A Community Outbreak of Conjunctivitis Caused by Nontypeable Streptococcus pneumoniae in Minnesota

Buck, Jessica; Lexau, Catherine; Shapiro, Miriam C.; Glennen, Anita; Boxrud, David; Koziol, Bonnie; Whitney, Cynthia G.; Beall, Bernard; Danila, Richard; Lynfield, Ruth

doi:10.1097/01.inf.0000238143.96607.ec

Cited by 29 publications

(30 citation statements)

References 16 publications

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“…In contrast, some serotypes were shown to be carried more than the others (148). Within NT pneumococci, group II NT pneumococci are well known for conjunctivitis outbreaks and NP carriage but are rarely responsible for IPD (112,149,150). The special proteins expressed by group II NTs appear to be important in pneumococcal carriage (111) and adhesion to epithelial cells (151).…”

Section: Serotype and Diseasementioning

confidence: 99%

Pneumococcal Capsules and Their Types: Past, Present, and Future

et al. 2015

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SUMMARY Streptococcus pneumoniae (the pneumococcus) is an important human pathogen. Its virulence is largely due to its polysaccharide capsule, which shields it from the host immune system, and because of this, the capsule has been extensively studied. Studies of the capsule led to the identification of DNA as the genetic material, identification of many different capsular serotypes, and identification of the serotype-specific nature of protection by adaptive immunity. Recent studies have led to the determination of capsular polysaccharide structures for many serotypes using advanced analytical technologies, complete elucidation of genetic basis for the capsular types, and the development of highly effective pneumococcal conjugate vaccines. Conjugate vaccine use has altered the serotype distribution by either serotype replacement or switching, and this has increased the need to serotype pneumococci. Due to great advances in molecular technologies and our understanding of the pneumococcal genome, molecular approaches have become powerful tools to predict pneumococcal serotypes. In addition, more-precise and -efficient serotyping methods that directly detect polysaccharide structures are emerging. These improvements in our capabilities will greatly enhance future investigations of pneumococcal epidemiology and diseases and the biology of colonization and innate immunity to pneumococcal capsules.

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Section: Serotype and Diseasementioning

confidence: 99%

Pneumococcal Capsules and Their Types: Past, Present, and Future

et al. 2015

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“…Four of these strains revealed MLST genotypes identical (ST344, ST448, and ST1186) or similar (ST1540, sharing 5 of 7 alleles with ST344) to those associated with previously-reported conjunctivitis outbreaks [24], [25]. ST1540 was previously recorded from a nontypeable carriage isolate according to the MLST database (http://www.mlst.net).…”

Section: Resultsmentioning

confidence: 96%

Population-Based Analysis of Invasive Nontypeable Pneumococci Reveals That Most Have Defective Capsule Synthesis Genes

et al. 2014

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Since nasopharyngeal carriage of pneumococcus precedes invasive pneumococcal disease, characteristics of carriage isolates could be incorrectly assumed to reflect those of invasive isolates. While most pneumococci express a capsular polysaccharide, nontypeable pneumococci are sometimes isolated. Carriage nontypeables tend to encode novel surface proteins in place of a capsular polysaccharide synthetic locus, the cps locus. In contrast, capsular polysaccharide is believed to be indispensable for invasive pneumococcal disease, and nontypeables from population-based invasive pneumococcal disease surveillance have not been extensively characterized. We received 14,328 invasive pneumococcal isolates through the Active Bacterial Core surveillance program during 2006–2009. Isolates that were nontypeable by Quellung serotyping were characterized by PCR serotyping, sequence analyses of the cps locus, and multilocus sequence typing. Eighty-eight isolates were Quellung-nontypeable (0.61%). Of these, 79 (89.8%) contained cps loci. Twenty-two nontypeables exhibited serotype 8 cps loci with defects, primarily within wchA. Six of the remaining nine isolates contained previously-described aliB homologs in place of cps loci. Multilocus sequence typing revealed that most nontypeables that lacked capsular biosynthetic genes were related to established non-encapsulated lineages. Thus, invasive pneumococcal disease caused by nontypeable pneumococcus remains rare in the United States, and while carriage nontypeables lacking cps loci are frequently isolated, such nontypeable are extremely rare in invasive pneumococcal disease. Most invasive nontypeable pneumococci possess defective cps locus genes, with an over-representation of defective serotype 8 cps variants.

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“…Multilocus sequence typing revealed that the majority of isolates were the ST448 strain. 6 Finally, an outbreak occurred in March and April 2005 in Saskatchewan, Canada. Fluorescence-based amplified fragment length polymorphism analysis was used to characterize the isolates rather than pulsed-field gel electrophoresis or MLST, so it is unknown if the ST448 strain caused this outbreak, however, like the Dartmouth outbreak, there were no associated cases of pneumonia, and the majority of cases had bilateral eye involvement.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features, Outcomes, and Costs of a Conjunctivitis Outbreak Caused by the ST448 Strain of Streptococcus pneumoniae

Zegans

Sanchez

Likosky

et al. 2009

Cornea

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Purpose An outbreak of pneumococcal conjunctivitis occurred at Dartmouth College in 2002. We describe the clinical features, outcomes, and costs associated with this outbreak. Methods Six hundred ninety-eight students were diagnosed with conjunctivitis; culture of conjunctival discharge was obtained for 254. A screening protocol was used to evaluate 67 patients. A retrospective survey was offered to all 698 cases and follow-up clinical examination to all patients with culture-confirmed infection (n = 110). Local ophthalmology offices were contacted to develop a cost analysis. The college health service provided conjunctivitis data for nonoutbreak years. Results Of 67 patients evaluated using the screening protocol, findings associated with culture-confirmed Streptococcus pneumoniae conjunctivitis (P < 0.01) were red eye visible from 2 feet, any type of conjunctival discharge, obscuration of tarsal conjunctival blood vessels, and chemosis. Two hundred thirty-two students responded to our retrospective survey; 89% reported bilateral eye involvement; 96% received topical antibiotics and noted symptom improvement within 3 days of treatment. No ocular sequelae were identified as a result of this infection. No recurrent outbreaks have occurred at Dartmouth since the initial event. The estimated cost of this outbreak including evaluations, cultures, and antibiotics ranged from $66,468 to $120,583. Conclusions The ST448 strain of S. pneumoniae caused a disruptive outbreak of conjunctivitis at Dartmouth College. A screening protocol was effective at identifying culture-positive cases. Although most culture-positive patients experienced bilateral conjunctivitis, the clinical course was mild with quick resolution of symptoms after initiating antibiotics and no ocular sequelae.

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A Community Outbreak of Conjunctivitis Caused by Nontypeable Streptococcus pneumoniae in Minnesota

Cited by 29 publications

References 16 publications

Pneumococcal Capsules and Their Types: Past, Present, and Future

Pneumococcal Capsules and Their Types: Past, Present, and Future

Population-Based Analysis of Invasive Nontypeable Pneumococci Reveals That Most Have Defective Capsule Synthesis Genes

Clinical Features, Outcomes, and Costs of a Conjunctivitis Outbreak Caused by the ST448 Strain of Streptococcus pneumoniae

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