Un empiema pleurico, una occasione per fare il punto sulla vaccinazione antipneumococcica

Abstract

The article describes the case of a 4-year-old girl present-ing with fever and dyspnea. Blood tests showed neutrophilic leukocytosis and a significant increase in inflammation markers. The antibiotic therapy (macrolide and amoxicillin) did not produce any clinical improvement. A chest X-ray and CT showed a pleural empyema associated to trilobar right pneumonia. An evacuative videothoracoscopy was then performed. Clinical evolution was positive with full remission. The real-time polymerase chain reaction enabled to isolate genetic sequences of Streptococcus pneumoniae type 3, one of the serotypes involved in the invasive pneumococcal disease and contained in the pneumococcal 13-valent conjugate vaccine (PCV13). The patient had completed a full PCV13 vaccination before two years of age. Despite antibiotic treatment and the spread of vaccinations, pleural empyema is still a frequent complication of pneumonia to date. Several studies suggest a poor effective-ness of the pneumococcal vaccine against the serotype 3. Moreover, the implementation of PCV13 may have influenced the distribution of serotypes of S. pneumoniae not included in this vaccine and the phenomenon of serotype replacement. Nonetheless, the phenomenon of serotype replacement does not seem to be exclusively due to the effect of vaccination programmes.