Pneumococcal disease (PD) represents a spectrum of infections caused by Streptococcus pneumoniae (S. pneumoniae). Isolation of S. pneumoniae from normally sterile areas and fluids is a key diagnostic method for Invasive pneumococcal disease (IPD). Despite the availability of conjugate vaccines, infections caused by non-vaccine serotypes have increased serious and invasive infection incidence ("serotype replacement"). We present a 20-month-old male admitted with a six-day history of fever and respiratory symptoms. Chest radiography and ultrasound confirmed pneumonia with pleural effusion. Laboratory findings revealed significantly elevated inflammatory markers (CRP 317 mg/L, PCT 3.43 ng/ml). S. pneumoniae serotype 19A was isolated from both blood culture and nasopharyngeal aspirate. It was susceptible to penicillins and cephalosporins but resistant to macrolides and aminoglycosides. The patient was successfully treated with empirical dual antibiotic therapy, followed by ceftriaxone monotherapy, resulting in full clinical and radiological recovery. Considering the incomplete vaccination, complete vaccination with the 13-valent vaccine was recommended. This case report demonstrates that IPD. remains a diagnostic and therapeutic challenge It can develop in immunocompetent children with incomplete pneumococcal vaccination and the initial symptoms are nonspecific (fever, lethargy, mild to moderate respiratory distress). Initial empirical therapy according to defined and updated protocols is the cornerstone of treatment and vaccination remains the most effective method for its prevention. Continuous monitoring of pneumococcal serotype distribution and antibiotic resistance is essential, as well as planning public health strategies.
Pekmezović et al. (Wed,) studied this question.