Streptococcus pneumoniae padermės vaikų, lankančių Vilniaus ikimokyklines ugdymo įstaigas, nosiaryklėje

Streptococcus pneumoniae, or pneumococcus, is Gram-positive, alpha-hemolytic, bile soluble diplococcus aerotolerant anaerobe and a member of the genus Streptococcus (phylum Firmicutes). Streptococcus pneumoniae (S.pneumoniae) is known in medical microbiology as the pneumococcus. It has a polysaccharide capsule that acts as a virulence factor for the organism; more than 90 different serotypes are known, and these types differ in virulence, prevalence, and extent of drug resistance. Streptococcus pneumoniae is a normal inhabitant of the human upper respiratory tract. The serotype distribution among nasopharyngeal carriage isolates varies by country, age-group, origin, type of cohort. Pneumococcal disease will not occur without preceding nasopharyngeal colonization with the homologous strain. In addition, pneumococcal carriage is believed to be an important source of horizontal spread this pathogen within the community. Because the highest frequency of the pneumococcal colonization and the highest crowding index are found in young children, this risk group is thought to be the most important vector for horizontal dissemination of pneumococcal strains within the community. In Europe asymptomatic nasopharyngeal carriage of pneumococcal infection is 30% -60% and in Asia or Africa it is up to 98%. Carriage rate of different serotypes in the same population changes during the time. S.pneumoniae is a common bacterial agent that causes a wide variety of infections including mucosal infections (e.g. sinusitis and otitis media), pneumonia, arthritis, pericarditis, peritonitis and severe invasive infections such as meningitis and septicemia. Morbidity and mortality due to pneumococcal infections is high, especially in developing countries. The incidence of invasive pneumococcal diseases (IPD) in young children residing in the United States and Europe is 8-75 cases/100000 population/years, whereas the incidence in young children residing in developing countries is several times higher, 100 to >500 cases/100000 population/year. Different serotypes have different ability to cause serious invasive pneumococcal diseases. Only some serotypes cause serious invasive diseases. According to a number of studies there is a significant inverse correlation between invasive disease and carriage prevalence for considered serotypes, which implies that the most invasive serotypes and serogroups are rarely carried, and that the most frequently carried serotypes and serogroups not allways cause invasive diseases. Historically pneumococci have been susceptible in vitro to penicillins, cephalosporins, macrolides (including erythromycin, clarithromycin, azithromycin), clindamycin, rifampicin, vancomycin, and trimethoprim-sulfamethoxazole. In the early 1970s multiresistant S.pneumoniae strains as well as resistant to penicillin were detected. In the early 1990s, however, pneumococcal strains resistant to penicillin and other antimicrobial agents emerged throughout the world. Resistance rates to penicillin and macrolides in various countries differ from 60% to 5%. The continuing morbidity and mortality of pneumococcal infections in the antibiotic era led to the development and licensure of a polyvalent polysaccharide vaccine in the late 1970s. The currently available pneumococcal polysaccharide vaccine, 23PS, is composed of purified capsular polysaccharide antigens of 23 serotypes that represent up to 90% of the serotypes causing invasive pneumococcal infections. But polysaccharide vaccines elicit type-specific antibody responses in most healthy adults and children of 5 years and older, the serologic response to the polysaccharide antigens is generally poor in children younger than 2 years of age. New conjugate vaccines are immunogenic for infants as young as 2 month of age, including B-lymphocyte memory cells resulting in an anamnestic response with subsequent doses, and reduce carriage of vaccine serotypes. A 7-valent type of pneumococcal conjugate vaccine was approved for infant immunization since late 1990s. Great changes in epidemiology of IPD were detected in countries where universal infant immunization started a few years ago. In Lithuania there is no universal vaccination with any of pneumococcal vaccines. S.pneumoniae is able to stimulate immune responses. In addition to ‘innate immunity’, the specific, antibody-mediated defence takes action already at the mucosal surfaces. Relatively few data exist on immune responses to the pneumococcus after natural exposure. It was demonstrated previously that contacts with Streptococcus pneumoniae induced natural salivary IgA responses against protein and polycaccharide antigens in children and adults. IgA is the predominant and relatively important in host defence immunoglobulin isotype in all mucosal secretions. In addition to IgA, pentameric IgM is likewise actively enriched in most exocrine fluids and is associated with the secretory component. IgG in mucosal secretions has traditionally been regarded as originating from serum by diffusion. In addition, IgG can be produced locally. This suggests that three isotypes: IgA, IgM and IgG are important in mucosal immunity

Streptococcus pneumoniae strains in the nasopharynx of preschool children- survey of Vilnius day care centers attendants

Streptococcus pneumoniae, or pneumococcus, is Gram-positive, alpha-hemolytic, bile soluble diplococcus aerotolerant anaerobe and a member of the genus Streptococcus (phylum Firmicutes). Streptococcus pneumoniae (S.pneumoniae) is known in medical microbiology as the pneumococcus. It has a polysaccharide capsule that acts as a virulence factor for the organism; more than 90 different serotypes are known, and these types differ in virulence, prevalence, and extent of drug resistance. Streptococcus pneumoniae is a normal inhabitant of the human upper respiratory tract. The serotype distribution among nasopharyngeal carriage isolates varies by country, age-group, origin, type of cohort. Pneumococcal disease will not occur without preceding nasopharyngeal colonization with the homologous strain. In addition, pneumococcal carriage is believed to be an important source of horizontal spread this pathogen within the community. Because the highest frequency of the pneumococcal colonization and the highest crowding index are found in young children, this risk group is thought to be the most important vector for horizontal dissemination of pneumococcal strains within the community. In Europe asymptomatic nasopharyngeal carriage of pneumococcal infection is 30% -60% and in Asia or Africa it is up to 98%. Carriage rate of different serotypes in the same population changes during the time. S.pneumoniae is a common bacterial agent that causes a wide variety of infections including mucosal infections (e.g. sinusitis and otitis media), pneumonia, arthritis, pericarditis, peritonitis and severe invasive infections such as meningitis and septicemia. Morbidity and mortality due to pneumococcal infections is high, especially in developing countries. The incidence of invasive pneumococcal diseases (IPD) in young children residing in the United States and Europe is 8-75 cases/100000 population/years, whereas the incidence in young children residing in developing countries is several times higher, 100 to >500 cases/100000 population/year. Different serotypes have different ability to cause serious invasive pneumococcal diseases. Only some serotypes cause serious invasive diseases. According to a number of studies there is a significant inverse correlation between invasive disease and carriage prevalence for considered serotypes, which implies that the most invasive serotypes and serogroups are rarely carried, and that the most frequently carried serotypes and serogroups not allways cause invasive diseases. Historically pneumococci have been susceptible in vitro to penicillins, cephalosporins, macrolides (including erythromycin, clarithromycin, azithromycin), clindamycin, rifampicin, vancomycin, and trimethoprim-sulfamethoxazole. In the early 1970s multiresistant S.pneumoniae strains as well as resistant to penicillin were detected. In the early 1990s, however, pneumococcal strains resistant to penicillin and other antimicrobial agents emerged throughout the world. Resistance rates to penicillin and macrolides in various countries differ from 60% to 5%. The continuing morbidity and mortality of pneumococcal infections in the antibiotic era led to the development and licensure of a polyvalent polysaccharide vaccine in the late 1970s. The currently available pneumococcal polysaccharide vaccine, 23PS, is composed of purified capsular polysaccharide antigens of 23 serotypes that represent up to 90% of the serotypes causing invasive pneumococcal infections. But polysaccharide vaccines elicit type-specific antibody responses in most healthy adults and children of 5 years and older, the serologic response to the polysaccharide antigens is generally poor in children younger than 2 years of age. New conjugate vaccines are immunogenic for infants as young as 2 month of age, including B-lymphocyte memory cells resulting in an anamnestic response with subsequent doses, and reduce carriage of vaccine serotypes. A 7-valent type of pneumococcal conjugate vaccine was approved for infant immunization since late 1990s. Great changes in epidemiology of IPD were detected in countries where universal infant immunization started a few years ago. In Lithuania there is no universal vaccination with any of pneumococcal vaccines. S.pneumoniae is able to stimulate immune responses. In addition to ‘innate immunity’, the specific, antibody-mediated defence takes action already at the mucosal surfaces. Relatively few data exist on immune responses to the pneumococcus after natural exposure. It was demonstrated previously that contacts with Streptococcus pneumoniae induced natural salivary IgA responses against protein and polycaccharide antigens in children and adults. IgA is the predominant and relatively important in host defence immunoglobulin isotype in all mucosal secretions. In addition to IgA, pentameric IgM is likewise actively enriched in most exocrine fluids and is associated with the secretory component. IgG in mucosal secretions has traditionally been regarded as originating from serum by diffusion. In addition, IgG can be produced locally. This suggests that three isotypes: IgA, IgM and IgG are important in mucosal immunity

Ūmus vaikų epiglotitas: diagnostikos ir gydymo patirtis Lietuvoje

Background. Acute epiglottitis which is usually caused by Haemophilus influenzae b (Hib) is a rare but serious, potentially life-threatening infection. The aim of our study was to evaluate the clinical peculiarities, management and outcome of acute epiglottitis in children. Patients and methods. Case histories of 37 children aged 6 months to 11 years, not vaccinated against Hib, who had been discharged with diagnosis of epiglottitis from Vilnius University Children’s Hospital in 1990–2004 were analysed retrospectively. Results. 23 children (62.2%) were aged 2–7 years. The primary diagnosis of epiglottitis was made only in 10 (27%) cases. 29 patients (78.4%) were admitted to the hospital on the first day of illness and 18 of them within 6 hours since the beginning of illness. All children appeared toxic and had fever. Other common symptoms were: dyspnoea (97.2%), dysphonia (97.2%), dysphagia (88%), drooling (72%), upright sitting position (86.4%). The white blood cell count varied from 4.8 to 39.8 × 109/l (mean 17.8 ± 8.8). In 8 patients (21.6%) an artificial airway was made. All the children were treated with parenteral antibiotics. Antibacterial treatment commenced at an early stage reduced the duration of the patients’ fever by a day and a half on average. There were no deaths due to epiglottitis. Conclusions. Physicians need to be wary of the possibility of epiglottitis in a toxic-appearing child with fever, upright sitting position and presenting “4D” symptoms. With a timely and appropriate intervention full recovery is expected

Antibiotic resistance of Streptococcus pneumoniae, isolated from nasopharynx of preschool children with acute respiratory tract infection in Lithuania

Background: Increasing pneumococcal resistance to commonly used antibiotics and multidrug resistance is a serious public health concern. Data on distribution of resistant Streptococcus pneumoniae (SPn) strains among children in Lithuania are limited. We evaluated the circulation of SPn serotypes and antimicrobial susceptibility among preschool children in Lithuania before the introduction of universal infant pneumococcal vaccination. Methods: A prospective study was carried out from February 2012 to March 2013 in five cities of Lithuania. A total of 900 children under six years of age who presented to primary care centre or a hospital emergency department with acute respiratory tract infection were enrolled in the study. Nasopharyngeal swabs were obtained and cultured for SPn. Positive samples (n = 367) were serotyped and tested for antimicrobial susceptibility. Associations of pneumococcal non-susceptibility with study site, season, age, sex, attendance of day care centre and treatment with antimicrobials (between one and six months prior the study) were evaluated. Results: About a half (56.7 %) of SPn strains were susceptible to all the antibiotics tested. Pneumococcal non-susceptibility to penicillin, erythromycin, clindamycin and trimethoprim–sulphamethoxazole was 15.8, 21.3, 16.9 and 27.3 %, respectively. None of the tested isolates was resistant to norfloxacin or vancomycin. We found a geographical variation of pneumococcal resistance within the cities of the country. Age, sex, the attendance of day care centre and treatment with antimicrobials prior the study was not significantly associated with a carriage of non-susceptible SPn strains. Among non-susceptible SPn serotypes 67.9 %–82.4 % were present in currently available pneumococcal conjugate vaccines. Conclusions: The rates of nasopharyngeal SPn susceptibility to penicillin and macrolides are still high among preschool children in Lithuania, however they are lower compared with previous studies. A strict policy with respect to antibiotic prescription together with widespread use of vaccination could potentially reduce the carriage rate of antibiotic-resistant pneumococci in our country

The influence of Streptococcus pneumoniae nasopharyngeal colonization on the clinical outcome of the respiratory tract infections in preschool children

Background: Streptococcus pneumoniae (SPn) is an important pathogen causing a variety of clinical manifestations. The effects of SPn nasopharyngeal colonization on respiratory tract infections are poorly studied. We evaluated the association of SPn colonization with features of respiratory tract infections. Methods: Children under the age of 6 years who visited a primary care physician because of respiratory tract infections were enrolled in the study. History was taken, children were clinically assessed by the physician, and nasopharyngeal swabs were obtained and cultured for SPn. Positive samples were serotyped. Associations of SPn colonization with clinical signs and symptoms, recovery duration, absence from day care centre, frequencies of specific diagnoses, and treatment with antimicrobials were evaluated. Results: In total 900 children were enrolled. The prevalence of SPn colonization was 40.8 % (n = 367). There were minor differences between male and female subjects (199 of 492, 40.4 % vs 168 of 408, 41.2 %, p = 0.825). Children with and without siblings had similar colonization rates (145 of 334, 43.4 % vs 219 of 562, 39.0 %, p = 0.187). Clinical signs and symptoms were not associated with SPn colonization. Children colonized with SPn had longer recovery duration compared to non-colonized children (114 of 367, 31.1 % vs 98 of 533, 18.4 %, p < 0.001) and were longer absent from day care (270 of 608, 44.4 % vs 94 of 284, 33.1 %, p = 0.001). Pneumonia, sinusitis, and acute otitis media were more frequently diagnosed in children colonized with SPn. Children attending day care centres had significantly higher prevalence of SPn colonization (270 of 367, 44.4 % vs 338 of 533, 33.1 %, p = 0.001). Children with pneumonia, sinusitis and acute otitis media were more frequently treated with antimicrobials than children with other diagnoses. Conclusions: SPn nasopharyngeal colonization has a negative impact on the course of respiratory tract infection, likely because of SPn being the cause of the disease or a complicating factor. It is also associated with and may be responsible for higher frequencies of bronchitis, pneumonia, acute otitis media, sinusitis and the need of antimicrobial treatment

Incidence of acute otitis media in children below 6 years of age seen in medical practices in five East European countries

Background: Although acute otitis media (AOM) remains a major public health problem worldwide and brings economic burden on health care system and caregivers, little information is available about its epidemiology in Eastern Europe. Methods: We conducted an epidemiological, prospective, observational, multi-centre cohort study (NCT01365390) in five East European countries (Estonia, Lithuania, Poland, Romania and Slovenia) between June 2011 and January 2013 to determine the incidence and clinical characteristics of AOM among children aged < 6 years during 1 year. Results: AOM incidence was 160.7 cases (95 % confidence interval [CI]: 144.7–177.9) per 1000 person-years (PY) being the lowest in the < 1 year age group (92.3 cases [95 % CI: 59.7–136.2] per 1000 PY) and the highest in the 3– < 4 years age group (208.9 cases [95 % CI: 165.1–260.7] per 1000 PY). AOM incidence was similar across the countries, with the exception of Slovenia (340.3 cases [95 % CI: 278.3–412.0] per 1000 PY). There was a lower risk in breastfed children and a higher risk in those attending school/childcare or with allergies. AOM required 521 visits to the doctor. Antibiotics were prescribed for 276 (74.8 %) episodes with the lowest prescription rate in Estonia (51.4 %) and the highest in Romania (83.7 %). Complications were rare and hospitalisations occurred in 2 % of the cases. Conclusions: The disease burden of AOM in Eastern Europe is relevant and public health initiatives to reduce it should be considered