title: Clinical features of patients with recurrent invasive Streptococcus pneumoniae disease.
abstract: BACKGROUND
  Invasive Streptococcus pneumoniae (pneumococcal) disease (IPD) carries a high risk of death, approximately 15% to 20% in pneumonia, 40% in meningitis and 10% to 15% in septicemia. The occurrence of 2 or more IPD (recurrent) in the same individual is uncommon. The authors investigated the clinical features of patients with recurrent IPD to assess whether they possessed risk factors that increased their likelihood of recurrent IPD.
  
  
  METHODS
  Between 1983 and 2010, the authors identified 27 patients with recurrent IPD during inpatient surveillance of 889 patients with IPD in Huntington, WV, by recovery of pneumococci from otherwise sterile sites. Serotype/serogroup (ST/SG) was determined by capsular swelling and the penicillin MIC by E-strip. Clinical data were abstracted from hospital charts.
  
  
  RESULTS
  Sixteen (59%) of 27 patients were 65 years and older at first IPD, males predominated (67%), two-thirds had pneumonia and 21 (78%) had the same clinical diagnosis at both IPD. Four (80%) of 5 patients with the same ST experienced their second IPD 1 to 6 months apart, unlike most patients with discordant ST/SGs (P = 0.047). Eighty-four percent of ST/SGs were included in the 23-valent pneumococcal vaccine and occurred as often during the first and second IPD. Twenty (77%) of 26 adults suffered from comorbid diseases placing them at high risk of IPD, including multiple myeloma, HIV/AIDS, neoplasia of hematological origin and sickle cell disease.
  
  
  CONCLUSIONS
  Recurrent IPD occurred uncommonly. Comorbid conditions including multiple myeloma and immunosuppressive/immunodeficient conditions, chronic alcoholism and splenectomy represented unique risk factors for recurrent IPD but did not predict recurrences.
authors.affiliation: Department of Medicine, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia 25701, USA. mufson@marshall.edu
authors.forename: Maurice A
authors.initials: MA
authors.lastname: Mufson
authors.forename: Jenelle B
authors.initials: JB
authors.lastname: Hao
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Stanek
authors.forename: Nancy B
authors.initials: NB
authors.lastname: Norton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D011159:Population Surveillance / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae / Q000302:isolation & purification* / Q000472:pathogenicity