Sex: M
Vaccine: PPV
Symptoms: Blood culture negative, Cerebrovascular accident, Endotracheal intubation, Haemoglobin normal, Intensive care
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 (S. pneumoniae), 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 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 6 year old male patient, without smoking exposure or daycare. The patient had sibling. Concomitant therapy included oral penicillin (complete), PREVNAR 13 for prophylaxis. On an unknown date, the patient received PNEUMOVAX23 for prophylaxis. The patient presented from home with fever of 40.9 Celsius degrees (date unspecified). In 2012, the non-vaccine serotypes patient developed invasive pneumococcal disease (IPD), resulting in hospitalization (date unknown). The Clinical presentation data: temperature: 38 Celsius degrees; heart rate was 92 /min. White blood cell count/ absolute neutrophil count (WBC/ANC) 20,400/16,800 /mm^3. Hemoglobin was 9.5 g/dL. Absolute reticulocyte count was 292,300 /mm^3. The other clinical findings at presentation: Seizure, right-sided stroke before fever (initially presented with seizures and left-sided stroke, and subsequently developed fever during hospitalization). The microbiological and outcome data: Blood culture: Negative; Time to culture positive: 96 hrs; S. pneumoniae Serotype analysis: not performed (NP); S. pneumoniae susceptibility: penicillin and ceftriaxone; pediatric intensive care unit (PICU) stay: Yes (admitted to the PICU due to stroke, needing intubation, and subsequently recovered from the S. pneumoniae respiratory disease); outcome of the event: recovered. Focal infection/other culture: S. pneumoniae on respiratory culture (obtained through endotracheal tube suctioning). The reporter considered the event to be related to PNEUMOVAX23. 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: Original Case: 1707USA005890.