Streptococcus pneumoniae (S. pneumonia or pneumococcus) is a bacteria that causes many different types of infection in children.  S. pneumonia is the most common cause of bacterial middle ear infections but also may cause life-threatening sepsis and meningitis in young children.  S. pneumonia infections can also affect the lungs, sinuses, eyes, joints, skin, heart and bones.  Children with chronic illnesses or without a functioning spleen are at higher risk for serious infection with S. pneumonia.  Widespread use of the pneumococcal vaccine has reduced the incidence of life-threatening infections with S. pneumonia, although only a few of the 90 plus serotypes are covered by the vaccine.  S. pneumonia infections are treated with antibiotics, although increasing bacterial resistance to antibiotics is a rising concern.

 

What is S. pneumonia?

S. pneumonia is a bacteria that is found in the respiratory tract of normal healthy children (approximately 50% of children at any one time).  The bacteria is classified into around 90 serotypes based on the type of capsule that surrounds and protects the bacteria.  Some serotypes are more likely to cause infections or to enter the blood where it can be spread to other parts of the body.  Most S. pneumonia disease is caused by a few of the serotypes, and it is these serotypes that are targeted by the pneumococcal vaccine.  S. pneumonia is spread from person-to-person via respiratory droplets.

What types of illness does S. pneumonia cause?

Otitis media (middle ear infection) - most commonly seen between ages 6 and 18 months.

Sepsis or bacteremia - most common in children less than 2 years of age, those without a functioning spleen, those with sickle cell disease, or in children with an immune system problem; may cause fever, irritability and/or life-threatening illness. 

Meningitis - can be severe and life-threatening, especially in young children. 

Pneumonia - usually presents as a more severe illness than the typical viral pneumonia.  Fever, chills, cough, shortness of breath, and malaise are common.  Often the chest x-ray shows a local area of infection.

Sinusitis - often requires long courses of antibiotics (14 days or more).

Conjunctivitis (eye infection)

Also... skin, joint, heart and bone infections.

How is S. pneumonia diagnosed?

S. pneumonia bacteria can be grown from samples of blood or from other body fluids such as: spinal fluid, middle ear fluid, or joint fluid.  Viewing body fluids under a microscope can give clues based on the typical appearance of pneumoccus with certain stains.

When pneumococcus is suspected based on the symptoms or type of illness (example - ear infections), a bacterial culture is often not needed.

How is S. pneumonia treated?

In addition to supportive care, antibiotics can treat S. pneumonia infections of all types.  S. pneumonia has become more resistant to some antibiotics with time.  Antibiotics such as cephalosporins, penicillins, and macrolides are typically effective, although if resistance is suspected other classes of antibiotics (ex - vancomycin) are required.

Can S. pneumonia infection be prevented?

The pneumococcal vaccine is recommended for all children to be given at ages 2, 4, 6, and between 12-15 months of age.  The pediatric pneumococcal vaccine (a.k.a. Prevnar) covers 7 of the 90 plus serotypes.  Fortunately the vaccine has reduced the occurrence of invasive disease (such as meningitis and sepsis) by more than 90% in children.  The reduction of cases of otitis media is less impressive, but still significant (reduced by approximately 10%).  There is an adult version of the pneumococcal vaccine that covers 23 serotypes.

Click here for the CDC recommended vaccine schedule.