pneumococcal infection

Pneumococcal infection is quite widespread on the planet. However, in Russia, the registration of cases of this infection is difficult due to the lack of universal diagnosis of all cases of acute respiratory diseases. Pneumococcal meningitis on average in Russia is detected in 10 children from 0 to 2 years old per 100,000 population, and this figure is quite high. The incidence of sepsis (blood poisoning) of pneumococcal etiology is 100 cases per 100 tons, pneumococcal pneumonia is 1200 cases per 100 tons, and pneumococcal otitis is 22000 cases per 100 tons. These indicators show that pneumococcal infection is much more common than we think. We must not forget that the frequency of severe forms of infection is high, which can lead to a long-term recovery of health, and disability and an unfavorable outcome.

The causative agent - pneumococcus or Streptococcus pneumoniae, is a representative of the normal microflora of the upper respiratory tract. Normally, there is a carriage of one or more types of pneumococci, the rate of which ranges from 5-10 to 60-65%. Pneumococcus is a gram-positive (gram-stained blue under microscopy) coccus surrounded by a polysaccharide membrane that contains antiaging. It is an antiphon that prevents the destruction (phagocytosis) of pneumococci by leukocytes. Such a shell allows pneumococcus to escape from the immune system of a small child from 0 to 2 years old. The immune cells of an adult already cope with the neutralization of pneumococcus. It is this feature that is the reason for the prevalence of pneumococcal infection in young children.

Currently, 84 pneumococcal serotypes are known to be pathogenic for humans. The main types of pneumococci found in young children and responsible for the overwhelming number of cases of this infection have been used in the development of vaccines for specific prophylaxis.

Pneumococci are unstable in the external environment. They die from the action of conventional disinfectants, at t - 600 they die within 10 minutes. However, they are resistant to drying. In dried sputum, they remain viable for 2 months.

Today there is a big problem of antibiotic resistance - that is, the resistance of pneumococci to a number of antibacterial drugs, which creates additional difficulties in the treatment of the disease.

Causes of pneumococcal infection

The source of infection is 1) patients with a clinically pronounced form of the disease, and 2) carriers of pneumococci. In infected environments, the source of infection is nasopharyngeal mucus, mucus of the bronchial tree (sputum).

The main mechanism of infection is atherogenic, and the route is airborne. Infection occurs when sneezing, coughing, or talking with a source of infection. Persons who are in direct contact with the source of infection are most susceptible to infection (when sneezing and coughing, this is an aerosol cloud 3 meters in diameter).

Human susceptibility to pneumococcal infections is high. Family outbreaks and outbreaks in children's groups are possible.

Risk groups for infection:

1. Children under 2 years old, whose immune cells are not able to fight the pathogen. Children in the first six months of life have maternal antibodies, the number of which after 6 months of life is greatly reduced, and therefore the risk of developing an infection increases.
2. Children and adults with immunodeficiency (chronic diseases of the respiratory system, cardiovascular system, diabetes mellitus, renal failure, cirrhosis of the liver; HIV infection, oncological diseases, blood diseases).
3. Age-related immunodeficiency (elderly people over 65 years old).
4. Persons with tobacco and alcohol dependence.

Symptoms of pneumococcal infection

How does an infection develop? The entrance gates of pneumococcal infection are the mucous membranes of the oropharynx and respiratory tract, where pneumococci can stay for a long time without any pathogenic effect. Of great importance in the development of the further process is the resistance (resistance) of the entrance gate of infection.

Adverse factors for the development of the disease:  hypothermia, decreased local immunity as a result of frequent respiratory infections, stressful situations, and overwork, hypovitaminosis. With a decrease in local resistance, the development of pneumonia is possible. Once in the blood, pneumococci can cause sepsis (blood poisoning), as well as spread to organs and tissues.

The incubation period  (from the moment of infection to the development of the disease) is from 1 to 3 days.

Disease manifestations: 

1. Pneumococcal pneumonia (pneumonia)
2. Pneumococcal meningitis (inflammation of the pia mater)
3. Pneumococcal otitis media (inflammation of the middle ear)
4. Pneumococcal sepsis (blood poisoning)

pneumococcal pneumonia

Pneumonia is characterized by high temperature - rise to high (febrile) numbers - 38-39 °, chills, severe weakness, muscle pain, shortness of breath, and palpitations; soon a wet cough appears with sputum of a mucopurulent nature (yellowish-greenish in color), sometimes chest pains are disturbed by coughing.

Pneumonia with pneumococcal infection can be croupous  (sudden onset, high fever, severe chills, blush on the cheeks, sharp pains in the chest and sputum with a brown tint - “rusty”, moist rales when auscultated, crepitus, “pleural friction noise”, dullness percussion sound) or focal (occurs against the background of manifestations of an acute respiratory infection - weakness, wet cough, sweating, shortness of breath, mucopurulent sputum, pain in a small area of ​​the chest, pallor of the skin, fine and medium bubbling rales are heard). Croupous pneumonia is more severe, it is possible to develop acute respiratory failure, the formation of abscesses, and pleurisy.

Focal pneumonia is lighter in severity, but infiltration resolves over a longer period - up to 4 weeks.

When you need to see a doctor:  the appearance of high fever with severe weakness, cough with purulent and “rusty” sputum, and chest pain.

Pneumococcal meningitis

Pneumococcal meningitis begins acutely with an increase in body temperature up to 40 °, and a diffuse headache of a bursting character appears. In most patients, repeated vomiting and hypersensitivity to all kinds of irritants join somewhat later. During the first 12-24 hours from the onset of meningitis, a detailed picture of meningeal and cerebral syndromes is formed. Meningeal symptoms appear and rapidly increase neck muscle stiffness, Kernig's symptom, Brudzinsky's symptoms, etc. Patients are characterized by a "meningeal posture" or "pointing dog posture". Consciousness is first preserved and then replaced by a state of stupor, stopping the coma.

The cerebrospinal fluid in the analysis - follows under pressure, turbid, cytosis of several tens of thousands of cells in 1 μl, neutrophils up to 90%, protein is often increased.

When to see a doctor:  high fever, severe headache, repeated vomiting, neck pain, inability to bend it - all these symptoms for immediate medical attention. In young children - high fever, constant crying, and anxiety of the child - a reason for an urgent visit to the doctor. Meningitis requires urgent medical interventions in a hospital setting.

Pneumococcal otitis media

Pneumococcal otitis media is characterized by fever, ear pain, and hyperacusis (increased sensitivity to auditory stimuli).

Pneumococcal sepsis

Pneumococcal sepsis is manifested by an infectious-toxic syndrome (fever, weakness, headaches), an enlarged spleen (which the patient often does not feel), and symptoms of damage to various organs and systems (lungs, heart, intestines, kidneys, meninges).

Complications of pneumococcal infection

Complications are associated with the development of one or another clinical form of the disease. With the development of pneumonia, one should be wary of acute respiratory failure, and heart failure. With meningitis - cerebral edema with the danger of herniation syndrome (cardiac and pulmonary arrest). In the case of sepsis, mortality reaches up to 50% and any complications can be expected.

After a pneumococcal infection, a low-tension, short-term, type-specific immunity is formed, which does not protect against re-infection with another pneumococcal serotype.

Diagnosis of pneumococcal infection

1. The preliminary diagnosis is clinical. Exhibited by a doctor when examining a patient on the basis of suspicious symptoms after a differential diagnosis. It is very difficult to distinguish pneumococcal infection from diseases with a similar clinic caused by other bacteria. Doctors need to exclude pneumonia of another etiology (staphylococcal, streptococcal, legionellosis, klebsiella, and others); other bacterial meningitis, etc.

2. The final diagnosis is made only after laboratory confirmation of the diagnosis. 

For research are selected: oropharyngeal mucus, sputum, blood, cerebrospinal fluid, and inflammatory exudates. Taking a certain type of material for laboratory research is carried out taking into account the clinical picture of the disease.

Features: the rapid death of pneumococcus in the external environment determines the rapid delivery of the material to the laboratory.

The main diagnostic methods are:

1. Microscopy of Gram-stained and His smears - lanceolate diplococci are visible under the microscope.

2. Bacteriological method - inoculation of the material on special media (blood agar and serum broth, 10% bile broth)

3. Serological method - a blood test using an agglutination reaction only confirms the main diagnosis.

Treatment of pneumococcal infection

1) Basic therapy (regime, diet).

Mode.  Hospitalization is carried out according to clinical indications. Patients with pneumococcal acute respiratory disease are treated at home only. Other forms of infection, and even more so in children, require hospitalization to avoid fatal complications. An invariable condition is the observance of bed rest for the entire febrile period, as well as until the elimination of complications. 

A complete diet with a balanced amount of proteins, fats, and carbohydrates; with the exception of obligate allergens, and a sufficient amount of liquid.

2) Etiotropic therapy (antibacterial drugs) - the drugs of choice for pneumococcal infection are a group of penicillins, cephalosporins, carbapenems, and vancomycin, depending on the form of infection.

We must remember the increase in strains of antibiotic-resistant species of pneumococcus, which certainly complicates the therapeutic search for the drug. There is only one way out - to determine the sensitivity of the secreted pneumococcus to various antibiotics, which takes 2-3 days.

3) Pathogenetic infusion therapy (correction of the protective functions of the body) includes detoxification therapy, bronchodilators, cardioprotectors, diuretics, agents to improve microcirculation, and so on.

4) Pathogenetic and symptomatic therapy (antipyretic, analgesics, anti-inflammatory, antihistamines);

1. Antipyretics (Nurofen, Panadol for children, Theraflu, Coldrex, Fervex, Efferalgan for adults) to reduce fever and improve general well-being.
2. Anti-inflammatory therapy and analgesics - ibuprofen, paracetamol, Voltaren, and ketorolac - relieve pain, in particular with myalgia.
3. Mucolytics (and expectorants) - acetylcysteine, ambroxol, also van, bromhexine, bronchiolitis, ascoril, and so on. Cough suppressants (second, codec, stop us in) are NOT recommended for pneumococcal infections.
4. Probiotics in case of development of drug enteritis (lines, bifistim, bifidum forte, etc.) in order to activate normal microflora and fight infection in the lesion.

5) Distracting and local therapy includes steam inhalations with a solution of soda, herbal solutions - sage, chamomile (which is important for catarrhal form and herpangina); irrigation of the pharynx with disinfectant solutions to avoid bacterial contamination of the affected area; anti-inflammatory eye drops for conjunctivitis.

Can I take antibiotics on my own for pneumococcal infections? It is undesirable since only a doctor can correctly determine the necessary group of antibacterial drugs. Incorrect selection of the drug and the dose can lead not only to the absence of the effect of treatment, but also to a significant decrease in immunity, and, consequently, to a deterioration in the general condition of the patient.

Prevention of pneumococcal infection

1. Specific - vaccination of young children.
2. There are two vaccines for immunization: Prevenar-13 and Pneumo 23.
3. Prevenar-13 is used to vaccinate children from 2 months to 5 years old, and Pneumo-23 from 2 years old and older. Vaccines do not contain pathogens but contain purified polysaccharides of the most common types of pneumococci. In addition, the introduction of the vaccine has a therapeutic effect in the form of sanitation from pneumococcus in the respiratory tract and a decrease in the number of carriers of pneumococcus. Vaccines are administered according to different schemes depending on age. Immunity is developed 10-15 days after administration and lasts for 5 years. The Government of the Russian Federation is considering a change to Article 9 of the Federal Law "On Immunoprophylaxis of Infectious Diseases", and if it is approved, vaccination against pneumococcus will become mandatory in 2014.
4. Nonspecific (isolation of patients, maintenance of immunity, vitamin prophylaxis, timely treatment of acute respiratory infections, sports, hardening).

WHEN TO VACCINE?

The following administration schedules are available for pneumococcal conjugate vaccines:

For children at risk, there is a scheme of booster vaccination with polysaccharide pneumococcal vaccine (PPV23) no earlier than 2 months after the introduction of PCV.

Immunization of adults is recommended to start with PCV13 vaccination to form immune memory and increase the duration of possible protection against pneumococci. A similar booster vaccination with PPV23 in adults is carried out no earlier than 12 months after the introduction of PCV.