Recurrent Pneumococcal Bacteremia: 34 Episodes in 15 Patients

Abstract

Thirty-four episodes of pneumococcal bacteremia were identified in 15 patients over 5 years in 10 hospitals in Franklin County, Ohio. Twelve patients each had 2 episodes of pneumococcal bacteremia, 2 had 3, and 1 had 4. All patients had predisposing conditions, with lymphoma, multiple myeloma, and chronic obstructive pulmonary disease being the most frequent. The mean interval between the first and second episode was 268 days. Serotyping and genotyping were performed on 29 isolates. The same serotypic and genotypic patterns were found for sequential isolates from four patients; three of these patients had a recurrence between 22 and 90 days after a previous episode. Seven (24%) of the 29 isolates were serotype 23F; four isolates (14%) were not susceptible to penicillin. All of our patients received appropriate antimicrobial therapy and appeared to be clinically cured of their initial infection. For patients with recurrent pneumococcal disease, alternate preventive measures such as immunization with conjugate pneumococcal vaccine and/or prophylactic antibiotic therapy should be considered.

Changing use of intensive care for hematological patients:

“…These data suggest that NIMV may be protective, although no significant effect on 30-day mortality was found, probably because of the small number of patients treated with this recently introduced technique. Lastly, the main reason for acute respiratory failure in our patients was pneumococcal infection, which was consistently associated with shock, suggesting that prophylactic antipneumococcal therapy deserves consideration in MM patients admitted to ICUs [29,30]. Consistent with earlier studies [10,11], we found that partial or complete remission was associated with a lower 30-day mortality rate.…”

Recurrence of occult pneumococcal bacteremia by an identical strain in an apparently healthy child

“…7 Furthermore, invasive pneumococcal diseases are usually combined with a recognizable focus of infection, 3e6,8e10 and more than 70% of recurrences were due to a different serotype from that in the first episode in each case. 5,7 Thus, to our knowledge, this is the first report describing an immunocompetent child presenting with recurrent occult bacteremia by an identical pneumococcal strain.…”

“…Moreover, the majority of patients with recurrent pneumococcal invasive infections have an apparent focus of infection including pneumonia, meningitis, cellulitis, and otitis media 3e6,8e10 and demonstrated distinct pneumococcal serotypes. 5,7,11 We report an otherwise healthy child, who developed two episodes of occult bacteremia by an identical pneumococcal strain, serotype 6B, approximately 4.5 months apart.…”

Fulminante Streptokokkensepsis als Erstmanifestation eines multiplen Myeloms

“…Einige Fälle schwerer Streptokokkeninfektionen als erster Hinweis eines zugrundeliegenden multiplen Myeloms sind in der Literatur bereits beschrieben [4][5][6]. Uns ist jedoch kein Fall bekannt, bei dem es im Rahmen einer Streptokokkensepsis gelang, gleichzeitig den lichtmikroskopischen Nachweis von Streptokokken im peripheren Blutausstrich wie auch im Knochenmarkausstrich zu führen.…”

“…Insbesondere das Risiko für Infektionen mit Streptococcus pneumoniae ist erhöht [6,7]. Tatsächlich sind Infektionen die überwiegende Todesursache des multiplen Myeloms [8][9][10].…”