Recurrent systemic pneumococcal infection in an immunocompromised patient

Exogenous re-infection by a novel Streptococcus pneumoniae serotype 14 as a cause of recurrent meningitis in a child from The Gambia

We report a case of an infant who experienced exogenous re-infection of Streptococcus pneumoniae serotype 14 as a cause of recurrent meningitis after apparently successful antibiotic treatment with ceftriaxone. eBURST analysis revealed that isolates from the two episodes of meningitis belonged to hypervirulent ST63 and ST3321 clonal complexes respectively.

Recurrent systemic pneumococcal disease in children

BACKGROUND

Recurrent systemic pneumococcal infection usually occurs in immunocompromised patients and patients with underlying conditions.

METHODS

Between 1993 and 2006, investigators at 8 pediatric hospitals prospectively identified cases of invasive pneumococcal disease (IPD) and retrospectively documented demographics and clinical information. Antibiotic susceptibility was determined for penicillin and ceftriaxone by microbroth dilution. Isolates were serotyped and molecular relatedness determined using pulse field gel electrophoresis (PFGE).

RESULTS

Four thousand sixty-seven children were diagnosed with IPD over 12.3 years. One hundred and 8 episodes of recurrent disease were seen in 90 children (2.6%); 75 experienced 2 infections, 12 experienced 3 infections and 3 experienced 4 infections. Fourteen of the 15 children with >2 episodes of infection had underlying conditions. The mean duration between 1st and 2nd infection was 22.9 weeks for children with no known underlying condition and 43.0 weeks for children with an underlying condition (P = 0.001). Seventy episodes of IPD among the 90 patients were caused by a different serotype or a different genotype as demonstrated by the PFGE. Sixteen children had intervals <30 days between infections; 7 were caused by different strains.

CONCLUSIONS

Approximately 80% of the children with recurrent invasive pneumococcal disease had underlying conditions. Seven of 16 children with recurrent infection <30 days apart were caused by acquisition of a new strain. Relapse of infection requires documentation that the pneumococcal isolates are not only the same serotype but also have the same PFGE patterns.

Serotypes and resistance patterns of Streptococcus pneumoniae causing systemic disease in northern Norway

During the period 1985-1990, Streptococcus pneumoniae was isolated form 97 patients with systemic pneumococcal disease in Northern Norway. Systemic disease occurred most frequently in the age groups 0-4 years and > 60 years. An increasing incidence was observed, especially among children less than five years old. Serotypes covered by the 23-valent pneumococcal polysaccharide vaccine were found in 86 of 97 (88.7%) isolates. The vaccine did not cover 16.7% of the systemic isolates from children less than five years old. Reduced sensitivity to penicillin was found in one isolate (1.0%) which was resistant to ampicillin, doxycycline and chloramphenicol. The E-test and the Rosco agar diffusion test differed in sensitivity to penicillin, chloramphenicol, ciprofloxacin and erythromycin. Three serotype 12F strains showed unusual cross-resistance to chloramphenicol and erythromycin.