of the cough, though cultures taken from the
MOUTH and NOSE may provide confirmation.
Cultures are positive in about 80 percent of people.
Treatment in the early stages of pertussis is
ANTIBIOTIC MEDICATIONS, typically erythromycin or
trimethoprim and sulfamethoxazole (TMP-SMZ).
The further into the course of illness, the less
effective antibiotics become, however. The infec-
tion causes the nasal passages, THROAT, bronchi,
and bronchioles to ooze fluid that clogs the air-
ways; the cough is the body’s attempt to remove
the fluid to permit free breathing. A profusely
runny nose (rhinorrhea) is the earliest symptom
of pertussis though often is perceived as a cold
until the cough begins. Antibiotic therapy can
substantially shorten the course and lessen the
severity of illness. Most people recover fully with
appropriate treatment, particularly when treat-
ment begins early.
See also CHILDHOOD DISEASES; DIPHTHERIA; PREVEN-
TIVE HEALTH CARE AND IMMUNIZATION.
pneumococcal pneumonia An illness resulting
from INFECTION with the bacterium Streptococcus
pneumoniae, which is normally present in the
mucous membranes of the NOSE and sinuses.
Researchers do not know what processes occur in
the body that allow S. pneumoniaeto shift from
NORMAL FLORAto causing infection in its native
environment. Pneumococcal pneumonia is a seri-
ous upper respiratory illness that can invade the
LUNGSand spread to the BRAIN(causing MENINGITIS)
and middle EAR(causing OTITISmedia). Pneumo-
coccal pneumonia can also cause SEPTICEMIA, a life-
threatening illness of widespread bacterial
infection that involves multiple organ systems.
Symptoms and Diagnostic PathSymptoms begin suddenly and are usually severe.
They include
- a shaking chill followed immediately by sudden
high FEVER - nonproductive COUGH
- difficulty BREATHING(DYSPNEA) and CHEST PAIN
- HEADACHE
- NAUSEAand VOMITING
- fatigue
The diagnostic path includes chest X-RAYand
BLOODor fluid tests to determine the presence of S.
pneumoniae. Because symptoms are severe and the
risk for complications is high, doctors typically
begin immediate treatment with ANTIBIOTIC MEDICA-
TIONS. Symptoms that dramatically improve with
the first 24 hours of treatment further confirm the
diagnosis.Treatment Options and Outlook
Penicillin is the antibiotic of first choice for treat-
ment, though about 25 percent of S. pneumococcal
strains are now resistant to it. Most resistant
strains are sensitive to other antibiotic medica-
tions. The antibiotic of last resort is vancomycin,
which doctors reserve for pneumonia that does
not respond to treatment with any other antibi-
otics. With appropriate antibiotic therapy many
people fully recover from pneumococcal pneumo-
nia, though it is important to take the full course
of antibiotics even after symptoms are gone. Pneu-
mococcal pneumonia can be fatal.ANTIBIOTIC MEDICATIONS
TO TREAT PNEUMOCOCCAL PNEUMONIA
cefotaxime ceftizoxime
ceftriaxone clindamycin
erythromycin gatifloxacin
grepafloxacin levofloxacin
penicillin moxifloxacin
sparfloxacin vancomycinRisk Factors and Preventive Measures
People most vulnerable to pneumococcal pneu-
monia are the very young, the very old, and those
who are IMMUNOCOMPROMISED. The pneumococcal
VACCINE, administered each year, can preventS.
pneumoniae infection.
See also ANTIBIOTIC RESISTANCE; INFLUENZA;
INFLUENZA PREVENTION.prion A protein fragment that becomes a
PATHOGEN. Prion illnesses affect the BRAINand cause
extensive damage to brain tissue, causing it to
become spongy in appearance. Though prion ill-
nesses are not contagious in typical fashion, intro-
duction of infectious prions into healthy brain
tissue transmits the INFECTION. Because of these
characteristics, researchers call prion illnessesprion 349