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.
A total of 685 clinical Streptococcus pneumoniae isolates from patients with pneumococcal diseases were collected from 14 centers in 11 Asian countries from January 2000 to June 2001. The in vitro susceptibilities of the isolates to 14 antimicrobial agents were determined by the broth micro dilution test. Among the isolates tested, 483 (52.4%) were not susceptible to penicillin, 23% were intermediate, and 29.4% were penicillin resistant (MICs ≥ 2 mg/liter). Isolates from Vietnam showed the highest prevalence of penicillin resistance (71.4%), followed by those from Korea (54.8%), Hong Kong (43.2%), and Taiwan (38.6%). The penicillin MICs at which 90% of isolates are inhibited (MIC90s) were 4 mg/liter among isolates from Vietnam, Hong Kong, Korea, and Taiwan. The prevalence of erythromycin resistance was also very high in Vietnam (92.1%), Taiwan (86%), Korea (80.6%), Hong Kong (76.8%), and China (73.9%). The MIC90s of erythromycin were >32 mg/liter among isolates from Korea, Vietnam, China, Taiwan, Singapore, Malaysia, and Hong Kong. Isolates from Hong Kong showed the highest rate of ciprofloxacin resistance (11.8%), followed by isolates from Sri Lanka (9.5%), the Philippines (9.1%), and Korea (6.5%). Multilocus sequence typing showed that the spread of the Taiwan19F clone and the Spain23F clone could be one of the major reasons for the rapid increases in antimicrobial resistance among S. pneumoniae isolates in Asia. Data from the multinational surveillance study clearly documented distinctive increases in the prevalence rates and the levels of antimicrobial resistance among S. pneumoniae isolates in many Asian countries, which are among the highest in the world published to date.
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 on Streptococcus pneumonia infection is done in Singapore by London School of Hygiene & Tropical Medicine.