Hypoglycemia associated with bacteremic pneumococcal infections.
OBJECTIVE
To evaluate the prevalence and associated presentations of hypoglycemia in bacteremic pneumococcal infections, and serotypes of the isolates.


METHODS
This was a retrospective study of 70 episodes of pneumococcal bacteremia that occurred in 2004 and 2005.


RESULTS
We found hypoglycemia (plasma glucose<3.05 mmol/l)) in six (8.6%) episodes. The patients were three children (mean age 3 years 1 month; range 1 year 5 months-4 years 5 months) and three adults (mean age 73.3 years; range 63-84 years). One child with asplenia and cyanotic heart disease had primary pneumococcal bacteremia. Of the other two children, one had meningitis and the other pneumonia. All the adults had cancer with previous chemotherapy and multilobar pneumonia, which progressed rapidly to respiratory failure. All patients developed their first hypoglycemic episode within two hours after presentation. The average plasma glucose during hypoglycemia was 1.78+/-0.78 mmol/l (range 0.33-2.94 mmol/l). One child and all of the adults died. Serotypes of isolates were those usually associated with severe pneumococcal infection: 6B and 19F in the children; 3, 14, and 23F in the adults. Only the asplenic child had received pneumococcal vaccine.


CONCLUSIONS
Hypoglycemia occurred in 8.6% of bacteremic pneumococcal infections and was associated with high mortality and serotypes that cause severe invasive disease. All patients suspected of having septicemia should have their glucose checked to avoid missing hypoglycemia leading to a worsening of their already poor condition.
Jan
I-Shiow
IS
Department of Laboratory Medicine, National Taiwan University College of Medicine and Hospital, 7 Chung Shan South Road, Taipei 100, Taiwan.
Tsai
Tzu-Hsiu
TH
Chen
Jong-Min
JM
Jerng
Jih-Shuin
JS
Hsu
Hsin-Fang
HF
Hung
Pei-Lun
PL
Hsueh
Po-Ren
PR
Lee
Li-Na
LN
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D001786:Blood Glucose; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D007223:Infant; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D015995:Prevalence; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
D001786:Blood Glucose