There may be hypoxemia due to poor aeration of the lung and respiratory alkalosis due to hyperventilation. It can determine serotype if a type-specific antiserum is used. Alternatively, some laboratories use counterimmunoelectrophoresis to determine serotypes of isolated strains or for case detection using specimens of sputum, urine, or other body fluids. A chest x-ray invariably shows a pulmonary infiltrate, although findings may be minimal or undetectable during the first several hours. Therapy should not be modified if there is gradual clinical improvement and the etiology is confirmed.
Antibody response is reduced in immunosuppressed patients.
Children with sickle cell disease or other causes of asplenia should receive prophylactic penicillin as well as pneumococcal vaccine. G 500,000 to 2 million U IV q 4 to 6 h. Many penicillin-resistant strains are also resistant to other antibiotics. For highly resistant strains, treatment should be based on in vitro sensitivity tests. Most resistant strains respond to high doses of penicillin, cefotaxime, or ceftriaxone.