Minireviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. Feb 25, 2015; 5(1): 1-10
Published online Feb 25, 2015. doi: 10.5495/wjcid.v5.i1.1
Pneumococcal disease in adult solid organ transplantation recipients
Cristina Roca-Oporto, María Eugenia Pachón-Ibañez, Jerónimo Pachón, Elisa Cordero
Cristina Roca-Oporto, María Eugenia Pachón-Ibañez, Jerónimo Pachón, Elisa Cordero, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío/CSIC/University of Seville, 41013 Seville, Spain
Author contributions: Roca-Oporto C and Pachón J contributed equally to this work, generated the tables and wrote the manuscript; Pachón-Ibañez ME and Cordero E wrote the manuscript; Roca-Oporto C, Pachón-Ibañez ME, Pachón J and Cordero E designed the aim of the minireview.
Supported by Ministerio de Economíay Competitividad, Instituto de Salud Carlos III - co-financed by the European Development Regional Fund “A way to achieve Europe” ERDF, and the Spanish Network for the Research in Infectious Diseases, No. REIPI RD12/00015/0001.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jerónimo Pachón, MD, PhD, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío/CSIC/University of Seville, Av. Manuel Siurot s/n, 41013 Seville, Spain. pachon@us.es
Telephone: +34-955-012185 Fax: +34-955-013292
Received: July 24, 2014
Peer-review started: July 24, 2014
First decision: August 14, 2014
Revised: August 26, 2014
Accepted: November 7, 2014
Article in press: November 10, 2014
Published online: February 25, 2015
Abstract

In solid organ transplant (SOT) recipients, Streptococcus pneumoniae can cause substantial morbidity and mortality ranging from non-invasive to invasive diseases, including pneumonia, bacteremia, and meningitis, with a risk of invasive pneumococcal disease 12 times higher than that observed in non-immunocompromised patients. Moreover, pneumococcal infection has been related to graft dysfunction. Several factors have been involved in the risk of pneumococcal disease in SOT recipients, such as type of transplant, time since transplantation, influenza activity, and nasopharyngeal colonization. Pneumococcal vaccination is recommended for all SOT recipients with 23-valent pneumococcal polysaccharides vaccine. Although immunological rate response is appropriate, it is lower than in the rest of the population, decreases with time, and its clinical efficacy is variable. Booster strategy with 7-valent pneumococcal conjugate vaccine has not shown benefit in this population. Despite its relevance, there are few studies focused on invasive pneumococcal disease in SOT recipients. Further studies addressing clinical, microbiological, and epidemiological data of pneumococcal disease in the transplant setting as well as new strategies for improving the protection of SOT recipients are warranted.

Keywords: Transplantation, Pneumococcal infections, Pneumococcal serotypes, Nasopharyngeal carriage, Pneumococcal vaccine

Core tip: Streptococcus pneumoniae causes substantial morbidity and mortality in solid organ transplant (SOT) recipients, ranging from non-invasive to invasive diseases, with a 12-fold risk of invasive pneumococcal disease higher than in non-immunocompromised patients. Pneumococcal vaccination is recommended for all SOT recipients with 23-valent pneumococcal polysaccharides vaccine. Although immunological rate response is appropriate, it is lower than in the rest of the population, decreases with time, and its clinical efficacy is variable. Booster strategy with 7-valent pneumococcal conjugate vaccine has not shown benefit in this population. Despite its relevance, robust evidence on pneumococcal disease in organ transplant recipients is lacking. New strategies for improving the protection of SOT recipients are warranted.