Sex: M
Vaccine: PPV
Symptoms: Intensive care, Liver injury, Neutrophil count increased, Pneumococcal infection, Polymerase chain reaction positive
Clinical narrative: This literature report has been received from the author of a published literature article. Background: Patients with sickle cell disease (SCD) were at risk of fatal sepsis with encapsulated bacteria, such as Streptococcus pneumonia, because of the inherent autosplenectomy that occurred in SCD. This risk was thwarted with oral penicillin prophylaxis during the first 5 years of life, and with stringent vaccination against S. pneumoniae alongside routine childhood immunization. But compared with the general specific pediatric population, the rate of invasive pneumococcal disease (IPD) in patients with SCD still remained high, resulting in hospitalization and fatality. This study aimed to investigate IPD in a patient population with SCD that had received standard pneumococcal prophylaxis. Methods: Patients with SCD who developed IPD from 2004 up to 2013 were identified using microbiology records. Those records belonging to patients with SCD between the ages of 0 to 21 years were selected for inclusion in this retrospective study. Descriptive analysis of presence of risk factors for IPD, type of SCD, pneumococcal vaccination and prophylaxis status, clinical presentation, microbiological data, and the outcome of IPD was performed. Results: 8 patients with SCD developed IPD (7 bacteremia and 1 respiratory tract infection). Three of the 8 isolates underwent serotype analysis (15 C in 2 and 15 A in 1), none covered with the current vaccination program. One patient had fatal outcome (15 A). Conclusions: Breakthrough cases of IPD might involve non-vaccine isolates, and seemed to occur after 5 years of age when oral penicillin prophylaxis had been terminated. Non-vaccine serotypes could cause IPD in patients with SCD, especially in older patients who were no longer on oral penicillin prophylaxis and/or those patients with incomplete immunization status. Prompt institution of antibiotic and supportive therapy was essential for the survival of these patients. This case refers to a 7 year old male patient, without smoking exposure. The patient had sibling and was also on the daycare. Concomitant therapy included oral penicillin (complete) and heptavalent pneumococcal conjugate vaccine (PCV7) (active) for prophylaxis. On an unknown date, the patient received PNEUMOVAX 23 for prophylaxis. In 2010, the non-vaccine serotypes patient developed invasive pneumococcal disease (IPD), resulting in hospitalization (date unknown). The patient presented with vomiting and diarrhea, developed acute liver and renal injury, and was found to have concurrent Epstein Barr viremia. The Clinical presentation data: temperature: 37 Celsius degrees; heart rate was 140 /min. White blood cell count/ absolute neutrophil count (WBC/ANC) 16,400/11,972 /mm^3. Hemoglobin was 4.1 g/dL (a significantly low level associated with reticulocytosis). Absolute reticulocyte count was 374,400 /mm^3. The other clinical findings at presentation: vomiting, diarrhea. The microbiological and outcome data: Blood culture: S. pneumoniae positive; Time to culture positive: 15 hrs; S. pneumoniae Serotype analysis: not performed (NP); S. pneumoniae susceptibility: penicillin and ceftriaxone; pediatric intensive care unit (PICU) stay: Yes (had to be transferred to the PICU due to concurrent liver and renal failure but he recovered from the disease); outcome of the event: recovered. Focal infection/other culture: Epstein Barr viremia by polymerase chain reaction (PCR). The reporter considered the event to be related to PNEUMOVAX 23. Upon internal review, IPD - bacteraemia was determined to be medically significant. This is one of several reports from the same literature. Sender's Comments: US-009507513-1707USA005890.