A Study of Lobar Pneumonia in Massachusetts: Methods and Results of Pneumococcus Type Determination, 1931-1932

Heffron, Roderick; Varley, F.M.

doi:10.2105/ajph.22.12.1230

Cited by 8 publications

(2 citation statements)

References 5 publications

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“…Since the UAD assay was positive in 89% (25/28) of PCV13 serotype bacteremias and/or DNAemia and only 63% (38/60) of episodes of bacteremia and/or DNAemia were due to a PCV13 serotype, we extrapolate that 78% of pneumonia episodes in this South African cohort of HIV-infected adults might be pneumococcal. This is close to proportions which were reported in the 1930s (4,36,37) and considerably higher than contemporary pneumococcal proportions (18), which vary from 5% (38) to 57% (7). Few recent comprehensive etiology studies with African adults are available.…”

Section: Discussionsupporting

confidence: 82%

Multiplex Urinary Antigen Detection for 13 Streptococcus pneumoniae Serotypes Improves Diagnosis of Pneumococcal Pneumonia in South African HIV-Infected Adults

et al. 2017

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A serotype-specific urinary antigen detection (UAD) assay for 13 serotypes included in the pneumococcal conjugate vaccine (PCV13) was recently reported as a useful diagnostic tool for pneumococcal pneumonia. We aimed to assess the diagnostic accuracy of the UAD in HIV-infected South African adults. Urine specimens from a well-defined cohort of HIV-infected South African adults with pneumonia were evaluated retrospectively in the UAD assay. Pneumonia was considered pneumococcal if either sputum Gram stain, sputum culture, blood culture, or the immunochromatographic (ICT) BinaxNow S. pneumoniae test (composite diagnostic) was positive. Among 235 enrolled pneumonia patients, the UAD assay was more frequently positive (104 [44.3%]) than the composite diagnostic (71 [30.2%]; P Ͻ 0.001) and increased the pneumococcal etiology from 30.2% by an additional 22.6% to 52.8%. The UAD assay detected more pneumococcal etiologies (45.0%) than the serotype-independent ICT (23.4%, P Ͻ 0.001). UAD identified 6/7 patients with PCV13 serotype bacteremia without misclassification of bacteremia episodes due to non-PCV13 serotypes. UAD was positive for 5.1% of asymptomatic HIV-infected persons, with higher rates among those with nasopharyngeal carriage. Concordance between serotypes identified by UAD and by Quellung reaction and PCR serotyping was 70/86 (81.4%). UAD identified the dominant serotype in multiple serotype carriage. This study confirms the utility of the UAD assay for HIV-infected adults comparing favorably with other diagnostic tests. A highly valent UAD may become a new standard for detection of pneumococcal pneumonia in adults. Prior to PCV introduction, at least 53% of pneumonia cases were due to pneumococci in HIVinfected South African adults.

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Section: Discussionsupporting

confidence: 82%

Multiplex Urinary Antigen Detection for 13 Streptococcus pneumoniae Serotypes Improves Diagnosis of Pneumococcal Pneumonia in South African HIV-Infected Adults

et al. 2017

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“…Pneumococci of both serotypes 1 and 5 are quite clonally restricted and are generally susceptible to antimicrobial agents, with extreme susceptibility to beta lactam antibiotics. It is possible that the broad usage of penicillin and other antibiotics in the later part of the 20th century played significant roles in the marked decrease of both serotypes, both of which were responsible for a heavy disease burden in the United States earlier in the century (Heffron and Varley, 1932). The five serotype 1 and three of the serotype 5 non-pneumococcal strains examined here had more resistance determinants and higher MICs to different antibiotics than typical pneumococcal isolates of these same serotypes recovered from different geographic regions (Hausdorff, 2007; Romney et al, 2008; Balicer et al, 2010; Metcalf et al, 2016a; Tomczyk et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Streptococcus infantis, Streptococcus mitis, and Streptococcus oralis Strains With Highly Similar cps5 Loci and Antigenic Relatedness to Serotype 5 Pneumococci

et al. 2019

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Streptococcus pneumoniae is a highly impactful bacterial pathogen on a global scale. The principal pneumococcal virulence factor and target of effective vaccines is its polysaccharide capsule, of which there are many structurally distinct forms. Here, we describe four distinct strains of three Mitis group commensal species (Streptococcus infantis, Streptococcus mitis, and Streptococcus oralis) recovered from upper respiratory tract specimens from adults in Kenya and the United States that were PCR-positive for the pneumococcal serotype 5 specific gene, wzy5. For each of the four strains, the 15 genes comprising the capsular polysaccharide biosynthetic gene cluster (cps5) shared the same order found in serotype 5 pneumococci, and each of the serotype 5-specific genes from the serotype 5 pneumococcal reference strain shared 76–99% sequence identity with the non-pneumococcal counterparts. Double-diffusion experiments demonstrated specific reactivity of the non-pneumococcal strains with pneumococcal serotype 5 typing sera. Antiserum raised against S. mitis strain KE67013 specifically reacted with serotype 5 pneumococci for a positive Quellung reaction and stimulated serotype 5 specific opsonophagocytic killing of pneumococci. Four additional commensal strains, identified using PCR serotyping assays on pharyngeal specimens, revealed loci highly homologous to those of pneumococci of serotypes 12F, 15A, 18C, and 33F. These data, in particular the species and strain diversity shown for serotype 5, highlight the existence of a broad non-pneumococcal species reservoir in the upper respiratory tract for the expression of capsular polysaccharides that are structurally related or identical to those corresponding to epidemiologically significant serotypes. Very little is known about the genetic and antigenic capsular diversity among the vast array of commensal streptococcal strains that represent multiple diverse species. The discovery of serotype 5 strains within three different commensal species suggests that extensive capsular serologic overlap exists between pneumococci and other members of the diverse Mitis group. These findings may have implications for our current understanding of naturally acquired immunity to S. pneumoniae and pneumococcal serotype distributions in different global regions. Further characterization of commensal strains carrying homologs of serotype-specific genes previously thought to be specific for pneumococci of known serotypes may shed light on the evolution of these important loci.

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Endemic Pneumonia

Bullowa¹,

Wilcox²

1937

Arch Intern Med (Chic)

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A Study of Lobar Pneumonia in Massachusetts: Methods and Results of Pneumococcus Type Determination, 1931-1932

Cited by 8 publications

References 5 publications

Multiplex Urinary Antigen Detection for 13 Streptococcus pneumoniae Serotypes Improves Diagnosis of Pneumococcal Pneumonia in South African HIV-Infected Adults

Multiplex Urinary Antigen Detection for 13 Streptococcus pneumoniae Serotypes Improves Diagnosis of Pneumococcal Pneumonia in South African HIV-Infected Adults

Streptococcus infantis, Streptococcus mitis, and Streptococcus oralis Strains With Highly Similar cps5 Loci and Antigenic Relatedness to Serotype 5 Pneumococci

Endemic Pneumonia

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