Skip to Main Content

++

Key Features

++
Essentials of Diagnosis
++

Bacteremia

++

  • High fever (> 39.4°C)

  • Leukocytosis (> 15,000/μL)

++

Pneumonia

++

  • Fever, leukocytosis, and tachypnea

  • Localized chest pain

  • Localized or diffuse rales

  • Chest radiograph may show lobar infiltrate (with effusion)

++

Meningitis

++

  • Fever, leukocytosis

  • Bulging fontanelle, neck stiffness

  • Irritability and lethargy

++

All types

++

  • Diagnosis confirmed by cultures of blood, CSF, pleural fluid, or other body fluid.

++
General Considerations
++

  • Sepsis, sinusitis, otitis media, pneumonitis, meningitis, osteomyelitis, cellulitis, arthritis, vaginitis, and peritonitis are part of the spectrum of pneumococcal infection

  • Incidence rate of pneumococcal meningitis has decreased since incorporation of the pneumococcal conjugate vaccine into the infant vaccine schedule

  • However, pneumococcal meningitis is still more common than Haemophilus influenzae type b meningitis

  • Children with sickle cell disease, other hemoglobinopathies, congenital or acquired asplenia, and some immunoglobulin and complement deficiencies are unusually susceptible to pneumococcal sepsis and meningitis

  • Children with cochlear implants are at higher risk for pneumococcal meningitis

++

Clinical Findings

++
Symptoms and Signs
++

  • Clinical findings that correlate with occult bacteremia in ambulatory patients include age (6–24 months), degree of temperature elevation (> 39.4°C), and leukocytosis (> 15,000/μL)

  • In pneumococcal sepsis

    • Fever usually appears abruptly, often accompanied by chills

    • Respiratory symptoms may be absent

  • In infants and young children with pneumonia

    • Fever, and tachypnea without auscultatory changes are the usual presenting signs

    • Respiratory distress is manifested by nasal flaring, chest retractions, and tachypnea

    • Abdominal pain is common

  • In older children, the adult form of pneumococcal pneumonia with signs of lobar consolidation may occur, but sputum is rarely bloody

  • Meningitis

    • Characterized by fever, irritability, convulsions, and neck stiffness

    • Most important sign in very young infants is a tense, bulging anterior fontanelle

    • In older children, fever, chills, headache, and vomiting are common

    • Classic signs are nuchal rigidity associated with positive Brudzinski and Kernig signs

    • Opisthotonos, stupor, and coma may develop with progression of untreated disease

++
Differential Diagnosis
++

  • viral infection, urinary tract infection, unrecognized focal infection elsewhere in the body, salmonellosis, or early acute shigellosis.

++

Diagnosis

++
Laboratory Findings
++

  • Leukocytosis is often pronounced (20,000–45,000/μL), with 80–90% polymorphonuclear neutrophils

  • Neutropenia may be seen early in very serious infections

  • Large numbers of organisms are seen on Gram-stained smears of endotracheal aspirates from patients with pneumonia

  • Isolation of S pneumoniae from a normally sterile site (eg, blood, CSF, joint fluid, middle ear fluid) or from a suppurative focus confirms the diagnosis

++
Diagnostic Procedure
++

  • Pneumococcal meningitis is diagnosed by lumbar puncture

  • CSF usually shows an elevated white blood cell (WBC) count of several thousand, chiefly polymorphonuclear neutrophils, with decreased glucose and elevated protein levels

++

Treatment

++

  • For empiric therapy of serious or ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.