Pediatric Pneumococcal Infections Clinical Presentation

  • Author: Meera Varman, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Sep 8, 2011
 

History

Children with pneumococcal infections usually have a temperature higher than 102°F. Children with invasive infections also demonstrate signs and symptoms related to the site of infection. Symptoms of specific infections in addition to fever are as follows:

Otitis media symptoms include the following:

  • Otalgia (irritability and ear pulling in younger children)
  • Upper respiratory symptoms
  • Vomiting

Sinusitis symptoms include the following:

  • Headache
  • Facial tenderness (much less frequent than in adults)
  • Symptoms of upper respiratory infection (cough, nasal drainage, congestion) lasting for 10 days or longer

Occult bacteremia may present with fever without a localizing source in children aged 2-24 months.

Pneumonia may present with the following:

  • Cough
  • Chest pain, shortness of breath, or respiratory difficulty
  • Malaise and poor appetite

Meningitis may present with the following:

  • Stiff neck
  • Vomiting
  • Headache (older children)
  • High fever (temperature >103°F)
  • Lethargy
  • Irritability
  • Poor feeding
  • Unconsolable crying
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Physical

Otitis media findings include bulging, erythematous, or yellow tympanic membrane with poor mobility and purulent fluid seen behind the tympanic membrane.

Sinusitis findings include the following:

  • Tenderness to palpation over maxillary or frontal sinuses
  • Nasal discharge of any color
  • Swollen nasal turbinates

Bacteremia has no physical findings except fever (temperature of 102°F or higher) and tachycardia associated with the fever.

Pneumonia findings include the following:

  • Crackles or decreased breath sounds in the area of lobar consolidation on chest auscultation, with egophony in patients with severe consolidation and dullness to percussion
  • Retractions, tachypnea, or both

Meningitis/CNS infection findings include the following:

  • Ill appearance
  • Nuchal rigidity (may not be present in infants < 4 mo)
  • Altered mental status, poorly responsive (patient may present in comatose state)
  • Other neurologic abnormalities possible, such as cranial nerve deficits, ataxia, and weakness
  • Poor perfusion and signs of shock in patients with concurrent pneumococcal sepsis
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Contributor Information and Disclosures
Author

Meera Varman, MD  Associate Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University Medical Center

Meera Varman, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: phamaceutical companies Honoraria Speaking and teaching; phamaceutical companies Grant/research funds clinical trials

Coauthor(s)

Archana Chatterjee, MD, PhD  Professor of Pediatrics, Medical Microbiology and Immunology, and Pharmacy, Division of Pediatric Infectious Diseases, Chief of Division of Pediatric Infectious Diseases, Creighton University School of Medicine; Hospital Epidemiologist and Medical Director of Infection Control, Children's Hospital

Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Nancy A Wick, MD  Consulting Staff, Department of Emergency Medicine, Section of Pediatrics, Children's at Scottish Rite

Nancy A Wick, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David Jaimovich, MD  Chief Medical Officer, Joint Commission International and Joint Commission Resources

David Jaimovich, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Chandy C. John, MD, MS, to the development and writing of this article.

References

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Sputum Gram stain from a patient with a pneumococcal pneumonia. Note the numerous polymorphonuclear neutrophils and gram-positive, lancet-shaped diplococci. Courtesy of C. Sinave, MD, personal collection.
Table. Drug Comparison
DrugSensitive, MIC mcg/mLResistant isolate, MIC mcg/mL
Intermediate resistanceResistant
Penicillin/amoxicillin≤0.060.1-1≥2
Cefotaxime or ceftriaxoneNonmeningeal ≤1, meningeal ≤0.5Nonmeningeal 2, meningeal 1Nonmeningeal ≥4, meningeal ≥2
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