STREPTOCOCCUS

PNEUMONIA
By Group 2
ABEDEJOS, MICAELLA
ALQUINO, HEART
CORTEZ, HERSON
JULAINE, TRISA JEN
PINEDA, HELAEANA MAY
Streptococcus pneumoniae
DOMAIN
Bacteria
FAMILY
Streptococcaceae

PHYLUM
Bacillota

Streptococcus pneumoniae, also known as

pneumococcus, is an opportunistic pathogen that
colonises the mucosal surface of the upper respiratory
tract. It has historically been the most common
pathogen to cause CAP worldwide. In the era before
antibiotics, S. pneumoniae was estimated to be the
cause of 95% of all cases of pneumonia.
Streptococcus pneumoniae
Streptococcus pneumoniae is also a common cause of
other infections such as bacterial meningitis, bacteremia,
and otitis media.

The pneumococci are highly adapted commensals, and

their main reservoir on the mucosal surface of the upper
airways of carriers enables transmission.
CHARACTERISTICS
GRAM-POSITIVE COCCI
NONMOTILE
NON-SPORE-FORMING
CATALASE: NEGATIVE
OXIDASE: NEGATIVE
FACULTATIVELY ANAEROBIC
Identification
The optochin test (sensitive to optochin)
The bile solubility test (positive)
Capsular swelling reaction
History
S. pneumonia was first isolated from the saliva of a patient with rabies in 1881 by Louis Pasteur and the
association between lobar pneumonia, and Friedlander and Talamon first reported the bacteria in 1883.

1977 - First pneumococcal vaccine made from polysaccharides from seven serotypes of S pneumoniae.

1983 - A new vaccine came out with 23 serotypes (PPSV23) and largely replaced the first.

2000 - First conjugate vaccine was released. (PCV7).

Colonization
Infection by Streptococcus pneumoniae begins with colonization in the oropharynx and nasopharynx of
healthy individuals. The bacterium is often carried asymptomatically in these upper respiratory tract sites.
Transmission occurs through respiratory droplets when infected individuals cough or sneeze.

Predisposing Factors
Infection typically does not lead to illness unless specific risk factors are present. These factors can
include a weakened immune system due to age, underlying medical conditions, or immunosuppressive
medications. Additionally, exposure to a high number of infectious bacterial cells or particularly virulent
strains of S. pneumoniae can increase the likelihood of infection.
Capsule and Immune Evasion
The capsule of S. pneumoniae is a crucial virulence factor. Composed of polysaccharides, it forms a
protective barrier around the bacterial cell wall. This capsule helps the bacterium evade the host's
immune system by preventing immune cells, such as granulocytes, from effectively phagocytizing
(engulfing and destroying) the bacterium. Furthermore, the diversity of capsule polysaccharides plays a
role in identifying and serotyping different strains of S. pneumoniae. Common serotypes, such as 6, 14,
18, 19, and 23, are known to cause infections.

Adherence and Invasion

S. pneumoniae has the ability to adhere to the respiratory epithelium, which lines the airways, and invade
host tissues. This adherence and invasion are facilitated by various surface proteins and virulence factors
produced by the bacterium. These factors aid in the initial attachment to host cells and the subsequent
penetration of epithelial barriers.
Disease Manifestations
Upper Respiratory Tract Infections:

Sinusitis: Inflammation and infection of the sinuses, leading to symptoms like facial pain, nasal
congestion, and headache.

Otitis Media: Middle ear infection characterized by ear pain, hearing loss, and possible fever, often
seen in children.

Lower Respiratory Tract Infections:

Pneumonia: An infection of the lungs that can range from mild to severe. Symptoms typically include
fever, cough with sputum production, chest pain, and difficulty breathing. Severe cases can lead to
respiratory failure.

Bronchitis: Inflammation of the bronchial tubes, causing coughing, mucus production, and chest
discomfort.
Disease Manifestations
Invasive Diseases:

Bacteremia: Presence of S. pneumoniae in the bloodstream, which can lead to

sepsis (systemic inflammatory response to infection) and result in symptoms like
high fever, rapid breathing, low blood pressure, confusion, and organ dysfunction.

Meningitis: Infection of the protective membranes covering the brain and spinal
cord, resulting in symptoms like severe headache, neck stiffness, fever, altered
mental status, and potentially life-threatening neurological complications.

Pleural Effusion: Accumulation of fluid in the space between the lung and chest
wall, often seen in pneumonia cases, causing chest pain and breathing difficulties.
Disease Manifestations
Other Invasive Infections
(UNCOMMON):

Septic Arthritis
Endocarditis
Osteomyelitis
Non-Respiratory Infections
Cellulitis
Peritonitis
Preferred Method
Quantitative cultivation of samples directly from affected lesions.

- Obtained through procedures like bronchoalveolar lavage (BAL)

- Safe specimen brushing with bronchoscopy is another reliable method.

For Intubated or Uncooperative Patients

Alternative: Endotracheal aspirates (ETA) have been reported as an alternative to BAL samples.
Useful when the patient is intubated or unable to provide an appropriate sputum sample.
Identification of Streptococcus Strains from
Respiratory Samples:
METHODS USED:
Gram Stain: Used for preliminary identification.
Conventional Culture: Standard method for further analysis.

GRAM STAIN ADVANTAGES

Speed: Provides quick results.
Cost-Effective: Relatively inexpensive.

LIMITATION OF GRAM STAINS

Safety Concerns: Not considered safe enough for making decisions regarding antimicrobial
treatment initiation.

GRAM STAIN: Blood, Tissue, Stool, Urine, Sputum

GRAM STAINS

In order to perform a gram stain, your doctor will need to collect a sample of body fluid or tissue for
analysis. Their collection methods will vary depending on the type of sample they need. For example, to
collect a sample of sputum, they may ask you to cough some into a specimen container. To collect a
sample of urine, they may ask you urinate into a sample cup. To collect a sample of blood, they may
perform a blood draw.

After they have collected the sample, they will send it to a laboratory for testing. A technician will use a
special staining technique to make it easier to see bacteria under a microscope.
PREVALENCE

S. pneumoniae is prevalent in large part due to its colonizing ability in the nasopharynx. Almost 40%-50%
healthy children and 20%-30% of healthy adults are carriers. With childhood conjugate vaccination for
Streptococcus pneumoniae, the colonization frequency has decreased.

Although S. pneumoniae can occur in all populations, however those older than 65, younger than 2,
those who smoke, misuse alcohol, have asthma or COPD, or those who are asplenic are more likely to
contract it. The overall percentage of S. pneumonia In the United States, there are 5.16 to 6.11 instances
of pneumoniae infection per 100,000 adults, 36.4 cases per 100,000 people over the age of 65, and 34.2
cases per 100,000 children under the age of one. According to the World Health Organization,
streptococcus pneumoniae was responsible for 1.6 million deaths in 2005, including 1 million deaths in
children under the age of 5. It is a frequent co-infection in people with influenza and has an impact on
their morbidity and death.
TREATMENT COURSE
In many cases, patients with conditions like conjunctivitis, otitis
media, sinusitis, bronchitis, and tracheobronchitis caused by S.
pneumoniae infection can be treated as outpatients with
appropriate antibiotics.

Supportive measures for staphylococcal pneumonia include

bronchodilation to help those with underlying lung diseases such as
asthma or chronic obstructive pulmonary disease (COPD)
TREATMENT COURSE
BRONCHODILATION
Beneficial for individuals with asthma or COPD.
Aids in opening airways for improved breathing.
Administered through inhalers or nebulizers.
TREATMENT COURSE
SUPPLEMENTAL OXYGENATION
Addresses reduced oxygen levels due to pneumonia.
Initiated with a nasal cannula.
Oxygen delivery adjusted based on oxygen saturation.
chronic obstructive pulmonary disease (COPD)
MECHANICAL VENTILATION
Required in severe cases or significant respiratory
distress.
Involves ventilator support for controlled breathing.
MONITORING
Continuous tracking of vital signs and oxygen levels.
Assessing the patient's clinical status.

ANTIBIOTIC THERAPY - necessary to treat the RESPIRATORY THERAPY

infection. Aids in optimizing lung function.
Involves techniques like chest physiotherapy and
PAIN MANAGEMENT - Alleviates chest pain and breathing exercises.
discomfort associated with pneumonia.

FLUIDS AND NUTRITION

Ensures proper hydration and nutrition.
Intravenous fluids or feeding tubes if needed.
Sinusitis
First-line therapy: Amoxicillin, treatment must be given for 5 days.

Otitis Media
First-line therapy: Amoxicillin
Second-line:
High-dose oral amoxicillin-clavulanate (80-90 mg/kg/day of amoxicillin component, 6.4 mg/kg/day of
clavulanate component.
Oral cefuroxime axetil (suspension, 30 mg/kg/day in divided doses; tablet, 250 mg twice daily.
Intramuscular (IM) ceftriaxone (administered as a single IM injection of 50 mg/kg on 3 consecutive days)

Pneumonia
Treatment: Penicillin G procaine (600,000-1,000,000 units IM qDay)
References
Cheng, H., Yao, C., Wang, Z., Hu, S., Wen, W., & Ma, Y. (2021). A Comprehensive Review of Staphylococcal Pneumonia: Pathogenesis, Clinical
Presentation, Diagnosis, and Treatment. Infection and Drug Resistance, 14, 2631-2643. https://doi.org/10.2147/IDR.S317889

De Pietro Crt, M. (2017, July 9). Gram Stain. Healthline. https://www.healthline.com/health/gram-stain#risks

Dion, C.F., Ashurst, J.V. Streptococcus pneumoniae. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470537/

Gamil, A., Lalas, M. Y., Z. Capeding, M. R., T. Ong-Lim, A. L., C. Bunyi, M. A., & Claveria, A. M. (2021). A Narrative Review of
Pneumococcal Disease in Children in the Philippines. Infectious Diseases and Therapy, 10(2), 699-718. https://doi.org/10.1007/s40121-
021-00434-6

Donkor, E. S. (2013). Understanding the pneumococcus: transmission and evolution. Frontiers in cellular and infection microbiology,
3, 7. https://doi.org/10.3389/fcimb.2013.00007

Streptococcus pneumoniae colony morphology and microscopic appearance, basic characteristic and tests for identification of
Streptococcus pneumoniae bacteria. Images of S.pneumoniae. Antibiotic treatment of pneumoococcal infections. (n.d.).
https://www.microbiologyinpictures.com/streptococcus-pneumoniae.php

Weiser, J. N., Ferreira, D. M., & Paton, J. C. (2018). Streptococcus pneumoniae: transmission, colonization and invasion. Nature reviews.
Microbiology, 16(6), 355–367. https://doi.org/10.1038/s41579-018-0001-8