Mason Edward O, Wald Ellen R, Tan Tina Q, Schutze Gordon E, Bradley John S, Barson William J, Givner Laurence B, Hoffman Jill, Kaplan Sheldon L
Pediatric Infectious Disease Section, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA.
Pediatr Infect Dis J. 2007 Jun;26(6):480-4. doi: 10.1097/INF.0b013e31805ce277.
Recurrent systemic pneumococcal infection usually occurs in immunocompromised patients and patients with underlying conditions.
Between 1993 and 2006, investigators at 8 pediatric hospitals prospectively identified cases of invasive pneumococcal disease (IPD) and retrospectively documented demographics and clinical information. Antibiotic susceptibility was determined for penicillin and ceftriaxone by microbroth dilution. Isolates were serotyped and molecular relatedness determined using pulse field gel electrophoresis (PFGE).
Four thousand sixty-seven children were diagnosed with IPD over 12.3 years. One hundred and 8 episodes of recurrent disease were seen in 90 children (2.6%); 75 experienced 2 infections, 12 experienced 3 infections and 3 experienced 4 infections. Fourteen of the 15 children with >2 episodes of infection had underlying conditions. The mean duration between 1st and 2nd infection was 22.9 weeks for children with no known underlying condition and 43.0 weeks for children with an underlying condition (P = 0.001). Seventy episodes of IPD among the 90 patients were caused by a different serotype or a different genotype as demonstrated by the PFGE. Sixteen children had intervals <30 days between infections; 7 were caused by different strains.
Approximately 80% of the children with recurrent invasive pneumococcal disease had underlying conditions. Seven of 16 children with recurrent infection <30 days apart were caused by acquisition of a new strain. Relapse of infection requires documentation that the pneumococcal isolates are not only the same serotype but also have the same PFGE patterns.
复发性系统性肺炎球菌感染通常发生在免疫功能低下的患者和有基础疾病的患者中。
1993年至2006年期间，8家儿科医院的研究人员前瞻性地确定侵袭性肺炎球菌病（IPD）病例，并回顾性记录人口统计学和临床信息。通过微量肉汤稀释法测定青霉素和头孢曲松的抗生素敏感性。对分离株进行血清分型，并使用脉冲场凝胶电泳（PFGE）确定分子相关性。
在12.3年期间，4067名儿童被诊断为IPD。90名儿童（2.6%）出现了108次复发病例；75人经历了2次感染，12人经历了3次感染，3人经历了4次感染。15名感染发作超过2次的儿童中有14名有基础疾病。无已知基础疾病的儿童首次和第二次感染之间的平均间隔时间为22.9周，有基础疾病的儿童为43.0周（P = 0.001）。PFGE显示，90名患者中的70次IPD发作是由不同的血清型或不同的基因型引起的。16名儿童感染间隔时间<30天；7次是由不同菌株引起的。
约80%的复发性侵袭性肺炎球菌病儿童有基础疾病。16名感染间隔时间<30天的复发性感染儿童中有7名是由获得新菌株引起的。感染复发需要证明肺炎球菌分离株不仅血清型相同，而且PFGE模式也相同。
