Burden of invasive pneumococcal disease in children in Casablanca, Morocco four years after the introduction of pneumococcal vaccination.

Streptococcus pneumonia is a common bacterium that can cause several types of infections, including invasive infections especially in children aged <5 years. The aim of this work is to report the different aspects of invasive pneumococcal disease (IPD) in a pediatric hospital in Casablanca, Morocco 4 years after the implementation of pneumococcal vaccination. We conducted a descriptive, retrospective study over a 4-year period from January 2015 to December 2018 in A. Harouchi Pediatric Hospital in Casablanca. This study included hospitalized children aged 0 to 14 years´ old who had an IPD. The data was collected using a data collection sheet from archived patient records and computerized laboratory database; organization of data was done using Microsoft Excel 2016 and analysis was done using SPSS-20. A total of 68 patients were included in this series over the 4-year period. Meningitis was the most common IPD (54.41%) followed by bacteremia (19.17%) and then pneumonia (16.17%). Of the 35 serogrouped strains, 7 were included in the pneumococcal conjugate vaccine (PCV) 10 (20%), 6 were PCV13-nonPCV10 serotypes (17.14%) and 6 were non-vaccine serotypes (17.14%). Among the strains tested for their antibiotic resistance profile, 32.70% were resistant to penicillin, tetracycline (29.78%), erythromycin (20.75%) and cotrimoxazole (17.31%). One strain was intermediate to ceftriaxone. The evolution was unfavorable for 18 patients (26.47%). This study reported high resistance rates to penicillin, tetracyclin and erythromycin. The mortality essentially concerned meningitis patients. Ongoing surveillance of antibiotic susceptibility and serotype distribution is needed by a national surveillance network.

A Rare Case of Pneumococcal Appendicitis in a Child.

Appendicitis is the most common cause for abdominal surgery in children. It is usually caused by Escherichia coli and Streptococcus species and is generally polymicrobial. However, Streptococcus pneumoniae is a rare cause of appendicitis. We report a rare case of pneumococcal appendicitis in a 7-year-old child with no underlying conditions, in association with E. coli and group F ß-hemolytic Streptococcus. The isolated pneumococcal strain was sensible to all tested antibiotics. The patient had a full recovery after surgery and antibiotics. This case emphasizes that S. pneumoniae can cause a variety of unusual infections like appendicitis, in patients with or without underlying conditions. Thus, even though being a rare entity, physicians should always be aware of S. pneumoniae as a possible causative agent.