Rare Classroom: Invasive Pneumococcal Disease

Welcome to the Rare Classroom, a new series from Patient Worthy. Rare Classroom is designed for the curious reader who wants to get informed on some of the rarest, most mysterious diseases and conditions. There are thousands of rare diseases out there, but only a very small number of them have viable treatments and regularly make the news. This series is an opportunity to learn the basics about some of the diseases that almost no one hears much about, or that we otherwise haven’t been able to report on very often.

Eyes front and ears open. Class is now in session.

The disease that we will be learning about today is:

Invasive Pneumococcal Disease

What is Invasive Pneumococcal Disease?

  • Invasive pneumococcal disease (IPD), an infection from a normally sterile site (e.g., blood or cerebrospinal fluid but not sputum), is an important and well-known cause of bacteremia in both immunocompetent and immunosuppressed patients.
  • When infections are considered “invasive”, this means germs invade parts of the body that are normally free from germs. 
  • Pneumococcal bacteria can invade the bloodstream, causing bacteremia, and secondary complications, such as arthritis, meningitis, and/or endocarditis; ear and sinus infections may occur.
  • Two types of invasive pneumococcal disease are:
    • Pneumococcal meningitis occurs when the bacteria invade the tissues and fluids surrounding the brain and spinal cord.
    • Bacteremia occurs when the bacteria invade the bloodstream and cause a serious and potentially fatal infection.
  • IPD is usually very severe, requiring treatment in a hospital
  • Approximately 10% of all patients with invasive pneumococcal disease die of their illness, but case-fatality rates are higher for the elderly and patients with certain underlying illnesses.

How Do You Get It?

  • Invasive pneumococcal disease is contagious and babies are at greater risk.
  • Babies under 2 years old are at highest risk, and they can be infected almost anywhere they are. ​
  • Pneumococcal bacteria are spread by close contact through sneezing, coughing, or even breathing. ​
  • Some people can even carry and spread pneumococcal disease without being sick themselves; if in daycare, the risk of being infected may be more than twice as high.​
  • Pneumococcal pneumonia is the most common clinical presentation of pneumococcal disease among adults. ​
  • The incubation period of pneumococcal pneumonia is short, about 1 to 3 days. ​

What Are The Symptoms?

  • Symptoms generally include an abrupt onset of fever and chills or rigors (Classically there is a single rigor, and repeated shaking chills are uncommon).
  • Other common symptoms include pleuritic chest pain, cough productive of mucopurulent, rusty sputum, dyspnea (shortness of breath), tachypnea (rapid breathing), hypoxia (poor oxygenation), tachycardia (rapid heart rate), malaise, and weakness. Nausea, vomiting, and headaches occur less frequently.

How Is It Treated?

  • Pneumococcal disease is treated with antibiotics. ​
  • Many types of pneumococcal bacteria, noted one or more antibiotics in 3 out of every 10 cases, have become resistant to some of the antibiotics used to treat these infections, ​
  • Antibiotic treatment for invasive pneumococcal infections typically includes ‘broad-spectrum’ antibiotics until results of antibiotic sensitivity testing are available. ​
  • Broad-spectrum antibiotics work against a wide range of bacteria. ​
  • Once the sensitivity of the bacteria is known, a more targeted (or ‘narrow spectrum’) antibiotic may be selected.​
  • With success of the pneumococcal conjugate vaccine, there’s much less antibiotic-resistant pneumococcal infections; appropriate use of antibiotics may also slow or reverse drug-resistant pneumococcal infections.​
  • Vaccines help prevent disease while antibiotics are only given to children after they become ill; this concerns for invasive pneumococcal disease, since its germs have often developed a resistance to certain antibiotics.​
  • Prevnar 13 is based on the scientific foundation of Prevnar® (Pneumococcal 7-valent Conjugate Vaccine [Diphtheria CRM197 Protein]), the first pneumococcal conjugate vaccine introduced in the U.S. in 2000 by Wyeth, now a part of Pfizer.​
  • Prevnar 13® is a vaccine approved for adults 50 years of age and older for the prevention of pneumococcal pneumonia and invasive disease caused by 13 Streptococcus pneumoniae strains (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F) for children 6 weeks through 17 years of age and for children 6 weeks through 5 years for the prevention of otitis media caused by 7 of the 13 strains​
  • Prevnar 13® was approved the FDA on February 24, 2010​

Where Can I Learn More???

  • Check out our cornerstone on this disease here.

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