Serotype Distribution And Vaccine Coverage
Of the 287 pneumococcal isolates, 261 isolates were successfully serotyped and 19F was the most common serotype, followed by 6A , 19A , 23F , 14 , 6B , 34 , 15B/C , and 15A . Other uncommon serotypes were detected in fewer than five strains each, which included serotype 7C , 11A , 20 , 4 , 33F , 9V , and 18 . The rest 26 isolates were classified as non-typeable. The serotype distribution of pneumococcal strains isolated is shown in Figure 1.
Figure 1. Serotype distribution of pneumococcal strains isolated in Shanghai in 2018.
The overall vaccine coverage rates of PCV7, PCV10, and PCV13 serotypes were 58.9, 58.9, and 80.5%, respectively. HAP had a lower vaccine serotype coverage rate than CAP. A higher rate of PCV13/non-PCV7 serotypes was noticed in HAP. Simultaneously, serotype 4, 9V, 15B/C, 7C, 18, 20 and 33F were only observed in CAP.
Upper Respiratory Infection Symptoms
Fever is a rare symptom of the common cold in adults but may be more likely in children.
Symptoms of an upper respiratory infection can last up to two weeks but usually peak at around three days and are gone within seven. Upper respiratory infections should clear up on their own without needing interventions from your healthcare provider.
But complications of colds can occur, including:
- Sinusitis: An infection in your sinuses causing pain and congestion
- Otitis media: An ear infection causing pain
- Pharyngitis: A sore throat, which might be strep throat
- Epiglottitis: An infection and resulting swelling of the epiglottis, a flap of tissue that covers your windpipe, which can interfere with breathing
- Laryngotracheitis: Infection of the larynx , trachea, or bronchi
Some of these complications may require treatment with antibiotics.
Managing Side Effects Of Antibiotics
While there are some cases in which you may be prescribed antibiotics for a common cold, these medications aren’t harmless. There are many side effects of antibiotics. Some are common, and others can be severe and potentially deadly.
- Allergic reactions
- Vaginal itching or yeast infections
- Nausea and vomiting
In a dataset from 2013 and 2014, adverse drug reactions caused 4 out of every 1,000 emergency room visits each year. The most common reason for the visit among children was an adverse reaction to antibiotics.
If you or your child is experiencing side effects from a prescribed antibiotic, make sure to tell your healthcare provider to be certain its nothing to worry about. Theyll also let you know if you should continue taking it or stop.
If youre taking antibiotics, here are a few things you can do to help ward off some side effects of antibiotics:
- Take a probiotic and eat fermented foods like yogurt and kefir.
- Limit sun exposure.
- Take your antibiotic as prescribed .
- Make sure to store it correctly .
- Ensure your healthcare provider knows about all other drugs and supplements youre taking.
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How Long Is Strep Throat Contagious
Without proper treatment with strep throat antibiotics, individuals with strep throat may be contagious for up to 1 month.
When an individual infected with Group A Streptococcus bacteria, they typically begin to present symptoms about 25 days after exposure. However, according to the United States Centers for Disease Control, some infected people do not have symptoms or seem sick. An infected person can spread strep throat to others by coughing, sneezing, or talking, which creates small respiratory droplets that contain the bacteria.
Treatment with strep throat antibiotics can stop the infection from spreading. People who take antibiotics to treat strep stop being contagious after approximately 24 hours.
Side Effects Of The Antibiotics From Streptococci
The most likely side effects of Imipenem, Meropenem and Cephyrom include:
Soreness at the injection site, nausea, vomiting, diarrhea, skin rashes with itching and flushing, a decrease in the level of leukocytes and an increase in urea in the blood. There may also be hyperthermia, headache, breathing and heart rhythm disturbances, convulsions, intestinal microflora disorders.
In addition to those already listed, the side effects of Clindamycin may be manifested as a taste of metal in the mouth, hepatitis and cholestatic jaundice, increased levels of bilirubin in the blood, pain in the epigastric region.
The use of Amoxiclav may be accompanied by nausea, vomiting and diarrhea, acute inflammation of the intestine due to activation of opportunistic infection – clostridia, as well as exudative erythema of the skin and development of toxic necroticisation of the epidermis.
Similar side effects may manifest in the treatment of green streptococcus antibiotics-glycopeptides . In addition, this antibiotic can adversely affect hearing.
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What Is Scarlet Fever
Scarlet fever is the name given to a bright red rash that develops following a Strep throat, although it can also develop following school sores .
Scarlet fever is less common than it was one hundred years ago because of antibiotic use and it only occurs in those who are susceptible to the toxins produced by the Streptococcal bacteria. It mostly occurs in children aged 4 to 8 years. By 10 years old more than 80% of children have developed lifelong protective antibodies against streptococcal toxins, whilst infants younger than 2 still have antibodies against the toxin that they acquired from their mother. This means that if two children in one family develop Strep throat, only one may develop scarlet fever.
Scarlet fever is a bright red rash that feels like sandpaper to the touch. The rash typically starts on the neck, underarm, or groin as small, flat red blotches that gradually become fine bumps and feel rough to the touch. In the body folds the rash may appear a brighter red . Facial flushing is common although a pale area may remain around the mouth. After seven days, the rash fades and some skin peeling may occur over the next month or longer, particularly around the fingertips, toes, and groin area.
Left untreated, Scarlet fever may progress to:
- Ear, sinus, and skin infections
- Joint inflammation
- Rheumatic fever
- Otitis media
When And Why You Might Need An Antibiotic For A Cold
Daniel More, MD, is a board-certified allergist and clinical immunologist with a background in internal medicine.
Steve Prezant / Getty
Any given adult will get a cold at least a couple of times a yearusually in the fall and winter. Kids can get many colds, maybe even half a dozen or more a year. When you get a cold, also known as an upper respiratory tract infection, should you visit your healthcare provider and get antibiotics?
The truth is, antibiotics for respiratory infections arent going to make you feel better sooner, and they might even leave you with side effects that make you feel worse.
Colds are known medically as upper respiratory tract infections because theyre usually limited to the upper half of your respiratory systemthe nose, sinuses, upper throat, larynx, and pharynx. These infections dont, for example, include infections that affect your lungs, like pneumonia.
Upper respiratory tract infections are usually caused by viruses, like rhinovirus, coronavirus, or influenza, though rarely they are caused by bacteria. Bacteria that infect the upper respiratory tract are most often S. pyogenes , or sometimes H influenzae.
Due to the development and routine administration of the H. influenzae vaccine over the past 30 years, the incidence of this infection has dropped substantially.
Antibiotics may be prescribed in a few different situations:
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Presence And Distribution Of Virulence Genes
The presence of virulence genes did not show any significant difference among the isolates obtained from CAP and HAP . Irrespective of the source of the isolation, all isolates carried lytA, ply, psaA, pavA, spxB, htrA, and clpP genes. In general, most of the isolates harbored nanA and piaA . Significant association was suggested between carriage rate and serotype in cps2A, cbpA, pspA and nanA. Besides, cps2A, cbpA, and pspA was also associated with clonal complex.
Table 3. Virulence genes among major serotypes and clonal complexes .
cps2A was present in 44.3% isolates and all serotypes 19A and 14 possessed it. The majority of serogroup 19 isolates carried cbpA, including 19F and 19A . Serotypes 6A and 6B were the most dominant serotypes to carry pspA. The relationship between virulence patterns and serotypes of S. pneumoniae isolated from CAP and HAP was listed in Table 4. Based on the studied genes, the most common virulence pattern in current study was lytA-ply-psaA-pavA-spxB-htrA-clpP-cbpA-nanA-piaA , with 19F accounting for the majority and 90% were MDR, followed by pattern lytA-ply-psaA-pavA-spxB-htrA-clpP-cps2A-nanA-piaA that contains a variety of serotypes.
Table 4. The relationship between virulence pattern and serotypes of S. pneumoniae isolated from CAP and HAP.
In Vitro Antimicrobial Susceptibility Testing
Antimicrobial resistance testing of all 287 isolates were determined by E-test and Kirby-Bauer disk tests. In our study, we used E-test assay to measure the minimum inhibitory concentrations to penicillin. The susceptibility to clindamycin, erythromycin, linezolid, moxifloxacin, sulfamethoxazole-trimethoprim and vancomycin was assessed using the disk diffusion method . All susceptibility tests and results interpretations were performed following the guidelines and criteria established by the Clinical and Laboratory Standard Institute 2018. The quality-control strain was S. pneumoniae ATCC 49619, which included in each set of tests to ensure the reliability of the results. Isolates resistant to three or more kinds of antibiotics tested were defined as MDR S. pneumoniae in this study.
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Newer Agents For Treating Meningitis Due To Antibiotic
Both cefepime, a broad-spectrum cephalosporin, and meropenem, a carbapenem antibiotic, have been evaluated in clinical trials for the treatment of bacterial meningitis. Cefepime has activity equivalent to cefotaxime or ceftriaxone against penicillin-resistant S. pneumoniae. Sáez-Llorens et al. compared cefepime with cefotaxime in 90 children with bacterial meningitis. The mean concentrations of cefepime in CSF ranged from 3.3 to 5.7 g/ml 0.5 to 8 h after a dose. Sequelae were equivalent between the two groups. However, no penicillin-resistant pneumococci were identified in the study, and so the effectiveness of cefepime for treating pneumococcal meningitis due to resistant strains could not be assessed and thus remains unknown.
Where Is Streptococcus Pneumoniae Found
The streptococcus bacterium already exists in the human body. Although it benefits from it, it does not generally cause any harm to the human body. This stands true until and unless the immune system of a person is extremely or considerably weak than others. One of the most common questions to be asked is where is Streptococcus Pneumoniae found. Hence, these kinds of bacterium are mostly found in the nose, skin, and throat of a person. It is found mainly in the nasopharynx of the nasal passages upper respiratory tract of all human beings all over the world.
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Impact Of Macrolide Azithromycin On The Metabolism Of S Pneumoniae
Macrolides have shown some strong anti-inflammatory effects , reducing the release of IL-8 and TNF-. Also macrolides inhibit effective adherence of bacteria to respiratory epithelial cells and so decrease the production of virulence factors . It has been demonstrated that azithromycin blocks peptide biosynthesis resulting in a reduced uptake of amino acids from the medium . Our findings showed no significant changes of amino acid uptake and intracellular concentrations by azithromycin stress. Interestingly, macrolides can be secreted by ATP dependent efflux pumps from pneumococcal cells . A study using E. coli has suggested a physical interaction between macrolide efflux proteins Mef and Mel, binding of macrolides to Mel and localization to the membrane . Induction of efflux proteins occurs very fast after exposure to different macrolide antibiotics . Efflux of antibiotics could be a reason that S. pneumoniae showed least metabolic alteration caused by azithromycin compared with other stress conditions. In this study, azithromycin treatment of S. pneumoniae influenced the purine and pyrimidine biosynthesis as also proved for S. aureus . These results suggested that the bacterial cells responded to azithromycin by reducing generation of nucleotides and resources for DNA synthesis .
Clinical Isolates And Population
The retrospective surveillance was conducted at Shanghai Children’s Hospital, which is the first specialist children’s hospital in China, with about 2.5 million outpatients visiting and 44,000 hospitalized each year. A total of 287 S. pneumoniae isolates were collected from patients diagnosed with pneumonia between January and December in 2018. CAP included the isolates obtained from an outpatient or collected earlier than 48 h after hospitalization, while specimens obtained more than 48 h after admission were included as HAP in this investigation .
Clinical and epidemiological information was systematically extracted from the medical records, including demographics of the patient, symptoms and findings at hospitalization, underlying, and other potential characteristics. The protocol for present study was approved by the Shanghai Children’s Hospital Ethics Committee . The retrospective study was to obtain the genus and species of the bacteria and did not affect the patients, the Review Board consequently exempted the informed consent requirements. Only one isolate was collected from each patient. Duplicate strains and patients colonized by bacteria with no clinical symptoms were excluded from the study.
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Who Is At Greater Risk Of Getting A Pneumococcal Disease
The Streptococcus pneumoniae is found and survives at the nose, skin, throat and nasal cavity more precisely the nasopharynx of a person. Although it does not cause any harm to the human body, this bacterium is known to pave the way for various diseases in the people who have weak immune systems. Therefore, certain people are at risk and should watch out for the symptoms of it.
Hence, the groups of people who are at more risk of getting pneumococcal diseases are:
Impact Of Cephalosporin Cefotaxime On The Metabolism Of S Pneumoniae
Metabolic response of S. pneumoniae to cefotaxime showed an increased amount of glutamine and glutamate intracellularly. Glutamine is major nitrogen donor for purine and pyrimidine biosynthesis and for the synthesis of the cell wall precursors. Glutamine is used by the aminotransferase GlmS to convert fructose-6-P into glucosamine-6-P . As shown in S. aureus inhibition of GlmS correlates with a broad set of cell wall synthesis inhibitors . Transcriptional response of S. pneumoniae to penicillin showed decreased glutamine metabolism. The most downregulated genes encode ABC transporter GlnQ, the transcriptional regulator GlnR, and the glutamine synthetase GlnA . Enhanced intracellular concentrations of glutamine and glutamate as described for S. pneumoniae after penicillin treatment were also observed after exposure to cefotaxime in this study whereas uptake of glutamine and glutamate was not influenced. Interestingly, it was shown that glutamine protects S. pneumoniae against penicillin stress . The inhibition of GlmS in methicillin-resistant S. aureus and of GlnA in penicillin-resistant S. pneumoniae decreased their level of resistance. Glutamine is also a cofactor for the cross-linking of the peptidoglycan by MurT/GatD . Our results showed that cefotaxime influenced the amounts of four peptidoglycan precursors reaffirming the known mechanism of action of cephalosporins .
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Get Strep Throat Treatment Online
If you or your child are experiencing throat pain, painful swallowing, and other common strep throat symptoms, we have good news: you dont need to visit your doctors office for strep throat antibiotics.
Instead, you can schedule an online appointment with one of the trusted doctors at PlushCare. If your doctor thinks strep throat antibiotics are right for you, they can send an electronic prescription to your local pharmacy.
Book an appointment with a PlushCare doctor and get an antibiotic prescription today.
Antibiotics Are Active Against The Streptococcus Pneumoniae
Name Intravenous. 400 mgs once a day Lysates of bacteria 20-30 ml 2-3 times a day for 10-14 days Levofloxacin twice a day for 7 – 14 days Azithromycin once a day at least 1 hour before or 2 hours following a meal Grepafloxacin once a day for 7 – 10 days Ampicillin + Oxacillin 0,5 – 1 g 5-7 days to 2 weeks Piperacillin Intramuscular, intravenous. 2 – 4 g every 6-12 hours 7 – 10 days once or twice a day between a meal Cefoperazone 2 – 4 g at least 10 days twice a day for 7 – 10 days Linezolid twice a day for 10-14 days Ceftazidime every 8 hours at least 5 days Cefpodoxime twice a day for 10-14 days. Meropenem twice a day for 7-14 days Roxithromycin once or twice a day Ceftriaxone 1 – 2 g once a day not more than 10 days. The introduction of the drug is recommended to continue for another 2-3 days after normalization of body temperature and symptoms disappear. Cefalexin 2-4 times a day before a meal for 7 – 14 days Cefuroxime 3-4 times a day for 5 – 10 days and more Gentamicin Intramuscular, intravenous. 3 mgs / kg /day every 6-8 hours 7 – 10 days 500 mgs every 6 hours, 1g every 12 hours Tobramycin 1-3 times a day for 5 – 10 days Sulfadimethoxine first day 1-2 g, then – 0.5-1 g once a day for 7 -14 days Erythromycin 4 times a day at least 2 hours before a meal Streptomycin Intramuscular. 15 mgs / kg /day for 7-10 days. Fusafungine 4 inhalation in the mouth and / or in each nostril every 4 hours for not more than 10 days Ambazone 3 times a day after a meal for 3 – 4 days
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What Are The Recommended Dosages Of Antibiotics Used To Treat Strep Throat
Antibiotic dosages can vary depending on age and weight. The CDC recommends the following dosages of antibiotics for Strep throat, for those people without a penicillin allergy. One dosage regimen should be chosen that is appropriate for the person being treated.
Oral Penicillin V
- Children: 250mg twice daily or 250mg three times daily for 10 days
- Adolescents and adults: 250mg four times daily or 500mg twice daily for 10 days
- Children and adults: 50 mg/kg once daily for 10 days
- Children and adults: 25 mg/kg twice daily for 10 days
Intramuscular Benzathine penicillin G
- Children < 27 kg: 600 000 units as a single dose
- Children and adults 27 kg: 1 200 000 units as a single dose
The CDC recommends the following dosages of antibiotics for Strep throat, for those people with a penicillin allergy. One dosage regimen should be chosen that is appropriate for the person being treated.
- Oral cephalexin 20 mg/kg twice daily for 10 days
- Oral cefadroxil 30 mg/kg once daily for 10 days
- Oral clindamycin 7 mg/kg three times daily for 10 days
- Oral azithromycin 12 mg/kg once daily for the first day , followed by 6 mg/kg once daily for the next 4 days
- Oral clarithromycin 7.5 mg/kg twice daily for 10 days.