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Description

Wu et al evaluated children with invasive pneumococcal disease. They identified early clinical findings associated with mortality. The authors are from Children's Hospital of Soochow University, the Key Laboratory of Public Health Safety, and Fudan University in China.


Patient selection: invasive infection with Streptococcus pneumoniae

 

Invasive pneumococcal disease: isolation of Streptococcus pneumoniae from a normally sterile site (blood, CSF, pleural effusion, joint effusion, peritoneal fluid, tissue biopsy).

 

Mortality rate: 18%, with 54% of non-survivors less than 2 years of age

 

All of the patients who died had sepsis with meningitis

 

Early findings seen more often in non-survivors:

(1) recurrent hyperpyrexia (temperature > 40°C)

(2) vomiting (> 3 times per day)

(3) anorexia

(4) lethargy

(5) poor perfusion of the extremities

(6) high PRISM III score (maximum score 74)

 

Factors affecting course:

(1) pneumococcal vaccine status, and coverage of vaccine versus the isolate

(2) antibiotic resistance shown by the isolate versus antibiotic coverage


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