Streptococcus pneumonia infection also known as pneumococcal disease is an infection caused by Streptococcus pneumonia bacteria. These bacteria can affect to the different parts of the body causing different signs and symptoms depending on the site of infection. Pneumonia i.e., infection of the lungs, ear infections, sinus infections, meningitis i.e., infection of the covering around the brain, spinal cord and bacteremia covering blood stream infection. Streptococcus pneumoniae is communicable and spread from the infected person through coughing, sneezing, and close contact. The symptoms include fever, cough, shortness of breath, chest pain, stiff neck, confusion and disorientation, sensitivity to light, joint pain, chills, ear pain, sleeplessness, and irritability. In extreme cases Streptococcus pneumoniae infection can cause brain damage, hearing loss and death. Streptococcus pneumoniae infection mainly tends to occur in the elderly or in people with serious underlying medical conditions. Groups such as children under 2 years of age, children in childcare and Torres Strait Islander people. Streptococcus pneumoniae infection is usually diagnosed by microscopic examination and growth of bacteria from blood, sputum or other specimens. PCR (polymerase chain reaction) testing in a pathology laboratory is also used.
Statewide active surveillance for invasive Streptococcus pneumoniae (pneumococcal) disease began in 2002, expanded from the metropolitan area, where active surveillance was ongoing since 1995. In 2013, 542(10.1 per 100,000) cases of invasive pneumococcal disease were reported. By age group, annual incidence rates per 100,000 were 12.6 cases among children aged 0-4 years, 2.2 cases among children and adults aged 5-39 years, 10.4 cases among adults 40-64 years, and 34.9 cases among adults aged 65 years and older. In 2013, pneumonia occurred most frequently (66% of infections), followed by bacteremia without another focus of infection (23%), and pneumococcal meningitis (4%). Fifty-eight (11%) cases died. Health histories were available for 51 of the 58 cases who died. Of these, 45 had an underlying health condition reported. The conditions most frequently reported were atherosclerotic cardiovascular disease (16), chronic obstructive pulmonary disease (9), diabetes (14), heart failure/congestive heart failure (11), and renal failure/ dialysis (5). In March 2010, the U.S. Food and Drug Administration approved a new 13-valent pediatric pneumococcal conjugate vaccine (PCV-13 [Prevnar 13]) which replaced PCV-7. The new vaccine provides protection against the same serotypes in PCV-7, plus 6 additional serotypes (serotypes 1, 3, 5, 6A, 7F, and 19A). From 2007 to 2010, the majority of invasive pneumococcal disease cases among children <5 years of age have been caused by the 6 new serotypes included in PCV-13. Since 2011, the majority of invasive pneumococcal disease cases among children <5 years of age have been caused by serotypes not included in PCV-13. In 2013, 20% of cases occurring among Minnesotans of all ages, with isolates available for testing, were caused by 3 of the new PCV-13-included serotypes: 3 (10%), and 7F (6%), 19A (4%). Of the 518 isolates submitted for 2013 cases, 90 (17%) isolates were resistant to penicillin using meningitis breakpoints. Using non-meningitis breakpoints, 3 (<1%) of 518 isolates were resistant to penicillin and 13 (3%) exhibited intermediate level resistance (Note: CLSI penicillin breakpoints changed in 2008; refer to the MDH Antibiogram on pages 26-27). Multi-drug resistance (i.e., high-level resistance to two or more antibiotic classes) was exhibited in 75 (14 %) isolates.
Symptoms widely vary in patients with pneumococcal pneumonia, mild illness to febrile pneumonia to respiratory distress requiring ICU-level care. Factors such as age, type of symptoms, and duration of symptoms, underlying or chronic illness, and compliance with treatment, appropriate home care and potential for worsening disease are considered in determining the need and level of hospitalization. Most hospitalized should be treated with parenteral antibiotics in addition to medications for pulmonary symptoms, pain medications, intravenous fluids or parenteral or enteral nutrition, oxygen, and additional medications, as indicated on an individual basis. The use of steroids in adult patients with bacterial meningitis is recommended with caution, as they may decrease CSF antibiotic concentration; patients with meningitis treated with steroids should be monitored closely. Steroids can be considered prior to antibiotic therapy in children aged 6 weeks and older with pneumococcal meningitis. They should be given before or at the time of first dose of antibiotics. Intravenous fluids, parenteral or enteral nutrition, and other medications should be used as indicated clinical instances. A patient with pneumococcal bacteremia is treated with appropriate antibiotics. Children who undergo workup to rule out serious bacterial illness but who are not treated initially with antibiotics and whose cultures subsequently grow S pneumoniae are often asymptomatic and have negative repeat blood culture findings at follow-up. Repeat blood cultures should always be obtained in patients with S pneumoniae bacteremia. Patients with cardiac, skin or soft-tissue, bone, and joint infections with S pneumoniae should usually be admitted to the hospital for observation, intravenous antibiotic therapy, expedition of further workup and evaluation of location. Major Research is been done in Belgium on Streptococcus pneumoniae infection by Louvain Drug Research Institute.