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MICROBIOLOGY LECTURE 6 – Streptococcus pneumoniae 1.

Alcohol or drug intoxication or other cerebral


Notes from Lecture impairment that can depress the cough reflex and
USTMED ’07 Sec C - AsM increase aspiration of secretions
2. Abnormality of the respiratory tract (eg. Viral
STREPTOCOCCUS PNEUMONIAE infections), pooling of mucus, bronchial obstruction
and respiratory tract injury and movement of the
1. Gram positive lancet shaped cocci arranged in pairs mucociliary blanket)
(diplococcis) or in short chains 3. Abdominal circulatory dynamics (eg. Pulmonary
2. Possesses a capsule of polysaccharide that permits congestion and heart failure)
typing with specific antisera 4. Splenectomy
3. Produces alpha hemolysis in blood agar 5. Certain chronic diseases such as sickle cell anemia
4. Lysed by surface active agents such as bile or and nephrosis
deoxycholate
CLINICAL FINDINGS
5. Growth is inhibited by optochin
6. Normal inhabitants of the upper respiratory tract of
1. Pneumococcal pneumonia
humans
a. infections are caused by aspiration of the
7. Most common cause of pneumonia and otitis media
endogenous oral organisms
8. An important cause of meningitis and
b. most commonly associated with an
bacteremia/sepsis
antecedent viral respiratory disease such as
ANTIGENIC STRUCTURE
influenza and measles
c. abrupt onset of fever, chills, chest pain and
1. Polysaccharide capsule or specific soluble substance productive cough with blood tinged
a. virulence factors – interferes with sputum or rusty sputum followed by a crisis
phagocytosis and favor invasiveness on days 7 to 10
b. specific antibody to capsule d. pleural effusion in seen in 25% of patients;
i. Opsonizes the organism empyema is a rare complication
ii. Facilitates phagocytosis
iii. Promotes resistance 2. Sinusitis and otitis media

c. Quellung reaction- swelling of capsule


o preceded by a viral infection of the upper
when type specific antiserum is added to respiratory tract, leading to infiltration
the organism with polymorphonuclear leukocytes and
d. elicits a B cell response obstruction of the sinuses and middle ear
2. C-substance 3. Meningitis
a. a carbohydrate in the cell wall o Spread of S. pneumoniae into the central
nervous system can follow bacteremia,
b. reacts with a normal serum protein made infections of the ear and sinuses, or head
by the liver – C-reactive protein(CRP) trauma with communication between the
subarachnoid space and nasopharynx.
CRP – is a nonspecific indicator of inflammation and
elevated in response to the presence of many organisms
4. Bacteremia
PATHOGENESIS o occurs inb 25% to 30% of patients with
pneumococcal pneumonia and more than
1. The most important virulence factor is the capsular 80% of patients with meningitis
polysaccharide, and anticapsular antibody is
protective. Laboratory Diagnosis
1. Microscopy
2. Lipoteichoic acid, which activates complement and
induces inflammatory cytokine production, - Gram stain of respiratory secretions. Gram positive
contributes to the inflammatory response and to the lancet shaped diplococci suggestive of Streptococcus
septic shock syndrome that occurs in some pneumoniae
immunocompromised patients.
3. Pneumolysin, the hemolysin that causes alpha
hemolysis, may also contribute to the pathogenesis.
4. Pneumococci produce IgA protease that enhances
the organism’s ability to colonize the mucosa of the
upper respiratory tract.
5. Pneumococci multiply in tissues and cause
inflammation.
6. When they reach the alveoli, there is outpouring of
fluid and red and white blood cells, results in
consolidation of the lung. 2. Culture
7. During recovery, pneumococci are phagocytized, - Colonies of Streptococcus pneumoniae on 5% sheep
mononuclear cells ingest debris, and consolidation blood agar. Young colonies are round with complete
resolves. edges, somewhat mucoid, and about 1 mm in
diameter urrounded by a zone of alpha hemolysis
Streptococcus pneumoniae virulence factors
Colonies of Streptococcus pneumoniae in 5% sheep blood
agar

Slightly older colonies show


the central indentation
caused by the Easily induced
autolysis.

Occasionally, colonies
may simply flatten out a
as they age.
Factors that lower resistance and predispose to
pneumococcal infection
Colonies of Streptococcus pneumoniae on chocolate agar
TREATMENT
Medium was incubated in
CO2, resultinn in fairly large 1. Most pneumococci are susceptible to penicillins and
zones of alpha hemolysis erythromycin.
2. Severe pneumococcal infections – penicillin G
3. Mild pneumococcal infections –oral penicillin V
4. Penicillin allergic patients- erythromycin or its
derivatives, azithromycin
5. Penicillin resistant strains – vancomycin
Colonies are quite flat on
Chocolate agar PREVENTION

1. Polyvalent (23 type) polysaccharide vaccine


a. provides long lasting protection(at least 5
years)
b. should be given to
 Elderly persons(over 65 years)
Optochin Susceptibility Test  Immunocompromised
(splectomized)
Zone of greater than or equal
 Debilitated persons
to 14 mm in diameter is
c. booster should be given to:
resumptive identification of
i. Over 65 years who received the
Streptococcus pneumoniae. If
vaccine more than 5 years ago
less that 14 mm in diameter,
ii. People between the ages 2 and
confirm with bile solubility
64 who are asplenic, HIV
test.
infected, receiving cancer
chemotherapy or receiving
A paper disk containing
immunosuppressive drugs to
optochin (ethylhydrocupreine
prevent transplant rejection
Hydrochloride) is applied to
the surface of an inoculated
5% sheep blood agar. 2. Pneumococcal vaccine containing pneumococcal
polysaccharide coupled to a carrier
protein(diphtheria toxoid) as the immunogen
Bile solubility test a. contains the 7 most common pneumococcal
serptypes
A drop of 2% sodium
deoxycholate is applied b. effective in young children in preventing
directly to both bacteremic infections, such as
The colonies. meningitis, and mucosal infections like
otitis media
Left – colonies remain intact
Right – lysis of the colonies 3. Oral penicillin is given to young children with
hypogammaglobulinemia or splenectomy because
they are prone to pneumococcal infection and
respond poorly to vaccine.
After the bile has
evaporated, Only the zone of
hemolysis remains
- fin -

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Capsule swelling tests