Clinical Features of Pneumococcal Disease

A summary of CDC's clinical features page for healthcare providers.

Streptococcus pneumoniae causes infections from mild to serious, even deadly. Serious syndromes can leave lasting damage or kill; complications of the mild ones are uncommon.

By age: pneumonia is the most common presentation in adults, acute otitis media in young children.

Bacteremia

• Presentation: may show as fever of 39 °C or more in children who otherwise look well. Bacteremia without an obvious focus presents according to the primary site of infection.
• Outcome: overall case-fatality rate about 20%, up to 60% in older adults. Patients with asplenia may have a fulminant course.

Meningitis

• Presentation: symptoms, cerebrospinal fluid profile and neurologic complications resemble other purulent bacterial meningitis — fever, headache, irritability, lethargy, vomiting, and nuchal rigidity, cranial nerve signs or seizures.
• Systemic complications: disseminated intravascular coagulation, organ failure, septic shock.
• Outcome: case-fatality rate about 8% in children and 22% in adults. Up to half of survivors have neurologic sequelae — behavioural disabilities, hearing loss, motor deficits, seizures.

Pneumonia

• Incubation: short, about 1 to 3 days.
• Presentation: usually an abrupt onset of fever and chills or rigors. Other common symptoms: cough with mucopurulent sputum, rusty sputum, dyspnoea, hypoxia, malaise or weakness, pleuritic chest pain, tachypnoea or tachycardia. Headache, nausea and vomiting are less frequent.
• Complications: empyema, pericarditis, respiratory failure.
• Outcome: case-fatality rate 5–7%, possibly much higher in older adults and people with underlying conditions.

Acute otitis media

• Presentation depends on age. In young children, ear pain may show as changes in sleeping or eating, holding or tugging at the ear, and irritability; there may be ear drainage, fever and hearing loss.
• Complications: mastoiditis and meningitis.

Sinusitis

• Triggers: acute bacterial sinusitis, with fluid building up in the paranasal sinuses, is often set off by airborne allergens, pollutants, or openings blocked by a viral infection.
• Versus viral sinusitis, bacterial sinusitis tends to last longer (for example, 10 days or more) and be more severe (for example, fever of 39 °C or more, purulent discharge, pain for 3 days or more).
• Complications: rarely, spread beyond the sinuses and nasal cavity into the central nervous system, the orbit or surrounding tissue.

Sources

• Centers for Disease Control and Prevention, "Clinical Features of Pneumococcal Disease." https://www.cdc.gov/pneumococcal/hcp/clinical-signs/index.html
• Further reading: the pneumococcal disease chapter of CDC's Pink Book.
• Rewritten in hubnx's own words.