In the present study, we analyzed the effect of a preceding respiratory syncytial virus (RSV) infection of human respiratory epithelial cells on the adherence of Streptococcus pneumoniae tested by means of a cytometric fluorescence assay. Adherence of clinically relevant pneumococcal serotypes 3, 9, 14, 18, 19, and 23 was studied using uninfected and RSV-infected monolayers. To this end, monolayers of both human nasopharyngeal cells (HEp-2) and pneumocyte type II cells (A549) were infected with RSV serotype A. Adherence to uninfected epithelial cells varied between pneumococcal serotypes. After RSV infection of the monolayers, all serotypes showed a strongly (2-to 10-fold) and significantly increased adherence when compared with adherence to uninfected monolayers. Enhanced adherence was observed with both cell lines. By fluorescence and scanning electron microscopy, we observed redistribution of pneumococcal adherence over the epithelial surface due to RSV infection, with dense bacterial accumulations near to epithelial syncytia. Streptococcus pneumoniae and RSV belong to the most important pathogens of upper and lower respiratory tract infections in young children (1, 2). There is accumulating evidence for a positive relationship between infections with S. pneumoniae and RSV, especially in the pathogenesis of otitis media, pneumonia, and meningitis (3-8). Epidemiologically, the peak incidences of RSV infections and invasive infections due to S. pneumoniae coincide (9). In a large study on the etiology of community-acquired bacterial pneumonia, a preceding viral infection could be detected by serology in 39% of the children (10). The combination of RSV and S. pneumoniae was seen most frequently in children below age 5 y.The most prevalent pneumococcal serotypes causing invasive pneumococcal disease in children include serotypes 9, 14, 18, 19, and 23. Pneumococcal sepsis in adults is often caused by serotype 3 (11-14).Enhanced pneumococcal adherence, secondary to a preceding RSV infection of the respiratory tract epithelium, is considered one of the mechanisms facilitating bacterial infection (15,16).The aim of the present study was to examine the influence of prior RSV infection on pneumococcal adherence to confluently grown epithelial cells using an assay based on adherence of fluorescent pneumococci. The influence of RSV-preinfection on pneumococcal superinfection with serotypes 3, 9, 14, 18, 19, and 23 was evaluated.
MATERIAL AND METHODS
Bacteria.Clinical pneumococcal isolates, serotypes 3, 9, 14, 18, 19, and 23, were kindly provided by Dr. C. Neeleman, Intensive Care Department of the University Hospital of Nijmegen, The Netherlands, and stored at Ϫ70°C in micro-banks (Pro-Lab Diagnostics, Austin, TX, U.S.AϾ). Before testing, an aliquot of stored bacteria was transferred from a micro-bank bead to blood-agar plates and was incubated overnight at 37°C in a CO 2 incubator. The next day, the bacteria were inoculated in Todd-Hewitt broth (Difco, Detroit, MI, U.S.A.), supple-