognosis [ 12 , 46 ]. However, both patients born with skin-only LCH and patients who develop skin-only LCH during infancy can have a “self-healing” disease with spontaneous regression or may progress to MS-LCH with a worse prognosis [ 47 ].…”

“…On the other hand, a maculopapular desquamative rash, which is located mainly within the scalp, retroauricular, inguinal or axillary area, can also appear in older children. Among other lesions occurring in the course of the disease, nodules and petechiae should be listed [ 46 ]. Sometimes there are superficial ulcerations of the lesions accompanied by oozing as the result of secondary processes leading to a bacterial superinfection.…”