Pneumococcus : Introduction, Morphology, Pathogenecity, Laboratory Diagnosis and Treatment
Introduction of Pneumococcus
Pneumococcus or Streptococcus pneumoniae in Gram stain showing Gram-positive diplococci or Gram-positive cocci in pairs as shown above picture.
Scientific classification of Pneumococcus
Species: S. pneumoniae
It is a Gram-positive elongated coccus usually found in pairs i.e diplococci or lanceolate, alpha-hemolytic on blood agar facultative anaerobic, non-sporulated, non-motile but a capsulated member of the genus Streptococcus. It resides asymptomatically in healthy carriers typically colonizing the respiratory tract, sinuses, and nasal cavity.
Pathogenicity of Pneumococcus
Pneumococcus is the most common cause of bloodstream infections, pneumonia, meningitis, and middle ear infections ( Otitis media) in young children. Severe infections can occur in the elderly and those already in poor health or immunosuppressed. The risk of infection is increased following splenectomy. In tropical and developing countries, S. pneumoniae is a major pathogen, responsible for acute life-threatening pneumonia and bacteremia in those co-infected with HIV The invasive pneumococcal diseases include bronchitis, rhinitis, acute sinusitis, otitis media, conjunctivitis, meningitis, sepsis, osteomyelitis, septic arthritis, endocarditis, peritonitis, pericarditis, cellulitis, and brain abscess. Childhood pneumonia and serious infections are
in patients with sickle cell disease.
Serotypes: Over 80 capsular serotypes whereas less than 15 serotypes are responsible for most infections.
Laboratory Diagnosis of Pneumococcus
Specimens: Depending on the site of infection, specimens may include sputum, exudate, blood for culture, and cerebrospinal fluid.
Gram stain of specimen
Gram-positive elongated (lanceolate) diplococci and may show evidence of capsule but no evidence of spore.
Blood agar: Following overnight incubation. S. pneumoniae forms translucent or mucoid colonies, 1–2 mm in diameter. In young cultures the colonies are raised but later become flattened with raised edges, giving them a ringed appearance i.e ‘draughtsman’. Strains of some serotypes (e.g. serotype 3) produce large mucoid colonies. Pneumococci show alpha-hemolysis, i.e. colonies are surrounded by an area of partial hemolysis with a green-brown discoloration in the medium (reduced hemoglobin)
Pneumococci are sensitive to optochin (ethylhydrocupreine hydrochloride). Placing a disc (5 µg) on primary sputum culture and culturing the plate aerobically (not in CO2) can help to provide rapid presumptive identification of pneumococcus.
Agglutination test: A latex reagent to detect S. pneumoniae capsular antigen.
Useful antibacterial drugs are ampicillin, amoxicillin, erythromycin, cotrimoxazole, doxycycline, ofloxacin, vancomycin, chloramphenicol (nitrofurantoin in case of urine ), teicoplanin, linezolid. Penicillin-resistant
strains are becoming an increasing problem.
Streptococcus pneumoniae shows alpha hemolysis on blood agar under aerobic conditions whereas beta-hemolysis under anaerobic condition
Absence of capsules in Gram stain if organisms from cultures.
It also forms short chains in Gram stain particularly the following culture but lacking such features in specimens.
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