The patient had no significant past medical complications and was fully immunized for the age-based recommendation from the Advisory Council and Immunization Practices, study shows.
There is a new emergence of invasive non-vaccine serotypes that could help the further development of pneumococcal vaccines to protect against new serotypes, according to the results of a study published in Cureus.
Investigators analyzed a case of non-vaccine serotype invasive pneumococcal disease, which caused meningitis, septic shock, and stroke in a previously healthy and vaccinated male, aged 23 months. Additionally, they used ChatGPT to generate the framework and text to identify key references to describe the invasive pneumococcal disease.
In the case, the child had no significant past medical complications and was fully immunized based on Advisory Council and Immunization Practices recommendations.
The child was taken to the pediatric emergency department with 48 hours of a fever, with increasing lethargy, irritability, and a temperature of 103 degrees Fahrenheit.
The blood culture that was obtained on admission grew Streptococcus pneumoniae within 2 hours of the sample. Additionally, the central spinal fluid sample was positive for gram-positive cocci and blood and central spinal fluid cultured returned with S. pneumoniae, which was sensitive to cephalosporins and no clinically relevant resistances.
Broad bacterial antibiotics were started, which included ceftriaxone and vancomycin and, and acyclovir was started for antiviral coverage until the central spinal fluid stain returned positive.
Within 2 days, the possible syndrome of inappropriate antidiuretic hormone secretion was solved by strict fluid management.
A magnetic resonance imaging (MRI) of the brain was conducted on day 2 because of altered mental status and lethargy, according to investigators.
The MRI showed that the punctuated areas of restricted diffusion in the left temporal lobe fitting with infarct, which investigators said was not the sole etiology of the mental change but an effect of the meningitis.
There was no seizure activity found, but the individuals’ had critical illness, which required 3 days of mechanical ventilation. This was required because of the inability to protect airways and because of stage 3 acute kidney injury.
The patient required continuous renal replacement therapy from day 3 to 11, with the development of chronic kidney injury. Additionally, the individuals received 2 weeks of cephalosporin treatment with cefepime or ceftriaxone or for the pneumococcal meningitis.
The individual steadily recovered and had improved magnetic resonance imaging findings of ischemia by the end of therapy, according to investigators.
There was ongoing support for chronic kidney disease and the effects of meningitis and sepsis with nephrology, physical, and speech therapy care after discharge.
The serotype of the infection returned as 10A.
The review highlights the need to survey and expand the pneumococcal serotypes to minimize the impact of invasive disease, according to investigators.
The 10A serotype, which was the cause of disease in this review, is covered in the 20-valent pneumococcal conjugate vaccine, they said, adding that recommendations do not include this vaccine for use of those under aged 18 years, but the results support the need for this vaccine to be included for this age range.
Thacker SA. Complicated invasive pneumococcal meningitis: highlighting the value of implementing new pneumococcal vaccines. Cureus. 2023;15(2):e35482. doi:10.7759/cureus.35482