Invasive Pneumococcal Disease Case Series in Pediatric Inpatients: A Clinical Experience from South India

Aim and objective: To monitor the causative pathogens, serotype distribution, and antimicrobial resistance patterns for pediatric invasive pneumococcal disease (IPD). Background: In India, IPD is a major contributing factor to the high under-five mortality rate, but surveillance-based studies are scarce on the subject, although vaccines are available for prevention. Case descriptions: We present a case series of IPD among Indian children aged ≤12 years attending a pediatric specialty hospital in Bengaluru, South India, over 5 years. Nine IPD cases were seen between June 2014 and July 2019 including both immunized and unimmunized children. The clinical presentation included pneumonia that progressed to sepsis, empyema, and pleural effusion in seven children and febrile seizures in one patient. Streptococcus pneumoniae was isolated from all the blood and pleural fluid cultures. The serotypes isolated were 19F, 19A, 2, 14, 9V/A, 6A/6B, and 3, which were all vaccine-preventable. Three cases were susceptible to all antibiotics, while others showed antimicrobial resistance to cotrimoxazole, benzylpenicillin, erythromycin, and clindamycin. All but one patient recovered uneventfully. Conclusion: Continued surveillance for IPDs and serotyping of pneumococcal isolates is important to study the effects of vaccination and monitor the emergence of non-vaccine-preventable serotypes. Clinical significance: Although IPD-causing pneumococcal serotypes have been documented in the Indian scenario, data are scarce on the emergence of non-vaccine-preventable serotypes, particularly in Indian children with IPD. Since the availability of pneumococcal vaccine (PCV) in India, this is possibly the first case series of IPD in Indian immunized children. The case series reveals that IPD-causing pneumococcal serotypes in Indian children are mostly vaccine-preventable and susceptible to standard antibiotics.