Invasive pneumococcal disease in Costa Rican children: a seven year survey

Area of Science:

• Pediatrics
• Infectious Diseases
• Microbiology

Background:

• Streptococcus pneumoniae causes significant invasive bacterial disease globally in children.
• Latin American infants face high morbidity and mortality from invasive pneumococcal disease (IPD).
• The current IPD situation in Central American children remains largely uncharacterized.

Purpose of the Study:

• To assess the epidemiology and clinical characteristics of invasive pneumococcal disease (IPD) in children in Costa Rica.
• To determine the outcomes, including complications, sequelae, and mortality rates, associated with IPD in this population.
• To evaluate antimicrobial susceptibility patterns of invasive pneumococcal isolates.

Main Methods:

• A retrospective review of 135 IPD cases in 132 pediatric patients treated at a national hospital in Costa Rica from January 1995 to December 2001.
• Analysis of patient demographics, clinical presentations, underlying medical conditions, and treatment outcomes.
• Microbiological data on antimicrobial susceptibility, specifically for penicillin and cefotaxime, were examined.

Main Results:

• The majority of IPD episodes (73.3%) occurred in children under 5 years, with 56% in those under 24 months.
• Meningitis was the most frequent presentation (41.5%), followed by pneumonia (26.7%) and bacteremia (22.2%).
• The overall case fatality rate was 14.4%, with younger children (<2 years) experiencing higher complication and mortality rates. Non-susceptibility to penicillin was 14.3% and to cefotaxime was 4.5%.

Conclusions:

• Invasive pneumococcal disease (IPD) in Costa Rican children is linked to substantial morbidity and mortality, particularly in young infants.
• The prevalent IPD serotypes appear similar to those seen in developed nations before widespread conjugate vaccine use.
• Low rates of penicillin and third-generation cephalosporin resistance were observed in invasive isolates.