Can Pneumococcal cause injury and/or death?
Although most pneumococcal infections are mild, pneumococcal disease can cause serious illness.1 The 3 most common illnesses caused by invasive S. pneumoniae include pneumonia, meningitis, and bacteremia;2 however, S. pneumoniae can also cause other rare but serious pneumococcal infections including peritonitis, endocarditis and pericarditis, and infection of the bones and joints (septic arthritis, osteomyelitis).3
S. pneumoniae can also cause middle ear infections, conjunctivitis, and sinus infections but these infections are generally mild and rarely result in complications.4 5 S. pneumoniae can also cause a worsening of symptoms in someone with chronic bronchitis.6
The most common serious form of pneumococcal disease is pneumonia. Symptoms of infection may include rapid or difficulty breathing, chest pain, chills, fever, and cough. Older adults may also experience altered levels of alertness and confusion. Complications of pneumococcal pneumonia include pericarditis, airway obstruction, empyema, lung abscess, lung collapse, and death.7 Between 5 and 7 percent of persons with pneumococcal pneumonia die from the illness and elderly patients are most at risk of death.8
Since the introduction of pneumococcal conjugate vaccines, pneumococcal empyema, a complication of pneumococcal pneumonia which causes pus to accumulate between the lungs and the inner aspect of the chest wall, has become more common. 9 10 S. pneumoniae strains noted to cause this complication include serotype 1, 3, and 19A. 11 12
S. pneumoniae can also cause an infection of the blood, known as bacteremia. Initial symptoms of bacteremia may include a lower level of alertness, fever, and chills. Symptoms of sepsis, a serious complication of bacteremia, often include severe pain, sweaty or clammy skin, difficulty breathing, elevated heartrate, and confusion. Sepsis can lead to organ failure, tissue damage, and death.13
Pneumococcal meningitis, an infection of the lining of the spinal cord and brain, can also be cause by S. pneumoniae. Symptoms of infection often include sensitivity to light, headache, fever, neck stiffness, and confusion. In infants, symptoms may include a reduced level of alertness, lack of appetite, poor fluid intake, and vomiting. Complications of pneumococcal meningitis include developmental delays, hearing loss, and death.14
Pneumococcal peritonitis, an infection of the lining of the walls of the abdomen and pelvis, is another rare but serious form of invasive pneumococcal disease. Pneumococcal peritonitis is more commonly found in persons with cirrhosis of the liver,15 HIV, and hepatitis C.16 but can also be the result of severe pelvic inflammatory disease, gastrointestinal ulcer or injury, or malignancy. Symptoms of infection often include diarrhea, vomiting, abdominal pain, fever, and dehydration.17
Pneumococcal endocarditis and pericarditis are 2 rare but serious heart infections. Symptoms of pneumococcal pericarditis often include fever, fatigue, chest pain which can radiate to the back, neck, abdomen or shoulder, cough, swelling of the extremities, and muffled heart sounds. Symptoms of pneumococcal endocarditis often include joint and/or muscle pain, fever, anorexia, sweating, and new or changing heart murmurs.18
In rare cases, S. pneumoniae can cause septic arthritis and osteomyelitis (bone infection). Symptoms of septic arthritis include hot, swollen, or painful joints and frequently involve the knees or ankles. Half of all persons who develop pneumococcal septic arthritis will also have osteomyelitis. Symptoms of osteomyelitis often include redness, warmth, and swelling to the infected area, fever, chills, pain, and children may show signs of lethargy or irritability.19
S. pneumoniae accounts for up to 50 percent of middle ear infections (otitis media). Symptoms of otitis media often include fever, a red or swollen ear drum, ear pain, and sleepiness. Ear and sinus infections are generally mild; however, children who develop frequent ear infections may require ear tube placement.20
IMPORTANT NOTE: NVIC encourages you to become fully informed about Pneumococcal and the Pneumococcal vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.
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1 CDC Pneumococcal Disease - Symptoms and Complications. Sep. 6, 2017
3 Neives Prado CA Pneumococcal Infections (Streptococcus pneumoniae) Clinical Presentation. Medscape. Aug 27, 2018
4 CDC Pneumococcal Disease - Symptoms and Complications. Sep. 6, 2017
5 Neives Prado CA Pneumococcal Infections (Streptococcus pneumoniae) Clinical Presentation. Medscape. Aug 27, 2018
7 CDC Pneumococcal Disease - Symptoms and Complications. Sep. 6, 2017
9Fletcher, MA, Schmitt HJ, Syrochkina M et al. Pneumococcal empyema and complicated pneumonias: global trends in incidence, prevalence, and serotype epidemiology. Eur J Clin Microbiol Infect Dis. 2014; 33(6): 879–910.
10 Burgos J1, Lujan M, Falcó V, et al. The spectrum of pneumococcal empyema in adults in the early 21st century. Clin Infect Dis. 2011 Aug 1;53(3):254-61
11 Shen CF, Wang SM, Lee KH et al. Childhood invasive pneumococcal disease caused by non-7-valent pneumococcal vaccine (PCV7) serotypes under partial immunization in Taiwan. J Formos Med Assoc. 2013 Sep;112(9):561-8
12 Byington CL, Korgenski K, Daly J et al. Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatr Infect Dis J. 2006 Mar;25(3):250-4.
13 CDC Pneumococcal Disease - Symptoms and Complications. Sep. 6, 2017
15 Capdevila O, Pallares R, Grau I et al. Pneumococcal peritonitis in adult patients: report of 64 cases with special reference to emergence of antibiotic resistance. Arch Intern Med. 2001 Jul 23; 161(14):1742-8.
16 Waisman DC, Gregory J Tyrrell GJ, Kellner JD et al. Pneumococcal peritonitis: Still with us and likely to increase in importance. Can J Infect Dis Med Microbiol. 2010 Spring; 21(1): e23–e27.
17 Neives Prado CA Pneumococcal Infections (Streptococcus pneumoniae) Clinical Presentation. Medscape. Aug 27, 2018
20 CDC Pneumococcal Disease - Symptoms and Complications. Sep. 6, 2017