MICROBIOLOGY LECTURE 6 – Streptococcus pneumoniae
Alcohol or drug intoxication or other cerebral
Notes from Lecture
USTMED ’07 Sec C - AsM
STREPTOCOCCUS PNEUMONIAE
1. Gram positive lancet shaped cocci arranged in pairs
(diplococcis) or in short chains
2. Possesses a capsule of polysaccharide that permits
typing with specific antisera
3. Produces alpha hemolysis in blood agar
4. Lysed by surface active agents such as bile or
deoxycholate
5. Growth is inhibited by optochin
6. Normal inhabitants of the upper respiratory tract of
humans
7. Most common cause of pneumonia and otitis media
8. An important cause of meningitis and
bacteremia/sepsis
ANTIGENIC STRUCTURE
1. Polysaccharide capsule or specific soluble substance
a. virulence factors – interferes with
phagocytosis and favor invasiveness
b. specific antibody to capsule
i. Opsonizes the organism
ii. Facilitates phagocytosis
iii. Promotes resistance
c. Quellung reaction- swelling of capsule
when type specific antiserum is added to
the organism
d. elicits a B cell response
2. C-substance
a. a carbohydrate in the cell wall
b. reacts with a normal serum protein made
by the liver – C-reactive protein(CRP)
CRP – is a nonspecific indicator of inflammation and
elevated in response to the presence of many organisms
PATHOGENESIS
1. The most important virulence factor is the capsular
polysaccharide, and anticapsular antibody is
protective.
2. Lipoteichoic acid, which activates complement and
induces inflammatory cytokine production,
contributes to the inflammatory response and to the
septic shock syndrome that occurs in some
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.
7. During recovery, pneumococci are phagocytized,
mononuclear cells ingest debris, and consolidation
resolves.
Streptococcus pneumoniae virulence factors
Factors that lower resistance and predispose to
pneumococcal infection
1.
impairment that can depress the cough reflex and
increase aspiration of secretions
2. Abnormality of the respiratory tract (eg. Viral
infections), pooling of mucus, bronchial obstruction
and respiratory tract injury and movement of the
mucociliary blanket)
3. Abdominal circulatory dynamics (eg. Pulmonary
congestion and heart failure)
4. Splenectomy
5. Certain chronic diseases such as sickle cell anemia
and nephrosis
CLINICAL FINDINGS
1. Pneumococcal pneumonia
a. infections are caused by aspiration of the
endogenous oral organisms
b. most commonly associated with an
antecedent viral respiratory disease such as
influenza and measles
c. abrupt onset of fever, chills, chest pain and
productive cough with blood tinged
sputum or rusty sputum followed by a crisis
on days 7 to 10
d. pleural effusion in seen in 25% of patients;
empyema is a rare complication
2. Sinusitis and otitis media
o preceded by a viral infection of the upper
respiratory tract, leading to infiltration
with polymorphonuclear leukocytes and
obstruction of the sinuses and middle ear
3. Meningitis
o Spread of S. pneumoniae into the central
nervous system can follow bacteremia,
infections of the ear and sinuses, or head
trauma with communication between the
subarachnoid space and nasopharynx.
4. Bacteremia
o occurs inb 25% to 30% of patients with
pneumococcal pneumonia and more than
80% of patients with meningitis
Laboratory Diagnosis
1. Microscopy
- Gram stain of respiratory secretions. Gram positive
lancet shaped diplococci suggestive of Streptococcus
pneumoniae
2. Culture
- Colonies of Streptococcus pneumoniae on 5% sheep
blood agar. Young colonies are round with complete
edges, somewhat mucoid, and about 1 mm in
diameter urrounded by a zone of alpha hemolysis
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.
 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