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Pneumococcal pneumonia in children

Elaine I Tuomanen, MD
Sheldon L Kaplan, MD
Section Editor
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD


Pneumococcus (Streptococcus pneumoniae) is a common cause of invasive bacterial infection in children and a frequent cause of community-acquired pneumonia (CAP) [1,2]. Intermediate or high-level resistance to penicillin has become a significant problem. Children, particularly those in child care facilities and those receiving frequent courses of antibiotics, appear to be important carriers of resistant strains [3-5].

The clinical features, diagnosis, and treatment of pneumococcal pneumonia will be reviewed here. An overview of the clinical features and diagnosis of CAP in children and the microbiology, pathogenesis, and epidemiology of S. pneumoniae are discussed separately. (See "Community-acquired pneumonia in children: Clinical features and diagnosis" and "Microbiology and pathogenesis of Streptococcus pneumoniae".)


The pneumococcus is acquired by aerosol or inhalation, leading to colonization of the nasopharynx; pneumococci are carried asymptomatically in approximately 50 percent of individuals at any point in time [6]. In children, the incidence of pneumococcal carriage may be as high as 60 percent, even after immunization with the pneumococcal conjugate vaccine [7-9] (see "Microbiology and pathogenesis of Streptococcus pneumoniae", section on 'Pathogenesis'). Antibiotic-resistant strains are increasingly common [10]. (See "Resistance of Streptococcus pneumoniae to beta-lactam antibiotics" and "Resistance of Streptococcus pneumoniae to the fluoroquinolones, doxycycline, and trimethoprim-sulfamethoxazole" and "Resistance of Streptococcus pneumoniae to the macrolides, azalides, lincosamides, and ketolides".)

Invasive disease most commonly occurs upon acquisition of a new serotype, typically after an incubation period of one to three days.

The incidence of disease increases strongly in association with a viral illness, such as influenza, parainfluenza, respiratory syncytial virus, adenovirus, or human metapneumovirus [11-14]. In a case-control study, upper respiratory infections with viruses such as influenza and parainfluenza correlated with acquisition of new serotypes of pneumococci in children [15]. This association is believed to be related to increased expression of receptors for pneumococcal attachment on virally activated respiratory epithelial cells [16]. In addition, viral neuraminidases cleave sialic acid from host cell glycoconjugates, and the resulting free sugar is used as a nutrient to increase the growth and density of pneumococci in the nasopharynx [17]. This adds another dimension to the synergy between viruses and pneumococci in the pathogenesis of pneumonia.

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Literature review current through: Nov 2017. | This topic last updated: Oct 23, 2017.
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