Pneumococcal Disease – Introduction, Causes, and Treatment

What is Pneumococcal Disease?

Pneumococcal disease is an infection caused by bacteria called Streptococcus pneumoniae (also known as pneumococcus). It’s contagious and may cause severe illness, so early diagnosis and treatment is important.

Pneumococcal disease can affect many different systems in your body. It may result in conditions with mild symptoms like a sinus infection (sinusitis). But it can also lead to pneumonia, blood infection (sepsis) or bacterial meningitis — and may be life-threatening at any age.

Treatment typically involves antibiotics. Vaccines can reduce the risk of infection, especially in young children and older adults. Talk to a healthcare provider about the immunizations that are appropriate for you and your family.

What is the difference between pneumonia and Pneumococcal Disease?

Pneumococcal disease is the name for any infection caused by pneumococcus. One of the pneumococcal diseases is pneumococcal pneumonia. It’s the most common, severe type of pneumococcal disease.

There are other causes of pneumonia besides pneumococcus. Other bacteria and viruses, along with fungi, can also cause pneumonia. So not every case of pneumonia is pneumococcal pneumonia.

Types of pneumococcal infection

Pneumococcal infections usually fall into one of two categories:

• Non-invasive pneumococcal infections – these occur outside the major organs or the blood and tend to be less serious
• Invasive pneumococcal infections – these occur inside a major organ or the blood and tend to be more serious

Non-invasive pneumococcal infections

Non-invasive pneumococcal infections include:

• Bronchitis – infection of the bronchi (the tubes that run from the windpipe down into the lungs)
• Otitis media – ear infection
• Sinusitis – infection of the sinuses

Invasive pneumococcal infections

Invasive pneumococcal infections include:

• Bacteraemia – a relatively mild infection of the blood
• Septicaemia (blood poisoning) – a more serious blood infection
• Osteomyelitis – infection of the bone
• Septic arthritis – infection of a joint
• Pneumonia – infection of the lungs
• Meningitis – infection of the meninges (the protective membranes surrounding the brain and spinal cord)

What causes pneumococcal disease?

Streptococcus pneumoniae bacteria cause pneumococcal disease. These bacteria are often found in the noses and throats of healthy people, especially children. Illness develops when the bacteria spread and set up infection in your body.

How does it spread

S. pneumoniae bacteria are common in the throats and noses of children.

Bacteria can spread through droplets in the air, for example, when a person with the infection coughs or sneezes. The bacteria do not spread through contaminated food or water.

Most people who become exposed to the bacteria have no symptoms because their immune system stops the germs from moving to another part of the body.

However, if a person has a weak immune system, the bacteria can move from the throat to the lungs, blood, sinuses, middle ear, or the brain. This can lead to a potentially severe infection.

A weak immune system can happen if a person:

• Has a condition that affects the immune system, such as HIV or AIDS
• Is taking medication to suppress the immune system, for example, after a transplant or for an autoimmune condition
• Is undergoing certain medical treatments, such as chemotherapy
• Contracts another serious infection, such as influenza

Risk factors

Anybody can get pneumococcal disease, but some people have a higher risk of the infection or its complications than others.

Those at higher risk include:

• Anyone under 2 years old or more than 65 years old
• Anyone with an underlying medical condition
• People with a weakened immune system
• Those with chronic diseases, such as diabetes, heart disease, kidney disease, alcohol use disorder, spleen dysfunction
• People who live in long-term care facilities
• Anyone who smokes tobacco
• People with a hearing aid known as a cochlear implant

What are the symptoms?

Symptoms appear suddenly — about 1 to 3 days after a person is infected. They may differ based on what type of infection you have. Symptoms may include:

• Fever and chills
• Chest pain
• Cough
• Difficulty breathing
• Weakness and feeling very ill
• Stiff neck (meningitis)
• Ear pain (middle ear infections)
• Headache

Complications of Pneumococcal Disease

• Sinusitis, ear infection (otitis media)
• Pneumonia
• Blood infection
• Inflammation of the membranes around the brain (meningitis)
• Around 3 people out of 10 cases with meningitis die
• Of the meningitis survivors, up to half will have serious disabilities

Diagnosis

A diagnosis of pneumococcal disease involves assessing symptoms and performing a physical exam. Depending on the severity of symptoms and which body parts are affected, your healthcare provider may recommend additional testing.

Additional tests may include:

• Lab work. Your practitioner may want to test sputum (a mix of saliva and mucus coughed up) or fluid from the lungs, joints, bone, heart or an abscess (pocket of pus). A cerebrospinal fluid test (CSF) with a lumbar puncture can help with making a diagnosis of meningitis.
• Chest X-ray. A chest X-ray can reveal a shadow that may indicate a pneumonia infection or fluid in the pleural cavity of a lung, and also it may assist in diagnosing other infections including acute chest or lung infections.

What is the treatment for Pneumococcal Disease?

Healthcare providers typically use antibiotics to treat bacterial infections such as pneumococcal disease. Your provider may have to try several antibiotics because the bacteria have become resistant to certain medications (this means some medications no longer kill the bacteria).

For mild infections, your healthcare provider may also recommend:

• Fluids
• Pain relievers
• Rest

In severe cases, such as meningitis, you may need to stay in the hospital for treatment.

Pneumococcal Vaccination

Vaccines help prevent pneumococcal disease, which is any type of illness caused by Streptococcus pneumoniae bacteria. There are two kinds of pneumococcal vaccines available in the United States:

• Pneumococcal conjugate vaccines (PCV13, PCV15, and PCV20)
• Pneumococcal polysaccharide vaccine (PPSV23)

CDC recommends PCV13 or PCV15 for all children younger than 5 years old and children 5 through 18 years old with certain medical conditions that increase their risk of pneumococcal disease.

CDC also recommends PPSV23 for children 2 through 18 years old with certain medical conditions that increase their risk of pneumococcal disease.

For those who have never received any pneumococcal conjugate vaccine, CDC recommends PCV15 or PCV20 for adults 65 years or older and adults 19 through 64 years old with certain medical conditions or risk factors. If PCV15 is used, this should be followed by a dose of PPSV23.

Talk with your or your child’s doctor if you have questions about pneumococcal vaccines.

Prevention of Pneumococcal Disease

Vaccination of infants, the elderly and those at increased risk due to underlying medical conditions can help to prevent pneumococcal disease and bacterial spread. Pneumococcal conjugate vaccines are available that help to protect against 10 to 13 strains of Streptococcus pneumoniae. Vaccination of all infants also helps to protect other age groups by reducing the carriage and spread of certain strains of the bacteria in children, this is known as ‘herd’ or ‘community’ immunity’. A polysaccharide vaccine is also available for use from the age of 2 years which provides broad protection against 23 serotypes of S. pneumoniae.

It is difficult to avoid coming into contact with such a common bacterium, but good hygiene practices, covering coughs and sneezes, hand washing, avoiding smoking and reducing overcrowded living conditions can help reduce spread.

Babies born to mothers who have high levels of pneumococcal antibodies may have some protection from the disease at birth. However, by two months of age almost one third of the maternal antibodies have gone and will have virtually disappeared by the age of seven months. Without vaccination, infants cannot develop their own effective protection against pneumococcal bacteria until about two years of age.