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Symptoms Diagnosis
cough (often produces rust colored mucus)
fever and chills
shortness of breath
chest pain
fatigue
Chest x-ray (in hospitals and clinics)
Blood test
Sputum culture
physical examination
CT scan
Streptococcus pneumoniae
nasopharynx of healthy people
Gram-positive bacteria
Paired (diplococci) or appear in chains
May also infect brain (pneumococcal meningitis) and blood stream (pneumococcus septicemia)
Scanning Electron Micrograph of Streptococcus pneumoniae. Source: CDC/ R. Facklam, J. Carr
S. pneumoniae was first isolated in 1881,
S. pneumoniae was first isolated in 1881,
but it still remains the number 1 killer of children under 5 today.
but it still remains the number 1 killer of children under 5 today
The Toll
4 million deaths every year
half of these deaths - children under age 5
5,500 children die from pneumonia every day
98% of children who die of pneumonia live in developing countries
contributes to the cycle of poverty
S. Pneumoniae -Virulence• Polysaccharide capsule, > 90 serotypes
• Resistance to phagocytosis and antibiotics
Virulence- Pneumolysin
Toxin
Cholesterol-dependent cytolysin
Cytokine synthesis
Inflammatory response
Pneumococcal conjugate vaccine
• Elicits antibodies against the seven most common capsular types
• Sero-specific
Problems:Expensive
Alter serotype distribution
Results:Decrease nasopharyngeal
colonizationReduce disease of included
serotypes
Treatment
• Antibiotics, <$1/dose
• Amoxicillin – inhibit cell wall formation
• Erythromycin- inhibit protein synthesis
• 1 out of 5 children with pneumonia receives antibiotics
They may not be excited now...
but they will be. This vaccine deal could save 900,000 lives by 2015.
References• Bruyn, G.W, Zegers, B. M, R. van Furth. Mechanisms of Host Defense against Infection with
Streptococcus pneumoniae. Clinical Infections Diseases 1992;14;251-62.
• Daniels, Briles, Mirza, Hakasson, Briles. Capsule does not block antibody binding to PspA, a surface virulence protein of Streptococcus pneumoniae. Microbial Pathogenesis. 40;2006;228-233.
• Alonsodevelasco, Verhuel, Verhoef, Snipe. Atreptococcus pneumoniae: Virulence Factors, Pathogenesis and Vaccines. Microbiological Reviews. Dec. 1995, 591-603.
• Hsieh, Lee, Shao, Chang, Huang. The Transforming Streptococcus Pneumoniae in the 21st century. Chang Gung Med J Vo. 30 No. 2 2008;31:117-24
• Hammerschmidt, Wolff, Hocke, Rosseau, Muller, Rohde. Illustration of Pneumonococcal Polysacharide Capsule during adherence and invasion of epithelial cells. Infection and Immunity. 2005; 4653-4667.
• Kadioglu, Weiser, Paton, Andrew. The role of streptococcus pneumoniae virulence factors in host respiratory colonization and disease. Nature. 2008;6.
• World Health Organization: The top 10 causes of death. October 2008. http://www.who.int/mediacentre/factsheets/fs310/en/index.html [2] Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008;86:408–16.
• World Health Organization. World health statistics 2009. Geneva: World Health Organization; 2008. http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf
• Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008;86:408–16.
• World Health Organization. World health statistics 2006. Geneva: World Health Organization; 2006. http://www.who.int/whosis/whostat2006.pdf.
• World Health Organization. World health statistics 2006. Geneva: World Health Organization; 2006. http://www.who.int/whosis/whostat2006.pdf..
• Rudan I, Boschi-Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ. 2008;86:408–16.
• Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the incidence of clinical pneumonia among children under five years of age. Bull World Health Organ. 2004;82:895–903.