Streptococcus pneumoniae (pneumococcus) is a leading cause of bacterial meningitis and neurological sequelae in children worldwide. Acute bacterial meningitis is widely considered to result from bacteremia that leads to blood-brain barrier breakdown and bacterial dissemination throughout the central nervous system (CNS). Previously, we showed that pneumococci can gain access to the CNS through a nonhematogenous route without peripheral blood infection. This access is thought to occur when the pneumococci in the upper sinus follow the olfactory nerves and enter the CNS through the olfactory bulbs. In this study, we determined whether the addition of exogenous sialic acid postcolonization promotes nonhematogenous invasion of the CNS. Previously, others showed that treatment with exogenous sialic acid post-pneumococcal infection increased the numbers of CFU recovered from an intranasal mouse model of infection. Using a pneumococcal colonization model, an in vivo imaging system, and a multiplex assay for cytokine expression, we demonstrated that sialic acid can increase the number of pneumococci recovered from the olfactory bulbs and brains of infected animals. We also show that pneumococci primarily localize to the olfactory bulb, leading to increased expression levels of proinflammatory cytokines and chemokines. These findings provide evidence that sialic acid can enhance the ability of pneumococci to disseminate into the CNS and provide details about the environment needed to establish nonhematogenous pneumococcal meningitis.
Streptococcus pneumoniae (pneumococcus) is a common asymptomatic colonizer of the nasopharynx of healthy individuals. Colonization can occur at any point during a person's life but occurs most frequently in the first few years of life, with colonization rates of 50% to 70% in hosts Ő
3 years of age (1). Colonization in the young and elderly can lead to bacterial pneumonia, otitis media, meningitis, and sepsis, with approximately 4 million new cases of illness and 22,000 deaths annually in the United States (2). Pneumococcal meningitis is traditionally thought to be established when bacteria disseminate into the lower respiratory tract and cause a focal pneumonia, which is proceeded by septicemia and subsequent crossing of the blood-brain barrier (3-5). We and others have shown that pneumococci and other pathogens have the ability to invade the central nervous system (CNS) through a nonhematogenous route after nasopharynx colonization. However, further research is needed to understand conditions that may contribute to CNS dissemination (6-11).Clinically, there have been cases of bacterial meningitis reported in the absence of a positive blood culture. A study of child cerebral malaria in Kenyan children found that of 29 cases of acute bacterial meningitis, 10 cases had negative blood cultures but positive cerebrospinal fluid (CSF) samples, and half of these infections were caused by Streptococcus pneumoniae (12). A 2005 study of neonatal meningitis found that 38% of cases of confirmed bacteria...