Parapneumonic effusions related to Streptococcus pneumoniae: serotype and disease severity trends

Catherine Hyams, David T Arnold, Robyn Heath, Zahin Amin-Chowdhury, David Hettle, Gabriella Ruffino, Paul North, Charlotte Grimes, Norman K Fry, Philip Williams, Leon Danon, O Martin Williams, Shamez Ladhani, Adam Finn, Nick A Maskell

Research output: Other contribution


Streptococcus pneumoniae epidemiology is changing in response to vaccination and some data suggest empyema incidence is increasing. However, differences exist between UK and USA studies. We describe trends in the clinical phenotype of adult pneumococcal pleural infection, including simple parapneumonic effusions (SPE) in the pneumococcal conjugate vaccination (PCV) era.
Retrospective cohort study, all adults ≥16 years admitted to three large UK hospitals, 2006-2018 with pneumococcal disease. Medical records were reviewed for each clinical episode. Serotype data were obtained from the UKHSA national reference laboratory.
2477 invasive pneumococcal cases were identified: 459 SPE and 100 pleural infection cases. Incidence increased over time, including non-PCV-serotype disease. PCV7-serotype disease declined following paediatric PCV7 introduction, but the effect of PCV13 was less apparent as disease caused by the additional six serotypes plateaued with serotypes 1 and 3 causing such parapneumonic effusions from 2011 onwards.
Mortality was lower in pleural infection patients than SPE patients. Patients with frank pus had lower mortality then those without. 90-day mortality could be predicted by baseline increased RAPID score.
Pneumococcal infection continues to cause severe disease despite the introduction of PCVs. The predominance of serotype 1 and 3 in this adult UK cohort is in keeping with previous studies in paediatric and non-UK studies. Rising non-PCV serotype disease and limited impact of PCV13 on cases caused by serotypes 1 and 3 offset the reductions in adult pneumococcal parapneumonic effusion disease burden observed following introduction of the childhood PCV7 programme.
Original languageEnglish
Publication statusPublished - 16 Mar 2022


  • pneumococcus
  • Streptococcus pneumoniae
  • respiratory infection
  • pleural disease
  • serotypes


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