NACINOVICH FRANCISCO

INVASIVE PNEUMOCCOCAL DISEASES (IPD) IN PEOPLE WITHOUT CO MORBIDITIES.
Nacinovich FM, Marin M, Bonvehí PE, Gentile J, Stamboulian D.
Nº 452
(on behalf of IPD Study Group - Fundación Centro de Estudios Infectológicos)
nacinovich@intramed.net
BACKGROUND
IPD remains a major cause of morbidity and mortality worldwide and
developing countries bear the major burden of this challenging disease. Occurs
principally in the extremes of age (children <2 yo and adults >65 yo) and people
with cardiovascular and respiratory diseases, diabetes, immunosuppression, etc.
are wellknown associated with an increased susceptibility to pneumococcal
disease and are further associated with higher mortality.
RESULTS
From 25 centers in 11 provinces of Argentina (January 2000 to January 2002) (Figure 1):
• 202 S. pneumoniae strains were isolated.
• 75 (37.13%) from people without evident co morbidities.
FIGURE 1: PARTICIPATING CENTERS
PARTICIPATING CENTERS
Bariloche
Buenos Aires
Capital Federal
Catamarca
Comodoro Rivadavia
Mar del Plata
Mendoza
Neuquén
Rosario
Santa Fé
Tandil
Tucumán
METHODS
• Subanalisys of the first prospective, multicenter and observational study of
IPD in adults ≥18 yo performed in Argentina.
• Only cases with S. pneumoniae strains isolated from sterile sites were
considered (blood cultures, CSF, pleural, pericardial and peritoneal fluid, bone
and joints).
• Demographic data, high-risk conditions for IPD (age, cardiovascular diseases
– CVD-, chronic pulmonary diseases – CPD -, diabetes, esplenectomy, smoking,
among others) and previous pneumococcal vaccination status of each eligible
subject was obtained through interview and/or from clinical records. All data
were collected in a data collecting form.
• Minimal inhibitory concentrations tests (MICs) to penicillin were determined
by broth microdilution method according to CLSI guidelines, 2008.
• Serotyping was carried out by the Quellung reaction using antiserum from the
Statens Seruminstitute (Copenhagen, Denmark).
• Financial support: this study was partially supported by Sanofi Pasteur,
GlaxoSmithKline and Fundación Alberto Roemmers (Argentina).
• Characteristics of patients without evident co morbidities:
-Age: 64±DS 22.
-Male sex 28.6%.
-30/75 patients (40%) were <65 yo.
-Source of isolation (table 1):
TABLE 1: SOURCE OF ISOLATION OF S. PNEUMONIAE (n= 75 EPISODES)
Blood cultures
Pleural fluid
CSF
Peritoneal fluid
TABLE 2: SEROTYPES OF STRAINS WITH AVAILABLE IPD CLINICAL DATA
Serotype
There is limited data regarding IPD in adults in Latin America and particularly
in Argentina, not only in people with predisposing conditions but also IPD
affecting those people without co morbidities.
The aim of this study was to analyze the clinical presentation, mortality and
serotypes involved in IPD in people without evident co morbidities (NC) and
compare NC group with the people with co morbidities (C).
• More frequent clinical presentation: pneumonia (76%) and meningitis
(14.7%) (table 2):
59 (78.7%)
9 (12%)
11 (14.7%)
3 (4 %)
Soft tissue infection
2 (2.6 %)
Sinovial fluid
1 (1.3%)
All IPD
n (%)
No evident co morbidities
(NC) n=75
With evident co morbidities
(C) n=127
Pneumonia
Meningitis
Bacteremia
Pneumonia
Meningitis
• Serotypes in people who died (n):
-14 (2)
-1 (1)
-18 (1)
-3 (3)
-19 A (2)
-4 (1)
-NT (2)
-12 F (1)
• Comparing between ages (<65 yo vs. >65 yo) people >65 yo died almost 6 times
more frequently (2/30 vs 11/45) than younger people, but it was a non-significant
tendency to mortality (6.67% vs 24.44%; p= 0.063) between both groups.
Bacteremia
14
25 (14.8)
7
2
1
12
1
21
5
20 (11.9)
11
1
3
7
-
15
1
17 (10.7)
6
1
3
10
-
14
3
14 (8.3)
4
2
4
4
1
8
19A
12 (7.1)
4
-
-
8
-
9
7F
11 (6.5)
2
-
-
-
-
10
23F
10 (6)
2
-
1
5
-
8
18
9 (5.4)
3
1
-
2
3
7
8
7 (4.2)
2
-
-
4
1
6
9V
7 (4.2)
1
-
-
6
-
7
12F
6 (3.6)
3
-
-
2
-
6
19F
5 (3)
-
-
-
4
-
4
20
4 (2.4)
1
-
-
1
-
3
4
4 (2.4)
3
-
1
1
-
1
6A
4 (2.4)
-
1
-
2
-
4
6B
3 (1.8)
-
-
-
3
-
1
9N
3 (1.8)
1
-
1
1
-
2
23B
3 (1.8)
-
-
-
2
-
2
22
2 (1.2)
-
-
-
1
-
1
7A
1 (0.6)
-
-
-
1
-
1
NT §
34 (17)
7
3
1
17
-
5
Total
202 (100)
57
11
15
93
6
135
§NT not serotyped
Serotypes in PCV13: 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F.
Serotypes in PPV23: 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, 33F.
• Available vaccine coverage of the identified serotypes:
- PCV 13: 76.5%.
- PPV23: 100%.
• There were no significant differences between NC and C group regarding
clinical presentation of IPD (although NC group had more meningitis
episodes) and serotypes involved.
CONCLUSION
• IPD may affect people of any ages and also those without any evident
co morbidities.
• Age >65 yo seems to be a risk factor per se to IPD, with or without
associated co morbid diseases.
• Of note, patients with a previous IPD are not in the list of candidates to
receive the current available pneumococcal vaccines.
• Due to almost 40% of the people with IPD had no evident risk factors
for it, population studies are needed in order to confirm these findings
that could have implications for prevention with vaccines.
• To assess pneumococcal disease burden, estimate the potential
impact of new vaccines, and identify gaps in vaccine recommendations,
regional monitoring of S. pneumoniae serotype prevalence and antibiotic
susceptibility is an outstanding task in the Latinoamerican region.
• All the strains were sensitive to penicillin.
• No people had previous pneumococcal vaccination.
IPD STUDY GROUP
Dr. Lazovsky J, Dra. De Wouters L, Dr. Costilla Campero G, Dr. Casellas JM*, Dra. Gutson K, Dr. Gómez R, Dra.
Mónica Grazziutti, Dr. Oscar Caberlotto, Dra. Gabriela Vidal, Dra. Marisa Fernández, Dr. Diego Maurizi, Dr. Carlos
• Hospital mortality (global): 13/75 (17.3%); 2/13 <65 yo.
-10 pneumonias
-2 meningitis
-1 peritonitis
Barclay, Dra. María Ester Lázaro, Dr. Jorge Brugna, Dr. Ernesto Jakob, Dr. José Luis Corrales, Dr. Luis Leiva, Dra.
María Gonzalez Arzac, Dr. Jorge Mera, Dra. Liliana Calanni, Dr. Carlos Bantar, Dr. José Luis De Michelis, Dr.
Joaquín Bermejo, Dra. Adriana Falco, Dra. Graciela Ortega, Dra. Deborah Stepanek. (*) In memoriam.