Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary 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... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth