Can pneumococcal pneumonia recur in my 63-year-old mother?

Question

Hello doctor,

My 63-year-old mom just got discharged from the hospital after being treated for pneumococcal disease pneumonia, and I am really scared it is going to come back. She was in the ICU for six days on oxygen and almost died. The doctors said the bacteria got into her bloodstream, too. She has lupus and has been on Prednisone 15 mg daily for the past 10 years, plus Hydroxychloroquine, which I think made her immune system weak.

Her chest x-ray still shows some clouding in the lower right lung, and she is still coughing up thick yellow mucus even after finishing Levofloxacin. The infectious disease doctor said she should have gotten the pneumococcal vaccine years ago, but nobody ever told us about it. Now I am wondering:

Should my sister and I get vaccinated too, since we take care of her?
Can she get vaccinated now after just having the infection?

She also has osteoporosis from the steroids and cannot walk much because she is so weak from the pneumococcal disease. Her oxygen saturation drops to 88% when she tries to climb stairs. I am also worried because she needs to start Methotrexate for her lupus, but the doctors are waiting until she is stronger.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am really sorry your family has been through such a frightening experience, and, understandably, you are still scared after how close your mother came to losing her life. Severe pneumococcal pneumonia with bacteria in the bloodstream is a major illness, especially in someone with lupus who has been on long-term Prednisone, so the weakness, lingering cough, mucus, and shortness of breath you are seeing now are sadly very common during recovery.

Healing can take weeks to months, and chest x-ray changes often lag how the patient feels, so some residual clouding does not automatically mean the infection is coming back. Thick sputum and fatigue can persist as the lungs slowly clear inflammation, but worsening fever, increasing breathlessness at rest, confusion, or dropping oxygen levels even at rest would be reasons to seek urgent care again.

Her immune system has indeed been weakened by lupus and chronic steroids, which is why pneumococcal vaccination is so important in people like her. The good news is that she can still be vaccinated even after having pneumococcal disease. In fact, vaccination is strongly recommended once she is clinically stable and recovering, because natural infection does not reliably protect against future infections.

Her doctors will usually wait until she is out of the acute phase and stronger, then give the appropriate pneumococcal vaccines in sequence. Starting Methotrexate is often delayed until infection risk is lower and strength improves, which sounds like a careful and appropriate plan.

As for you and your sister, routine pneumococcal vaccination is not usually required for healthy younger caregivers, but it is reasonable to discuss this with your doctors, especially if either of you has chronic medical conditions. More importantly, staying up to date on influenza and other routine vaccines, practicing good hand hygiene, and avoiding contact when sick all help protect her.

The oxygen drop with activity and her weakness are signs that her body is still recovering from a very serious illness, not that she has failed treatment. Pulmonary rehabilitation, gentle physical therapy, good nutrition, and time are often needed to rebuild strength, especially with underlying osteoporosis and long-term steroid use.

What she survived was life-threatening, and recovery is rarely quick or linear, but many people do gradually regain function. You are doing the right thing by being vigilant and supportive, and with close follow-up from her medical team, vaccination once she is stable, and careful monitoring, there is real hope for continued recovery rather than recurrence.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.