Investigation of Concurrent Pneumococcal Meningitis in Two Children Attending the Same Day-Care Center

Alexis Rybak; Emmanuelle Varon; Elodie Masson; Anne Etchevers; Daniel Levy-Brühl; Naïm Ouldali; Corinne Levy; Robert Cohen

doi:10.3389/fped.2022.945767

Investigation of Concurrent Pneumococcal Meningitis in Two Children Attending the Same Day-Care Center

Front Pediatr. 2022 Jul 14:10:945767. doi: 10.3389/fped.2022.945767. eCollection 2022.

Authors

Alexis Rybak^{1

2

3

4}, Emmanuelle Varon^{5

6}, Elodie Masson⁷, Anne Etchevers⁸, Daniel Levy-Brühl⁸, Naïm Ouldali^{1

3

9

10}, Corinne Levy^{1

2

5

11}, Robert Cohen^{1

2

5

11

12}

Affiliations

¹ ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.
² AFPA, Association Française de Pédiatrie Ambulatoire, Orléans, France.
³ Assistance Publique-Hôpitaux de Paris, Clinical Epidemiology Unit, Robert Debré University Hospital, ECEVE INSERM UMR 1123, Université de Paris, Paris, France.
⁴ Assistance Publique-Hôpitaux de Paris, Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Paris, France.
⁵ Université Paris Est, IMRB-GRC GEMINI, Créteil, France.
⁶ Laboratory of Medical Biology and National Reference Centre for Pneumococci, Intercommunal Hospital of Créteil, Créteil, France.
⁷ Assistance Publique-Hôpitaux de Paris, Pediatric Emergency Department, Bicêtre University Hospital, Paris-Saclay University, Le Kremlin-Bicêtre, France.
⁸ The National Public Health institute, Saint-Maurice, France.
⁹ Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.
¹⁰ Infectious Diseases Division, CHU Sainte Justine - Montreal University, Montreal, QC, Canada.
¹¹ Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France.
¹² Neonates Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France.

Abstract

Only a few clusters of invasive pneumococcal disease have been described globally in children, and most of these cases occurred before pneumococcal vaccination implementation. Two unusual cases of pneumococcal meningitis, occurring in the same daycare center over a 3-day period, were reported. Both cerebrospinal fluid (CSF) were sent to the National reference center for pneumococci. In addition, we decided to perform a pneumococcal carriage study on all children and staff of the daycare center to analyze the pneumococcal serotypes circulating in this DCC and to discuss an antibiotic chemoprophylaxis. CSF culture was positive for pneumococcus, and serotype 25A was identified by latex agglutination. The second case had negative CSF culture, but CSF antigen test and gene amplification results were positive for Streptococcus pneumoniae. Serotype 12F was identified by using molecular biology. The absence of correlation between these strains was confirmed by multi-locus sequence typing. In the carriage study, we included 29 children (median age 1.9 years, interquartile range 1.4-2.5) and 10 adults. Among the children, 24 carried Streptococcus pneumoniae (83%). The main serotypes isolated were 23A for 6 children and 25A for 5 children; serotypes were non-typeable for 3 children. Only 1 of 10 adults tested carried Streptococcus pneumoniae (serotype 12F). Despite this temporo-spatial pattern, the cases were unrelated and not due to carriage of a particular serotype. No specific action has been taken for the other children attending this DCC, and no other case of bacterial meningitis occurred.

Keywords: cluster; daycare center; invasive pneumococcal disease; pneumococcal carriage; pneumococcal meningitis.