A.

Morphology
• Gram positive
• non-motile and non-sporing
• Diplococci-capsule encloses each pair
• In old cultures, the capsule is usually lost
• aerobes and facultative anaerobes

form large mucoid colonies (abundant capsular

polysaccharides)
destroyed at 52°C for 15 minutes
 grow only in enriched media

Growth is improved by (5- 10 per cent CO2). optimum temperature- 37°C and
pH 7.8

B. Culture Specimen is inoculated on blood agar and incubated at 37°C for 24 hours .

Typical colonies develop with ALPHA haemolysis. But anerobic conditions

colonies show BETA haemolysis

On prolonged incubation, the colonies become flat, with raised edges and central
umbonation (due to autolysis occuring at centre) which creates a draughtsman
appearance (concentric rings are seen when viewed from above)
Under anerobic conditions
colonies show beta haemolysis
due to liberation of oxygen labile
pneumolysin O by these bacteria.

glucose broth-produce uniform

turbidity. .
 Hiss's serum water. Fermentation of
inulin

Bile solubility test -lysis of the cocci

by sodium deoxycholate
BIOCHEMICAL
REACTIONS

sensitive to optochin

catalase and oxidase negative

Antigenic Structure

a group specific
Capsular
M protein cell wall
polysaccharide
carbohydrate.
1.) Capsular polysaccharide- called the soluble specific substance (SSS).
Pneumococci are classified into 90 types based on the nature of the capsular
polysaccharide. are recognised as 1, 2, 3, and so on.
Serological typing of pneumococcus is carried out by three methods
(i) Agglutination of organisms with type specific antiserum.
(ii) Precipitation of capsular polysaccharide with type specific antiserum.
(iii) Quellung reaction or capsule swelling reaction
• described by Neufeld
• a suspension of pneumococci is mixed on a slide with a drop of specific antiserum
and a loopful of methylene blue solution.
• the capsule around pneumococcus swells up , sharply delineated and refractile
under the microscope.
• The Quellung test can be done either in sputum or in culture, and used to be a
routine bedside procedure in older days .
 2.)M protein
• characteristic for each type of pneumococcus.
• not associated with virulence
 Precipitated by abnormal protein (globulin), that
appears in the acute phase sera of cases of
pneumonia but disappears during later stages .

This is known as the C-reactive protein (CRP)

3. Cell Wall (acute phase) ,produced by hepatocytes, detected
by latex agglutination test.
Carbohydrate
Its production is stimulated by bacterial
(C-Substance) infections, malignancies and tissue destruction.

CRP is used as an index of activity in rheumatic

fever and certain other conditions.
virulent in capsulated (smooth) form
but non-capsulated (rough) forms are
avirulent.

On repeated subculture, a smooth to

rough (S-R) variation occurs.
 an oxygen labile intracellular
haemolysin
Toxins and
Other Leucocidin
Virulence
Factors Pneumolysin, (complement
activating and immunogenic.)
 -by inhalation of contaminated
dust, droplets , Infection usually
leads to pharyngeal carriage.
Disease results only when the
host resistance is lowered by
respiratory viral infections,
Epidemiology malnutrition etc.
Pathogenesis
• one of the most common bacteria causing pneumonia, both lobar
and bronchopneumonia. It is also responsible for acute
tracheobronchitis and empyema.
1. Lobar Pneumonia= results only when the general resistance is
lowered. Common infective types of Str. pneumoniae include types 1-
12 in adults and type 6 responsible in children.
2. Bronchopneumonia- It is almost always a secondary infection
following viral infection of the respiratory tract. Caused by Any
serotype of pneumococcus . .
• 3. Meningitis- most serious .
This disease is common in children.Pneumococcus spreads from the
pharynx to the meninges via blood stream.
• 4. Other Infections- may produce empyema, pericarditis, otitis
media, sinusitis, conjunctivitis, peritonitis and suppurative arthritis,
usually as complications of pneumonia.
 1. Specimens Clinical samples- such as
sputum, cerebrospinal fluid (CSF), pleural
exudate or blood .

Laboratory
Diagnosis 2. Collection and Transport - sterile
containers under all aseptic conditions. In
case of delay, CSF specimen should never be
refrigerated but kept at 37°C (H. influenzae,
another causative agent of pyogenic
meningitis may die at cold temperature).
4. Direct Microscopy and Antigen Detection
Gram staining -
Gram positive diplococci, small (1 µm diameter)

Capsule swelling . Capsular polysaccharide antigen can be demonstrated by

counterimmunoelectrophoresis.

Antigen may also be detected latex agglutination or coagglutination.

The capsule may be demonstrated as a clear halo in India ink preparation

5. CULTURE

On prolonged
usually small (0.5- 1 incubation, colonies
alpha haemolysis
mm) have draughtsman
appearance.
7.Biochemical Reactions Important biochemical tests are
inulin fermentation and bile solubility tests. Another test
which has a great value is optochin sensitivity test.

8. Antibiotic Sensitivity Test It is especially useful in

strains which are resistant.
Treatment

• The antibiotic of choice is parenteral penicillin.

• Cephalosporin is indicated in case of penicillin resistant strains.
 Three pneumococcal vaccines are available.

• The heptavalent pneumococcal conjugate

vaccine (7 serotypes) for use in children from
two months to two years.
Prophylaxis • a new 13-valent vaccine that contain six
additional serotypes was approved for young
children.
• A polysaccharide vaccine containing prevalent
serotypes (23 serotypes) is administered by a
single dose injection.(immunodeficiencies)