Streptococcus pneumoniae infections

Streptococcus pneumoniae infections include Pneumococcal pneumonia & Pneumococcal meningitis. Diagnostic: Gram stain (lancet-shaped, Gram positive cocci in pairs & chains); Sputum & blood cultures; Pneumococcal antigen (not useful in children because of high rates of pharyngeal colonization).

CASES/YEAR
900,000 (US); 18,000,000 (Global)
CATEGORY
Person-To-Person
AGENT TYPE
Bacteria
OTHER NAMES
Pneumococcal pneumonia; Pneumococcal meningitis;
ACUITY
Acute-Severe
INCUBATION
Pneumonia: as short as 1-3 days; Meningitis: probably 1-4 days; [CCDM, 466. 412]
INITIAL SYMPTOMS
Pneumonia: fever, productive cough, chest pain, and dyspnea. Young children may present with fever, vomiting, and seizures. [CCDM, p. 465] Meningitis: fever, lethargy, and stiff neck. [CCDM, p. 411]
PRECAUTIONS
Standard; See precautions for multidrug-resistance organisms. [CDC 2007 Guideline for Isolation Precautions]
COMMENTS
After a single culture, pharyngeal carrier rates are up to 10% in healthy adults and 40% in healthy children. S. pneumoniae causes infections of the lungs, bronchi, middle ears, sinuses, CNS, heart valves, bones, joints, and peritoneal cavity. Predisposing conditions for pneumococcal pneumonia include cigarette smoking, COPD, alcoholism, neutropenia, malignancy, diabetes, old age, prior viral respiratory infection, and AIDS. Bilirubin may be increased to 3-4 mg/dl, and hemolysis of red blood cells in the lung is thought to contribute. [PPID, p. 2479-82] In some countries, vaccination is recommended for individuals 65 and older and those with asplenia or chronic diseases (sickle cell disease, HIV infection, heart and lung disease, cirrhosis of the liver, renal insufficiency and diabetes mellitus. [CCDM, p. 467-8] S. pneumoniae causes meningitis in adults, especially those older than 50 years with comorbid conditions. [Cecil, p. 2443]
DIAGNOSTIC
Gram stain (lancet-shaped, Gram positive cocci in pairs and chains); Sputum and blood cultures; Detect pneumococcal antigen, but the test is not useful in children because of high rates of pharyngeal colonization; [PPID, p. 2482]
SCOPE
Global
SIGNS & SYMPTOMS
  • >fatigue, weakness
  • >fever
  • >myalgia
  • G abdominal pain
  • G diarrhea
  • G jaundice
  • G liver function test, abnormal
  • G nausea, vomiting
  • H anemia
  • H hemolysis
  • H leukocytosis
  • H leukopenia
  • N confusion, delirium
  • N headache
  • N lethargy
  • N muscle weakness
  • N seizure
  • N stiff neck
  • O conjunctivitis, acute
  • R chest pain
  • R cough
  • R dyspnea
  • R hemoptysis
  • R sputum production
  • S petechiae and ecchymoses
  • X cystic or cavitary lesions
  • X lung infiltrates
  • X pleural effusions
  • *acute renal failure
  • *ARDS
  • *arthritis
  • *bleeding tendency
  • *brain abscess or lesion
  • *cranial neuropathy
  • *endocarditis
  • *glomerulonephritis
  • *mediastinitis
  • *meningitis
  • *osteomyelitis
  • *paralysis
  • *pericarditis
  • *pneumonia
  • *rhabdomyolysis
  • *sepsis
  • *shock
  • *stupor, coma
ANTIMICROBIC

Yes

VACCINE

Yes

ENTRY
Inhalation
SOURCE
Person-to-Person
RESERVOIR
Human
RISK FACTORS
  • AIDS patients
  • Asplenic patients
  • Cancer patients
  • Fail to complete immunizations
  • Live together in close quarters
DRUG LINK
Merck Manual: Community-Acquired Pneumonia
REFERENCES FOR CASES/YEAR
1. (US) MMWR 2011: 17,138; Pneumococci cause every year in the US: otitis media (7 million cases), pneumonia (500,000 cases), sepsis (50,000 cases), and meningitis (3,000 cases). [Merck Manual, p. 1600] 31,600 reported cases/year of invasive pneumococcal infections, all ages; [Harrison ID, p. 49] In the US, 900,000 cases/year of pneumococcal pneumonia and 67,500 deaths; [Cecil, p. 1868]
2. (Global) WHO estimated in 2005 1.6 million deaths/yr caused by S. pneumoniae; [Cecil, p. 1868] Estimate: 20 X US rate = global rate = 18 million cases/year;