Pediatric Pneumococcal Infections Clinical Presentation

Updated: Jan 14, 2019
  • Author: Meera Varman, MD; Chief Editor: Russell W Steele, MD  more...
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Presentation

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

  • Inconsolable 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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