When vaccination is not enough: Streptococcus pneumoniae serotype 3 as a cause of necrotizing pneumonia in a child

Abstract

Introduction: Necrotizing pneumonia is a rare but severe complication of bacterial pneumonia in children, most often associated with Streptococcus pneumoniae infection. Despite successful vaccination programs, certain serotypes not covered by vaccines continue to pose a significant clinical problem.

Case report: We present the case of a 1.5-year-old boy who was admitted due to high fever, respiratory distress, and general poor condition. The child was properly vaccinated according to the national vaccination program, including the 10-valent pneumococcal vaccine. Radiological workup (chest X-ray and MSCT) revealed necrotizing pneumonia with the formation of cavitary lesions. Streptococcus pneumoniae serotype 3 was isolated from the pleural puncture. Despite initial antibiotic therapy, the clinical course was complicated, requiring prolonged hospitalization and adjustments to antibiotic therapy. The child gradually recovered without lasting consequences.

Discussion: Streptococcus pneumoniae serotype 3 is known for its high virulence and tendency to cause severe pneumonia, including necrotizing pneumonia. This serotype is not covered by the 10-valent pneumococcal vaccine, which explains the occurrence of invasive pneumococcal disease in a properly vaccinated child. The presented case highlights the limitations of current vaccination programs and the importance of clinical suspicion of severe complications of pneumonia, even in vaccinated children.

Conclusion: Necrotizing pneumonia caused by Streptococcus pneumoniae serotype 3 can occur even in properly vaccinated children. This case highlights the need for timely diagnosis, adequate treatment, and consideration of wider serotype coverage of pneumococcal vaccines in the prevention of severe forms of the disease.