1. Streptococcus pneumoniae Lecture 9 Summer, 2004 Demosthenes Pappagianis, MD MMI 480B

2. The world’s deadliest infections* AIDS, acquired immunodeficiency synodrome. *Worldwide mortality data, for 1990(complied by the World Health Organization and the Harvard School of Public Health

3. Representative Organisms

4. Lower Respiratory Tract Infections

5. EM Diplococci - Strep

6. Lancet

7. Portion of cell wall peptidoglycan Amidase action

8. Streptococcus pneumoniae ( pneumococcus) type 3 pneumococcus

9. Type 3 and Type 8 antigens pneumococcus cross reaction

10. Predominant type in descending order of frequency Present in “23-valent” vaccine 85% * most often in pneumonia: 23, 26 (6B), 9(9F) in meningitis Serotypes (Capsular) of Streptococcus pneumoniae

13. Pneumonias Community Acquired Nosocomial % of patients 65Streptococcus pneumoniae CoKlebsiella pneumoniae 12Haemophilus influenzaEscherichia coli Co 2Staphylococcus aureus CO60Serratia marcescens Co 1Gram negative aerobic bacilli CoEnterobacter spp Co 4Miscellaneous agents * CoPseudomonas sp Co 4Legionella spp Co13Staphylococcus aureus 7Mycoplasma pneumoniae 8Streptococcus pneumoniae Co 1Chlamydia pneumoniae 3Viruses *Moraxella catarrhalis Mycobacterium tuberculosis Endemic fungi Co = Comorbid condition

14. Influenza Normal respiratory ciliated pseudostratified epithelium Epithelium damaged by influenza virus

15. Pneumococci Type I Alveolar Edema

16. Pneumonia/Congestion

17. Lobar Pneumonia

18. Bronchopneumonia in 4 1/2 y/o female

20. Alveolar exudate

21. Untreated Lobar Pneumonia

22. Acute Bacterial Meningitis * Has become infrequent in USA ** Especially in hospitalized patients *** Especially with underlying disease, e.g. renal failure

23. 76 y/o man - died of acute pneumococcal meningitis Arrows point to depressed scar Exudate

24. Percentage of persons aged >/= 65 years who reported receiving influenza or pneumococcal vaccine, by year Behavioral Risk Factor Surveillance System, United States, 1993-1999

26. Strep. pneumoniae Sites of resistance to antimicrobials

28. Prevalence of bacterial causes of common infections Bacteria Pneumoniae Otitis mediaSinusitis Meningitis Streptococcus pneumoniae8.4% 40%30% 35% Legionella species6% ---- -- Hemophilus influenzae5.3% 25%20% 10% Mycoplasma pneumoniae3.6% ---- -- Moraxella (Branhamella)-- 10%20% -- Catarrhalis Neisseria meningitidis-- ---- 35% Mycobacterium tuberculosis1.5% ---- -- Unknown43% 25%30% -- *Percentages do not add up to 100% in some cases because not all species are included. Infection *

29. Bacterial Meningitis in the United States in 1995 Causes of 248 Cases of Bacterial Meningitis in 1995 and Overall Case Fatality Rate According to Organism *Because of rounding, the percentages do not total 100. +The incidence is the number of cases per 100,000 population. ++Outcome data were missing for 11 cases of meningitis (4 percent). The case fatality rates are based on cases with known outcomes.

30. Resistance of Strep. Pneumoniae to fluoroquinolones

31. Aural Trauma Strep. pneumo. meningitis

33. Early Consolidation - alveoli with Strep. pneumoniae

34. Inner Zone of Advanced Consolidation (pneumococi phagocytosed)

35. Type Distribution of Pneumoccoccal Pneumonias in Adults and Children (Collected from various sources) Incidence (Per cent)

36. Streptococcus pneumoniae

37. Streptococcus pneumoniae type 1 in alveoli clumped by antibody

38. Leukocyte containing opsonized pneumococci

39. Lung, organizing pneumonia

40. Lobar Pneumonia

41. Optochin disk, Strep. pneumoniae P = oPtochin disc