Streptococcus pneumoniae meningitis in children. Case records 1985 - 2003

Acute bacterial meningitis and sepsis are the most severe among invasive diseases due to Streptococcus pneumoniae, particularly in pediatric age, and present a high risk of mortality and neurologic sequelae. S. pneumoniae is a major worldwide pathogen in children. The widespread emergence of penicillin-resistant pneumococci, a new pneumococcal conjugate vaccine, and the epidemiological prevalence of some serotypes, have recently focused attention on S. pneumoniae disease. We reviewed the data on incidence, epidemiology, diagnosis, therapy in children hospitalized with acute bacterial meningitis in the Division of Infectious Diseases of the Bambino Gesu Children's Hospital, Rome, between 1985- 2003. S. pneumoniae was isolated in 16.3% of the children, progressively emerging as the prevalent pathogen. The highest incidence was found in children younger than 2 yrs. The disease still presents a high rate of long-term sequelae, especially hearing loss and neurological handicap. Penicillin and ampicillin resistant isolates were found in 2.3% of positive cultures; no strain was resistant to cephalosporins and vancomycin. Our data support the recommendations to consider administration of the 7-valent pneumococcal conjugate vaccine for children older than 2 months of age, with special consideration for selected groups. We recommend monitoring all invasive pneumococcal infections in children, the emergence of antibiotic-resistance and changes in prevalence of pathogen serotypes.