Serotypes of Streptococcus pneumoniae isolated from blood and cerebrospinal fluid related to vaccine serotypes and to clinical characteristics

Berg, Stefan; Trollfors, Birger; Persson, Elisabeth; Backhaus, Erik; Larsson, Peter; Ek, Elisabeth; Claesson, Berndt E. B.; Jönsson, Lars; Rådberg, Gunilla; Johansson, S. G. O.; Ripa, Torvald; Kaltoft, Margit S.; Konradsen, Helle Bossen

doi:10.1080/00365540500532852

Cited by 33 publications

(32 citation statements)

References 17 publications

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“…38 The association of serotype 3 IPD and an increased risk of a fatal outcome compared with serotype 1 has been more recently documented in other European countries. [47][48][49][50] Overall these studies concur with Stillman's observation in 1916 that 'although this organism [Type III] is responsible for but a small percentage of the cases of lobar pneumonia, it produces an unusually severe type of the disease'. 51 carrIer states of serotypes 1 and 3…”

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confidence: 78%

Observations regarding historical accounts of pneumococcal diseases due to serotypes 1 and 3

Inverarity

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2010

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Observations regarding historical accounts of pneumococcal diseases due to serotypes 1 and 3 aBstract Surveillance of the serotypes causing invasive pneumococcal diseases in the UK has indicated increasing incidence of serotype 1-and serotype 3-related disease in recent years. The introduction of a pneumococcal conjugate vaccine to the paediatric vaccination schedule in 2006, which did not cover these serotypes, has been regarded as a contributing factor. Serotypes 1 and 3 were perhaps the most extensively studied pneumococcal serotypes in the early twentieth century when pneumococcal serotyping began. Such historical observations are pertinent to our understanding of contemporary disease manifestations for these serotypes as many parallels can be seen between their behaviour in the early twentieth century and the early twenty-first century. There are many relevant lessons to be learned from these pre-antibiotic era descriptions and the observations of our predecessors. 18,19 S. mucosus (renamed Pneumococcus mucosus) was described in 1917 as 'larger, rounder, and less lanceolate than other types of pneumococcus' and possessing 'a large distinct capsule '. 20 It grew on blood agar with colonies which were 'moist, mucoid, and confluent' and became known as the Type III pneumococcus. 20 This phenotypic description matches that which would be seen for contemporary serotype 3 isolates ( Figure 1). There is potential for misclassification when only the phenotypic appearances are used to classify serotype 3 as mucoid colonies can be observed in some other pneumococcal serotypes, albeit uncommonly. 21 It was not until 1934 that Type III could be distinguished serologically from phenotypically similar Type VIII. 22 So only after 1934 can it be concluded that the Type III pneumococcus is equivalent to the contemporary serotype 3 pneumococcus.In the absence of antibiotics and with growing success in the treatment of lobar pneumonia using type-specific horse or rabbit sera, 23 serotyping of disease-related isolates of pneumococci became important in order to use the correct antisera as therapy. Lobar pneumonia was a reportable illness and in the 1920s the prevalence of, and mortality associated with, the different serotypes of pneumococci responsible for lobar pneumonia and other invasive disease manifestations began to be documented in Britain. This continued throughout the 1930s.The discovery of sulphonamide and penicillin antibiotics (which no longer required a knowledge of serotype to determine appropriate treatment) resulted in a decline in interest in pneumococcal serotyping from the 1940s until the 1980s when it again became important to determine the composition of local pneumococcal populations as polysaccharide vaccines were being introduced. By this time (likely due to the success of its pharmacological treatment), lobar pneumonia was no longer a notifiable condition. Consequently serological surveillance switched to documenting instances of pneumococcal bacteraemia and meningitis to record IPD cases. This m...

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supporting

confidence: 78%

Observations regarding historical accounts of pneumococcal diseases due to serotypes 1 and 3

Inverarity

Diggle²

2010

JRCPE

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“…Some studies suggest that host factors such as underlying disease and age are more important determinants than a particular serotype [6,7]. In contrast, certain serotypes are associated with more severe outcome and mortality even after adjustment for relevant host factors [4,8-10].…”

Section: Introductionmentioning

confidence: 99%

High incidence of septic shock caused by Streptococcus pneumoniae serotype 3 - a retrospective epidemiological study

et al. 2013

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BackgroundMore than 90 immunologically distinct serotypes of Streptococcus pneumoniae exist, and it is not fully elucidated whether the serotype is a risk factor for severity of invasive pneumococcal disease (IPD). Our hypothesis is that serotypes differ in their capacity to cause septic shock.MethodsWe performed a retrospective study in Southern Sweden based upon 513 patients with IPD in the pre-vaccine era 2006–2008. The serotype, co-morbidity, and sepsis severity were determined. Serotypes were compared to serotype 14 as a reference and grouped according to their invasive potential, that is, high (serogroups 1, 5 and 7), intermediate (serogroups 4, 9, 14 and 18) and, finally, low invasive potential (serogroups 3, 6, 8, 15, 19, 23 and 33).ResultsPatients with S. pneumoniae serotype 3 had significantly more often septic shock (25%, odds ratio (OR) 6.33 [95% confidence interval (CI) 1.59-25.29]), higher mortality (30%, OR 2.86 [CI 1.02-8.00]), and more often co-morbidities (83%, OR 3.82 [CI 1.39-10.54]) when compared to serotype 14. A significant difference in age and co-morbidities (p≤0.001) was found when patient data were pooled according to the invasive potential of the infecting pneumococci. The median age and percentage of patients with underlying co-morbidities were 72 years and 79%, respectively, for serogroups associated with low invasiveness, 68 years and 61%, respectively, for serogroups with intermediate invasiveness, and, finally, 62 years and 48%, respectively, for serogroups with high invasiveness. No difference in sepsis severity was found between the three groups.ConclusionsS. pneumoniae serotype 3 more often caused septic shock compared to serotype 14. Our results support the hypothesis that serotypes with high invasiveness mainly cause IPD in younger patients with less co-morbidities. In contrast, serogroups with low and intermediate invasive potential mostly cause IPD in the elderly with defined co-morbidities, and thus can be considered as opportunistic.

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“…Clinical data were collected for the patients (1191 patients were included in previous studies) [2,21,24]. Only the first event in each patient during the study period was included in the analyses.…”

Section: Patients and Pneumococcal Isolatesmentioning

confidence: 99%

“…Serotyping and molecular typing Serotyping using antisera directed against the capsular polysaccharide was performed according to standard methods as described previously [3,21]. To further study the genetic relatedness between the strains, molecular typing was performed to identify different genetic clonal types.…”

Section: Patients and Pneumococcal Isolatesmentioning

confidence: 99%

“…The extent of type replacement differs between populations and in Stockholm County in Sweden, to date, no net reduction of invasive pneumococcal disease in older adults has been observed due to an increase of serotypes not included in the PCV13 vaccine (data not shown) [19]. Some studies have investigated the potential association of serotype to clinical disease [2,20,21]; however, further data is needed to understand to what extent non-vaccine strains provide the same ability to cause invasive pneumococcal disease and whether the disease manifestations are the same as for vaccine strains. Furthermore, pneumococci are genetically diverse due to an efficient DNA transformation system and molecular typing regimes can distinguish a number of genetically related clonal lineages that might express different capsular serotypes [2,3,16].…”

Section: Introductionmentioning

confidence: 99%

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Clinical manifestations of invasive pneumococcal disease by vaccine and non-vaccine types

et al. 2014

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Pneumococcal conjugated vaccines (PCVs) have shown protection against invasive pneumococcal disease by vaccine serotypes, but an increase in non-vaccine serotype disease has been observed. Type-specific effects on clinical manifestation need to be explored.Clinical data from 2096 adults and 192 children with invasive pneumococcal disease were correlated to pneumococcal molecular serotypes. Invasive disease potential for pneumococcal serotypes were calculated using 165 invasive and 550 carriage isolates from children.The invasive disease potential was lower for non-PCV13 compared to vaccine-type strains. Patients infected with non-PCV13 strains had more underlying diseases, were less likely to have pneumonia and, in adults, tended to have a higher mortality. Furthermore, patients infected with pneumococci belonging to clonal serotypes only expressing non-PCV13 capsules had a higher risk for septicaemia and mortality.PCV vaccination will probably lead to a decrease in invasive pneumococcal disease but an alteration in the clinical manifestation of invasive pneumococcal disease. Genetic lineages causing invasive pneumococcal disease in adults often express non-vaccine serotypes, which can expand after vaccination with an increased risk of infection in patients with underlying diseases. @ERSpublications Pneumococcal non-vaccine type strains cause severe disease, but with different spectrums of clinical manifestations

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Serotypes of Streptococcus pneumoniae isolated from blood and cerebrospinal fluid related to vaccine serotypes and to clinical characteristics

Cited by 33 publications

References 17 publications

Observations regarding historical accounts of pneumococcal diseases due to serotypes 1 and 3

Observations regarding historical accounts of pneumococcal diseases due to serotypes 1 and 3

High incidence of septic shock caused by Streptococcus pneumoniae serotype 3 - a retrospective epidemiological study

Clinical manifestations of invasive pneumococcal disease by vaccine and non-vaccine types

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