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Arfi A, Cohen R, Varon E, Béchet S, Bonacorsi S, Levy C. Case-control study shows that neonatal pneumococcal meningitis cannot be distinguished from group B Streptococcus cases. Acta Paediatr 2017; 106:1915-1918. [PMID: 28508419 DOI: 10.1111/apa.13919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/14/2017] [Accepted: 05/11/2017] [Indexed: 11/30/2022]
Abstract
AIM Streptococcus pneumoniae (S. pneumoniae) is sometimes implicated in neonatal bacterial meningitis. This study described the demographic, clinical and biological features of neonatal S. pneumoniae meningitis and compared pneumococcal and group B streptococcal (GBS) neonatal meningitis. METHODS We conducted a case-control study that compared neonates, aged one to 28 days with S. pneumoniae meningitis or GBS meningitis. Each case with S. pneumoniae was randomly matched to four control patients with GBS by age group and study year. RESULTS From 2001 to 2013, the national French paediatric network, which comprises 227 paediatric wards, recorded 831 neonatal cases of meningitis. S. pneumoniae (n = 18, 2.2%) was the fifth infection cause after GBS (n = 464, 55.8%), Escherichia coli (n = 232, 27.9%), Neisseria meningitidis (n = 23, 2.8%) and Listeria monocytogenes (n = 20, 2.4%). Neonatal pneumococcal and GBS meningitis did not differ in demographic data or clinical and biological characteristics. All S. pneumoniae strains were fully susceptible to cefotaxime, and we observed a decrease of 13-valent pneumococcal conjugate vaccine (PCV13) serotypes (88.9%-20.0%) after PCV13 implementation. CONCLUSION Clinically and biologically, neonatal pneumococcal meningitis could not be distinguished from GBS cases. A herd effect of PCV13 implementation was suggested by the decrease in the prevalence of vaccine serotypes.
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Affiliation(s)
- Alexandra Arfi
- Hôpital Intercommunal de Créteil; Service de Gynécologie Obstétrique; Université Paris Est, Paris XII; Créteil France
| | - Robert Cohen
- ACTIV - Association Clinique et Thérapeutique Infantile du Val de Marne; Saint-Maur-des-Fossés France
- Université Paris Est, IMRB - GRC GEMINI; Créteil France
- Clinical Research Center (CRC); Centre Hospitalier Intercommunal de Créteil; Créteil France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP); Paris France
- Unité Court Séjour, Petits Nourrissons, Service de Néonatologie; Centre Hospitalier Intercommunal de Créteil; Créteil France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci; Laboratoire de Microbiologie; Assistance Publique-Hôpitaux de Paris; Hopital Européen Georges-Pompidou; Paris France
| | - Stéphane Béchet
- ACTIV - Association Clinique et Thérapeutique Infantile du Val de Marne; Saint-Maur-des-Fossés France
- Université Paris Est, IMRB - GRC GEMINI; Créteil France
| | - Stéphane Bonacorsi
- Sorbonne Paris Cité; Université Denis Diderot; Paris France
- Service de Microbiologie; Hôpital Robert-Debré, AP-HP; Paris France
| | - Corinne Levy
- ACTIV - Association Clinique et Thérapeutique Infantile du Val de Marne; Saint-Maur-des-Fossés France
- Université Paris Est, IMRB - GRC GEMINI; Créteil France
- Clinical Research Center (CRC); Centre Hospitalier Intercommunal de Créteil; Créteil France
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP); Paris France
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Mount V, Burton C, Jackson C, Heffernan H, Best E. Neonatal invasive pneumococcal disease: New Zealand experience in the era of pneumococcal vaccination. Aust N Z J Obstet Gynaecol 2016; 57:280-285. [PMID: 27530965 DOI: 10.1111/ajo.12512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/05/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) became a notifiable disease in New Zealand in 2008, and in the same year pneumococcal conjugate vaccine (PCV) was added to the childhood immunisation schedule. DESIGN This was a retrospective study of IPD in infants aged <90 days reported to the national notifiable disease database, EpiSurv, from 1 January 2009 to 31 December 2013. All cases had Streptococcus pneumoniae isolated from a normally sterile site. MAIN OUTCOME MEASURES IPD incidence was calculated for babies aged <90 and <30 days using the number of national IPD cases with a denominator of annual infant live births. Clinical, demographic and outcome data were reviewed for infants aged less than seven days (early onset). RESULTS There were 29 cases of IPD in infants aged <90 days and 19 cases in infants aged <30 days. Of the nine early-onset cases, six occurred within the first 48 h. Six of the early-onset cases were infants of NZ Maori ethnicity. One infant died six hours after birth. Three infants developed long-term neurological or respiratory sequelae. Isolates from five of the early-onset cases were S. pneumoniae serotypes not covered by the PCV in use at the time of infection. Maternal vaccination with 23-valent pneumococcal vaccine would have covered 84% (16 of 19) of serotypes responsible for the cases in infants <30 days old. CONCLUSION Strategies such as maternal vaccination or accelerated neonatal vaccination may be beneficial to protect neonates at high risk of IPD.
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Affiliation(s)
- Vicki Mount
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Cameron Burton
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Catherine Jackson
- Auckland Regional Public Health Service, Auckland District Health Board, Auckland, New Zealand
| | - Helen Heffernan
- Institute of Environmental Science and Research (ESR), Kenepuru Science Centre, Porirua, New Zealand
| | - Emma Best
- Department of Paediatrics, University of Auckland, Auckland, New Zealand.,Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
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Soto-Noguerón A, Carnalla-Barajas MN, Solórzano-Santos F, Arrendondo-García JL, Arzate-Barbosa P, Tinoco-Favila JC, Anzurez-Gutiérrez A, Echániz-Aviles G. Streptococcus pneumoniae as cause of infection in infants less than 60 days of age: serotypes and antimicrobial susceptibility. Int J Infect Dis 2015; 42:69-73. [PMID: 26673859 DOI: 10.1016/j.ijid.2015.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/26/2015] [Accepted: 12/02/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the distribution of serotypes and the antimicrobial susceptibilities of Streptococcus pneumoniae clinical isolates causing invasive and non-invasive disease in children aged ≤60 days in hospitals in Mexico. METHODS A 15-year retrospective study was conducted for the period 2000 to 2014. Pneumococcal clinical isolates were serotyped by Quellung reaction, and antimicrobial susceptibility testing was performed with the broth microdilution method. RESULTS A total of 126 pneumococcal isolates were collected. Pneumonia was the most frequent diagnosis (40.5%), followed by meningitis (29.4%), septicemia (16.7%), and other clinical entities, including otitis media and conjunctivitis (13.5%). The most frequent serotypes before the introduction of heptavalent pneumococcal conjugate vaccine (PCV7) were 19F, 23F, 7F, and 35B. Serotypes 3, 6A, 10A, 12F, and 15A/B increased after the introduction of PCV7. Serotype 19A was isolated most frequently in the pneumonia and meningitis cases only after the introduction of PCV7, and it displayed a high resistance to penicillin. CONCLUSIONS Although the number of infections in infants aged ≤60 days was low, such infections were not unusual events. New vaccination strategies should be evaluated to limit the risks in this age group.
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Affiliation(s)
- Araceli Soto-Noguerón
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Cuernavaca, Morelos 62100, Mexico
| | | | - Fortino Solórzano-Santos
- Unidad Médica de Alta Especialidad, Hospital de Pediatría Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | | | | | | | - Gabriela Echániz-Aviles
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Cuernavaca, Morelos 62100, Mexico.
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Infektionen. NEUROINTENSIV 2015. [PMCID: PMC7175474 DOI: 10.1007/978-3-662-46500-4_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In diesem Kapitel werden zunächst die für die Neurointensivmedizin wesentlichen bakteriellen Infektionen (Meningitis, spinale und Hirnabszesse, Spondylodiszitis, septisch-embolische Herdenzephalitis) abgehandelt, die trotz gezielt eingesetzter Antibiotika und neurochirurgischer Therapieoptionen noch mit einer erheblichen Morbidität und Mortalität behaftet sind. Besonderheiten wie neurovaskuläre Komplikationen, die Tuberkulose des Nervensystems, Neuroborreliose, Neurosyphilis und opportunistische Infektionen bei Immunsuppressionszuständen finden hierbei besondere Berücksichtigung. Der zweite Teil dieses Kapitels behandelt akute und chronische Virusinfektionen des ZNS sowie in einem gesonderten Abschnitt die HIVInfektion und HIV-assoziierte Krankheitsbilder sowie Parasitosen und Pilzinfektionen, die in Industrieländern seit Einführung der HAART bei HIV zwar eher seltener, aber mit zunehmender Globalisierung auch in unseren Breiten immer noch anzutreffen sind.
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Olarte L, Ampofo K, Stockmann C, Mason EO, Daly JA, Pavia AT, Byington CL. Invasive pneumococcal disease in infants younger than 90 days before and after introduction of PCV7. Pediatrics 2013; 132:e17-24. [PMID: 23733800 PMCID: PMC3691535 DOI: 10.1542/peds.2012-3900] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Introduction of the heptavalent pneumococcal conjugate vaccine (PCV7) changed the epidemiology of invasive pneumococcal disease (IPD). We evaluated the changes that occurred after PCV7 introduction among Utah infants aged 1 to 90 days, too young to be fully immunized. METHODS We identified children <18 years with culture-confirmed IPD from 1997-2010. We analyzed demographic, clinical, and serotype data for infants aged 1-90 days. The pre- and post-vaccine introduction periods spanned 1997-2000 and 2001-2010, respectively. RESULTS Of 513 children with IPD, 36 were 1 to 90 days and accounted for 7% of IPD cases in both the pre- and post-vaccine introduction period. The pre-vaccine IPD incidence rate was 5.0 per 100 000 live births, and was unchanged in the post-vaccine introduction period. IPD caused by PCV7 serotypes decreased by 74% (from 2.2 to 0.58 per 100 000), whereas non-vaccine serotype IPD increased by 57% (from 2.8 to 4.4 per 100 000). Sixteen infants (44%) required intensive care, and 3 (8%) died. Bacteremia without focus (56%) and meningitis (44%) were the predominant syndromes in the pre- and post-vaccine introduction periods, respectively. In the post-vaccine introduction period, serotype 7F was the most common serotype among infants and was responsible for 50% of meningitis. CONCLUSIONS The incidence of IPD in Utah infants aged 1 to 90 days caused by PCV7 serotypes decreased after PCV7 introduction, but overall incidence was unchanged. In the post-vaccine introduction period, serotype 7F predominated in this age group and was associated with meningitis.
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Affiliation(s)
- Liset Olarte
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah; and
| | - Krow Ampofo
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah; and
| | - Chris Stockmann
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah; and
| | - Edward O. Mason
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Judy A. Daly
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah; and
| | - Andrew T. Pavia
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah; and
| | - Carrie L. Byington
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah; and
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Ashkenazi L, Bar-Meir M, Schlesinger Y, Megged O. Invasive pneumococcal disease in infants younger than 60 days. Clin Pediatr (Phila) 2012; 51:478-82. [PMID: 22315484 DOI: 10.1177/0009922811436337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review the epidemiology and clinical course of invasive pneumococcal diseases of infants younger than 60 days. STUDY DESIGN All Streptococcus pneumoniae strains isolated from blood and cerebrospinal fluid cultures of infants below the age of 60 days during the years 1999-2009 were included in this study. Demographic, clinical, and laboratory data were collected from medical records. RESULTS In all, 24 cases of pneumococcal invasive infections were identified. The primary diagnoses were bacteremia without a focus (n = 13), meningitis (n = 6), bacteremia with otitis media (n = 3), and joint infection with bacteremia (n = 2). Only one of the serotypes found is included in the heptavalent pneumococcal conjugated vaccine (PCV7). CONCLUSIONS Streptococcus pneumoniae should be considered and treated empirically in infants with suspected invasive bacterial disease during the first 60 days of life. Routine vaccination with PCV7 in not expected to substantially reduce the incidence of invasive pneumococcal disease in Israeli infants of this age as a result of herd immunity.
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Affiliation(s)
- Limor Ashkenazi
- Pediatrics and Infectious Diseases Unit, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel.
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Infektionen. NEUROINTENSIV 2012. [PMCID: PMC7123678 DOI: 10.1007/978-3-642-16911-3_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trotz Weiterentwicklung moderner Antibiotika in den letzten Jahren sind die Letalitätszahlen der bakteriellen (eitrigen) Meningitis weiterhin hoch; Überlebende haben häufig neurologische Residuen. Die ungünstigen klinischen Verläufe der bakteriellen Meningitis sind meist Folge intrakranieller Komplikationen, wie z. B. eines generalisierten Hirnödems, einer zerebrovaskulären arteriellen oder venösen Beteiligung oder eines Hydrozephalus.
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McIntosh EDG, Reinert RR. Global prevailing and emerging pediatric pneumococcal serotypes. Expert Rev Vaccines 2011; 10:109-29. [PMID: 21162625 DOI: 10.1586/erv.10.145] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Streptococcus pneumoniae is the leading cause of vaccine-preventable deaths among children younger than 5 years of age worldwide. The 7-valent pneumococcal conjugate vaccine (PCV7) is currently licensed in more than 90 countries and has contributed to significant declines in the incidence of invasive pneumococcal disease (IPD). Recent studies report an increased incidence of IPD caused by non-PCV7 vaccine serotypes (NVTs). Seroepidemiology of IPD caused by NVTs following the introduction of PCV7 is of interest, and this article provides a comprehensive global summary of the prevailing and emerging serotypes causing IPD in children. Currently, globally emerging or persistent NVTs include serotypes 1, 3, 5, 6A, 7F and 19A. Serotypes included in the recently licensed 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PCV10) and 13-valent pneumococcal conjugate vaccine (PCV13) account for pneumococcal disease burdens in most developed countries of 65-85% and 80-90%, respectively. The seroprevalence of NVTs after widespread use of PCV10 and PCV13 requires ongoing monitoring.
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Affiliation(s)
- E David G McIntosh
- Novartis Vaccines, Hullenbergweg 83-85, Amsterdam 1101CL, The Netherlands.
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Imöhl M, Reinert RR, Mutscher C, van der Linden M. Macrolide susceptibility and serotype specific macrolide resistance of invasive isolates of Streptococcus pneumoniae in Germany from 1992 to 2008. BMC Microbiol 2010; 10:299. [PMID: 21108778 PMCID: PMC3001718 DOI: 10.1186/1471-2180-10-299] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 11/25/2010] [Indexed: 11/25/2022] Open
Abstract
Background Macrolide resistant Streptococcus pneumoniae has been on a gradual increase in Germany for over a decade. The current study was undertaken against the background of the recent observation of declining macrolide resistance rates especially among German children. Nationwide surveillance of invasive pneumococcal disease has been conducted in Germany since 1992. A population- and laboratory-based approach was used to collect data on invasive pneumococcal disease, and isolates sent to the National Reference Center for Streptococci by diagnostic microbiological laboratories from 1992 to 2008 were included in this study. Results From 1992 to 2008, data on macrolide susceptibility were available for 11,807 invasive isolates. 8,834 isolates (74.8%) were from adults (≥ 16 years), and 2,973 isolates (25.2%) from children (< 16 years). The overall nonsusceptibility rate of all isolates was 16.2% (intermediate, 0.2%; resistant, 16.0%). Higher resistance rates were observed among children (intermediate, 0.2%; resistant, 23.8%) than among adults (intermediate, 0.3%; resistant 13.4%). Maximum nonsusceptibility rates during the period under study were observed in 2005 (children: intermediate, 0.3%; resistant, 32.3%; adults: intermediate, 0.0%; resistant, 18.6%), while nonsusceptibility rates in 2008 were considerably lower, especially for children (children: intermediate, 0.0%; resistant, 15.2%; adults: intermediate, 0.1%; resistant, 12.9%). The rate of resistance was higher among the vaccine serotypes (7-valent, 36.6%; 10-valent, 28.2%; 13-valent, 24.3%) than among the non vaccine serotypes (non 7-valent, 6.5%; non 10-valent, 7.4%; non 13-valent, 6.3%). Serotype 14 (69.6% nonsusceptibility) proved to be the most resistant serotype. Conclusions There has been a considerable and statistically significant decrease in macrolide nonsusceptibility in Germany since 2005, especially among children.
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Affiliation(s)
- Matthias Imöhl
- National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany.
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