Streptococcus pneumoniae pneumococus



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Streptococcus pneumoniae pneumococus

  • Pneumonia
  • Meningitis
  • bacteraemia

Description

  • Gram-positive diplococci (in pairs)
  • Encapsulated ovoid or lanceolate coccus
  • Non-motile
  • Fastidious (enriched media)
    • Blood or chocolate agar
    • 5-10 % CO2
  • Alpha haemolysis + draughtsman appearance
  • Some strains are mucoid
  • Soluble in bile
  • Optochin sensitive

Pathogenesis

  • Virulence factors
    • Capsular polysaccharide
      • The major factor
      • 84 serotypes
      • Both antigenic and type specific
      • Antiphagocytic
      • Serotype 3 , 7 are most virulent
      • 90% of cases of bacteraemic pneumococcal pneumonia and meningitis are caused by 23 serotypes
      • Quellung reaction , india ink
    • Pneumolysin

Carrier rate

  • Carrier rate
    • Oropharyngeal flora of 5 – 70% of the
    • population
    • Significance in respiratory infection
  • Predisposing factors
    • Aspiration of upper airway secretions ( endogenous )
    • No person-person spread
    • Disturbed consciousness , general anaesthesia , convulsions , CVA , epilepsy , head trauma
    • Prior LRT. VIRAL infection
    • Preexisting respiratory diseases , smoking
      • Chronic bronchitis , bronchogenic malignancy
    • Chronic heart disease
    • Chronic renal disease ( nephrotic syndrome )
    • Chronic liver disease ( cirrhosis)
    • Diabetes mellitus
    • Old age , (extreme of age )
    • Malnutrition , alcoholism

Specific deficiencies in host defence

  • Specific deficiencies in host defence
    • Hypogamaglobulinaemia
    • Asplenia , hypospenism ( tuftsin )
    • Homozygous sickle cell disease
    • Coeliac disease
    • Multiple myeloma , leukaemia , lymphomas
    • Neutropenia
    • HIV
    • Relative or absolute deficiency of opsonic antibody or inadequate manufacture of type specific antibody

Diseases

  • Respiratory tract infections
    • Lobar pneumonia ( commonest cause of CAP )
    • Empyema
    • Otitis media (6 months – 3 yrs )
    • Mastoiditis
    • Sinusitis
    • Acute exacerbation of chronic bronchitis
  • Meningitis
  • Conjunctivitis
  • Peritonitis ( primary )
  • Bacteraemia ( 15 % of pneumonia )
  • septicaemia

Clinical feature

  • Lobar pneumonia
    • Sudden onset
    • Fever
    • rigor
    • Cough , rusty sputum
    • Pleural pain
    • Signs of lobar consolidation
    • Polymorphonuclear leucocytosis
    • Empyema , pericarditis

Meningitis

  • Meningitis
    • The most virulent pathogen of meningitis
    • Mortality ( 20% )
    • Primary
    • Complicate infections at other site ( lung )
    • Bacteraemia usually coexists
    • Bimodal incidence ( < 3 yr - > 45 yr )

Mortality

  • Age (> 65 yr )
  • Preexisting disease
  • Bacteraemia
  • Serotype 3 , 7

Laboratory diagnosis

  • Specimen
    • Sputum
    • CSF
    • Swabs
    • Pus
    • Blood culture
    • Aspirate

Microscopy

  • Microscopy
    • Gram stained smear
      • Gram-positive diplococci + pus cells
  • culture
      • Blood agar , chocolate agar + 10 % CO2
  • identification
      • Alph-haemolytic colonies
      • Optochin sensitive
      • Bile soluble

Sensitivity testing

  • Sensitivity testing
    • Penicillin
    • susceptible
      • Sensitive
    • Nonsusceptible
      • Intermediate
      • Resistant
    • Ampicillin , amoxicillin
    • Erythromycin
    • Ceftriaxone , cefuroxime
    • Clindamycin
    • Fluroquinolones
    • tetracyclines
    • Vancomycin

Treatment

  • Meningitis
    • Parenteral ceftriaxone + vancomycin
  • pneumonia
    • Outpatients
      • Erythromycin
      • Amoxacillin – clavulanic acid
      • Cefuroxime or ceftriaxone (IV) + oral b- lactam
    • Inpatients
      • Parenteral cefuroxime or ceftriaxone

Prevention

  • 23 polysaccharide vaccine
  • 7-valent – protein- conjugated vaccine
    • Children < 3 yrs

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