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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

Insights

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.
  • 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.
Abstract

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