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Pneumococcal mastoiditis in children and the emergence of multidrug-resistant serotype 19A isolates

Julina Ongkasuwan1, Tulio A Valdez, Kristina G Hulten

  • 1Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.

Pediatrics
|July 4, 2008
PubMed

Insights

The pneumococcal conjugate vaccine

Area of Science:

  • Pediatric infectious diseases
  • Vaccinology
  • Otolaryngology

Background:

  • Pneumococcal mastoiditis is a serious complication of otitis media in children.
  • The pneumococcal conjugate vaccine (PCV) was introduced to reduce the burden of invasive pneumococcal disease.
  • Serotype 19A has emerged as a significant pathogen in invasive pneumococcal disease following PCV introduction.

Purpose of the Study:

  • To evaluate the impact of the pneumococcal conjugate vaccine on pneumococcal mastoiditis in children.
  • To identify changes in serotype prevalence and clinical characteristics of pneumococcal mastoiditis post-vaccine introduction.

Main Methods:

  • Retrospective review of medical charts of children with pneumococcal mastoiditis from 1995 to 2007.
  • Serotyping of pneumococcal isolates using the capsular swelling method.
  • Pulsed-field gel electrophoresis and multilocus sequence typing for characterizing 19A isolates.

Main Results:

  • Serotype 19A became the predominant cause of pneumococcal mastoiditis after PCV introduction.
  • Cases caused by 19A were more likely to present with subperiosteal abscess and require mastoidectomy.
  • Multidrug resistance was common in 19A isolates, associated with clonal complex 271.

Conclusions:

  • Serotype 19A, particularly multidrug-resistant strains of clonal complex 271, has emerged as a leading cause of pneumococcal mastoiditis in children.
  • Pneumococcal mastoiditis due to 19A is associated with more severe clinical presentations, including subperiosteal abscesses and increased need for mastoidectomy.
Abstract

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