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Unprotected People Reports: Pneumococcal |
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Three-Year-Old's Ordeal with Severe Pneumococcal Disease Includes Bloodstream and Lung Infection |
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| Click here for a fully-formatted PDF version
of this report |
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| The Immunization Action Coalition (IAC)
publishes articles about people who have suffered or died from
vaccine-preventable diseases and periodically devotes an IAC Express issue
to such an article. This is the 75th in our series. In 1996, four years before pneumococcal
conjugate vaccine (PCV) was licensed in the United States, three-year-old
Leo Wexler-Mann underwent two days of emergency room visits and a four-day
hospital stay being treated for pneumococcal pneumonia, sepsis, and pleural
effusions. On his return home, he faced weeks of illness and months of
recovery. His parents, Deborah Wexler and Michael Mann, endured agonizing
days watching their son struggle to breathe and anxious months monitoring
his breathing quality. Fortunately, Leo made a complete recovery. Leo's mother, the executive director of IAC,
wrote the following account out of a sense of relief and gratitude that
today's infants, toddlers, and preschoolers do not have to experience the
pain and distress Leo did, and that their parents are spared the anguish of
watching their children struggle with pneumococcal disease and the fear that
their child might die or develop significant, lifelong health problems as a
result of the disease. |
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| By Deborah L. Wexler, MD, ABFP |
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 I am the mother of three children and also a board certified family
physician and immunization specialist.
What follows are my recollections of my
now-12-year-old son's illness with invasive pneumococcal disease in March
1996. His disease included pneumococcal pneumonia (lung infection), sepsis
(blood infection), and pleural effusion (inflammatory fluid in the lungs).
When Leo had just turned three, he developed
what I thought was a mild viral illness--a cough and fever. The fever
responded well to treatment with anti-fever medication. But by the third
night of illness, as I was drying him off after his bath and starting to put
his pajamas on him, he suddenly turned gray and became completely limp. He
was in some kind of shock. Terrified, I scooped him up, wrapped a blanket
around him, and shouted for my husband that we had to go the hospital now.
We ran to the car and sped to St. Paul Children's Hospital Emergency Room
(ER), about two miles from our home.
Leo recovered a bit in the car, regaining
some color. By the time he arrived at the hospital, his appearance was much
improved. He was no longer gray but still had a fever. The emergency
department staff evaluated him, took multiple tubes of blood from his little
arm for various tests including blood cultures, and x-rayed him. Ultimately,
they thought he was stable enough to return home after he received two
injections of a potent antibiotic. We were given a prescription for an oral
antibiotic that he was to begin taking the next evening. What we didn't know
that night in the ER was that Leo was septic (had a serious blood infection)
with invasive pneumococcal disease. His blood and lungs were infected with
deadly bacteria.
Because of the antibiotic injection, the next
morning Leo appeared better. But that evening when we tried to give him the
oral antibiotic, even the smallest amount tasted so bad to him that try as
we might, we couldn't get him to open his mouth for the full dose. We fought
and struggled with him but to no avail. His breathing grew worse. We decided
we'd better stop stressing him, called the physician on call, and explained
the situation. He asked us to bring Leo back to the hospital for another
injection of the previous night's antibiotic. Poor little Leo.
The next day, the physician on call phoned to
tell us the laboratory had reported that the blood cultures drawn the first
night in the ER showed positive results--pneumococcal bacteria were growing
in Leo's blood. She wanted to be sure he was being treated fully and doing
well. We described our problems with the oral antibiotic failure. She
recommended that he be switched to amoxicillin---easy to tolerate.
Leo was able to take this oral medication
without difficulty. But as the hours passed, I noticed his breathing rate
was gradually becoming more rapid. He was eventually breathing at the rate
of 40-50 breaths per minute. (Normal breathing rate for his age is 20-30
breaths per minute.) I assumed his rapid breathing was caused by the
pneumonia and would subside. When it didn't slow down by the next day, I
called his physician. We agreed that Leo should come back to the hospital
for further evaluation and x-rays.
Leo's new chest x-rays showed fluid had now
settled in the bases of both of his lungs. He had pleural effusions on both
sides. He was experiencing a severe inflammatory response in his lungs, and
the accumulating fluid in his chest cavity was making it difficult for him
to fully expand his lungs. This was the reason for his rapid breathing. Leo
was admitted to the hospital, where an infectious disease specialist
recommended treatment with stronger antibiotics.
In addition, because of his breathing
difficulties a pediatric pulmonary specialist was consulted. My husband and
I were agonized by the thought that if his breathing were to become too
impaired, our three-year-old might have to have a needle inserted into his
chest cavity to remove excess inflammatory fluid.
The consultants recommended we observe Leo's
breathing rate for worsening signs and that he have daily chest x-rays. By
doing these things, we would be able to determine if the fluid would need to
be removed with a needle or if his body would absorb it on its own. We were
fortunate that Leo's breathing problems stabilized and that he did not need
to experience the needle procedure (pleuracentesis).
After a four-day stay, Leo was discharged
from the hospital on oral antibiotics, but the complications of his illness
did not end there--and neither did his suffering. Following his necessary
treatment with the multiple antibiotics, the normal bacterial growth in his
intestine was altered dramatically. His intestine was overwhelmed with a new
bacterium called Clostridium dificile. This caused Leo to cry with severe
stomach cramps and to pass 20-30 painful bloody stools every day for several
days.
We called his physician the day the severe
abdominal pain and bloody diarrhea began. Leo's doctor recommended stopping
the antibiotics for the pneumococcal disease and giving him a different
antibiotic to combat the Clostridium infection. The medication was put in
liquid form so Leo could swallow it, but it tasted so terrible that he
gagged and couldn't swallow it. We called the physician again; he asked if
our three-year-old could possibly swallow the medication in pill form. Leo
said he'd try. Fortunately, he was able to swallow the pills, and over the
next several days, the bloody diarrhea and cramping resolved.
Our family was overwhelmed by the severity of
Leo's illness and its complications for nearly a month. Following his acute
illness, there were additional visits during the year with the pediatric
pulmonary specialist to make sure Leo's breathing returned to normal.
To this day, I am thankful that Leo's brain
was not infected with the pneumococcal organism and that he is a healthy
child. I wish the pneumococcal vaccine for children had been available nine
years ago. It would have saved Leo from six days in and out of the hospital,
weeks of illness, months of recovery, and saved me and my husband from
months of worry as we monitored his breathing quality and hoped for his full
recovery.
Thousands of other families have endured
similar ordeals when their children were infected with pneumococcal
bacteria. Many parents have watched their children suffer the ravages of
pneumococcal meningitis (an even worse form of pneumococcal disease); some
have watched their children die. Our family was extremely fortunate, all
things considered.
As a physician, public health educator, and
mother, I never hesitate to urge parents of young children to vaccinate
their children against pneumococcal disease. I've been much too close to the
pain and suffering this disease can cause a child and a family.
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| 6/8/05 • REPORT #75 |
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| Disclaimer: The Immunization Action Coalition (IAC) publishes
Unprotected People Reports for the purpose of making them available
for our readers' review. We have not verified the content of this
report. |
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