Differential Diagnoses

Acute Pericarditis
Acute Sinusitis
Bacterial Pneumonia
Bacterial Sepsis
Bronchitis
Community-Acquired Pneumonia (CAP)
Group A Streptococcal (GAS) Infections
HIV Infection and AIDS
Haemophilus Influenzae Infections
Infective Endocarditis
Influenza
Klebsiella Infections
Legionnaires Disease
Lower Respiratory Tract Infection
Meningitis
Meningococcal Infections
Hospital-Acquired Pneumonia (Nosocomial Pneumonia) and Ventilator-Associated Pneumonia
Parapneumonic Pleural Effusions and Empyema Thoracis
Pleural Effusion
Septic Arthritis
Septic Shock
Staphylococcal Infections
Upper Respiratory Tract Infection

Workup

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Media Gallery

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.
Lobar consolidation with pneumococcal pneumonia. Posteroanterior film. Courtesy of R. Duperval, MD.
Lobar consolidation with pneumococcal pneumonia. Lateral film. Courtesy of R. Duperval, MD.
Empyema caused by Streptococcus pneumoniae. Anteroposterior film. Courtesy of R. Duperval, MD.
Purpura due to pneumococcal sepsis in a 39-year-old man who underwent a splenectomy 20 years earlier. Courtesy of Thomas Herchline, MD, Wright State University, Dayton, Ohio.

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Table 1. Routine Vaccination With Pneumococcal Vaccines ^{[86, 89, 90]}

Population	Vaccine
Children aged 6 weeks through 5 years: 0.5 mL IM	Pneumococcal conjugate vaccine 13-valent (Prevnar 13) or 15-valent (Vaxneuvance) Series of 4 doses at ages 2, 4, 6, and 12-15 months (catch-up schedule through age 5 y)
Adults aged 65 years and older*†: 0.5 mL IM	Adults who have not previously received a pneumococcal conjugate vaccine or whose previous immunization history is unknown should receive either PCV20 or PCV15 If PCV15 is used, follow with a dose of pneumococcal polyvalent vaccine 23-valent (PPSV23) after 1 year (or at least 8 weeks if immunocompromised)
†Those who received PPSV23 before age 65 years for any indication should receive another dose of the vaccine at age 65 years or later if at least 5 years have passed since their previous dose.

Table 2. Vaccination of High-Risk Children Aged 2-18 Years With Pneumococcal Polyvalent Vaccine 23-Valent ^[91]

Pediatric Risk Group	High-Risk Condition
Chronic medical conditions	Chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure) Chronic lung disease (including asthma if treated with high-dose corticosteroids) Diabetes mellitus Cerebrospinal fluid leaks Cochlear implant Sickle cell disease and other hemoglobinopathies Anatomic or functional asplenia
Hepatic disease	Chronic liver disease, alcoholism
Immunocompromising conditions	HIV infection Chronic renal failure and nephrotic syndrome Immunosuppressive drugs or radiation therapy, malignant neoplasms, leukemias, lymphomas, Hodgkin disease, solid organ transplantation Congenital or acquired immunodeficiency

Table 3. Vaccination of High-Risk Adults Aged 19 Years and Older With Pneumococcal Vaccines ^{[89, 88]}

Risk Group	Condition
Immunocompetent individuals	Chronic heart disease*
	Chronic lung disease†
	Diabetes mellitus
	Cerebrospinal fluid leaks
	Cochlear implant
	Alcoholism
	Chronic liver disease, cirrhosis
Functional or anatomic asplenia	Sickle cell disease and other hemoglobinopathies
Functional or anatomic asplenia	Congenital or acquired asplenia
Immunocompromised individuals	Congenital or acquired immunodeficiency
	HIV infection
	Chronic renal failure
	Nephrotic syndrome
	Leukemia
	Lymphoma
	Hodgkin disease
	Generalized malignancy
	Iatrogenic immunosuppression‡
	Solid organ transplant
	Multiple myeloma
*Congestive heart failure and cardiomyopathies, excluding hypertension. †Including chronic obstructive pulmonary disease, emphysema, and asthma. ‡Diseases requiring treatment with immunosuppressive drugs, including long-term systemic corticosteroids and radiation therapy.

Table 4. Recommended Schedule for Doses of PCV13 or PCV15, Including Catch-up Immunizations in Previously Unimmunized and Partially Immunized Children ^[90]

Age at Examination (mo)	Immunization History	Recommended Regimen*
2-6	0 doses	3 doses, 2 mo apart; fourth dose at age 12-15 mo
	1 dose	2 doses, 2 mo apart; fourth dose at age 12-15 mo
	2 doses	1 dose, 2 mo after the most recent dose; fourth dose at age 12-15 mo
7-11	0 doses	2 doses, 2 mo apart; third dose at age 12 mo
	1 or 2 doses before age 7 mo	1 dose at age 7-11 mo, with another dose at age 12-15 mo (≥2 mo later)
12-23	0 doses	2 doses, ≥2 mo apart
	1 dose at < 12 mo	2 doses, ≥2 mo apart
	1 dose at ≥12 mo	1 dose, ≥2 mo after the most recent dose
	2 or 3 doses at < 12 mo	1 dose, ≥2 mo after the most recent dose
24-71
Healthy children (24-59mo)	Any incomplete schedule	1 dose, ≥2 mo after the most recent dose†
Children at high risk‡ (24-71 mo)	Any incomplete schedule of < 3 doses	2 doses, one ≥2 mo after the most recent dose and another dose ≥2 mo later
	Any incomplete schedule of 3 doses	1 dose, ≥2 mo after the most recent dose
*In children immunized before age 12 mo, the minimum interval between doses is 4 weeks. Doses administered at age 12 months or later should be administered at least 8 weeks apart. † Providers should administer a single dose to all healthy children aged 24-59 mo with any incomplete schedule. ‡Children with sickle cell disease, asplenia, chronic heart or lung disease, diabetes mellitus, CSF leak, cochlear implant, HIV infection, or another immunocompromising condition. PPV23 is also indicated (see below).

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Author

Eduardo Sanchez, MD Resident Physician, Department of Internal Medicine, Einstein Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Sarah Perloff, DO, FACP Associate Chair for Faculty Affairs, Department of Internal Medicine, Program Director, Infectious Diseases Fellowship, Associate Program Director, Internal Medicine Residency, Einstein Medical Center

Sarah Perloff, DO, FACP is a member of the following medical societies: American College of Physicians, American Osteopathic Association, HIV Medicine Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Aaron Glatt, MD Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, South Nassau Communities Hospital

Aaron Glatt, MD is a member of the following medical societies: American Association for Physician Leadership, American College of Chest Physicians, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Chief Editor

John L Brusch, MD, FACP Corresponding Faculty Member, Harvard Medical School

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Received research grant from: Regeneron.

Michael Rajnik, MD Associate Professor, Department of Pediatrics, Program Director, Pediatric Infectious Disease Fellowship Program, Uniformed Services University of the Health Sciences

Michael Rajnik, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

Dawn F Muench, MD Assistant Professor of Pediatrics, F Edward Herbert School of Medicine, Uniformed Services University of the Health Sciences; Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA; Pediatric Infectious Disease Physician, Department of Pediatrics, Madigan Army Medical Center

Dawn F Muench, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

Claudia Antonieta Nieves Prado, MD Resident Physician, Department of Internal Medicine, Albert Einstein Medical Center

Disclosure: Nothing to disclose.