Minato Sonoko, Yoshida Michiko, Shoji Kensuke, Yotani Nobuyuki, Takeshita Kenichi, Takeuchi Noriko, Ishiwada Naruhiko, Kubota Mitsuru, Ishiguro Akira, Miyairi Isao
Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Japan.
Center for Postgraduate Education and Training, National Center for Child Health and Development, Japan.
Jpn J Infect Dis. 2021 Sep 22;74(5):477-480. doi: 10.7883/yoken.JJID.2020.841. Epub 2021 Jan 29.
The pneumococcal conjugate vaccines successfully decreased the incidence of invasive pneumococcal diseases and pneumococcal antibiotic resistance. However, they also led to serotype replacements. According to a report by the National Institute of Infectious Diseases (NIID) in 2017, 96% of pneumococcal isolates obtained from children with IPD aged < 5 years were non-PCV13 serotypes. Here, we report the case of a Japanese immunocompetent and vaccinated child who developed refractory meningitis caused by Streptococcus pneumoniae nonvaccine serotype 10A. PCR revealed genotypic penicillin-resistant Streptococcus pneumoniae (gPRSP) with triple mutations (pbp1a + 2b + 2x). Multilocus sequence typing identified the strain as a sequence type (ST) 11189. The ST11189 strain has not been reported in Japan, but it has recently been reported as a cause of invasive infections in Korea. The clinical course was complicated by the development of brain and subdural abscesses that necessitated prolonged antibiotic treatment and multiple burr hole drainages. Unfortunately, the neurological sequelae persisted. Continued molecular surveillance is needed for monitoring emerging virulent clinical strains.
肺炎球菌结合疫苗成功降低了侵袭性肺炎球菌疾病的发病率和肺炎球菌对抗生素的耐药性。然而，它们也导致了血清型替换。根据国立感染症研究所（NIID）2017年的一份报告，从5岁以下侵袭性肺炎球菌疾病患儿中分离出的肺炎球菌菌株，96%为非13价肺炎球菌结合疫苗（PCV13）血清型。在此，我们报告一例日本免疫功能正常且接种过疫苗的儿童，该儿童患上了由非疫苗血清型10A肺炎链球菌引起的难治性脑膜炎。聚合酶链反应（PCR）检测发现基因型耐青霉素肺炎链球菌（gPRSP）存在三重突变（pbp1a + 2b + 2x）。多位点序列分型确定该菌株为序列型（ST）11189。ST11189菌株在日本尚未有报道，但最近在韩国被报道为侵袭性感染的病因。临床病程因脑脓肿和硬膜下脓肿的出现而复杂化，这需要延长抗生素治疗时间并进行多次钻孔引流。不幸的是，神经后遗症仍然存在。需要持续进行分子监测以监测新出现的毒力临床菌株。
