An Outbreak of Conjunctivitis Due to Atypical<i>Streptococcus pneumoniae</i>

Martin, Michael; Turco, John H.; Zegans, Michael E.; Facklam, Richard R.; Sodha, Samir V.; Elliott, John A.; Pryor, John H.; Beall, Bernard; Erdman, Dean D.; Baumgartner, Yolanda Y.; Sanchez, Paul A.; Schwartzman, Joseph D.; Montero, José T.; Schuchat, Anne; Whitney, Cynthia G.

doi:10.1056/nejmoa022521

Cited by 150 publications

(136 citation statements)

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“…Some NTPn have been described as extremely contagious and have been associated with pneumococcal conjunctivitis, causing either large outbreaks (Centers for Disease Control and Prevention, 2002, 2003;Crum et al, 2004;Ertugrul et al, 1997;Martin et al, 2003;Shayegani et al, 1982) or sporadic cases of this disease (Barker et al, 1999;Berron et al, 2005 Until 1997, no systematic study of the genetic relatedness of NTPn had been reported (Ertugrul et al, 1997). Since then, a few studies have described the NTPn lineages associated with conjunctivitis episodes, and successful persistent lineages have been identified (Berron et al, 2005;Martin et al, 2003). In addition, a recent report from Hathaway and coworkers characterizes 27 NTPn isolates from various sources and provides important insights into the molecular nature of non-serotypeability in the lineages described (Hathaway et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

“…The distinction between these closely related species is clinically important, since S. pneumoniae can cause serious disease and viridans streptococci are commensal organisms. Some NTPn have been described as extremely contagious and have been associated with pneumococcal conjunctivitis, causing either large outbreaks (Centers for Disease Control andPrevention, 2002, 2003;Crum et al, 2004;Ertugrul et al, 1997;Martin et al, 2003;Shayegani et al, 1982) or sporadic cases of this disease (Barker et al, 1999;Berron et al, 2005). Occasionally, NTPn have been implicated in other types of pneumococcal disease, such as otitis, respiratory infections, and invasive disease (Berron et al, 2005;Finland & Barnes, 1977;Hathaway et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

“…Since then, a few studies have described the NTPn lineages associated with conjunctivitis episodes, and successful persistent lineages have been identified (Berron et al, 2005;Martin et al, 2003). In addition, a recent report from Hathaway and coworkers characterizes 27 NTPn isolates from various sources and provides important insights into the molecular nature of non-serotypeability in the lineages described (Hathaway et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

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Identification, prevalence and population structure of non-typable Streptococcus pneumoniae in carriage samples isolated from preschoolers attending day-care centres

et al. 2006

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The authors aimed to get insights into the population structure of non-(sero)typable pneumococci (NTPn), a specific group of natural atypical pneumococci whose identification is often difficult, and which has remained insufficiently studied. A total of 265 presumptive NTPn, isolated between 1997 and 2003 from the nasopharynx of children, were characterized. Strains were confirmed to be pneumococci on the basis of bile solubility, and PCR detection or Southern blotting hybridization of lytA and psaA, genes ubiquitous in this species. Multilocus sequence typing (MLST) was used to exclude two isolates that gave ambiguous results. Non-typability was confirmed by the Quellung reaction using Omniserum. A total of 213 isolates were considered to be true NTPn. The molecular analysis of the true NTPn by PFGE and MLST showed that this population was genetically diverse, although a dominant cluster, accounting for 66 % of the isolates, was identified. Antimicrobial resistance was observed in most genetic backgrounds, and multidrug resistance to penicillin, erythromycin, clindamycin, tetracycline and sulfamethoxazole-trimethoprim was associated with strains belonging to the dominant cluster. Comparison with PFGE fingerprints and sequence types of large collections of serotypable strains showed that the genetic backgrounds of all but two NTPn were different from those found in serotypable strains. In addition, we found that NTPn strains with similar genetic backgrounds to those identified in our study had been isolated from disease sources in other countries. These observations seem to indicate that NTPn have diverse genetic backgrounds and may have evolved as a distinct group of pneumococcal isolates. INTRODUCTIONStreptococcus pneumoniae is a respiratory pathogen that colonizes asymptomatically the nasopharynx of humans. Although the mortality and morbidity associated with pneumococci are high, they are considered to be facultative pathogens: colonization is the rule, and disease the exception (Centers for Disease Control and Prevention, 2000).Most pneumococci are shielded by a polysaccharide capsule, a major virulence factor that hinders phagocytosis. Up to now, at least 90 different capsular types have been described (Henrichsen, 1995). The capsule can be detected by reaction with specific antisera. However, although some isolates are presumptively identified as pneumococci by routine identification tests, a negative result with type-specific antisera for the 90 serotypes is obtained. These atypical isolates are designated non-typable pneumococci (NTPn), and their correct discrimination from commensal viridans streptococci is often difficult (Carvalho et al., 2003;Hanage et al., 2005;Shayegani et al., 1982;Whatmore et al., 2000). The distinction between these closely related species is clinically important, since S. pneumoniae can cause serious disease and viridans streptococci are commensal organisms. Some NTPn have been described as extremely contagious and have been associated with pneumococcal conjunctivitis, causing ...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Identification, prevalence and population structure of non-typable Streptococcus pneumoniae in carriage samples isolated from preschoolers attending day-care centres

et al. 2006

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“…41 Martin et al also reported an outbreak affecting 698 college students with this organism. 42 In another report, Haemophilus influenzae was shown to be responsible for 428 cases in Israel. 43 …”

Section: Acute Infectionsmentioning

confidence: 98%

Epidemiological Aspects of Infectious Conjunctivitis

Mejia-Lopez¹,

Pantoja-Meléndez²,

Climent-Flores³

et al. 2011

Conjunctivitis - A Complex and Multifaceted Disorder

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“…36,37 School-aged children and those living in crowded urban areas have been identified as groups at high risk for infection in such events. 38 ' 39 Elementary schools, 40 college campuses, 41 and military facilities 42 ' 43 have also been the site of reported outbreaks.…”

Section: Conjunctivitis (Pink Eye)mentioning

confidence: 99%

Infection Prevention and Control in Residential Facilities for Pediatric Patients and Their Families

Guzman-Cottrill

Ravin

Bryant

et al. 2013

Infect. Control Hosp. Epidemiol.

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The Society for Healthcare Epidemiology of America (SHEA) guideline “Infection Prevention and Control in Residential Facilities for Pediatric Patients and Their Families” is the first infection prevention and control (IPC) guideline to address preventing transmission of infectious agents in “home away from home” residential settings, of which the Ronald McDonald Houses (RMHs) serve as a prototype. These types of facilities provide support services, including overnight lodging, for ill and injured children and their families. Food preparation occurs in common areas, and cleaning of rooms or apartments is performed by the occupants during their stay and before departure. Pediatric patients are frequent guests of the family-centered facilities while receiving or recovering from specialized medical therapy. Examples of high-risk populations served in these facilities include families of patients with cancer, recipients of stem cell or solid organ transplants, surgical and/or very-low-birthweight infants who receive care in neonatal intensive care units (NICUs), those with cystic fibrosis, and women with high-risk pregnancies awaiting delivery in a nearby medical center. Such facilities are located worldwide and vary in their physical structure and the predominant population served.

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An Outbreak of Conjunctivitis Due to AtypicalStreptococcus pneumoniae

Abstract: This large outbreak of conjunctivitis on a college campus was caused by an atypical, unencapsulated strain of S. pneumoniae that was identical to strains that had caused outbreaks two decades earlier.

Cited by 150 publications

References 28 publications

Identification, prevalence and population structure of non-typable Streptococcus pneumoniae in carriage samples isolated from preschoolers attending day-care centres

Identification, prevalence and population structure of non-typable Streptococcus pneumoniae in carriage samples isolated from preschoolers attending day-care centres

Epidemiological Aspects of Infectious Conjunctivitis

Infection Prevention and Control in Residential Facilities for Pediatric Patients and Their Families

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