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Published on: February 23, 2014
[Pneumococcal conjugate vaccine failure in HIV-infected child. Clinical case]
M T Rives Ferreiro1, J J Menéndez Suso, B Calderón Llopis
1Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario La Paz, Madrid, Spain. maiterives@hotmail.com
Insights
Invasive pneumococcal infections can be fatal even with treatment, particularly in high-risk individuals. This case highlights a fatal outcome in an HIV-positive adolescent despite vaccination and therapy.
Area of Science:
- Infectious Diseases
- Immunology
- Pediatrics
Background:
- Invasive pneumococcal infections (IPIs) pose a significant mortality risk, especially in immunocompromised individuals.
- Human Immunodeficiency Virus (HIV) infection can increase susceptibility to IPIS, even with effective antiretroviral therapy (ART).
- Vaccination strategies, including 23-valent polysaccharide and 7-valent pneumococcal conjugate vaccines, aim to prevent IPIS.
Observation:
- A 13-year-old male with vertically acquired HIV, on ART, presented with symptoms of severe infection.
- Despite vaccination and controlled HIV disease (CD4 count 1,000/microl, viral load 3800 cop/ml), the patient developed fever, vomiting, and altered consciousness.
- Streptococcus pneumoniae serotype 18C was identified in blood and cerebrospinal fluid.
Findings:
- The patient rapidly deteriorated, exhibiting meningismus and a depressed level of consciousness.
- Despite prompt administration of antibiotics (cefotaxime, vancomycin) and supportive care, brain death was confirmed within 24 hours of admission.
- The specific pneumococcal serotype 18C was implicated in the fatal invasive infection.
Implications:
- This case underscores the persistent risk of severe IPIS in individuals with HIV, even with optimal management.
- It highlights the limitations of current vaccination strategies in preventing all IPIS in certain high-risk populations.
- Further research into enhanced prevention and treatment strategies for IPIS in immunocompromised patients is warranted.
Abstract:
Despite appropriate antimicrobial therapy and vaccination, invasive pneumococcal infections remain associated with significant mortality, especially in selected high-risk groups (asplenic, humoral immunity deficient patients, etc.). We present a 13-year-old caucasian boy with HIV infection (vertical transmission). He received treatment with highly-active antiretroviral therapy (amprenavir, lamivudine and zidovudine) and vaccination with 23-valent vaccine (6 years old) and 7-valent pneumococcal conjugate vaccine (10 years old). His CD4 count and his viral load at these times were 2,063/microl and 13461 cop/ml, when he was 6 years old and 1,315/microl and 32400 cop/ml when he was 10 years old, respectively. The latest CD4 count (1,000/microl) and his viral load (3800 cop/ml) confirmed satisfactory control of the disease. He was referred to our emergency department presenting with fever, head and stomach-ache and vomiting. In the following hours his condition continued to deteriorate and depressed level of consciousness and meningismus were observed. Streptococcus pneumoniae, serotype 18 C, was detected in blood and cerebrospinal fluid cultures. Despite appropriate treatment with antibiotics (cefotaxime and vancomycin) and anti-oedema medications, brain-death was confirmed 24 hours after his admittance.
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