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Recurrent systemic pneumococcal disease in children.

Edward O Mason1, Ellen R Wald, Tina Q Tan

  • 1Pediatric Infectious Disease Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA. emason@bcm.edu

The Pediatric Infectious Disease Journal
|May 29, 2007
PubMed
Summary
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Recurrent invasive pneumococcal disease (IPD) in children often indicates underlying conditions. Most recurrent IPD cases are caused by new bacterial strains, not relapses.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Microbiology

Background:

  • Recurrent systemic pneumococcal infection is uncommon, typically affecting immunocompromised individuals or those with pre-existing health issues.
  • Understanding the characteristics and causes of recurrent invasive pneumococcal disease (IPD) is crucial for effective management.

Purpose of the Study:

  • To investigate the incidence, clinical features, and causative agents of recurrent invasive pneumococcal disease (IPD) in a pediatric population.
  • To differentiate between true reinfection and relapse in cases of recurrent IPD.

Main Methods:

  • Prospective identification and retrospective data collection of invasive pneumococcal disease (IPD) cases across 8 pediatric hospitals from 1993 to 2006.
  • Serotyping of Streptococcus pneumoniae isolates and molecular typing using pulse-field gel electrophoresis (PFGE) to determine strain relatedness.

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  • Antibiotic susceptibility testing for penicillin and ceftriaxone.

    • Main Results:

    • Out of 4,067 children diagnosed with IPD, 90 (2.6%) experienced 108 episodes of recurrent disease over 12.3 years.
    • The majority of children with recurrent IPD (approximately 80%) had underlying medical conditions.
    • In 70 episodes, recurrent IPD was caused by a different serotype or genotype (PFGE pattern), suggesting new infections rather than relapses.

    Conclusions:

    • Recurrent invasive pneumococcal disease in children is strongly associated with underlying health conditions.
    • A significant proportion of short-interval recurrent infections (<30 days) were attributed to new strain acquisition.
    • Distinguishing between relapse and reinfection in recurrent IPD necessitates confirming identical serotype and PFGE patterns of the causative pneumococcal isolates.