Streptococcus pneumoniae Lecture 9 Summer, 2004 Demosthenes Pappagianis, MD MMI 480B.
-
Upload
candice-sanders -
Category
Documents
-
view
216 -
download
1
Transcript of Streptococcus pneumoniae Lecture 9 Summer, 2004 Demosthenes Pappagianis, MD MMI 480B.
Streptococcus pneumoniaeLecture 9
Summer, 2004
Demosthenes Pappagianis, MDMMI 480B
Type of Infection Annual Deaths
Acute respiratory infections (primarily pneumonia)
4,300,000
Diarrheal diseases 3,200,000 Tuberculosis 3,000,000 Hepatitis B 1,000,000 – 2,000,000 Malaria 1,000,000 Measles 880,000 Neonatal tetanus 600,000 AIDS 550,000 Pertussis 360,000
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
Representative Organisms
Lower Respiratory Tract Infections
EMDiplococci - Strep
Lancet
Portion of cell wall peptidoglycan
Amidase action
Streptococcus pneumoniae (pneumococcus) type 3 pneumococcus
Type 3 and Type 8 antigens pneumococcus cross reaction
Predominant type in descending order of frequency
Present in “23-valent” vaccine
In Children
26*(6B Danish)
19* (19F Dan)
23* (23F Dan)
1
4
9* (9F Dan)
43 (11A Dan)
14*
15 (15F Dan)
85%
In Adults
8431451 (7F Dan)12 (12F Dan)9 (9N Dan)156 (18C Dan)19 (19F Dan)26 (6B Dan)23 (23F Dan)
85%
* most often in pneumonia:
23, 26 (6B), 9(9F) in meningitis
1 202 223 23 (23F Dan)4 34 (10A Dan)5 43 (11A Dan)26 (6B Dan) 51 (7F Dan)8 54 (15B Dan)9 (9N Dan) 56 (18C Dan)12 57 (19A Dan)14 68 (9V Dan)17 70 (33F Dan)19 (19F Dan)
Serotypes (Capsular) of Streptococcus pneumoniae
Pneumonias Community Acquired Nosocomial% of patients % of patients65 Streptococcus pneumoniae Co Klebsiella pneumoniae12 Haemophilus influenza Escherichia coli Co 2 Staphylococcus aureus CO 60 Serratia marcescens Co 1 Gram negative aerobic bacilli Co Enterobacter spp Co 4 Miscellaneous agents * Co Pseudomonas sp Co 4 Legionella spp Co 13 Staphylococcus aureus 7 Mycoplasma pneumoniae 8 Streptococcus pneumoniae Co 1 Chlamydia pneumoniae 3 Viruses
*Moraxella catarrhalisMycobacterium tuberculosisEndemic fungiCo = Comorbid condition
Influenza
Normal respiratoryciliated pseudostratified epithelium
Epithelium damaged by influenza virus
Pneumococci Type I Alveolar Edema
Pneumonia/Congestion
Lobar Pneumonia
Bronchopneumonia in 4 1/2 y/o female
Bronchopneumonia in 4 1/2 y/o female
Alveolar exudate
Untreated Lobar Pneumonia
Premature and neonate: Grp B Strep. agalactiae, E. coli K1, other enteric bacilli, Listeria monocytogenes, Enterococcus sp..
2 weeks – 3 months: E. coli K1. Strep. agalactiae, L. monocytogenes, Strep. pneumoniae.
3 months – 4 years: S. pneumoniae, N. meningitidis, H. influenzae*, other Strep.. G(-) bacilli.
5 years – 50 years: N. meningitidis, Strep. pneumoniae, H. influenzae*, G(-) bacilli**, Staph. aureus*, Streptococcus species
>50 years: Strep. pneumoniae, N. meningitidis, G(-) bacilli**, S. aureus, Strep. agalactiae, L. monocytogenes**
Acute Bacterial Meningitis
* Has become infrequent in USA
** Especially in hospitalized patients
*** Especially with underlying disease, e.g. renal failure
76 y/o man - died of acute pneumococcal meningitis
Arrows point to depressed scar
Exudate
Percentage of persons aged >/= 65 years who reported receiving influenza or pneumococcal vaccine, by year
Behavioral Risk Factor Surveillance System, United States, 1993-1999
Strep. pneumoniae
Sites of resistance to antimicrobials
Prevalence of bacterial causes of common infections
Bacteria Pneumoniae Otitis media Sinusitis Meningitis
Streptococcus pneumoniae 8.4% 40% 30% 35%
Legionella species 6% -- -- --
Hemophilus influenzae 5.3% 25% 20% 10%
Mycoplasma pneumoniae 3.6% -- -- --
Moraxella (Branhamella) -- 10% 20% --
Catarrhalis
Neisseria meningitidis -- -- -- 35%
Mycobacterium tuberculosis 1.5% -- -- --
Unknown 43% 25%30% --
*Percentages do not add up to 100% in some cases because not all species are included.
Infection *
Organism No. of Cases
Reported
Percentage Of Total*
Incidence Case Fatality Rate (%)
Haemophilus influenzae
18 7 0.2 6
Streptococcus pneumoniae
117 47 1.1 21
Neisseria meningitidis 62 25 0.6 3
Group B streptococcus 31 12 0.3 7
Listeria monocytogenes
20 8 0.2 15
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.
Resistance of Strep. Pneumoniae to fluoroquinolones
Aural TraumaStrep. pneumo.
meningitis
Aural TraumaStrep. pneumo.
meningitis
Early Consolidation - alveoli with Strep. pneumoniae
Inner Zone of Advanced
Consolidation (pneumococi
phagocytosed)
Type Adults Children Type Adults Children I 22.0 14.1 XVII 1.2 1.4 II 7.4 2.2 XVIII 2.5 2.9 III 12.8 3.9 XIX 2.4 8.2 IV 5.7 4.6 XX 1.6 1.4 VII 9.3 4.0 XXIII 0.7 3.0 VIII 8.0 1.4 XXIV 0.6 0.7 IX 2.2 1.6 XXV 1.1 0.03 X 1.1 0.8 XXVII 0.3 0.003 XI 1.1 1.6 XXVIII 0.4 0.9 XII 1.6 O.4 XXIX 0.8 1.3 XIV 4.1 17.2 XXXII 0.2 0.01 XV 0.9 2.8 XXXIII 0.5 0.5 XVI 0.8 1.4
Type Distribution of Pneumoccoccal Pneumonias in Adults and Children
(Collected from various sources)
Incidence (Per cent)
Streptococcus pneumoniae
Streptococcus pneumoniae type 1 in alveoli clumped by antibody
Leukocyte containing opsonized pneumococci
Lung, organizing pneumonia
Lobar Pneumonia
Optochin disk, Strep. pneumoniae
P = oPtochin disc