Bacteremia-Induced Cholestatic Jaundice as a Major Manifestation of Pneumococcal Infection in a Healthy Toddler

Abstract

The development of pneumococcal conjugate vaccines has substantially decreased the incidence of invasive pneumococcal diseases. However, the incidence of bacteremia due to nonvaccine serotypes has increased. Therefore, it is important to recognize the symptoms and complications of pneumococcal infection to expedite diagnosis. Herein, we report the case of a 22-month-old patient diagnosed with pneumococcal bacteremia who presented with cholestatic jaundice and fever without any other signs of systemic sepsis. The patient's condition improved soon after antibacterial therapy. Other causes of jaundice were possibly ruled out based on the screening test for viral hepatitis, and there were no abnormal findings on abdominal ultrasonography. Therefore, the present case suggests that cholestatic jaundice could be a manifestation of pneumococcal bacteremia.

Keywords

cholestasis - Streptococcus pneumoniae - bacteremia - jaundice

^* deceased on September 8, 2018

Publication History

Received: 08 May 2020

Accepted: 30 October 2020

Article published online:
07 December 2020

• References

• 1 Suga S, Chang B, Asada K. et al. Nationwide population-based surveillance of invasive pneumococcal disease in Japanese children: effects of the seven-valent pneumococcal conjugate vaccine. Vaccine 2015; 33 (45) 6054-6060
• 2 Nakano S, Fujisawa T, Ito Y. et al. Nationwide surveillance of paediatric invasive and non-invasive pneumococcal disease in Japan after the introduction of the 13-valent conjugated vaccine, 2015-2017. Vaccine 2020; 38 (07) 1818-1824
• 3 Glikman D, Dagan R, Barkai G. et al; Israel Bacteremia and Meningitis Active Surveillance Group. Dynamics of severe and non-severe invasive pneumococcal disease in young children in Israel following PCV7/PCV13 introduction. Pediatr Infect Dis J 2018; 37 (10) 1048-1053
• 4 Camilli R, D'Ambrosio F, Del Grosso M. et al. Pneumococcal Surveillance Group. Impact of pneumococcal conjugate vaccine (PCV7 and PCV13) on pneumococcal invasive diseases in Italian children and insight into evolution of pneumococcal population structure. Vaccine 2017; 35 (35 Pt B): 4587-4593
• 5 Metcalf BJ, Gertz Jr RE, Gladstone RA. et al. Strain features and distributions in pneumococci from children with invasive disease before and after 13 valent conjugate vaccine implementation in the United States. Clin Microbiol Infect 2016; 22: 60.e9-60.e29
• 6 Pelton SI, Jacobs MR. Pneumococcal infections. In: Cherry JD, Harrison GJ, Kaplan SL, Hotez PJ. eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 7th edition. Philadelphia: Saunders Elsevier; 2014: 1198-1246
• 7 Harb R, Thomas DW. Conjugated hyperbilirubinemia: screening and treatment in older infants and children. Pediatr Rev 2007; 28 (03) 83-91
• 8 Vitola BE, Balisteri WF. Liver disease associated with systemic disorders. In: Kliegman RM, Stanton BF, St Geme III JW, Schor NF. eds. Nelson Textbook of Pediatrics. 20th edition. Philadelphia: Saunders Elsevier; 2016: 1954-1957
• 9 Takikawa H, Takamori Y, Kumagi T. et al. Assessment of 287 Japanese cases of drug induced liver injury by the diagnostic scale of the International Consensus Meeting. Hepatol Res 2003; 27 (03) 192-195
• 10 European Association for the Study of the Liver, Electronic address: [e-mail], Clinical Practice Guideline Panel: Chair, Panel members, EASL Governing Board representative. EASL clinical practice guidelines: drug-induced liver injury. J Hepatol 2019; 70 (06) 1222-1261
• 11 Torres JM, Cardenas O, Vasquez A, Schlossberg D. Streptococcus pneumoniae bacteremia in a community hospital. Chest 1998; 113 (02) 387-390
• 12 Franson TR, Hierholzer Jr WJ, LaBrecque DR. Frequency and characteristics of hyperbilirubinemia associated with bacteremia. Rev Infect Dis 1985; 7 (01) 1-9
• 13 Kobashi H, Toshimori J, Yamamoto K. Sepsis-associated liver injury: Incidence, classification and the clinical significance. Hepatol Res 2013; 43 (03) 255-266
• 14 Chand N, Sanyal AJ. Sepsis-induced cholestasis. Hepatology 2007; 45 (01) 230-241
• 15 Pan CG, Leichter HE, Werlin SL. Hepatocellular injury in Streptococcus pneumoniae-associated hemolytic uremic syndrome in children. Pediatr Nephrol 1995; 9 (06) 690-693
• 16 Chen JP, Chen SM, Sheu JN. Unusual manifestation of severe conjugated hyperbilirubinemia in an infant with Streptococcus pneumoniae-associated hemolytic uremic syndrome. J Formos Med Assoc 2007; 106 (2, Suppl): S17-S22
• 17 Patel MG, Porto AF. Conjugated hyperbilirubinemia in a child with streptococcus pneumoniae-associated hemolytic uremic syndrome. ACG Case Rep J 2013; 1 (01) 64-67
• 18 Bratton L, Teele DW, Klein JO. Outcome of unsuspected pneumococcemia in children not initially admitted to the hospital. J Pediatr 1977; 90 (05) 703-706
• 19 Shapiro ED, Aaron NH, Wald ER, Chiponis D. Risk factors for development of bacterial meningitis among children with occult bacteremia. J Pediatr 1986; 109 (01) 15-19
• 20 Rothrock SG, Harper MB, Green SM. et al. Do oral antibiotics prevent meningitis and serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia? A meta-analysis. Pediatrics 1997; 99 (03) 438-444