title: Invasive pneumococcal disease in children prior to implementation of the conjugate vaccine in the Zurich region, Switzerland.
abstract: OBJECTIVE
  To describe symptoms, disease manifestations and outcome of invasive pneumococcal disease in children prior to implementation of the pneumococcal vaccine.
  
  
  METHODS
  Analysis of children younger than 16 years of age with invasive pneumococcal disease (IPD; n = 119). Children with culture-confirmed IPD, without underlying illness at risk for invasive disease, were included.
  
  
  RESULTS
  IPD in 90 children (age: median 2, mean 3.2 years) included 15 with meningitis, 16 with septicaemia, 14 with bacteraemia, 24 with pneumonia and 21 with skin, bone and joint infections. Symptoms of IPD most often described were fever and gastrointestinal symptoms (abdominal pain, vomiting, or diarrhoea), and coughing. More than 90% of children with pneumonia were coughing. Most importantly, clinical signs significantly predictive for severe IPD included tachycardia for sepsis, tachypnea for pneumonia, and meningeal signs for meningitis. Leukocyte, neutrophil and platelet counts were lower and C-reactive protein concentrations were higher on admission in children with complicated than in children with uncomplicated IPD but, due to wide overlap of these numbers, the difference was not of prognostic help to predict clinical course and outcome. Overall, 40% of children with IPD manifested complications and IPD showed a mortality rate of 6.6%.
  
  
  CONCLUSIONS
  IPD is a serious disease with a high complication rate and mortality. The clinical signs tachycardia, tachypnea, and meningism were highly predictive for severe IPD. The initial clinical presentation and laboratory evaluation were mostly unpredictable with respect to complications and outcome in contrast to the clinical signs.
authors.affiliation: University Children's Hospital, Zurich, Switzerland. peter.gessler@klinikum-konstanz.de
authors.forename: P
authors.initials: P
authors.lastname: Gessler
authors.forename: F
authors.initials: F
authors.lastname: Martin
authors.forename: D
authors.initials: D
authors.lastname: Suter
authors.forename: C
authors.initials: C
authors.lastname: Berger
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000382:microbiology; D001850:Bone Diseases, Infectious / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D005767:Gastrointestinal Diseases / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000150:complications* / Q000401:mortality*; D022242:Pneumococcal Vaccines; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018461:Soft Tissue Infections / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D013557:Switzerland / Q000453:epidemiology; D018074:Vaccines, Conjugate
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate