Streptococcus pneumoniae infections and bacteremia in patients with acquired immune deficiency syndrome, with report of a pneumococcal vaccine failure.

Five patients had Streptococcus pneumoniae infections among the 35 hospitalized with acquired immune deficiency syndrome (AIDS) at the New York Veterans Administration Medical Center between January 1, 1982, and June 30, 1983. Three of these patients had pneumococcal bacteremia and 2 had pneumonia without bacteremia. Twenty-seven bacteremic S. pneumoniae infections occurred among 5,143 patients without AIDS admitted to the Medical Service of this hospital during the same period. Thus, pneumococcal bacteremia was more likely to occur in patients with AIDS than in the general hospitalized population (x2 = 26, p = less than 0.001). Two of the bacteremic infections were caused by S. pneumoniae type 4. One of these occurred in a patient who had been inoculated with the 14 valent pneumococcal vaccine 5 months earlier. There were no significant differences in concentrations of radioimmunoassay antibody to type 4 pneumococcal polysaccharide in sequential serum samples collected from this patient, and opsonic titers to this organism were not detected. It is concluded that pneumococcal infections are very common among patients with AIDS, and may not be prevented by active immunoprophylaxis.