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  Table of Contents  
CORRESPONDENCE
Year : 2019  |  Volume : 37  |  Issue : 4  |  Page : 598-599
 

Clinico-microbiological profile of invasive pneumococcal disease amongst hospitalised children in South India


1 Department of Pediatrics, Kanchi Kamakoti CHILDS Trust Hospital, The CHILDS Trust Medical Research Foundation, Chennai, Tamil Nadu, India
2 Department of Microbiology, Kanchi Kamakoti CHILDS Trust Hospital, The CHILDS Trust Medical Research Foundation, Chennai; Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India

Date of Submission31-Mar-2020
Date of Acceptance25-Apr-2020
Date of Web Publication18-May-2020

Correspondence Address:
Dr. Praachi Singh
Kanchi Kamakoti CHILDS Trust Hospital, Chennai - 600 034, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmm.IJMM_20_135

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How to cite this article:
Balasubramanian S, Singh P, Dhanalakshmi K, Putlibai S, Varghese R. Clinico-microbiological profile of invasive pneumococcal disease amongst hospitalised children in South India. Indian J Med Microbiol 2019;37:598-9

How to cite this URL:
Balasubramanian S, Singh P, Dhanalakshmi K, Putlibai S, Varghese R. Clinico-microbiological profile of invasive pneumococcal disease amongst hospitalised children in South India. Indian J Med Microbiol [serial online] 2019 [cited 2020 Jun 2];37:598-9. Available from: http://www.ijmm.org/text.asp?2019/37/4/598/284523


Dear Editor,

Invasive pneumococcal disease (IPD) causes mortality in approximately 1 million children annually, a major part occurs in developing countries.[1] We aimed to describe IPD spectrum, serotype distribution in relation to vaccine strains, antibiotic susceptibility and outcome in a private children's hospital in India.

This retrospective, observational study was conducted at a teaching hospital in Chennai from January 2018 to March 2019 after obtaining institute's ethical committee approval. Children were recruited based on IPD (CDC definition) and underwent medical history by interviewing the parents. Streptococcus pneumoniae isolated after antimicrobial susceptibility testing by VITEK 2 were serotyped by Quellung method at the pneumococcal WHO regional reference laboratory, CMC, Vellore.

A total of 33 confirmed IPD cases were enrolled in the study, of which twenty (61%) were males and 13 (39%) were females. The incidence of IPD was 2.3/1000 hospitalised children. Majority (48%) of the cases were <1 year old. Pneumonia (52%) contributed to majority of cases followed by bacteraemia (36%) and meningitis (12%). Nearly 79% of the infections were of vaccine types (major serotypes 19F [27%], 6B [21%], 23F [6%], 9V [6%] and 14 [6%]) and the rest 21% are nonvaccine types (2, 31, 15B, 15F, 11A, 18A and 25F) similar to earlier reports from South India.[2],[3],[4],[5] Penicillin and cephalosporin resistance of 6% was seen in meningeal isolates. Antibiotic resistance is on an upsurge and is described in [Table 1]. Complications during the hospital stay which included empyema, ARDS, cerebral infarction, seizures, acute kidney injury and MODS were seen in 39%. Twenty-seven (82%) children were discharged well, 2 (6%) developed neurological deficits and four (12%) children succumbed. Proportional mortality rate was 3.2%, whereas case fatality rate was 12%.
Table 1: Comparison with antibiotic susceptibility and resistance pattern as reported in previously published studies

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Data on variability and rapid emergence of replacement pneumococcal serotypes are pivotal to introduce vaccines with wider coverage based on local epidemiological data. Pneumococcal vaccines have significantly decreased the incidence of IPD in developed countries, and the same needs to be introduced as a part of Universal Immunization Programme (UIP) all over India.

Limitations

It is a single hospital-based study, which may underestimate the true number of cases in the region, and the data might not be representative of the entire country.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 ~ References Top

1.
Johnson HL, Deloria-Knoll M, Levine OS, Stoszek SK, Freimanis Hance L, Reithinger R, et al. Systematic evaluation of serotypes causing invasive pneumococcal disease among children under five: The pneumococcal global serotype project. PLoS Med 2010;7:e1000348.  Back to cited text no. 1
    
2.
Manoharan A, Manchanda V, Balasubramanian S, Lalwani S, Modak M, Bai S, et al. Invasive pneumococcal disease in children aged younger than 5 years in India: A surveillance study. Lancet Infect Dis 2017;17:305-12.  Back to cited text no. 2
    
3.
Nisarga R, Premalatha R, Shivananda, Ravikumar KL, Shivappa U, Gopi A, et al. Hospital-based surveillance of invasive pneumococcal disease and pneumonia in South Bangalore, India. Indian Pediatr 2015;52:205-11.  Back to cited text no. 3
    
4.
Balaji V, Jayaraman R, Verghese VP, Baliga PR, Kurien T. Pneumococcal serotypes associated with invasive disease in under five children in India implications for vaccine policy. Indian J Med Res 2015;142:286-92.  Back to cited text no. 4
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5.
Varghese R, Neeravi A, Subramanian N, Pavithra B, Kavipriya A, Kumar JL, et al. Clonal similarities and sequence-type diversity of invasive and carriage Streptococcus pneumoniae in India among children under 5 Years. Indian J Med Microbiol 2019;37:358.  Back to cited text no. 5
    



 
 
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