Invasive Disease Caused Simultaneously by Dual Serotypes of Streptococcus pneumoniae

Ndlangisa, Kedibone; Plessis, Mignon du; Allam, Mushal; Wolter, Nicole; Gouveia, Linda de; Klugman, Keith P.; Cohen, Cheryl; Gladstone, Rebecca A.; Gottberg, Anne von

doi:10.1128/jcm.01149-17

Cited by 14 publications

(12 citation statements)

References 33 publications

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“…Presence of capsule enhanced growth in hCSF as following loss of capsule, growth was greatly reduced. This is in line with the literature which states that although nonencapsulated strains have been noted in IPD cases [33][34][35], these findings are very rare [36] and suggests that the capsule plays a fundamental role in survival and ability to grow in hCSF thereby contributing to meningitis.…”

Section: Discussionsupporting

confidence: 91%

Pneumococcal serotype determines growth and capsule size in human cerebrospinal fluid

et al. 2020

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Background: The polysaccharide capsule is a major virulence factor of S. pneumoniae in diseases such as meningitis. While some capsular serotypes are more often found in invasive disease, high case fatality rates are associated with those serotypes more commonly found in asymptomatic colonization. We tested whether growth patterns and capsule size in human cerebrospinal fluid depends on serotype using a clinical isolate of S. pneumoniae and its capsule switch mutants. Results: We found that the growth pattern differed markedly from that in culture medium by lacking the exponential and lysis phases. Growth in human cerebrospinal fluid was reduced when strains lost their capsules. When a capsule was present, growth was serotype-specific: high carriage serotypes (6B, 9 V, 19F and 23F) grew better than low carriage serotypes (7F, 14, 15B/C and 18C). Growth correlated with the case-fatality rates of serotypes reported in the literature. Capsule size in human cerebrospinal fluid also depended on serotype. Conclusions: We propose that serotype-specific differences in disease severity observed in meningitis patients may, at least in part, be explained by differences in growth and capsule size in human cerebrospinal fluid. This information could be useful to guide future vaccine design.

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Section: Discussionsupporting

confidence: 91%

Pneumococcal serotype determines growth and capsule size in human cerebrospinal fluid

et al. 2020

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“…Pneumococcus has at least 98 serotypes that have potential to cause invasive (eg, meningitis, bacteraemia) and non-invasive (eg, pneumonia, sinusitis, otitis media) diseases 7 13. Although only single-serotype infection is generally reported, which is because of limitation of the conventional culture and identification methods, simultaneous infections with two serotypes have been reported.…”

Section: Introductionmentioning

confidence: 99%

“…Besides these case reports, to our knowledge, only one epidemiological study about multiple-serotype infections that caused invasive pneumococcal diseases has been published 13. However, there is no published study that describes the epidemiological and clinical characteristics of multiple-serotype infections in adults with non-invasive pneumonia.…”

Section: Introductionmentioning

confidence: 99%

High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors

Dhoubhadel

Katsurada

Ishifuji

et al. 2022

Thorax

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BackgroundMultiple serotypes of pneumococci have epidemiological and clinical implications, such as the emergence of non-vaccine serotypes and the acquisition of antimicrobial resistance. Prevalence of multiple serotypes of pneumococci in adults and their risk factors are not known.MethodsWe enrolled adult patients from age ≥15 years with radiologically confirmed pneumonia in four hospitals across Japan. Pneumococcal pneumonia was defined with a pneumococcal bacterial density of ≥104/mL in sputum by lytA quantitative PCR, and serotypes were determined. Pneumonias with a single serotype were categorised as single-serotype pneumococcal pneumonia and with two or more serotypes as multiple-serotype pneumococcal pneumonia. Multivariable logistic regression was used to assess the risk factors.Results3470 patients (median age 77 years, IQR 65–85) were enrolled. Pneumococcal pneumonia was identified in 476 (18.3%, n=2605) patients. Multiple serotypes were detected in 42% of them. Risk of having multiple serotypes was low among patients who had received 23-valent pneumococcal polysaccharide vaccine (PPSV23) vaccines (adjusted OR 0.51 (95% CI 0.27 to 0.94)). Proportion of non-PCV7 PPSV23 serotypes in overall distribution of multiple serotypes was 67.4% (n=324/481) compared with 46.4% (n=128/276) in that of single serotypes (p=0.001). Serotypes 5, 9N/9L, 10A, 12/22/46, 17F and 35F were associated with multiple-serotype pneumonia, and serotypes 6A/6B, 23F, 11 and 6C/6D were associated with single-serotype pneumonia. Proportion of more invasive serotypes (serotypes 1, 5, 7F, 8) was significantly higher in multiple-serotype pneumonia (p=0.001).ConclusionsMultiple serotypes of pneumococci are common in sputum of adult patients with pneumonia. The risk of multiple-serotype pneumococcal pneumonia is lower than that of single-serotype pneumococcal pneumonia among PPSV23-vaccinated patients.Trial registration numberUMIN000006909.

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“…Streptococcus pneumoniae infection remains the leading cause of bacterial pneumonia worldwide but can also lead to other life-threatening invasive pneumococcal diseases (IPDs) such as meningitis and sepsis, as well as non-invasive diseases (non-IPDs) such as sinusitis and otitis media [1]. The causative bacterium typically resides asymptomatically in the upper respiratory tract in the carriage state but can also evade the immune system of the host and cross the mucosal membrane to cause invasive disease [2]. Bacterial transmission occurs through direct contact of respiratory droplets expelled by infected individuals or asymptomatic carriers [3].…”

Section: Introductionmentioning

confidence: 99%

Serotype distribution of invasive, non-invasive and carried Streptococcus pneumoniae in Malaysia: a meta-analysis

Lister

Cheah

et al. 2021

Pneumonia

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Background Pneumococcal pneumonia is the leading cause of under-five mortality globally. The surveillance of pneumococcal serotypes is therefore vital for informing pneumococcal vaccination policy and programmes. Pneumococcal conjugate vaccines (PCVs) have been available as an option in the private healthcare setting and beginning December 2020, PCV10 was incorporated as part of routine national immunisation programme (NIP) in Malaysia. We searched existing literature on pneumococcal serotype distribution across Malaysia to provide an overall view of this distribution before the implementation of PCV10. Methods Online databases (PubMed, Ovid MEDLINE and Scopus), reference lists of articles identified, and grey literature (Malaysian Ministry of Health website, WHO website) were systematically searched for relevant literature on pneumococcal serotype distribution across Malaysia up to 10th November 2020. No lower date limit was set to maximise the number of target reports returned. Results of serotypes were split by age categories, including ≤5 years, > 5 years and unreported for those that did not specify. Results The search returned 18 relevant results, with a total of 2040 isolates. The most common serotypes across all disease types were 19F (n = 313, 15.3% [95%CI: 13.8–17.0]), 23F (n = 166, 8.1% [95%CI: 7.0–9.4]), 14 (n = 166, 8.1% [95%CI: 7.0–9.4]), 6B (n = 163, 8.0% [95%CI: 6.9–9.2]) and 19A (n = 138, 6.8% [95%CI: 5.8–7.9]). Conclusion Four of the most common serotypes across all isolate sources in Malaysia are covered by PCV10, while PCV13 provides greater serotype coverage in comparison to PCV10. There is still a need for surveillance studies, particularly those investigating serotypes in children under 5 years of age, to monitor vaccine effectiveness and pneumococcal population dynamic following implementation of PCV10 into routine immunisation.

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Invasive Disease Caused Simultaneously by Dual Serotypes of Streptococcus pneumoniae

Cited by 14 publications

References 33 publications

Pneumococcal serotype determines growth and capsule size in human cerebrospinal fluid

Pneumococcal serotype determines growth and capsule size in human cerebrospinal fluid

High prevalence of multiple serotypes of pneumococci in patients with pneumonia and their associated risk factors

Serotype distribution of invasive, non-invasive and carried Streptococcus pneumoniae in Malaysia: a meta-analysis

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