This review article gives an overview of pneumonia in the Philippines, with focus on childhood pneumonia. Its primary objective is to provide information on epidemiology, etiology, economic burden, risk factors and prevention of pneumonia. A review of literature was done to gather information about the disease, with emphasis on local data. In the Philippines, pneumonia is the third leading cause of death across all ages and is the most common cause of death among children<5 years of age. A prospective study on Invasive Pneumococcal Disease conducted in the Philippines looked at the incidence of chest x-ray–confirmed pneumonia (N=5,940) in three hospitals over a 2-year period. The highest incidence was seen in those 28 days to <6 months of age at two sites and those 6–12 months of age in another site. Risk factors include not exclusively breastfeeding infants <6 months, undernutrition, zinc deficiency, crowding and exposure to indoor air pollution, low birth weight, poverty and socio-economic factors, presence of underlying comorbidities and immunodeficiency states. CAP ranks number one in processed Philippine Health Insurance (PhilHealth) claims, showing the huge economic burden. Therefore, rationalizing its management with simple standardized guidelines, exclusive breastfeeding for 6 months and continued breastfeeding with appropriate complementary feeding, improving indoor air pollution, and promoting vaccination are effective interventions.
Pneumonia ; Pneumococcal Infections

Patients with acquired immunodeficiency syndrome (AIDS) are at higher risks of bacterial pneumonia than the general population, and the pathogen is the most commonly involved Streptococcus pneumoniae. We hereby report a case of pneumococcal pneumonia associated with leptomeningitis, osteomyelitis and epidural abscess in a patient with AIDS. He is being successfully treated with ampicillin/sulbactam and clindamycin. And because the pneumococcal infection is usually associated with morbidity and mortality rates in the setting of AIDS, we should consider for pneumococcal vaccinations among the AIDS populations.
Acquired Immunodeficiency Syndrome ; Clindamycin ; Epidural Abscess* ; Humans ; Meningitis ; Mortality ; Osteomyelitis* ; Pneumococcal Infections ; Pneumonia* ; Pneumonia, Bacterial ; Pneumonia, Pneumococcal ; Streptococcus ; Streptococcus pneumoniae ; Vaccination

BACKGROUND: Despite the widespread emergence of antimicrobial resistance among pneumococcal strains worldwide, clinical implications of in vitro resistance still remain an open question. To evaluate the clinical impact of pneumococcal resistance in Asian countries where the prevalence of pneumococcal resistance was reported to be highest in the world, ANSORP has performed a prospective, multinational surveillance study with cases with invasive pneumococcal diseases in Asian countries. METHODS: In vitro susceptibility of pneumococcal isolates was determined by broth microdilution tests with 16 antimicrobial agents. All enrolled cases of pneumococcal infections were analyzed with regard to demographic data, clinical features, risk factors and mortality. RESULTS: A total of 646 patients with pneumococcal infections were enrolled from 14 centers in 12 countries between the period from November 1999 to August 2001. Pneumonia (58.4%) was the most common clinical disease followed by bacteremia (33.4%), otitis media (10.4%), and meningitis (10.2%). Among 646 isolates, 347 (53.7%) were penicillin non-susceptible (intermediate 23.1%, resistant 30.7%). MIC90s for penicillin ranged from 0.03 (India) to 4.0 microgram/mL (Korea, Taiwan, Vietnam, and Hong Kong). Overall mortality from pneumococcal diseases by penicillin non-susceptible strains was not different from that by susceptible strains. Pneumococcal pneumonia caused by penicillin- or erythromycin-resistant strains showed similar mortality, severity of illness, or complications to that by susceptible strains. Mortality from pneumococcal meningitis caused by penicillin non-susceptible strains was also similar to that by susceptible strains. CONCLUSION: Data suggest that current situation of in vitro resistance to penicillin or macrolides may not affect the mortality from pneumococal pneumonia or meningitis caused by antibiotic-resistant strains.
Anti-Infective Agents ; Asian Continental Ancestry Group* ; Bacteremia ; Humans ; Macrolides ; Meningitis ; Meningitis, Pneumococcal ; Mortality ; Otitis Media ; Penicillins ; Pneumococcal Infections ; Pneumonia ; Pneumonia, Pneumococcal ; Prevalence ; Prospective Studies ; Risk Factors ; Taiwan ; Vietnam

BACKGROUND: Despite the widespread emergence of antimicrobial resistance among pneumococcal strains worldwide, clinical implications of in vitro resistance still remain an open question. To evaluate the clinical impact of pneumococcal resistance in Asian countries where the prevalence of pneumococcal resistance was reported to be highest in the world, ANSORP has performed a prospective, multinational surveillance study with cases with invasive pneumococcal diseases in Asian countries. METHODS: In vitro susceptibility of pneumococcal isolates was determined by broth microdilution tests with 16 antimicrobial agents. All enrolled cases of pneumococcal infections were analyzed with regard to demographic data, clinical features, risk factors and mortality. RESULTS: A total of 646 patients with pneumococcal infections were enrolled from 14 centers in 12 countries between the period from November 1999 to August 2001. Pneumonia (58.4%) was the most common clinical disease followed by bacteremia (33.4%), otitis media (10.4%), and meningitis (10.2%). Among 646 isolates, 347 (53.7%) were penicillin non-susceptible (intermediate 23.1%, resistant 30.7%). MIC90s for penicillin ranged from 0.03 (India) to 4.0 microgram/mL (Korea, Taiwan, Vietnam, and Hong Kong). Overall mortality from pneumococcal diseases by penicillin non-susceptible strains was not different from that by susceptible strains. Pneumococcal pneumonia caused by penicillin- or erythromycin-resistant strains showed similar mortality, severity of illness, or complications to that by susceptible strains. Mortality from pneumococcal meningitis caused by penicillin non-susceptible strains was also similar to that by susceptible strains. CONCLUSION: Data suggest that current situation of in vitro resistance to penicillin or macrolides may not affect the mortality from pneumococal pneumonia or meningitis caused by antibiotic-resistant strains.
Anti-Infective Agents ; Asian Continental Ancestry Group* ; Bacteremia ; Humans ; Macrolides ; Meningitis ; Meningitis, Pneumococcal ; Mortality ; Otitis Media ; Penicillins ; Pneumococcal Infections ; Pneumonia ; Pneumonia, Pneumococcal ; Prevalence ; Prospective Studies ; Risk Factors ; Taiwan ; Vietnam

Streptococcus pneumoniae can asymptomatically colonize the nasopharynx and cause a diverse range of illnesses. This clinical spectrum from colonization to invasive pneumococcal disease (IPD) appears to depend on the pneumococcal capsular serotype rather than the genetic background. According to a literature review, serotypes 1, 4, 5, 7F, 8, 12F, 14, 18C, and 19A are more likely to cause IPD. Although serotypes 1 and 19A are the predominant causes of invasive pneumococcal pneumonia, serotype 14 remains one of the most common etiologic agents of non-bacteremic pneumonia in adults, even after 7-valent pneumococcal conjugate vaccine (PCV7) introduction. Serotypes 1, 3, and 19A pneumococci are likely to cause empyema and hemolytic uremic syndrome. Serotype 1 pneumococcal meningitis is prevalent in the African meningitis belt, with a high fatality rate. In contrast to the capsule type, genotype is more closely associated with antibiotic resistance. CC320/271 strains expressing serotype 19A are multidrug-resistant (MDR) and prevalent worldwide in the era of PCV7. Several clones of MDR serotype 6C pneumococci emerged, and a MDR 6D clone (ST282) has been identified in Korea. Since the pneumococcal epidemiology of capsule types varies geographically and temporally, a nationwide serosurveillance system is vital to establishing appropriate vaccination strategies for each country.
Drug Resistance, Multiple, Bacterial ; Empyema/etiology ; Hemolytic-Uremic Syndrome/etiology ; Humans ; Meningitis/etiology ; Peritonitis/etiology ; Pneumococcal Infections/complications/*immunology ; Pneumonia, Pneumococcal/immunology ; Serotyping ; Streptococcus pneumoniae/*classification/pathogenicity

BACKGROUND: Streptococcus pneumoniae is one of the most important causes of pneumonia, meningitis, bacteremia, and other invasive diseases in children and adults. The 23-valent polysaccharide pneumococcal vaccine (PPV) has been recommended to adults with high risk conditions by the Korea Society of Infectious Diseases in 2007, but there is no data on the epidemiology of invasive pneumococcal disease in Korean adults to support this recommendation. Therefore, we performed a study to investigate the epidemiology of invasive pneumococcal disease in Korean population. MATERIALS AND METHODS: We collected clinical and microbiologic data of patients diagnosed with invasive pneumococcal disease (IPD) in 3 university-hospitals located in Seoul and Gyeonggi-do from January 2002 to December 2007. RESULTS: A total of 168 patients were diagnosed with IPD in the selected hospitals during the study period. Invasive pneumonia and meningitis were the most common forms of IPDs. The mean length of hospitalization of patients with IPD was 18.5+/-26.7 days and mortality rate of IPD was 18.6%. Among the isolates from patients with IPD, 59.7% was susceptible to penicillin and 38.3% was susceptible to erythromycin. Mortality rate of IPD increased with age and in patients with Eastern Cooperative Oncology Group performance status 4. CONCLUSIONS: Epidemiology of IPD in Korean population was described. Further studies should be performed to secure the risk factors of invasive pneumococcal diseases and to confirm the appropriateness of recommendation for vaccination with the 23-valent PPV.
Adult ; Bacteremia ; Child ; Communicable Diseases ; Erythromycin ; Hospitalization ; Humans ; Korea ; Meningitis ; Penicillins ; Pneumococcal Infections ; Pneumonia ; Risk Factors ; Streptococcus pneumoniae ; Vaccination

PURPOSE: Streptococcus pneumoniae is a major etiologic agent for pneumonia, meningitis, otitis media, and sepsis among young children. Multi-drug resistant strains have raised great concern worldwide, thus the importance of prevention with vaccines has been emphasized. However, vaccines may force the appearance of pneumococcal infections by nonvaccine serotypes. Thus, distribution of pneumococcal serotypes should be monitored to estimate vaccine efficacy. We used a new and efficient multibead assay in determining pnemococcal serotypes. METHODS: From January to February 2005, 643 children were recruited from ten day care centers to isolate pneumococci from their oropharynx. Pneumococcal serotyping was performed on 62 pneumococcal isolates from 60 children by multibead assay. This immunoassay required two sets of latex particles coated with pneumococcal polysaccharides and serotype-specific antibodies. Twenty four newly developed monoclonal antibodies specific for common serotypes and a pool of polyclonal rabbit sera for some of the less common serotypes were used. RESULTS: The most prevalent pneumococcal serotypes were serotype 6A, 19A, 19F, 23F, and 11A/ D/F which accounted more than 50 precent of all the 62 pneumococcal isolates. We found that multibead assay can be performed very rapidly and objectively. CONCLUSION: This multibead immunoassay was very useful in serotyping clinical isolates of S. pneumoniae because it was simple, reliable and fast.
Antibodies ; Antibodies, Monoclonal ; Child ; Day Care, Medical ; Humans ; Immunoassay ; Meningitis ; Microspheres ; Oropharynx ; Otitis Media ; Pneumococcal Infections ; Pneumonia ; Polysaccharides ; Sepsis ; Serotyping* ; Streptococcus pneumoniae* ; Streptococcus* ; Vaccines

Streptococcus pneumoniae (pneumococcus) is an important pathogen with high morbidity and mortality worldwide. Pneumococcal vaccine is an important measure to reduce the pneumococcal disease burden. Currently, two pneumococcal vaccines are available in adults, including 23-valent pneumococcal polysaccharide vaccine (PPV23) and 13-valent pneumococcal protein-conjugate vaccine (PCV13). PCV13 consists of capsular polysaccharides derived from the 13 most common types that cause invasive diseases (serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19F, 19A, and 23F). PPV23 covers 10 additional serotypes compared to PCV13, but it does not include serotype 6A. Even though limited in the number of serotypes, PCV13 has several important advantages over PPV23: T-cell dependent superior immunogenicity, booster effect, absence of hypo-responsiveness and protective effect on pneumonia. Although PPV23 is effective to prevent 50% to 80% of invasive pneumococcal diseases, it may be ineffective for high-risk immunocompetent and immunocompromised patients. In adults, the choice of pneumococcal vaccine should be based on the severity of underlying medical conditions and local serotype distribution. Serotype distribution is quite variable temporally and geographically. Continuous sero-surveillance is essential for the establishment of optimal vaccination strategy.
Adult ; Humans ; Immunocompromised Host ; Mortality ; Pneumococcal Infections ; Pneumococcal Vaccines ; Pneumonia ; Polysaccharides ; Streptococcus pneumoniae ; T-Lymphocytes ; Vaccination

More than 100 serotypes of Streptococcus pneumonia have been identified, which has been one bottleneck problem for pneumococcal disease diagnosis, surveillance, development of pneumococcal vaccine and effectiveness evaluation of pneumococcal vaccines. Three categories of approaches for pneumococcal serotyping will be discussed including phenotyping based on anti-serum, biochemical typing based on pneumococcal capsular characteristics and genotyping based on pneumococcal capsular locus sequences. We reviewed the development and applications of different serotyping of pneumococcus to provide guidance for pneumococcal disease prevention and control.
Humans ; Serotyping/methods* ; Pneumococcal Infections/prevention & control* ; Pneumococcal Vaccines ; Streptococcus pneumoniae/genetics* ; Pneumonia

BACKGROUND: In January 2008, the Clinical and Laboratory Standards Institute (CLSI) published revised penicillin breakpoints for Streptococcus pneumoniae according to clinical presentation and the route of penicillin administration. The aim of this study was to evaluate the impacts of the new penicillin breakpoints on the susceptibility rates of S. pneumoniae isolated from blood. METHODS: A total of 156 non-duplicated S. pneumoniae strains recovered from blood of hospitalized patients were collected between January 2003 and December 2008. Penicillin and cefotaxime susceptibility tests were performed using an E-test (AB Biodisk, Solna, Sweden). Results of the penicillin susceptibility tests were analyzed using the former and new CLSI guidelines. RESULTS: Of the 156 S. pneumoniae strains isolated from blood, penicillin susceptibility under the former CLSI guidelines resulted in 42.3% susceptible, 42.3% intermediate, and 15.4% resistant states. According to the new CLSI guidelines (nonmeningitis, parenteral), 87.8% of isolates were susceptible, 9.6% were intermediate, and 2.6% were resistant to penicillin. CONCLUSION: When the new CLSI guidelines are applied, the penicillin susceptibility rate of S. pneumoniae strains isolated from blood is considerably increased. This suggests that penicillin should still be useful for the treatment of nonmeningeal pneumococcal infections and that the use of broad-spectrum antimicrobials should not replace this treatment.
Cefotaxime ; Humans ; Penicillins ; Pneumococcal Infections ; Pneumonia ; Streptococcus ; Streptococcus pneumoniae