Pneumococcal disease is a common infection which is mostly mild, but it can also lead to serious health problems. These include infection with the middle ear, an infection with the blood, pneumonia, or bacterial meningitis.
The pneumococcal disease causes the bacterium Streptococcus pneumoniae (S. pneumoniae), which is also known as pneumococcus.
Invasive pneumococcal disease in 10 percent of cases is a life-threatening infection that is fatal. Older people and those with underlying medical conditions have a higher risk of serious complications compared with others.
Regular vaccinations can prevent many pneumococcal disease types and potential complications.
Types
There are two major types of pneumococcal disease: non-invasive and invasive with the less serious being the non-invasive.
Noninvasive pneumococcal diseases
These occur outside the blood or major organs.
S. Pneumoniae can spread to the upper and lower respiratory tract from the nose and throat.
The bacteria can cause:
- Otitis media: This causes inflammation of the middle ear. Symptoms usually include fluid in the middle ear, swelling of the eardrum, and earache. If the eardrum becomes perforated, pus may drain into the ear canal.
- Bronchitis: Acute bronchitis is an inflammation of the airways, resulting in a cough with the production of mucus. It usually lasts up to 3 weeks and often affects children below the age of 5 years.
- Sinusitis: This is a common condition causing inflammation of the sinuses in a person’s skull. Its symptoms include pain, swelling, and tenderness around the cheeks, eyes, and forehead.
Invasive pneumococcal diseases
Invasive pneumococcal diseases (IPDs) are more severe than the non-invasive type and occur within a major organ, or in the blood of a person.
Examples include:
- Bacteremia: A bacterial infection of the blood causes this condition and can be fatal. It often progresses rapidly to sepsis. Symptoms include fever, chills, and reduced alertness.
- Sepsis: This is a potentially life-threatening infection response by the body. Symptoms include fever, chills, clammy skin, confusion, a rapid heart rate, difficulty breathing, and severe pain.
- Meningitis: This is an inflammation of the meninges, the three membranes that cover the brain and the spinal cord. Symptoms include a stiff neck, a headache, confusion, sensitivity to light, and a fever. However, symptoms can vary, and some may not appear at all.
- Pneumonia: This is a serious lung disease. Symptoms include chest pain, difficulty breathing, a cough, a fever, and chills.
Other infections that may occur are:
- osteomyelitis, which affects the bone
- septic arthritis, an infection in the joint
All IPDs need urgent medical treatment.
Diagnosis
A doctor should ask about the signs while diagnosing pneumococcal diseases, and conduct a physical examination.
The doctor may also recommend some tests, depending on how serious the symptoms are, and which part of the body they affect.
Tests could include:
A chest X-ray: An X-ray image may reveal a “shadow” indicating pneumonia, or fluid in the pleural cavity, which is also a sign of pus pockets, called empyema.
Laboratory tests: Meningitis may be detected by a cerebrospinal fluid test (CSF) with lumbar puncture. Sometimes, the doctor will decide to check the person’s sputum, plus lung fluid, joints, muscles, around the heart or an abscess fluid.
Unless the infection may be serious, physicians are likely to initiate treatment and recommend a course of antibiotics before the results of such tests are obtained.
Risk factors
Anyone may develop pneumococcal disease but some people are at greater risk of infection or complications than others.
Those at higher risk include:
- anyone under 2 years old or more than 65 years old
- anyone with an underlying medical condition
- people with a weakened immune system
- those with chronic diseases, such as diabetes, heart disease, kidney disease, alcohol use disorder, spleen dysfunction
- people who live in long-term care facilities
- anyone who smokes tobacco
- people with a hearing aid known as a cochlear implant
How does it spread?
S. The pneumoniae bacteria are normal in children’s throats and noses.
For example , when a person with the infection coughs or sneezes, bacteria may spread through droplets in the air. The bacteria are not spread by infected food or water.
Most people exposed to the bacteria do not have any symptoms because their immune system prevents the germs from moving to another part of the body.
If an individual has a weak immune system, however, the bacteria can move from the throat to the lungs, blood, sinuses, middle ear, or brain. This may lead to an infection that is potentially dangerous.
A poor immune system can occur when a individual is:
- has a condition that affects the immune system, such as HIV or AIDS
- is taking medication to suppress the immune system, for example, after a transplant or for an autoimmune condition
- is undergoing certain medical treatments, such as chemotherapy
- contracts another serious infection, such as influenza
Prevention: Vaccination
There are a minimum of 90 strains of S. Pneumoniae, and no vaccine will offer safety against any of them. However, vaccination can help to avoid infection by the bacteria’s most common strains.
Two vaccines are known as:
- pneumococcal conjugate vaccine (PCV13)
- pneumococcal polysaccharide vaccine (PPSV23)
Doctors recommend certain routine vaccinations to protect children and older adults from pneumococcal disease.
Who needs immunization?
The Centers for Disease Control and Prevention (CDC) recommend the following vaccinations:
- PCV13 for all children under 2 years of age.
- PCV13 and PPSV23 for all adults aged 65 years and over.
- PCV13 and PPSV23 for those aged from 2 to 64 years old with certain medical conditions.
- PPSV23 for people aged 19 to 64 year old who smoke cigarettes or have asthma.
Patients can see some redness and swelling at the injection site after the injection, and feel a moderate fever. Generally these signs go away quickly and aren’t usually severe.
A doctor will have further advice on who can have a vaccine and how often.
Who should not have the vaccine?
Anyone who has had a severe allergic reaction from one dose to PPSV23, PCV13 or PCV7, which is an older version of the conjugated vaccine, should not have another. However, severe allergenic reactions are rare.
The vaccine will be given to those who are seriously or moderately ill with another infection until their health improves.
The vaccines can not cause pneumococcal disease because they are composed of components of the bacterial capsules.
Treatment
The treatment will depend on how the bacteria affect the individual.
Noninvasive pneumococcal infections
Generally, one person will recover without any treatment from a mild pneumococcal infection. However, in some cases a doctor will prescribe antibiotics so that infections will not arise.
Invasive pneumococcal infections
An IPD is treated with antibiotics by a doctor.
We can immediately prescribe broad-spectrum antibiotics before we find out exactly which bacteria are involved, as waiting can be dangerous.
If tests show what bacteria cause the problem, then the doctor can modify the antibiotics to target the specific microbe.
An individual must take these either by mouth or intravenously (IV), depending on how serious an infection is.
Growing resistance to antibiotics means that certain antibiotics no longer work for some people and some conditions, so a doctor can prescribe a combination of antibiotics.
Many patients with a more serious condition would need to stay in the hospital for longer.
When a person has extreme symptoms, they may require extra oxygen and other types of treatment, depending on the type of infection they have.
Takeaway
Pneumococcal disease is of different types. The impact of these diseases depends on the type and health of the individual it affects.
Many of these diseases can be mild and pass without treatment or they can become life-threatening and severe.
Treatment requires antibiotics but vaccination is important to avoid several forms of pneumococcal diseases in babies, the elderly and others with compromised immune systems.
