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[Clinical study of 33 children with systemic pneumococcal infections]
1Department of Pediatrics, Yokohama Sakae Kyosai Hospital.
Insights
Systemic pneumococcal infections in children, including bacteremia and meningitis, were analyzed. Early antibiotic intervention for pneumococcal bacteremia is suggested due to the severe outcomes of meningitis.
Area of Science:
- Pediatric Infectious Diseases
- Bacterial Pathogenesis
- Clinical Microbiology
Context:
- Retrospective analysis of 33 pediatric cases (bacteremia and meningitis) of Streptococcus pneumoniae infections treated between 1985-1999.
- Incidence peaked in infants aged 7-24 months, with meningitis occurring in younger children compared to bacteremia.
- Two cases presented with low serum IgG2 levels, suggesting potential immune deficiencies.
Purpose:
- To analyze clinical characteristics, diagnostic timelines, and outcomes of pediatric pneumococcal bacteremia and meningitis.
- To investigate potential differences in presentation and laboratory findings between bacteremia and meningitis.
- To evaluate the impact of early diagnosis and treatment on patient outcomes.
Summary:
- Fever and convulsions were common symptoms. Meningitis cases showed delayed diagnosis (>12 hours post-fever onset), lower white blood cell counts, and higher C-reactive protein levels compared to bacteremia.
- Bacteremia cases had favorable outcomes with antibiotic treatment, while meningitis resulted in significant mortality (27.3%) and severe neurological sequelae (36.4%).
- Findings support the hypothesis that meningitis develops from bacteremia, underscoring the need for prompt antibiotic treatment of pneumococcal bacteremia.
Impact:
- Highlights the critical importance of early diagnosis and intervention for pediatric pneumococcal infections.
- Provides evidence supporting aggressive management of pneumococcal bacteremia to prevent progression to severe meningitis.
- Informs clinical practice regarding the timely administration of antibiotics in young children presenting with symptoms suggestive of pneumococcal infection.
Abstract:
We retrospectively analyzed 33 cases of children with systemic pneumococcal infections, 22 bacteremia and 11 meningitis, diagnosed and treated in Asahi General Hospital between 1985 and 1999. The median age at diagnosis was 15 months old and the incidence peaked in infants between 7 and 24 months of age (57.6%). Two cases showed low serum IgG2 levels. Fever was a common symptom in all cases and 13 (39.4%) presented convulsions. Meningitis [median age: 10 months] tended to occur, if not significant, in younger children than bacteremia [16 months]. All cases of meningitis were diagnosed 12 hours or later after the onset of fever, though 54.5% of the cases of bacteremia were diagnosed within 12 hours. The cases of meningitis showed statistically lower white blood cell counts [median: 9,700/mm3] and higher CRP levels [median: 25.6 mg/dl] than those of bacteremia [23,900/mm3 and 4.2 mg/dl, respectively] at diagnosis. Although all cases of bacteremia were cured without any sequelae by antibiotic treatment, 3 cases (27.3%) of meningitis died and 4 (36.4%) developed severe neurological sequelae. Our findings suggest that the putative pathogenesis by which pneumococcal meningitis results from bacteremia and, taking in the account of the poor outcome of meningitis, may justify the early antibiotic intervention against pneumococcal bacteremia.