Sections

Sections Pediatric Pneumococcal Infections
Overview
Presentation
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
Tables
References

Presentation

History

Children with pneumococcal infections usually have a temperature higher than 102°F. Children with invasive infections also demonstrate signs and symptoms related to the site of infection. Symptoms of specific infections in addition to fever are as follows:

Otitis media symptoms include the following:

Otalgia (irritability and ear pulling in younger children)
Upper respiratory symptoms
Vomiting

Sinusitis symptoms include the following:

Headache
Facial tenderness (much less frequent than in adults)
Symptoms of upper respiratory infection (cough, nasal drainage, congestion) lasting for 10 days or longer

Occult bacteremia may present with fever without a localizing source in children aged 2-24 months.

Pneumonia may present with the following:

Cough
Chest pain, shortness of breath, or respiratory difficulty
Malaise and poor appetite

Meningitis may present with the following:

Stiff neck
Vomiting
Headache (older children)
High fever (temperature >103°F)
Lethargy
Irritability
Poor feeding
Inconsolable crying

Physical

Otitis media findings include bulging, erythematous, or yellow tympanic membrane with poor mobility and purulent fluid seen behind the tympanic membrane.

Sinusitis findings include the following:

Tenderness to palpation over maxillary or frontal sinuses
Nasal discharge of any color
Swollen nasal turbinates

Bacteremia has no physical findings except fever (temperature of 102°F or higher) and tachycardia associated with the fever.

Pneumonia findings include the following:

Crackles or decreased breath sounds in the area of lobar consolidation on chest auscultation, with egophony in patients with severe consolidation and dullness to percussion
Retractions, tachypnea, or both

Meningitis/CNS infection findings include the following:

Ill appearance
Nuchal rigidity (may not be present in infants < 4 mo)
Altered mental status, poorly responsive (patient may present in comatose state)
Other neurologic abnormalities possible, such as cranial nerve deficits, ataxia, and weakness
Poor perfusion and signs of shock in patients with concurrent pneumococcal sepsis

Differential Diagnoses

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Levine OS, Farley M, Harrison LH, et al. Risk factors for invasive pneumococcal disease in children: a population-based case-control study in North America. Pediatrics. 1999 Mar. 103(3):E28. [QxMD MEDLINE Link].
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Media Gallery

Sputum Gram stain from a patient with a pneumococcal pneumonia. Note the numerous polymorphonuclear neutrophils and gram-positive, lancet-shaped diplococci. Courtesy of C. Sinave, MD, personal collection.

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Author

Meera Varman, MD Associate Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University Medical Center

Meera Varman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Pfizer, Sanofi<br/>Received research grant from: Merck; MedImmune; Regenron; Pfizer;Novartis; Sanof; GSK<br/>Received honoraria from phamaceutical companies for speaking and teaching; Received grant/research funds from phamaceutical companies for clinical trials research.

Coauthor(s)

Archana Chatterjee, MD, PhD Professor and Chair, Department of Pediatrics, Senior Associate Dean for Faculty Development, Sanford School of Medicine, The University of South Dakota

Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD, FACP Editor-in-Chief, ID Cases; Moderator, Program for Monitoring Emerging Diseases; Adjunct Professor of Medicine, State University of New York Downstate College of Medicine

Larry I Lutwick, MD, FACP is a member of the following medical societies: American Association for the Advancement of Science, American Association for the Study of Liver Diseases, American College of Physicians, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, Infectious Diseases Society of New York, International Society for Infectious Diseases, New York Academy of Sciences, Veterans Affairs Society of Practitioners in Infectious Diseases

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Chandy C John, MD, MS Director, Division for Global Pediatrics, Associate Professor of Pediatrics and Medicine, University of Minnesota Medical School

Disclosure: Nothing to disclose.

Nancy A Wick, MD Consulting Staff, Department of Emergency Medicine, Section of Pediatrics, Children's at Scottish Rite

Nancy A Wick, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Sections Pediatric Pneumococcal Infections
Overview
Presentation
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
Tables
References

Drug	Sensitive, MIC mcg/mL	Resistant isolate, MIC mcg/mL
Drug	Sensitive, MIC mcg/mL	Intermediate resistance	Resistant
Penicillin/amoxicillin	≤0.06	0.1-1	≥2
Cefotaxime or ceftriaxone	Nonmeningeal ≤1, meningeal ≤0.5	Nonmeningeal 2, meningeal 1	Nonmeningeal ≥4, meningeal ≥2

Pediatric Pneumococcal Infections Clinical Presentation

History

Physical

References

Tables

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