Which clinical history findings are characteristic of pneumococcal bacteremia?

Updated: Aug 27, 2018
  • Author: Claudia Antonieta Nieves Prado, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

Bacteremia is the most common manifestation of invasive pneumococcal disease. Most cases are primary bacteremia and are found in children younger than 2 years. It is estimated that S pneumoniae infection has been the cause of 90% of occult bacteremia (bacteremia without a source) cases since the widespread use of the Hib vaccine, although the overall incidence has been decreasing since the institution of routine pneumococcal immunization in infants. [49, 50]

In adult patients, pneumococcal bacteremia is much more likely to be associated with another focus of infection, such as pneumonia or meningitis.

Signs, symptoms, and physical examination findings are usually nonspecific in patients with occult pneumococcal bacteremia. In most patients, fever develops within 24 hours of positive culture findings. A peripheral WBC count greater than 15,000 cells/μL is associated with the presence of occult bacteremia.

Complications, which develop in an estimated 10% of patients with occult bacteremia, include meningitis, osteomyelitis, pneumonia, soft tissue and joint infections, and sepsis. Patients with higher WBC counts and fever, those who have not undergone prior antibiotic therapy, and children younger than 20 months are at a higher risk for persistent bacteremia or the development of focal infection. [31, 30]


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