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Martínez ME, Grenón SL, Benítez J, Labán C, Mollerach ME, von Specht MH. [Primary pneumococcal peritonitis in a pediatric hospital from Argentina]. Rev Argent Microbiol 2023; 55:240-245. [PMID: 36935274 DOI: 10.1016/j.ram.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/11/2022] [Accepted: 01/24/2023] [Indexed: 03/19/2023] Open
Abstract
Pneumococcal peritonitis represents a small subset of patients suffering from invasive pneumococcal disease (IPD). We describe 5 cases of primary peritonitis documented in the pediatric hospital over 15 years (2005-2020) of IPD surveillance. The patients, 3girls and 2boys with a mean age of 5 years, experienced peritoneal signs and symptoms; 3of them suffered from nephrotic syndrome. Based on the local resistance profiles, all isolates were sensitive to beta-lactams, one strain showed resistance to cotrimoxazole and tetracycline while another strain, to cotrimoxazole only. Serotypes found in 4/5 strains (one was non-viable) were: 1, 19F, 15C and 23A. Children were treated with third-generation cephalosporins or ampicillin, gentamicin and metronidazole and all of them evolved favorably. Pneumococcal etiology should be included in the differential diagnosis of acute abdominal pain in children. Our study aims to contribute to the knowledge of this condition and to the local epidemiology of IPD.
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Affiliation(s)
- Mónica E Martínez
- Departamento de Microbiología, Facultad de Ciencias Exactas Químicas y Naturales, Universidad Nacional de Misiones, Posadas (Misiones), Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Sandra L Grenón
- Departamento de Microbiología, Facultad de Ciencias Exactas Químicas y Naturales, Universidad Nacional de Misiones, Posadas (Misiones), Argentina
| | - Jessica Benítez
- Departamento de Microbiología, Facultad de Ciencias Exactas Químicas y Naturales, Universidad Nacional de Misiones, Posadas (Misiones), Argentina
| | - Celia Labán
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Marta E Mollerach
- Hospital Provincial de Pediatría Dr. Fernando Barreyro, Servicio de Clínica Médica Posadas, Posadas (Misiones), Argentina; Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Investigaciones en Bacteriología y Virología Molecular, Buenos Aires, Argentina
| | - Martha H von Specht
- Departamento de Microbiología, Facultad de Ciencias Exactas Químicas y Naturales, Universidad Nacional de Misiones, Posadas (Misiones), Argentina.
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Papadatou I, Moudaki A, Mentessidou A, Tsakogiannis D, Georgiadou E, Spoulou V. Intrafamilial Transmission of Pneumococcal Acute Spontaneous Peritonitis. Infect Dis Rep 2023; 15:299-306. [PMID: 37367189 DOI: 10.3390/idr15030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 06/28/2023] Open
Abstract
Streptococcus pneumonia (S. pneumoniae, Pneumococcus) is a major cause of childhood morbidity and mortality worldwide. The most common presentations of invasive pneumococcal disease (IPD) in children include bacteremic pneumonia, meningitis, and septicemia. However, pneumococcal acute spontaneous peritonitis is a highly uncommon-and potentially life-threatening-presentation of invasive pneumococcal disease and should be considered in cases of abdominal sepsis. To our knowledge, we report the first case of intrafamilial transmission of pneumococcal peritonitis in two previously healthy children.
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Affiliation(s)
- Ioanna Papadatou
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
- Immunology and Vaccinology Research Lab, First Department of Paediatrics, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- University Research Institute for the Study of Genetic & Malignant Disorders in Childhood, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
| | - Angeliki Moudaki
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
| | - Anastasia Mentessidou
- Department of Paediatric Surgery, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
| | | | - Elissavet Georgiadou
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
| | - Vana Spoulou
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
- Immunology and Vaccinology Research Lab, First Department of Paediatrics, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- University Research Institute for the Study of Genetic & Malignant Disorders in Childhood, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
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3
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Maraki S, Moraitis P, Barbagadakis S, Vlachakis I. Primary Bacterial Peritonitis Caused by Streptococcus pneumoniae. J Glob Infect Dis 2021; 13:103-104. [PMID: 34194180 PMCID: PMC8213084 DOI: 10.4103/jgid.jgid_197_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/26/2020] [Accepted: 01/04/2021] [Indexed: 11/24/2022] Open
Abstract
Primary peritonitis is a rare infection in healthy children, mainly affecting patients with underlying medical disorders. We report a case of primary pneumococcal peritonitis in an immunocompetent 3-year-old boy. Diagnosis was made at laparotomy and cultures of the intra-abdominal pus yielded Streptococcus pneumoniae. Timely antibiotic treatment administered resulted in complete resolution of the infection.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - Panagiotis Moraitis
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, Crete, Greece
| | - Sophia Barbagadakis
- Department of Pediatric Surgery, University Hospital of Heraklion, Crete, Greece
| | - Ioannis Vlachakis
- Department of Pediatric Surgery, University Hospital of Heraklion, Crete, Greece
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Darbà J, Marsà A. Hospital incidence, in-hospital mortality and medical costs of pneumococcal disease in Spain (2008-2017): a retrospective multicentre study. Curr Med Res Opin 2021; 37:523-530. [PMID: 33459058 DOI: 10.1080/03007995.2021.1876007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the characteristics of the patients attended with a pneumococcal disease in Spanish hospitals, to evaluate trends in hospital incidence and in-hospital mortality and to quantify patients' use of resources and medical costs. METHODS Medical admission records of patients admitted due to pneumococcal disease between 1 January 2008 and 31 December 2017 were obtained from a Spanish hospital discharge database. Records were identified with the International Statistical Classification of Diseases and Related Health Problems, 9th and 10th version codes corresponding to pneumococcal pneumonia, bacteraemia, pyogenic arthritis, endocarditis, meningitis, peritonitis and unspecified pneumococcal infections. RESULTS Admissions of 168,074 patients were analyzed, with a mean age of 63.5 years (median = 72; interquartile range = 28). Pneumococcal pneumonia was responsible for 64.1% of all admissions, with a hospital incidence of 31.1 per 10,000 patients that decreased significantly over the study period (p = .002). Hospital incidence of meningitis also displayed a decreasing trend over the study period (p = .003), whereas incidence of bacteraemia and pyogenic arthritis increased significantly (p = .001; p = .004). Mean Charlson Comorbidity Index was 3.3 (standard deviation = 2.2). In-hospital mortality was 7.0% over the study period, being the highest in patients admitted with endocarditis (17.2%). Sepsis, acute renal failure, disorders of fluid electrolyte and acid-base balance, heart failure and acute respiratory failure were strongly associated with in-hospital mortality. Mean length of hospital stay was of 11.1 days (median = 22; interquartile range = 26) and there was a majority of urgent admissions (95.0%); the most extended stays were registered in patients with endocarditis, meningitis and pyogenic arthritis. The mean hospital admission cost was €5676, €104.2 million annually for all registered patients; 50.3% of all costs were associated with pneumonia, whereas the highest admission costs were registered in patients with endocarditis (€15,991) and meningitis (€11,934). Mean admission costs increased significantly over the study period for pneumonia and bacteraemia and decreased for endocarditis. CONCLUSIONS The incidence of pneumococcal pneumonia and meningitis decreased over the study period after the introduction of vaccination in Spain. The advanced age of patients and presence of chronic comorbid conditions that are associated to in-hospital mortality must be taken into account when improving care protocols and upcoming vaccination plans.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Alicia Marsà
- BCN Health Economics & Outcomes Research S.L., Barcelona, Spain
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Streptococcus pneumoniae Peritonitis and Enterocolitis in a Previously Healthy Female. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ugrinovic S, Firth H, Kavanagh D, Gouliouris T, Gurugama P, Baxendale H, Lachmann PJ, Kumararatne D, Gkrania-Klotsas E. Primary pneumococcal peritonitis can be the first presentation of a familial complement factor I deficiency 1. Clin Exp Immunol 2020; 202:379-383. [PMID: 32640035 PMCID: PMC7670128 DOI: 10.1111/cei.13490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 06/07/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022] Open
Abstract
Primary pneumococcal peritonitis is a rare infection that has been described in women but has not been previously linked with immunodeficiency. The complement system plays a central role in immune defence against Streptococcus pneumoniae and, in order to evade complement attack, pneumococci have evolved a large number of mechanisms that limit complement‐mediated opsonization and subsequent phagocytosis. We investigated an apparently immunocompetent woman with primary pneumococcal peritonitis and identified a family with deficiency for complement factor I. Primary pneumococcal peritonitis should be considered a possible primary immunodeficiency presentation.
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Affiliation(s)
- S Ugrinovic
- Department of Immunology, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - H Firth
- Department of Clinical Genetics, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - D Kavanagh
- National Renal Complement Therapeutics Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - T Gouliouris
- Department of Infectious Diseases, Cambridge University Hospital NHS Trust, Cambridge, UK.,Department of Microbiology, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - P Gurugama
- Department of Immunology, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - H Baxendale
- Department of Immunology, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - P J Lachmann
- Centre for Veterinary Science, University of Cambridge, Cambridge, UK
| | - D Kumararatne
- Department of Immunology, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - E Gkrania-Klotsas
- Department of Infectious Diseases, Cambridge University Hospital NHS Trust, Cambridge, UK
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Okumura K, Sato Y, Yonekura H, Toki N, Kuki T, Watanuki S, Nishida K. Pneumococcal perihepatitis due to hematogeneous dissemination. IDCases 2020; 21:e00856. [PMID: 32518756 PMCID: PMC7272505 DOI: 10.1016/j.idcr.2020.e00856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/30/2022] Open
Abstract
Perihepatitis can occur via hematogeneous dissemination of Streptococcus pneumoniae. A blood culture is useful for clarifying the infection route and pathogens in perihepatitis.
Perihepatitis is mainly caused by a direct extension of pelvic inflammatory disease, in which the causative pathogen is typically Neisseria gonorrhoeae or Chlamydia trachomatis. We herein discuss the case of a 61-year-old female patient who presented with a fever and right upper quadrant pain. Perihepatitis was diagnosed by contrast-enhanced computed tomography. She had no previous history of sexual activity, genital symptoms, remarkable physical findings or examination results indicative of pelvic inflammatory disease or other diseases. A blood culture detected Streptococcus pneumoniae, leading to the suspicion of hematogeneous dissemination. The patient was therefore treated with the appropriate antimicrobials. While invasive pneumococcal disease mainly results in bacteremic pneumonia, meningitis or endocarditis, the present case showed that it can also lead to perihepatitis; a blood culture is therefore useful for clarifying the infection route and pathogens in perihepatitis if the patient has no past history of sexual activity, genital symptoms or physical or other findings indicative of pelvic inflammatory disease.
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Affiliation(s)
- Koichiro Okumura
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Yu Sato
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Hiroaki Yonekura
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Noriyoshi Toki
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Takaie Kuki
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Satoshi Watanuki
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Kenji Nishida
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
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Jarovsky D, Grodzicki Ambrus T, Galvão Gurgel M, Jenné Mimica M, Volpe Arnoni M, Almeida FJ, Palazzi Sáfadi MA, Naaman Berezin E. Spontaneous pneumococcal peritonitis diagnosed by qPCR. IDCases 2019; 15:e00489. [PMID: 30656139 PMCID: PMC6327877 DOI: 10.1016/j.idcr.2019.e00489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/06/2019] [Accepted: 01/06/2019] [Indexed: 11/26/2022] Open
Abstract
Spontaneous bacterial peritonitis is an uncommon manifestation of invasive pneumococcal disease and frequently occurs when an underlying hepatic disease is present. Bacterial identification through culture can be particularly challenging in patients with prior or concurrent antimicrobial use. DNA amplification detects very few copies of target DNA under ideal conditions in CSF or pleural effusion and, therefore, can be useful in selected infections. A culture-negative spontaneous pneumococcal peritonitis without preexisting peritoneal disease diagnosed by qPCR is herein described.
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Affiliation(s)
- Daniel Jarovsky
- Pediatric Infectious Diseases Unit - Santa Casa de São Paulo, São Paulo, Brazil
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Gotts JE, Chun L, Abbott J, Fang X, Takasaka N, Nishimura SL, Springer ML, Schick SF, Calfee CS, Matthay MA. Cigarette smoke exposure worsens acute lung injury in antibiotic-treated bacterial pneumonia in mice. Am J Physiol Lung Cell Mol Physiol 2018. [PMID: 29543040 DOI: 10.1152/ajplung.00405.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Evidence is accumulating that exposure to cigarette smoke (CS) increases the risk of developing acute respiratory distress syndrome (ARDS). Streptococcus pneumoniae is the most common cause of bacterial pneumonia, which in turn is the leading cause of ARDS. Chronic smokers have increased rates of pneumococcal colonization and develop more severe pneumococcal pneumonia than nonsmokers; yet mechanistic connections between CS exposure, bacterial pneumonia, and ARDS pathogenesis remain relatively unexplored. We exposed mice to 3 wk of moderate whole body CS or air, followed by intranasal inoculation with an invasive serotype of S. pneumoniae. CS exposure alone caused no detectable lung injury or bronchoalveolar lavage (BAL) inflammation. During pneumococcal infection, CS-exposed mice had greater survival than air-exposed mice, in association with reduced systemic spread of bacteria from the lungs. However, when mice were treated with antibiotics after infection to improve clinical relevance, the survival benefit was lost, and CS-exposed mice had more pulmonary edema, increased numbers of BAL monocytes, and elevated monocyte and lymphocyte chemokines. CS-exposed antibiotic-treated mice also had higher serum surfactant protein D and angiopoietin-2, consistent with more severe lung epithelial and endothelial injury. The results indicate that acute CS exposure enhances the recruitment of immune cells to the lung during bacterial pneumonia, an effect that may provide microbiological benefit but simultaneously exposes the mice to more severe inflammatory lung injury. The inclusion of antibiotic treatment in preclinical studies of acute lung injury in bacterial pneumonia may enhance clinical relevance, particularly for future studies of current or emerging tobacco products.
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Affiliation(s)
- Jeffrey E Gotts
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California , San Francisco, California
| | - Lauren Chun
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California , San Francisco, California
| | - Jason Abbott
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California , San Francisco, California
| | - Xiaohui Fang
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California , San Francisco, California
| | - Naoki Takasaka
- Department of Pathology, University of California , San Francisco, California
| | - Stephen L Nishimura
- Department of Pathology, University of California , San Francisco, California
| | - Matthew L Springer
- Department of Medicine, Cardiovascular Research Institute, University of California , San Francisco, California
| | - Suzaynn F Schick
- Department of Medicine, Cardiovascular Research Institute, University of California , San Francisco, California
| | - Carolyn S Calfee
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California , San Francisco, California
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California , San Francisco, California
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Kim T, Hong SI, Park SY, Jung J, Chong YP, Kim SH, Lee SO, Kim YS, Woo JH, Lim YS, Sung H, Kim MN, Choi SH. Clinical Features and Outcomes of Spontaneous Bacterial Peritonitis Caused by Streptococcus pneumoniae: A Matched Case-Control Study. Medicine (Baltimore) 2016; 95:e3796. [PMID: 27258513 PMCID: PMC4900721 DOI: 10.1097/md.0000000000003796] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Streptococcus pneumoniae is a well-known cause of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. However, little information is available regarding clinical characteristics and outcomes of SBP caused by S. pneumoniae. It has been suggested that spontaneous pneumococcal peritonitis (SPP) often spreads hematogenously from concomitant pneumococcal pneumonia, and is associated with a higher rate of mortality.During the period between January 1997 and December 2013, 50 SPP cases were identified. These cases were then age/sex-matched with 100 patients with SBP due to causes other than S. pneumoniae (controls).SPP accounted for 4.3% (50/1172) of all culture-proven SBPs. The baseline Child-Pugh class, etiology of cirrhosis, and model for end-stage liver disease scores were comparable for the 2 groups. SPP patients were more likely than control patients to have a community-acquired infection (90.0% vs. 76.0%; P = 0.04), concurrent bacteremia (84.0% vs. 59.0%; P = 0.002), and to present with variceal bleeding (10.0% vs. 1.0%; P = 0.02). None of the study patients had pneumococcal pneumonia. The most common initial empirical therapy for both groups was third-generation cephalosporins (96.0% vs. 91.0%; P = 0.34) which was active against a significantly higher proportion of the cases than of the controls (97.8% vs. 78.7%; P = 0.003). Thirty-day mortality was significantly lower in the case group than in the control group (10.0% vs. 24.0%; P = 0.04).SPP was not associated with pneumococcal pneumonia and showed lower mortality than SBP caused by other organisms. However, the present study was constrained by the natural limitations characteristic of a small, retrospective study. Therefore, large-scale, well-controlled studies are required to demonstrate the influence of SPP on mortality, which was marginal in the present study.
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Affiliation(s)
- Taeeun Kim
- From the Department of Infectious Diseases (TK, SIH, SYP, JJ, YPC, S-HK, S-OL, YSK, JHW, S-HC); Department of Gastroenterology (Y-SL); and Department of Laboratory Medicine (HS, M-NK), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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11
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Ritchie ND, Mitchell TJ, Evans TJ. What is different about serotype 1 pneumococci? Future Microbiol 2012; 7:33-46. [DOI: 10.2217/fmb.11.146] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Serotype 1 Streptococcus pneumoniae is among the most commonly isolated serotype in invasive pneumococcal disease but is rarely found causing asymptomatic nasopharyngeal colonization. Compared to infection by other serotypes, infection caused by serotype 1 is more likely to be identified in young patients without comorbidities but is generally associated with a lower mortality. Empyema and extrapulmonary manifestations are common. Outbreaks of serotype 1 disease have been reported in closed communities and epidemics are particularly common in sub-Saharan Africa. The serotype 1 capsular polysaccharide is a zwitterionic structure that enables it to function as a T-cell dependent antigen under some circumstances, in contrast to other pneumococcal capsular polysaccharides that are T-cell independent antigens. There are also differences in the key virulence factor pneumolysin in some serotype 1 isolates. The clinical significance of these differences remains to be determined.
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Affiliation(s)
- Neil D Ritchie
- Institute of Infection, Immunity & Inflammation, University of Glasgow, UK
| | - Tim J Mitchell
- Institute of Infection, Immunity & Inflammation, University of Glasgow, UK
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