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Fulltext Invasive pneumococcal disease in a tertiary paediatric hospital in Malaysia

Aisha Fadhilah Abang Abdullah, Kee, Sze Ying, Kamarul Azhar Mohd Razali, Jamal Mohamed, Thahira A., Zubaidah Abdul Wahab, Norlijah Othman

Malaysian Journal of Paediatrics and Child Health, 2017;23(1):0-0.
MyJurnal

Introduction and Objective: Pneumococcal disease is a leading cause of morbidity and mortality worldwide. There were limited publications on invasive pneumococcal infection (IPD) in Malaysia. The aim of this study is to describe restrospectively cases of IPD in hospitalised children of less than 12 years old and highlighting the unusual cases.

Methodology: A retrospective review of children with IPD from March 2002 to November 2005 at a tertiary paediatric hospital. IPD cases were defined as isolates of Streptococcus pneumoniae from a normally sterile body fluid site.

Results: Twenty-four patients were identified with a male preponderance. Two-thirds of patients were below 1-year-old; with three cases presenting in the premature newborn. Thirty-seven percent of cases had underlying conditions. Sepsis and pneumonia were the commonest manifestation, followed by meningitis. The unusual manifestations were in a form of postinfectious glomerulonephritis and overwhelming purpura fulminans. There were two mortalities; both infants had meningitis. Antibiotic susceptibility pattern showed that more than half of the isolates were sensitive towards penicillin and erythromycin. Penicillin resistance was found in 6 (25%) isolates. Conclusion: IPD results in significant morbidity and mortality, especially in young children below 2 years of age and justifies further evaluation of preventive strategies including the implementation of pneumococcal vaccine in the national immunisation programme.

Matched MeSH terms: Pneumococcal Infections
Fulltext PCR-based construction and transformation of CodY gene deletion construct in Streptococcus Pneumoniae

Aisyah Mohamed Rehan, Mohammad Izwan Enche Othman, Nor Munirah Mohd Amin, Intan Azura Shahdan, Hanani Ahmad Yusof@Hanafi

International Medical Journal Malaysia, 2017;16(11):7-7.
MyJurnal

Streptococcus pneumoniae (S. pneumoniae) is a gram-positive diplococci belonging to the genus Streptococcus and it is a well-studied pathogenic bacterium. Pneumococcal diseases such as otitis media, pneumonia, sepsis and meningitis caused by pathogenic strains of S. pneumoniae still brought significant mortality and morbidity worldwide. The pathogenicity of S. pneumoniae is exerted by various virulence factors and one of it is the enzyme hyaluronate lyase. Hyaluronate lyase plays a major role in
the invasive capability of S. pneumoniae. Its mechanism of action and crystallographic
structure have been determinedbut its regulatory mechanism is still poorly understood.
Drawing connections between the nutritional behaviour and invasive property of S.
pneumoniae, CodY regulator is hypothesized as a potential hyaluronate lyase regulator.
This work was aimed to construct CodY deficient mutant of S. pneumoniae to form
foundational work for the study of CodY regulatory effect on hyaluronate lyase.

Matched MeSH terms: Pneumococcal Infections
Fulltext Impact of routine PCV7 (Prevenar) vaccination of infants on the clinical and economic burden of pneumococcal disease in Malaysia

Aljunid S, Abuduxike G, Ahmed Z, Sulong S, Nur AM, Goh A

BMC Infect Dis, 2011;11:248.
PMID: 21936928 DOI: 10.1186/1471-2334-11-248

BACKGROUND: Pneumococcal disease is the leading cause of vaccine-preventable death in children younger than 5 years of age worldwide. The World Health Organization recommends pneumococcal conjugate vaccine as a priority for inclusion into national childhood immunization programmes. Pneumococcal vaccine has yet to be included as part of the national vaccination programme in Malaysia although it has been available in the country since 2005. This study sought to estimate the disease burden of pneumococcal disease in Malaysia and to assess the cost effectiveness of routine infant vaccination with PCV7.
METHODS: A decision model was adapted taking into consideration prevalence, disease burden, treatment costs and outcomes for pneumococcal disease severe enough to result in a hospital admission. Disease burden were estimated from the medical records of 6 hospitals. Where local data was unavailable, model inputs were obtained from international and regional studies and from focus group discussions. The model incorporated the effects of herd protection on the unvaccinated adult population.
RESULTS: At current vaccine prices, PCV7 vaccination of 90% of a hypothetical 550,000 birth cohort would incur costs of RM 439.6 million (US$128 million). Over a 10 year time horizon, vaccination would reduce episodes of pneumococcal hospitalisation by 9,585 cases to 73,845 hospitalisations with cost savings of RM 37.5 million (US$10.9 million) to the health system with 11,422.5 life years saved at a cost effectiveness ratio of RM 35,196 (US$10,261) per life year gained.
CONCLUSIONS: PCV7 vaccination of infants is expected to be cost-effective for Malaysia with an incremental cost per life year gained of RM 35,196 (US$10,261). This is well below the WHO's threshold for cost effectiveness of public health interventions in Malaysia of RM 71,761 (US$20,922).

Matched MeSH terms: Pneumococcal Infections/economics*; Pneumococcal Infections/mortality; Pneumococcal Infections/epidemiology*; Pneumococcal Infections/prevention & control
Economic Impact of Pneumococcal Protein-D Conjugate Vaccine (PHiD-CV) on the Malaysian National Immunization Programme

Aljunid S, Maimaiti N, Ahmed Z, Muhammad Nur A, Md Isa Z, Azmi S, et al.

Value Health Reg Issues, 2014 May;3:146-155.
PMID: 29702920 DOI: 10.1016/j.vhri.2014.04.008

OBJECTIVE: To assess the cost-effectiveness of introducing pneumococcal polysaccharide and nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in the National Immunization Programme of Malaysia. This study compared introducing PHiD-CV (10 valent vaccine) with current no vaccination, as well as against the alternative 13-valent pneumococcal conjugate vaccine (PCV13).

METHODS: A lifetime Markov cohort model was adapted using national estimates of disease burden, outcomes of pneumococcal disease, and treatment costs of disease manifestations including pneumonia, acute otitis media, septicemia, and meningitis for a hypothetical birth cohort of 550,000 infants. Clinical information was obtained by review of medical records from four public hospitals in Malaysia from the year 2008 to 2009. Inpatient cost from the four study hospitals was obtained from a diagnostic-related group-based costing system. Outpatient cost was estimated using clinical pathways developed by an expert panel. The perspective assessed was that of the Ministry of Health, Malaysia.

RESULTS: The estimated disease incidence was 1.2, 3.7, 70, and 6.9 per 100,000 population for meningitis, bacteremia, pneumonia, and acute otitis media, respectively. The Markov model predicted medical costs of Malaysian ringgit (RM) 4.86 billion (US $1.51 billion) in the absence of vaccination. Vaccination with PHiD-CV would be highly cost-effective against no vaccination at RM30,290 (US $7,407) per quality-adjusted life-year gained. On comparing PHiD-CV with PCV13, it was found that PHiD-CV dominates PCV13, with 179 quality-adjusted life-years gained while saving RM35 million (US $10.87 million).

CONCLUSIONS: It is cost-effective to incorporate pneumococcal vaccination in the National Immunization Programme of Malaysia. Our model suggests that PHiD-CV would be more cost saving than PCV13 from the perspective of the Ministry of Health of Malaysia.

Study site: UKM Medical Centre, Hospital Kuala Lumpur, Hospital
Alor Setar, and Hospital Queen Elizabeth, Kota Kinabalu

Matched MeSH terms: Pneumococcal Infections
Antimicrobial resistance in Streptococcus pneumoniae: an overview

Appelbaum PC

Clin Infect Dis, 1992 Jul;15(1):77-83.
PMID: 1617076

Clinical resistance to penicillin in Streptococcus pneumoniae was first reported by researchers in Boston in 1965; subsequently, this phenomenon was reported from Australia (1967) and South Africa (1977). Since these early reports, penicillin resistance has been encountered with increasing frequency in strains of S. pneumoniae from around the world. In South Africa strains resistant to penicillin and chloramphenicol as well as multiresistant strains have been isolated. Similar patterns of resistance have been reported from Spain. Preliminary evidence points to a high prevalence of resistant pneumococci in Hungary, other countries of Eastern Europe, and some countries in other areas of Europe, notably France. In the United States most reports of resistant pneumococci come from Alaska and the South, but resistance is increasing in other states and in Canada. Pneumococcal resistance has also been described in Zambia, Japan, Malaysia, Pakistan, Bangladesh, Chile, and Brazil; information from other African, Asian, and South American countries is not available. The rising prevalence of penicillin-resistant pneumococci worldwide mandates selective susceptibility testing and epidemiological investigations during outbreaks.

Matched MeSH terms: Pneumococcal Infections/drug therapy; Pneumococcal Infections/epidemiology*
Fulltext Pneumococcal serotype distribution and antibiotic susceptibility in Malaysia: A four-year study (2014-2017) on invasive paediatric isolates

Arushothy R, Ahmad N, Amran F, Hashim R, Samsudin N, Azih CRC

Int J Infect Dis, 2019 Mar;80:129-133.
PMID: 30572022 DOI: 10.1016/j.ijid.2018.12.009

OBJECTIVE: This study was performed to analyze the serotype distribution of Streptococcus pneumoniae causing invasive pneumococcal disease (IPD) in children aged 5 years and under in Malaysia and to assess the antimicrobial resistance.
METHODS: From 2014 to 2017, a total of 245 invasive S. pneumoniae isolates from children ≤5 years of age were received from hospitals all around Malaysia. All isolates were identified and subjected to serotyping and antimicrobial susceptibility testing.
RESULTS: Of the 245 isolates, 117 (48.0%) were from children aged <1year, 46 (19.05%) were from children aged 1-2 years, and 82 (33.0%) were from children aged 2-5 years. The most common serotypes were 14 (26.9%), 6B (19.6%), 19A (11.8%), 6A (10.6%), and 19F (6.9%) and vaccine coverage was 88.2% for PCV13, 64.1% for PCV10, and 63.3% for PCV7. Resistance to penicillin was 0.2% for non-meningitis cases and 22.2% for meningitis cases; erythromycin resistance was reported in 42.9%, co-trimoxazole in 35.9%, and tetracycline in 42.9%.
CONCLUSIONS: Serotypes 14, 6B, 19A, 6A, and 19F were the most common serotypes isolated from children with IPD in Malaysia during this pre-vaccination era. The lack of reports on the serotype distribution has limited action for the implementation of PCV in the national immunization programme (NIP). The information from this study may benefit future policies for the introduction of PCV in the Malaysian NIP and ultimately may reduce the morbidity and mortality among children in Malaysia.

Matched MeSH terms: Pneumococcal Infections
Fulltext Multidrug-resistant Streptococcus pneumoniae causing invasive pneumococcal disease isolated from a paediatric patient

Arushothy R, Ramasamy H, Hashim R, Raj A S S, Amran F, Samsuddin N, et al.

Int J Infect Dis, 2020 Jan;90:219-222.
PMID: 31682962 DOI: 10.1016/j.ijid.2019.10.037

The emergence of non-vaccine multidrug-resistant Streptococcus pneumoniae serotypes is on rise. This study was performed to investigate a highly resistant serotype 15A S. pneumoniae isolated from the blood specimen of a 20-month-old patient who died of her infection. The SS40_16 isolate was resistant to erythromycin, co-trimoxazole, tetracycline, and chloramphenicol, as well as to penicillin, ceftriaxone, and cefotaxime (using meningitis cut-off points, Clinical and Laboratory Standards Institute). The isolate belonged to sequence type 1591 (ST1591) and was related to CC81 clonal complex, suggesting the possibility of horizontal gene transfer. Scanning electron microscopy comparison between resistant and sensitive pneumococcal isolates also indicated similar phenotypic characteristics that confer high resistance. The emergence of highly resistant non-vaccine pneumococci is of great concern to public health and in the clinical setting. Pneumococcal surveillance programs represent a crucial tool, not only for determining the impact of pneumococcal conjugate vaccines, but also for monitoring the selective pressure of serotype replacement with regard to the treatment of invasive pneumococcal disease.

Matched MeSH terms: Pneumococcal Infections/microbiology*; Pneumococcal Infections/epidemiology
Overview of the disease burden of invasive pneumococcal disease in Asia

Bravo LC, Asian Strategic Alliance for Pneumococcal Disease Prevention (ASAP) Working Group

Vaccine, 2009 Dec 9;27(52):7282-91.
PMID: 19393708 DOI: 10.1016/j.vaccine.2009.04.046

This paper represents a collaborative effort by the Asian Strategic Alliance for Pneumococcal Disease Prevention (ASAP) Working Group to collate data on the disease burden due to invasive pneumococcal disease (IPD) in participating Asian countries and territories; namely, Hong Kong, India, Indonesia, Korea, Macau, Malaysia, Pakistan, the Philippines, Singapore, Sri Lanka, Taiwan and Thailand. A review of both published and unpublished data revealed that the incidence of IPD in some countries is well documented by way of large, long-duration studies, while in other countries, much of the available data have been extrapolated from international studies or have come from small population studies of limited geographical coverage. This paper confirms that data regarding the incidence of IPD in Asia are grossly lacking and reinforces the need for urgent and more substantial studies.

Matched MeSH terms: Pneumococcal Infections/epidemiology*
Antibiotic susceptibility and serotype distribution of Streptococcus pneumoniae in Malaysian children

Cheong YM, Jegathesan M, Henrichsen J, Wong YH, Ng AJ, Louis A

J Trop Pediatr, 1988 08;34(4):182-5.
PMID: 3172328 DOI: 10.1093/tropej/34.4.182
Matched MeSH terms: Pneumococcal Infections/microbiology
Distribution of CBP genes in Streptococcus pneumoniae isolates in relation to vaccine types, penicillin susceptibility and clinical site

Desa MN, Sekaran SD, Vadivelu J, Parasakthi N

Epidemiol Infect, 2008 Jul;136(7):940-2.
PMID: 17678563

Choline-binding proteins (CBP) have been associated with the pathogenesis of Streptococcus pneumoniae. We screened, using PCR, for the presence of genes (cbpA, D, E, G) encoding these proteins in 34 isolates of pneumococci of known serotypes and penicillin susceptibility from invasive and non-invasive disease. All isolates harboured cbpD and cbpE whereas cbpA and cbpG were found in 47% and 59% respectively; the latter were more frequent in vaccine-associated types and together accounted for 77% of these isolates. No association was observed with penicillin susceptibility but 85% of non-invasive isolates were positive for these genes.

Matched MeSH terms: Pneumococcal Infections/microbiology*
Penicillin susceptibility and molecular characteristics of clinical isolates of Streptococcus pneumoniae at the University of Malaya Medical Center, Kuala Lumpur, Malaysia

Desa MN, Lin TK, Yasin RM, Parasakthi N

Int J Infect Dis, 2003 Sep;7(3):190-7.
PMID: 14563222

To determine the prevalence of penicillin resistance and molecular characteristics of pneumococcal isolates at the University of Malaya Medical Center.

Matched MeSH terms: Pneumococcal Infections/microbiology; Pneumococcal Infections/epidemiology*
Fulltext Nasopharyngeal Bacterial Carriage in the Conjugate Vaccine Era with a Focus on Pneumococci

Devine VT, Jefferies JM, Clarke SC, Faust SN

J Immunol Res, 2015;2015:394368.
PMID: 26351646 DOI: 10.1155/2015/394368

Seven-valent pneumococcal conjugate vaccine (PCV7) was included in the UK national immunisation program in 2006, and this was replaced by thirteen-valent PCV in 2010. During this time, the carriage of vaccine-type Streptococcus pneumoniae decreased but pneumococcal carriage remained stable due to increases in non-vaccine-type S. pneumoniae. Carriage studies have been undertaken in various countries to monitor vaccine-type replacement and to help predict the serotypes, which may cause invasive disease. There has been less focus on how conjugate vaccines indirectly affect colonization of other nasopharyngeal bacteria. If the nasopharynx is treated as a niche, then bacterial dynamics are accepted to occur. Alterations in these dynamics have been shown due to seasonal changes, antibiotic use, and sibling/day care interaction. It has been shown that, following PCV7 introduction, an eradication of pneumococcal vaccine types has resulted in increases in the abundance of other respiratory pathogens including Haemophilus influenzae and Staphylococcus aureus. These changes are difficult to attribute to PCV7 introduction alone and these studies do not account for further changes due to PCV13 implementation. This review aims to describe nasopharyngeal cocarriage of respiratory pathogens in the PCV era.

Matched MeSH terms: Pneumococcal Infections/immunology*; Pneumococcal Infections/microbiology; Pneumococcal Infections/prevention & control*
Fulltext Antimicrobial susceptibility, serotype distribution, virulence profile and molecular typing of piliated clinical isolates of pneumococci from east coast, Peninsular Malaysia

Dzaraly ND, Mohd Desa MN, Muthanna A, Masri SN, Taib NM, Suhaili Z, et al.

Sci Rep, 2021 Apr 15;11(1):8220.
PMID: 33859249 DOI: 10.1038/s41598-021-87428-z

Pilus has been recently associated with pneumococcal pathogenesis in humans. The information regarding piliated isolates in Malaysia is scarce, especially in the less developed states on the east coast of Peninsular Malaysia. Therefore, we studied the characteristics of pneumococci, including the piliated isolates, in relation to antimicrobial susceptibility, serotypes, and genotypes at a major tertiary hospital on the east coast of Peninsular Malaysia. A total of 100 clinical isolates collected between September 2017 and December 2019 were subjected to serotyping, antimicrobial susceptibility test, and detection of pneumococcal virulence and pilus genes. Multilocus sequence typing (MLST) and phylogenetic analysis were performed only for piliated strains. The most frequent serotypes were 14 (17%), 6A/B (16%), 23F (12%), 19A (11%), and 19F (11%). The majority of isolates were resistant to erythromycin (42%), tetracycline (37%), and trimethoprim-sulfamethoxazole (24%). Piliated isolates occurred in a proportion of 19%; 47.3% of them were multidrug-resistant (MDR) and a majority had serotype 19F. This study showed ST236 was the most predominant sequence type (ST) among piliated isolates, which was related to PMEN clone Taiwan19F-14 (CC271). In the phylogenetic analysis, the piliated isolates were grouped into three major clades supported with 100% bootstrap values. Most piliated isolates belonged to internationally disseminated clones of S. pneumoniae, but pneumococcal conjugate vaccines (PCVs) have the potential to control them.

Matched MeSH terms: Pneumococcal Infections/microbiology*; Pneumococcal Infections/epidemiology
Emergence of antibiotic resistant Streptococcus pneumoniae in malaysia

Farida Jamal

Malaysian Journal of Child Health, 1997;9(2):174-177.
MyJurnal

Streptococcus pneumoniae is an important cause of community acquired infections, particularly pneumonia, acute otitis media, sinusitis and exacerbations of chronic bronchitis. Together with Haemophilus influenzae, it is an important cause of childhood meningitis. It is also a major cause of bacterial meningitis among adults. The emergence of Streptococcus pneumoniae resistant to penicillin and other antibiotics in recent years has complicated the management of pneumococcal infections world-wide'. In some areas, penicillin resistant strains have become the predominant pneumococcal isolates2. Multiply resistant strains and those resistant to second and third generation cephalosporins are also increasingly reported'. Treatment of meningitis and acute otitis media caused by such strains is particularly problematic. (Copied from article).

Matched MeSH terms: Pneumococcal Infections
Fulltext Molecular detection and genotypic characterisation of Streptococcus pneumoniae isolated from children in Malaysia

Goh SL, Kee BP, Abdul Jabar K, Chua KH, Nathan AM, Bruyne J, et al.

Pathog Glob Health, 2020 02;114(1):46-54.
PMID: 32003298 DOI: 10.1080/20477724.2020.1719325

Streptococcus pneumoniae (S. pneumoniae) is one of the main causative agents of pneumococcal diseases. To date, more than 90 distinct serotypes have been identified. Implementation of vaccines has caused a drastic reduction in vaccine-serotype pneumococcal diseases but increase in cases due to non-vaccine serotype has been observed in Malaysia. However, further investigation on different serotype incidence in Malaysia is needed and the rate of pneumococcal vaccination for new-born babies in Malaysia remains low. The recent emergence of drug-resistant S. pneumoniae (DRSP) has also been a global concern, especially penicillin resistance. This study determined the serotypes of S. pneumoniae strains (n = 95) isolated from nasopharyngeal specimens from children admitted to UMMC from 2013 to 2015. In accordance with previous studies, PCR result showed 40% of NT isolates were successfully typed as 3 less common serotypes, namely 9N/L, 17A, and 23B. The repetitive-element PCR (REP-PCR) result revealed genetic variations among the strains whereby five major clusters were observed at the similarity of 80% by clustering analysis based on fingerprint data. Penicillin-binding proteins (pbps) of selected isolates were studied by PCR and sequencing. Three strains with ≤19-mm diameter zone for Oxacillin Disc Diffusion (ODD) test previously were recorded to have mutation on all pbp1a, pbp2b, and pbp2x with MIC of 4 µg/ml, which were penicillin-intermediate resistance according to the CLSI breakpoints.

Matched MeSH terms: Pneumococcal Infections/microbiology*
Fulltext Safety and Efficacy of Pneumococcal Vaccination in Pediatric Nephrotic Syndrome

Goonewardene ST, Tang C, Tan LT, Chan KG, Lingham P, Lee LH, et al.

Front Pediatr, 2019;7:339.
PMID: 31456997 DOI: 10.3389/fped.2019.00339

Nephrotic syndrome affects both children and adults. Idiopathic nephrotic syndrome is reported to be one of the most frequent renal pathologies in childhood. Nephrotic children are at high risk for severe pneumococcal infections as one of the life-threatening complications of nephrotic syndrome due to involvement of the immunosuppressive regimen and the acquired immune deficiency induced by nephrotic syndrome including decreased plasma IgG and low complement system components. Aiming to prevent pneumococcal infection is of paramount importance especially in this era of ever-increasing pneumococcal resistance to penicillins and cephalosporins. The pneumococcal vaccines currently available are inactivated vaccines-the two main forms in use are polysaccharide vaccines and conjugated vaccines. However, the data supporting the use of these vaccines and to guide the timing and dosage recommendations is still limited for nephrotic children. Thus, this review discusses the evidences of immunogenicity and safety profile of both vaccinations on nephrotic patients as well as the effect of nephrotic syndrome treatment on vaccine seroresponses.

Matched MeSH terms: Pneumococcal Infections
Fulltext Molecular docking of alpha-enolase to elucidate the promising candidates against Streptococcus pneumoniae infection

Hassan M, Baig AA, Attique SA, Abbas S, Khan F, Zahid S, et al.

Daru, 2021 Jun;29(1):73-84.
PMID: 33537864 DOI: 10.1007/s40199-020-00384-3

PURPOSE: To predict potential inhibitors of alpha-enolase to reduce plasminogen binding of Streptococcus pneumoniae (S. pneumoniae) that may lead as an orally active drug. S. pneumoniae remains dominant in causing invasive diseases. Fibrinolytic pathway is a critical factor of S. pneumoniae to invade and progression of disease in the host body. Besides the low mass on the cell surface, alpha-enolase possesses significant plasminogen binding among all exposed proteins.
METHODS: In-silico based drug designing approach was implemented for evaluating potential inhibitors against alpha-enolase based on their binding affinities, energy score and pharmacokinetics. Lipinski's rule of five (LRo5) and Egan's (Brain Or IntestinaL EstimateD) BOILED-Egg methods were executed to predict the best ligand for biological systems.
RESULTS: Molecular docking analysis revealed, Sodium (1,5-dihydroxy-2-oxopyrrolidin-3-yl)-hydroxy-dioxidophosphanium (SF-2312) as a promising inhibitor that fabricates finest attractive charges and conventional hydrogen bonds with S. pneumoniae alpha-enolase. Moreover, the pharmacokinetics of SF-2312 predict it as a therapeutic inhibitor for clinical trials. Like SF-2312, phosphono-acetohydroxamate (PhAH) also constructed adequate interactions at the active site of alpha-enolase, but it predicted less favourable than SF-2312 based on binding affinity.
CONCLUSION: Briefly, SF-2312 and PhAH ligands could inhibit the role of alpha-enolase to restrain plasminogen binding, invasion and progression of S. pneumoniae. As per our investigation and analysis, SF-2312 is the most potent naturally existing inhibitor of S. pneumoniae alpha-enolase in current time.

Matched MeSH terms: Pneumococcal Infections/drug therapy
A case of nephrosis

Hawes RB

Malayan Medical Journal, 1931;6:108-110.

Matched MeSH terms: Pneumococcal Infections
Fulltext Regional epidemiology of invasive pneumococcal disease in Asian adults: epidemiology, disease burden, serotype distribution, and antimicrobial resistance patterns and prevention

Hung IF, Tantawichien T, Tsai YH, Patil S, Zotomayor R

Int J Infect Dis, 2013 Jun;17(6):e364-73.
PMID: 23416209 DOI: 10.1016/j.ijid.2013.01.004

To summarize published data on the clinical and economic burden, epidemiology, antimicrobial resistance levels, serotype prevalence, and prevention strategies for pneumococcal disease among adults in Asia.

Matched MeSH terms: Pneumococcal Infections/epidemiology*; Pneumococcal Infections/prevention & control
Pneumococcal sepsis presenting as purpura fulminans in a healthy infant

Intan IH, Rozita AR, Norlijah O

Ann Trop Paediatr, 2009 Sep;29(3):235-8.
PMID: 19689868 DOI: 10.1179/027249309X12467994694139

The majority of cases of purpura fulminans are associated with Neisseria meningitidis sepsis. However, other bacteria, including Streptococcus pneumoniae, can also be the cause. Underlying predisposing conditions are immunodeficiencies and splenic dysfunction, the latter being the most frequent in the paediatric age group. Purpura fulminans secondary to pneumococcal sepsis in a healthy infant is described.

Matched MeSH terms: Pneumococcal Infections/complications*

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