Streptococcus pneumoniae (pneumococcus) are gram-positive, ?-hemolytic, aerobic, bekapselter diplococci In the US cause pneumococcal infections around 7 million annual cases of otitis media, pneumonia 500,000, 50,000 septicemia, meningitis 3000 and 40,000 deaths. The diagnosis is made by Gram stain and culture. The treatment is done after the resistance profile z. Example, with a ?-lactam, a macrolide, a fluoroquinolone and sometimes respitatorischen with vancomycin.

Pneumococci are demanding microorganisms that require catalase to grow on agar plates. In the laboratory pneumococcal be identified by

Streptococcus pneumoniae (pneumococcus) are gram-positive, ?-hemolytic, aerobic, bekapselter diplococci In the US cause pneumococcal infections around 7 million annual cases of otitis media, pneumonia 500,000, 50,000 septicemia, meningitis 3000 and 40,000 deaths. The diagnosis is made by Gram stain and culture. The treatment is done after the resistance profile z. Example, with a ?-lactam, a macrolide, a fluoroquinolone and sometimes respitatorischen with vancomycin. Pneumococci are demanding microorganisms that require catalase to grow on agar plates. In the laboratory, pneumococci are identified by a hemolysis on blood agar Sensitivity to optochin lysis of bile salts pneumococcal frequently colonize the human respiratory tract, particularly in winter and early spring. The transmission takes place via air. Real epidemics of pneumococcal infections are rare, but seem some serotypes with outbreaks in certain (eg. As military, institutional) to be populations in context. The pneumococcal serotypes capsule consists of a complex polysaccharide which determines the serotype and contributes to virulence and pathogenicity. The virulence varies somewhat within serological types, because of the genetic diversity. Currently,> 90 different serotypes have been identified. The most severe infections are from serotypes by a small number (4, 6B, 9V, 14, 18C, 19F and 23F), are contained in the 13-valent pneumococcal conjugate vaccine caused. These serotypes cause about 90% of invasive infections in children and 60% in adults. However, these patterns are changing slowly, partly due to the widespread use of polyvalent vaccine. Serotype 19A, which is highly virulent and multidrug-resistant, has emerged as an important cause of respiratory infections and invasive diseases, thus it is now included in the 13-valent pneumococcal conjugate vaccine. Risk factors Among the patients particularly susceptible to serious and invasive pneumococcal infections sin, include those with chronic diseases (eg. As chronic heart and lung disease, diabetes, liver disease, alcoholism) Those with immunosuppression (eg., HIV) those with functional or anatomical asplenia those with sickle cell anemia The residents of long-term care facilities smoking Aborigines, natives of Alaska and certain American Indian populations Older people, even those without other diseases tend to have poorer prognosis in pneumococcal infections. Damage to the respiratory epithelium by chronic bronchitis or common respiratory viral infections, especially influenza, may predispose to pneumococcal invasion. Pseudomonas diseases caused The pneumococcal diseases include otitis media sinusitis pneumonia meningitis endocarditis Septic arthritis peritonitis (rare) A primary infection usually affects the middle ear or the lungs. The diseases mentioned below are discussed elsewhere in the MSD Manual. Pneumococcal bacteremia pneumococcal bacteremia may occur in immunocompetent and immunocompromised patients; Patients who have undergone a splenectomy have a special risk. Bacteremia may be the primary infection, or it can also accompany the acute stages of any pneumococcal infection. When a bacteremia, a secondary colonization of distant organs infections such as septic arthritis, meningitis and endocarditis can cause. Despite treatment, the overall mortality rate of bacteremia is 15-20% in children (especially those who have meningitis, which are immune compromised and / or have had a splenectomy and have a severe bacteremia) and in adults and 30-40% in the elderly; the mortal danger is during the first 3 days at höchsten.Pneumokokken pneumonia Pneumonia is the most common serious pneumococcal-related infection; it can manifest as lobar pneumonia or rarely, as bronchopneumonia. Over 4 million cases of community-acquired pneumonia occur each year in the United States when a community-acquired pneumonia requiring hospitalization, pneumococci are the most common pathogens in patients of all ages. Pleural effusion occurs in up to 40% of patients, but most bruising dissolve during drug treatment, only about 2% of patients develop an empyema, which encapsulate themselves, thick and can be fibrinopurulent. Lung abscesses are selten.Pneumokokken acute otitis media Acute otitis media in infants (after the newborn period) and children is caused in about 30-40% of cases by pneumococci. More than a third of the children of most of the population develop in the first two years of acute pneumococcal-related otitis media and pneumococcal-related otitis occurs frequently repeated. In most cases, relatively few S. pneumoniae serotypes are the cause. After a begun in the US in 2000, immunization of children unvaccinated Sereotypen of S. pneumoniae (particularly serotype 19A) were the most common cause of acute otitis media. Complications include mild conductive hearing vestibular balance dysfunction eardrum mastoiditis Petrositis labyrinthitis Intracranial complications are rare in developed countries, but may as meningitis, epidural abscess, brain abscess, lateral sinus thrombosis, cavernous sinus thrombosis, Subduralempyem and carotid artery thrombosis auftreten.Nasennebenhöhlenentzündung pneumococcal A paranasal sinusitis can be caused by pneumococci and both become chronic also as polymicrobial. Most frequently, the maxillary and ethmoid sinuses are involved here. The infection of the sinuses causes pain and purulent discharge and may spread to the skull, so that the following complications arise: cavernous sinus thrombosis brain, epidural or subdural abscess Septic cortical thrombophlebitis meningitis pneumococcal meningitis Acute purulent meningitis is often caused by pneumococci and may also secondarily as a result of bacteraemia from other foci (particularly pneumonia), starting from an infection of the ear, the mastoid or the paranasal sinuses, or as part of a base of the skull fracture involving one of the above Locations or (usually with leakage of cerebrospinal fluid) develop cribriform plate, allowing the bacteria in the nasal sinuses, nasopharynx or middle ear access to the CNS. Typical meningitis symptoms (eg. As headaches, stiff neck, fever) occur. Complications after pneumococcal meningitis include hearing loss (up to 50% of patients) seizures learning disorders Mental dysfunction paralysis pneumococcal endocarditis Because of acute bacterial endocarditis can cause endocarditis, even in patients without disease of the heart valves, but this rarely happens , A Pneumokokkenendokarditis may cause a corrosive valvular with sudden rupture or fenestration, the rapidly to progressive heart failure führt.Pneumokokken-septic arthritis, septic arthritis, similar to that caused by other Gram-positive cocci septic arthritis, is usually a complication of a scattering of a different localization Pneumokokkenbakteriämie .Spontan bacterial Pneumokokkenperitonitis spontaneous Pneumokokkenperitonitis usually occurs in patients with cirrhosis and ascites, with no specific signs that distinguish these other by a spontaneous bacterial peritonitis cause. Diagnosis Gram stain and culture pneumococcus are easily identifiable by their typical appearance in the Gram stain as lancet-shaped diplococci. The characteristic capsule best be demonstrated using the swelling tests. In this test, an antiserum is applied first, followed by staining with ink, which causes the capsule such as a ring appear to the body around. The capsule is also visible in methylene blue-stained preparations. If the culture confirmed the identification, antimicrobial susceptibility testing should be performed. A serological and genetic testing of isolates may be useful (eg. As to track the spread of specific clones and antimicrobial resistance patterns) from an epidemiological perspective. Differences in the virulence of a serotype can be detected by techniques such as pulsed-field gel electrophoresis and multilocus sequence typing. Therapy A ?-lactam, macrolide or a fluoroquinolone respitatorisches (z. B. levofloxacin, moxifloxacin, gemifloxacin) Suspicion of pneumococcal infection, the initial treatment pending the results of the sensitivity tests on local resistance patterns should align. Although ?-lactams or macrolides are the preferred therapy for pneumococcal infections, the treatment has become more demanding, because resistant strains have developed. Meanwhile, ampicillin and other ?-lactams highly resistant strains are most often to penicillin, occurred. The most common predisposing factor for ?-lactam resistance is the use of these substances within the last few months. The resistance to macrolide antibiotics has also increased significantly, these drugs are no longer recommended as monotherapy for patients hospitalized with community-acquired pneumonia. Intermediately susceptible organisms can be treated with normal or high doses of penicillin G or other ?-lactam. Seriously ill patients with nichtmeningealen infections caused by pathogens that are highly resistant to penicillin, can often be treated with ceftriaxone, cefotaxime or Ceftarolin. Very high doses of parenteral penicillin G (20-40 million units / day iv for adults) are also effective when the minimum inhibitory concentration of the isolate is not very high. Fluoroquinolones (z. B. moxifloxacin, levofloxacin and gemifloxacin) are effective in respiratory infections caused by highly penicillin-resistant pneumococci in adults. There are indications that the death rate for bacteremic pneumococcal pneumonia is lower when a combination therapy (eg. As macrolide plus. ?-lactam) is used. All penicillin-resistant isolates were previously sensitive to vancomycin, but parenteral vancomycin does not always produce adequate CSF concentrations for the treatment of meningitis (especially if corticosteroids are given). Therefore be used in patients with meningitis, ceftriaxone or cefotaxime, rifampicin or both, together with vancomycin. Prevention Infection leads to a type-specific immunity, which does not apply to other serotypes. Otherwise the Prevention includes vaccination antibiotic prophylaxis pneumococcal vaccines Two pneumococcal vaccines are available: A conjugate vaccine against 13 serotypes (PCV13) A polyvalent polysaccharide vaccine that against the 23 serotypes (PPSV23) is directed at for> 90% of serious pneumococcal infections adults and children who are responsible, the vaccine schedules vary by age and medical conditions that are present in the patient. Pneumococcal conjugate vaccine (PCV13) is recommended for the following: All children aged 6 months to 18 years see table: Recommended vaccination schedule for the age of 0-6 years) Adult ? years Patients aged 6 to 64 years with conditions that lead to them at a high risk of pneumococcal infection to the conditions that provide a high risk for pneumococcal infections for patients include the following: a cochlear implant CSF leak sickle cell anemia and other hemoglobinopathies Congenital or acquired asplenia immunosuppressive conditions (eg. B. congenital immunodeficiency, chronic renal failure, nephrotic syndrome, HIV infection, leukemia, lymphoma, generalized cancer, use of immunosuppressants, solid organ transplantation) pneumococcal polysaccharide Vaccine (PPSV23) is recommended for the following: adults ? 65 years Patients aged 2 to 64 years with high risk, including the above listed high risk. Additional Impfkriterien for adults 19 to 64 years include the following: Chronic lung disease (including asthma) Chronic cardiovascular disease (except hypertension) diabetes mellitus A chronic liver disease chronic alcoholism cigarette smoking (See also the the CDC’s Recommended Immunization Schedule for Persons Aged 0 Through 18 years and Recommended Adult Immunization Schedule, by Vaccine and age Group.) antibiotic prophylaxis in children <5 years with functional or anatomical asplenia is prophylactic penicillin V 125 mg po twice daily is recommended. The duration of chemoprophylaxis is empirical, some experts attribute in high risk patients with asplenia permanent prophylaxis over the entire childhood to adulthood. Penicillin 250 mg p.o. 2 times daily. Is recommended for at least one year after splenectomy for older children or teenagers. Important points pneumococcal cause many cases of otitis media and pneumonia, and can also lead to meningitis, sinusitis, and septic arthritis. Patients with chronic respiratory diseases or Asplenia are at high risk for severe and invasive pneumococcal disease, as well as patients with a weakened immune system. Uncomplicated or minor infection to be treated with a ?-lactam or macrolide antibiotic. Because the resistance to ?-lactam and macrolide antibiotics increases, seriously ill patients should use a cephalosporin from the next generation (eg. As ceftriaxone, cefotaxime, ceftaroline) and / or a respiratory fluoroquinolones (z. B. moxifloxacin, levofloxacin, be treated gemifloxacin). Routine vaccination is recommended for all children aged 6 weeks-59 months, all adults ? 65 years and people of other age groups with specific risk factors. More information The CDC's Recommended Immunization Schedule for Persons aged from 0 to 18 years recommended immunization schedule for adults, vaccine and age group Pneumococcal Vaccine ACIP Recommendations

Health Life Media Team

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