Case Studies Highlighting Urgent Need for Vaccination Against Invasive Pneumococcal Disease

Invasive pneumococcal disease (IPD) poses a significant global health risk, in spite of advancement in immunization and antibiotic treatment, particularly following the increase in cases after COVID-19. Streptococcus pneumoniae can cause serious infections like meningitis and pneumonia, warrants the need for urgent preventive measures, including vaccination. The following case report discusses three complex cases of IPD to illustrate the importance of vaccination and the varied clinical presentations of the disease.

The first case involved a healthy 4-year-old boy who, after presented with fever, seizures, and altered consciousness, was diagnosed with complicated pneumococcal meningitis and brain abscesses. Despite receiving vaccinations per the national schedule, he had not received the pneumococcal conjugate vaccine (PCV). He was treated with ceftriaxone and vancomycin and was discharged with significant disability. 

The second case was another 4-year-old boy, also unvaccinated with PCV, presented with fever, abdominal pain and respiratory distress, was diagnosed with pneumococcal pleuropericarditis. He required intubation and drainage procedures before being discharged.

The third case focussed on a 7-year-old girl who presented with fever, vomiting, and altered sensorium and had a history of CSF rhinorrhea who had received a single dose of PCV-10. She arrived in shock, necessitating intensive treatment, including mechanical ventilation and dialysis, due to complications like hemolytic uremic syndrome.

These cases highlighted the critical need for complete vaccination, including newer PCV15 and PCV20, as well as the challenges posed by delayed diagnoses and rising antibiotic resistance in Streptococcus pneumoniae strains.

Source: Jayaram J, Vyasam S, Muralidharan J, et al. Extrapulmonary Spectrum of Invasive Pneumococcal Disease. Indian J Pediatr.2024. https://doi.org/10.1007/s12098-024-05360-2.