Pediatric Infectious Disease

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VOLUME 4 , ISSUE 1 ( January-March, 2022 ) > List of Articles

Original Article

Invasive Pneumococcal Disease Case Series in Pediatric Inpatients: A Clinical Experience from South India

R Kishore Kumar, Sanjay Swamy, Adithi Shetty

Keywords : Invasive pneumococcal disease, Pediatric, Serotype, Vaccine

Citation Information : Kumar RK, Swamy S, Shetty A. Invasive Pneumococcal Disease Case Series in Pediatric Inpatients: A Clinical Experience from South India. Pediatr Inf Dis 2022; 4 (1):1-5.

DOI: 10.5005/jp-journals-10081-1293

License: CC BY-NC 4.0

Published Online: 08-02-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Aim and objective: To monitor the causative pathogens, serotype distribution, and antimicrobial resistance patterns for pediatric invasive pneumococcal disease (IPD). Background: In India, IPD is a major contributing factor to the high under-five mortality rate, but surveillance-based studies are scarce on the subject, although vaccines are available for prevention. Case descriptions: We present a case series of IPD among Indian children aged ≤12 years attending a pediatric specialty hospital in Bengaluru, South India, over 5 years. Nine IPD cases were seen between June 2014 and July 2019 including both immunized and unimmunized children. The clinical presentation included pneumonia that progressed to sepsis, empyema, and pleural effusion in seven children and febrile seizures in one patient. Streptococcus pneumoniae was isolated from all the blood and pleural fluid cultures. The serotypes isolated were 19F, 19A, 2, 14, 9V/A, 6A/6B, and 3, which were all vaccine-preventable. Three cases were susceptible to all antibiotics, while others showed antimicrobial resistance to cotrimoxazole, benzylpenicillin, erythromycin, and clindamycin. All but one patient recovered uneventfully. Conclusion: Continued surveillance for IPDs and serotyping of pneumococcal isolates is important to study the effects of vaccination and monitor the emergence of non-vaccine-preventable serotypes. Clinical significance: Although IPD-causing pneumococcal serotypes have been documented in the Indian scenario, data are scarce on the emergence of non-vaccine-preventable serotypes, particularly in Indian children with IPD. Since the availability of pneumococcal vaccine (PCV) in India, this is possibly the first case series of IPD in Indian immunized children. The case series reveals that IPD-causing pneumococcal serotypes in Indian children are mostly vaccine-preventable and susceptible to standard antibiotics.

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  1. Chhatwal J. The unchecked pneumococcal reign over Indian children aged younger than 5 years. Lancet Infect Dis 2017;17(3):243–244. DOI: 10.1016/S1473-3099(16)30543-6.
  2. Manoharan A, Jayaraman R. Pneumococcal caccines. Indian J Med Microbiol 2018;36(4):465–474. DOI: 10.4103/ijmm.IJMM_18_442.
  3. Manoharan A, Manchanda V, Balasubramanian S, et al. Invasive pneumococcal disease in children aged younger than 5 years in India: a surveillance study. Lancet Infect Dis 2017;17(3):305–312. DOI: 10.1016/S1473-3099(16)30466-2.
  4. Shariff M, Choudhary J, Zahoor S, et al. Characterization of Streptococcus pneumoniae isolates from India with special reference to their sequence types. J Infect Dev Ctries 2013;7(02):101–109. DOI: 10.3855/jidc.2553.
  5. Balaji V, Jayaraman R, Verghese V, et al. Pneumococcal serotypes associated with invasive disease in under five children in India & implications for vaccine policy. Indian J Med Res 2015;142(3):286–292. DOI: 10.4103/0971-5916.166588.
  6. Molander V, Elisson C, Balaji V, et al. Invasive pneumococcal infections in Vellore, India: clinical characteristics and distribution of serotypes. BMC Infect Dis 2013;13(1):532. DOI: 10.1186/1471-2334-13-532.
  7. John TJ, Pai R, Lalitha MK, et al. Prevalence of pneumococcal serotypes in invasive diseases in southern India. Indian J Med Res 1996;104:205–207.
  8. Nisarga R, Premalatha R, Shivananda, et al. Hospital-based surveillance of invasive pneumococcal disease and pneumonia in South Bangalore, India. Indian Pediatr 2015;52(3):205–211. DOI: 10.1007/s13312-015-0607-0.
  9. Singh J, Sundaresan S, Manoharan A, et al. Serotype distribution and antimicrobial susceptibility pattern in children ≤5 years with invasive pneumococcal disease in India - a systematic review. Vaccine 2017;35(35):4501–4509. DOI: 10.1016/j.vaccine.2017.06.079.
  10. Ktari S, Jmal I, Mroua M, et al. Serotype distribution and antibiotic susceptibility of Streptococcus pneumoniae strains in the south of Tunisia: a five-year study (2012-2016) of pediatric and adult populations. Int J Infect Dis 2017;65:110–115. DOI: 10.1016/j.ijid.2017.10.015.
  11. John J, Varghese R, Lionell J, et al. Non-vaccine pneumococcal serotypes among children with invasive pneumococcal disease. Indian Pediatr 2018;55(10):874–876. DOI: 10.1007/s13312-018-1398-x.
  12. Mathew JL, Patwari AK, Gupta P, et al. Acute respiratory infection and pneumonia in India: a systematic review of literature for advocacy and action: UNICEF-PHFI series on newborn and child health, India. Indian Pediatr 2011;48(3):191–218. DOI: 10.1007/s13312-011-0051-8.
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