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[An infant with meningitis caused by resistant pneumococcus: infection despite vaccination]

Henny van der Meer1, Annelies van Zwol, Lodewijk Spanjaard

  • 1VU medisch centrum, Amsterdam, Afd. Intensive Care kinderen, the Netherlands. h.vandermeer@vumc.nl

Nederlands Tijdschrift Voor Geneeskunde
|January 6, 2012
PubMed

Insights

A case of drug-resistant pneumococcal meningitis in a child highlights the ongoing risk of invasive pneumococcal disease (IPD) even after vaccination. Early symptom recognition remains crucial for effective treatment.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Vaccinology

Background:

  • The introduction of the heptavalent pneumococcal conjugate vaccine (PCV7) in 2006 led to a significant decrease in invasive pneumococcal disease (IPD) in the Netherlands.
  • A notable shift towards IPD caused by non-vaccine serotypes has been observed since the vaccine's implementation.

Observation:

  • This report details a case of multidrug-resistant non-vaccine serotype 19A pneumococcal meningitis in a 5-month-old infant.
  • The child presented with seizures and septic shock, requiring intensive care, including a barbiturate-induced coma and antimicrobial treatment with ceftriaxone and vancomycin.
  • Long-term sequelae included unilateral deafness and mild developmental delay one year post-discharge.

Findings:

  • Pneumococcal serotype 19A is globally the leading cause of IPD in children, with a rising prevalence of multidrug-resistant strains.
  • This increasing trend of multidrug-resistant 19A strains has not yet been documented in the Netherlands.
  • The case underscores that pneumococcal meningitis can still occur despite PCV7 vaccination.

Implications:

  • This case emphasizes the critical need for prompt clinical recognition of pneumococcal meningitis symptoms, irrespective of vaccination status.
  • It highlights the evolving landscape of pneumococcal disease, with non-vaccine serotypes posing a continued threat.
  • The findings necessitate ongoing surveillance and potential adaptation of vaccination strategies to address emerging resistant strains.
Abstract

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