Extrapulmonary Spectrum of Invasive Pneumococcal Disease

To the Editor: Invasive pneumococcal disease (IPD) remains a global threat despite advances in immunization and antibiotic treatment [1]. After COVID-19, there was an alarming increase in IPD cases, underscoring the need for heightened vigilance and prevention [2]. Streptococcus pneumoniae can invade multiple body sites, leading to severe infections such as meningitis, pneumonia, and sepsis. We present three complex IPD cases to highlight varied presentation and importance of vaccination. Case 1, a 4-y-old healthy boy, presented with fever, headache, altered sensorium, and seizures. He received vaccines as per national schedule but not pneumococcal conjugate vaccine (PCV). Diagnosed as complicated pneumococcal meningitis and multiple brain abscesses, he was treated with ceftriaxone and vancomycin. He was discharged on day 22 with antiseizure medications and physiotherapy. At discharge, the GOS-E score was 3 suggesting severe disability. Case 2, a 4-y-old boy, also did not receive PCV, presented with fever, abdominal pain, and respiratory distress. Diagnosed as pneumococcal pleuropericarditis, he required intubation and multiple drainage procedures and antibiotics. He was weaned off respiratory support and discharged on day-30. Case 3, a 7-y-old girl who received single dose of PCV-10, presented with fever, vomiting, and altered sensorium. She had history of CSF rhinorrhea and underwent multiple ENT interventions. Upon arrival in shock, she required fluid resuscitation and mechanical ventilation. Blood culture grew Streptococcus pneumoniae sensitive to ceftriaxone, erythromycin, and vancomycin. She developed hemolytic uremic syndrome and received CRRT and transfusions. Vasoactive drugs were stopped by day-6. She was extubated on day-11 and continued on intermittent hemodialysis. These cases underscore the necessity of complete vaccination, incorporation of PCV15/PCV20 to ensure optimal protection [3]. Delayed diagnosis and inadequate empirical antibiotic therapy are linked to poor outcomes in IPD cases. The emergence of ceftriaxone resistance in Streptococcus pneumoniae strains adds to the complexity of decisions [4]. …