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) • α Hemolytic on blood agar • non sporing and non motile • catalase negative • Optochin sensitive • Qulung positive

• Peptidoglycan layer:
• Teichoic acid and Lipoteichoic acid contain phosphoryl-choline • Choline:
• Adhesion to choline binding receptors on all cells • Activates & attaches to PAF receptors → Increase capillary permeability → serious accumulation and leukocyte aggregation • Receptor mediated endocytosis • C-reactive protein recognize choline → immune response (macropahge & cytokines) • Acts as autolysins → destructs pneumococcus → Pneumolysins & H2O2→ destructs host cells, ↓ cilia action, ↑ inflammatory cytokines, ↓ PMN activity and ↓compliment.

• Capsule:
• Polysacharide • Phagocytosis by inhibiting C3b • 90 serotypes – vaccine

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

• IgA protease

Epidemiology

• Most common cause of Pneumonia and meningitis • Susceptible –
• children and elders • Viral infections, respiratory infections and immune suppressed pts

• Transmits - Respiratory route

Attachment: Choline and pili

Pneumococci Lobar Pneumonia Attachment: choline receptors, pili • IL1,6, TNF and PMNs, inflammatory cytokines, macrophage activations Immune response • Capsule↓ phagocytosis PMNs accumulation, PAF activation Autolysins release, pneumolysin release leads more damage. H2O2 Suppuration and serous fluid • Dissemination leads Meningitis etc.

Alveoli

Eustachian tube – Otitis Media

Pathogenesis

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

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