Streptococcus pneumonia

(Pneumococcus)

 Causes infection in Children & elderly

Viral influenza, immunity and respiratory infection.

Most common cause of pneumonia (lobar) in adults Meningitis in adults Otitis media in children Other infections

Courtesy: CDC Gram stain Sputum sample with Pneumococcus

 Gram positive Diplococcus (lancet shaped in pairs or small chains) Hemolytic on blood agar non sporing and non motile catalase negative Optochin sensitive Qulung positive Bile soluble

 Peptidoglycan layer:
Teichoic acid and Lipoteichoic acid contain phosphoryl-choline

Choline:
Adhesion to choline binding receptors on all cells (alveolar cells) Activates & attaches to PAF receptors Increase capillary permeability serious accumulation and leukocyte aggregation Receptor mediated endocytosis C-reactive protein recognize choline immune response (macrophage & cytokines) Choline binding proteins Acts as autolysins destructs pneumococcus Pneumolysins & H2O2 destructs host cells, cilia action, inflammatory cytokines, PMN activity and compliment.

H2O2 neuron destruction Meningitis Pneumolysins binds to cholesterol and toxic all cells

 Capsule:
Polysacharide Phagocytosis by inhibiting C3b 90 serotypes vaccine

Pili:
Adhesion to carbohydrate receptors and stimulates immune response , more TNF

IgA protease Neuraminidase - adhesion

Epidemiology

Most common cause of Pneumonia and meningitis Susceptible

children and elders Viral infections, respiratory infections and immune suppressed pts

Transmits - Respiratory route

Attachment: neuraminidase, Choline and pili

Pneumococci Lobar Pneumonia Alveoli IL1,6, TNF and PMNs, inflammatory cytokines, macrophage activations Immune response Capsule phagocytosis PMNs accumulation, PAF activation Autolysins release, pneumolysin release leads more damage. Suppuration and serous fluid Dissemination leads Meningitis etc.

Attachment: choline receptors, pili

Eustachian tube Otitis Media

Pathogenesis

H2O2

Clinical conditions
Pneumonia Meningitis Otitis media Sinusitis Bacterimia

Diagnosis
Quellung reaction Optochin test Soluble in bile
Quellung Reaction

Treatment
Drug of Choice: Penicillin

Alternates: Cephalosporin's, erythromycin, chloramphenicol

Multiple Antibiotic Resistance

Prevention

Vaccination polysaccharide capsule