Infectious diseases. Pneumococcal infection. Clinic. Diagnostics. Treatment. Prevention (most important)

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Infectious diseases. Pneumococcal infection. Clinic. Diagnostics. Treatment. Prevention (most important)

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14. Pneumococcal infection. Clinic. Diagnostics. Treatment. Prevention

Clinical manifestations. Clinical symptoms of pneumococcal infection depend on the localization of the underlying pathological process. Most often, it involves the upper and deep sections of the respiratory tract, often accompanied by a viral infection. Pneumonia, otitis media, sinusitis and pharyngitis, laryngotracheobronchitis, peritonitis and bacteremia develop. Pneumococci remain the most common causative agent of otitis media in children over the age of 1 month. Spread of infection can occur by contact, resulting in empyema, pericarditis, mastoiditis, epidural abscess, and, rarely, meningitis. Bacteremia can cause meningitis, purulent arthritis, osteomyelitis, endocarditis, and brain abscess. Subcutaneous abscesses rarely form with pneumococcal bacteremia. Kidney diseases such as glomerulonephritis and cortical arteriole thrombosis are often associated with pneumococcal bacteremia. Localized gingivitis, gangrenous areas on the skin of the face or extremities, and disseminated intravascular coagulation of the blood can also be a manifestation of pneumococcal bacteremia.

Diagnosis. The exact diagnosis of pneumococcal infection can be established on the basis of the isolation of pneumococci from the focus of inflammation or blood.

Pneumococci are often found in urine cultures. In the early stages of pneumococcal meningitis, cocci may be found in the CSF. Quantitative immunoelectrophoresis of serum, CSF, or urine using combined pneumococcal serum can be of great help in diagnosing pneumococcal meningitis or bacteremia. Pneumococcal antigens in blood and urine can also be detected in localized pneumococcal disease. Type-specific antiserum significantly improves the accuracy of serological diagnostic methods.

Treatment. Penicillin is the drug of choice for pneumococcal infections. Doses and duration of treatment should vary depending on the location of the infection. It is desirable in all cases to determine the drug sensitivity of isolated pneumococci using the dilution method to correct treatment tactics. The impossibility of foreseeing or predicting the drug resistance of the pathogen creates the need in all cases to conduct an appropriate bacteriological study of all strains of pneumococci isolated from blood and CSF. Erythromycin, cephalosporin, clindamycin and levomycetin, sulfadiazine and sulfazoxazole can be successfully used to treat patients who cannot tolerate penicillin.

Prevention. The polyvalent pneumococcal vaccine "PNEUMO-23" is highly immunogenic and rarely causes adverse reactions; it is recommended for vaccination of children over the age of 2 years from the high-risk group. Children with an immunodeficiency state, if they come into contact with a patient with pneumococcal infection, gamma globulin can be administered.

Author: Pavlova N.V.

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