The early symptoms of pneumococcal disease can be non-specific and difficult to distinguish from common infections of childhood.
As the pneumococcal disease progresses, it may localise to specific organ systems and manifest symptoms which bring the diagnosis to attention.
These include pneumonia (infection in the lungs), meningitis (infection of the outer coverings of the brain), middle ear infections or even bacteraemia (infection that has spread into the bloodstream).
The gold standard of diagnosis is still by bacterial cultures which usually take at least 48 to 72 hours for confirmation.
Patients can present with fever, cough, progressing to breathlessness and chest pain and other constitutional symptoms such as lethargy and poor appetite.
Patients can present with ear pain, discharge or just fever. Younger children can present with tugging at the ear or irritability.
Most of the symptoms and signs are similar for both the bacterial and the viral meningitis, and there is no one symptom or sign that are specifically indicate one or the other. The common clinical symptoms that may indicate meningitis are fever associated with seizures, impairment of consciousness, irritability, lethargy, nausea and/or vomiting.
The important signs indicating meningitis includes neck stiffness (pain or resistance to someone flexing the child's neck) and increased sensitivity to light (photophobia), usually in the presence of drowsiness or irritability.
For young infants where the anterior fontanelle (the soft spot on the top of the head) has not closed, this could be under increased pressure and bulging out of the scalp (bulging fontanelle). Signs of bleeding under the skin (purpuric rash) together with other symptoms or signs indicating involvement of the brain may also suggest bacterial meningitis.
Bacterial meningitis is the most serious and potentially fatal disease caused by the pneumococcal bacteria.
Any form of bacterial meningitis is serious, and death can occur due to septicemic (blood poisoning) shock from the bacterial invasion of the blood stream. Death can also occur due to severe brain swelling that result in compression/pressure on the vital centres in the brainstem. Mortality from bacterial meningitis is approximately 5% - 20% depending on the virulence of micro-organism involved.