Pneumococcal Disease

Pneumococcal disease presents more commonly as non-invasive disease in the form of non-bacteraemic pneumonia, middle-ear infections, sinusitis, or bronchitis. However, it may also manifest as Invasive Pneumococcal Diseases (IPD) in the form of pneumonia with empyema and/or bacteraemia or meningitis as a result of haematogenic spread. In developing countries, non-bacteraemic pneumonia causes the majority of pneumococcal deaths. Ninety distinct serotypes have been identified.

Pneumococcal disease is effectively prevented with Pneumococcal Conjugate Vaccine (PCV) at 6,10 and 14 weeks for infants. Pneumococcal Polysaccharide Vaccine (PPSV23) is recommended for persons older than 2 years with underlying medical conditions such as Sickle Cell Disease. Adults with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants should receive PCV13 followed by PPSV23.

Cause

Streptococcus pneumoniae

Symptoms

Fever
Other symptoms associated with pneumonia, otitis media, meningitis, septicaemia

Signs

Please refer to signs and symptoms of the specific diseases in other sections

Investigations

Culture and sensitivity of appropriate body fluids (e.g. pus from the ear in suppurative otitis media, cerebrospinal fluid in meningitis, pleural aspirate in empyema, blood).

Note: Blood culture is only relevant in invasive pneumococcal disease and would not be helpful in uncomplicated pneumonias.

TreatmentTreatment Objectives

To eliminate the bacteria
To provide supportive care

Non-pharmacological treatment

(See relevant sections on the presenting illness e.g. meningitis, pneumonia)

Pharmacological treatment

(See relevant sections on the presenting illness e.g. meningitis, pneumonia)

Referral Criteria

All patients who fail to show remarkable signs of improvement in 3 days following drug treatment, or present with complications should be referred for higher-level care.