Pneumococcal infection in children

Pneumococcal infections - a group of diseases of bacterial etiology, clinically manifested pyoinflammatory changes in various organs and systems, but especially in the lungs of the type of croupous pneumonia and in the central nervous system by the type of purulent meningitis.

The disease is more often in children and adults with a deficiency of humoral immunity.

Infection with pneumococci can occur both exogenous and endogenous. When exogenous infection is most often develops croupous pneumonia. Endogenous infection occurs due to a sharp weakening of immune defense and activation of saprophytic pneumococci on the mucous membranes of the respiratory tract. In these conditions, pneumococci can cause meningitis, septicemia, endocarditis, otitis media, pericarditis, peritonitis, sinusitis and other purulent-septic diseases.

[1], [2], [3], [4], [5], [6], [7], [8], [9]

Epidemiology of pneumococcal infection

Pneumococci are common inhabitants of the upper respiratory tract of man and in this sense they can be attributed to conditionally pathogenic microorganisms.

The source of infection is always a person - a patient or a carrier of pneumococci. The causative agent is transmitted by air-droplet and by contact-household way.

Susceptibility to pneumococci is not accurately established. The disease usually develops in children with type-specific antibodies deficit and is particularly severe in children with sickle cell anemia, other forms of hemoglobinopathy, deficiency of the C3 complement component. It is believed that in these cases the disease develops against the background of inferior opsonization of pneumococci, which makes it impossible to eliminate them with phagocytosis.

[10], [11], [12], [13], [14], [15], [16], [17], [18],

Causes of pneumococcal infection

According to the modern classification of pneumococci are referred to the family Streptococcaceae, the genus Streptococcus. These are Gram-positive cocci of an oval or spherical shape 0.5-1.25 μm in size, arranged in pairs, sometimes in the form of short chains. Pneumococci have a well-organized capsule. By its polysaccharide composition, more than 85 serotypes (serovars) of pneumococci have been isolated. Pathogens for humans are only smooth capsular strains, which, with the help of special serums, belong to one of the first 8 types, the remaining serovars for humans are weakly pathogenic.

[19], [20], [21], [22], [23], [24], [25], [26]

Pathogenesis of pneumococcal infection

Pneumococci can affect any organs and systems, but the triple organ should be considered lung and respiratory tract. The causes that determine the tropism of pneumococci to the bronchopulmonary system have not been established for certain. It is more likely that capsular pneumococcal antigens have an affinity for lung tissues and respiratory tract epithelium. The introduction of an agent into the lung tissue is promoted by acute respiratory diseases, which eliminate the protective function of the epithelium of the respiratory tract and reduce the overall immunoreactivity. Various congenital and acquired defects of the bacterial antigen elimination system are also important: defects in the lung surfactant system, inadequate phagocytic activity of neutrophils and alveolar macrophages, impaired bronchial patency, decreased cough reflex, etc.

Causes and pathogenesis of pneumococcal infection

Symptoms of pneumococcal infection

Croupous pneumonia (English croup - croaking) is an acute inflammation of the lungs, characterized by the rapid involvement of the lung and adjacent portion of the pleura in the process.

The disease is noted mainly in older children. In infants and young children, croupous pneumonia is extremely rare, which is explained by the lack of reactivity and features of the anatomical and physiological structure of the lungs (relatively wide intersegmentary connective tissue layers that prevent the contact spread of the inflammatory process). Croupous pneumonia is often caused by I, III and especially IV serotypes of pneumococci, other serotypes cause it rarely.

Symptoms of pneumococcal infection

Classification

Depending on the focus of the lesions, there are croupous pneumonia, pneumococcal meningitis, otitis media, osteomyelitis, endocarditis, peritonitis.

[27], [28], [29], [30], [31], [32], [33], [34],

Diagnosis of pneumococcal infection

Precisely diagnose pneumococcal infection can only be after the excretion of the pathogen from the lesion or blood. For examination, sputum is taken for croupous pneumonia, blood for suspected sepsis, purulent discharge or inflammatory exudate in other diseases. Pathological material is subjected to microscopy. The detection of gram-positive diplococci lanceolate form, surrounded by a capsule, is the basis for the preliminary diagnosis of pneumococcal infection.

Diagnosis of pneumococcal infection

[35], [36]

Treatment of pneumococcal infection

In severe forms, antibiotics must be prescribed.

In light and medium-sized forms (nasopharyngitis, bronchitis, otitis, etc.), phenoxymethylpenicillin (vepicombe) can be administered at 5000-100 000 units / kg per day in 4 doses or penicillin at the same dose 3 times a day intramuscularly for 5- 7 days.

Treatment of pneumococcal infection

• Pneumonia - Treatment regimen and nutrition
• Antibacterial drugs for the treatment of pneumonia
• Pathogenetic treatment of pneumonia
• Symptomatic treatment of pneumonia
• Fighting complications of acute pneumonia
• Physiotherapy, exercise therapy, respiratory gymnastics with pneumonia
• Sanatorium treatment and rehabilitation for pneumonia

Prevention of pneumococcal infection

For the prevention of pneumococcal infection, a polyvalent polysaccharide graft was proposed from the pneumococcal pneumonia 23 infection of Sanofi Pasteur (France), which represents a mixture of purified capsular polysaccharides of the 23 most common serotypes of pneumococcus. One dose of this vaccine contains 25 micrograms of each type of polysaccharide, as well as isotonic sodium chloride solution and 1.25 mg of phenol as a preservative. Other impurities do not contain the vaccine. It is recommended to inject to children at risk of pneumococcal infection older than 2 years, which include children with immunodeficiency, aspiration, sickle cell anemia, nephritic syndrome, hemoglobinopathies.

Prevention of pneumococcal infection

Forecast

With pneumococcal meningitis, mortality is about 10-20% (in the preantibiotic era - 100%). In other forms of the disease, lethal cases are rare. They occur, as a rule, in children with congenital or acquired immunodeficiency, long-term treatment with immunosuppressive drugs, in children with congenital malformations.

[37], [38], [39], [40]