Invasive pneumococcal disease caused by mucoid serotype 3 Streptococcus pneumoniae: a case report and literature review

Abstract

BackgroundAmong the different serotypes of Streptococcus pneumoniae, serotype 3 has received global attention. We report the fatal case of a 76-year-old Japanese man who had an invasive pneumococcal disease associated with pneumonia caused by serotype 3 S. pneumoniae.Case presentationThe patient had a history of hypertension, laryngeal cancer, chronic obstructive pulmonary disease, and type 2 diabetes mellitus. Following a cerebral arteriovenous malformation hemorrhage, he underwent surgery to remove the hematoma and began rehabilitation. On day 66 of hospitalization, he suddenly developed a fever, and coarse crackles and wheezes were heard in his right lung. A diagnosis of hospital-acquired aspiration pneumonia was made, and initial treatment with piperacillin/tazobactam was started. Teicoplanin was added after S. pneumoniae was isolated from the blood culture, however, the patient died 5 days later. The S. pneumoniae detected in the sputum smear was serotype 3, showed mucoid colonies and susceptibility to penicillins, cephalosporins, carbapenems, and levofloxacin, but resistance to erythromycin.ConclusionWe experienced a fatal case of pneumonia caused by mucoid serotype 3 S. pneumoniae with a thick capsule. Serotype 3-associated pneumonia may develop a wider pulmonary infiltrative shadow, a prolonged therapeutic or hospitalization course, and a poor outcome. Careful observation and intervention are required, and the use of additional antibiotics or intravenous immunoglobulins should be considered in such cases. Pneumococcal immunization is also an important public health measure to minimize the development of severe infections caused by serotype 3 strains.

<p>Serotype Distribution and Antibiotic Susceptibility of <em>Streptococcus pneumoniae</em> Isolates in Tehran, Iran: A Surveillance Study</p>

“…27 However, in line with other studies, we have found serotypes 3 to be a frequent cause of non-IPD. 28,29 Serotypes 3 and 19A are not recently covered by PCV-10, thus using these vaccines may not be sufficient. The data showed low serotype coverage of PCV-7 (50%) in period II which is in concordance with data from other Asian countries such as Nepal.…”

Immunological and Epidemiological Aspects of the Immunogenicity of Streptococcus Pneumoniae Serotype 3 Capsular Polysaccharide in Pneumococcal Vaccines

“…Полимерные цепи целлобиуроновой кислоты капсулы S. pneumoniae серотипа 3 ковалентно не связаны с клеточной стенкой, в отличие от других серотипов пневмококка (кроме серотипа 37) [18], и характеризуются тенденцией образовывать при росте на агаре мукоидные колонии [19,20]. Мукоидные штаммы S. pneumoniae серотипа 3 вызывают тяжелые заболевания, характеризующиеся менее успешным и более длительным лечением по сравнению с немукоидными серотипами и нередко заканчивающиеся летально [14,21,22]. В настоящее время накопилось значительное количество данных, свидетельствующих о недостаточной иммуногенности КП S. pneumoniae серотипа 3 в составе пневмококковых вакцин, и дискуссии по этому вопросу продолжаются.…”

Disruption of the cpsE and endA Genes Attenuates Streptococcus pneumoniae Virulence: Towards the Development of a Live Attenuated Vaccine Candidate

“…Mortalities are mainly due to pneumococcal pneumonia (81%) with the rest attributed to meningitis (12%), bacteraemia, and sepsis (7%) [2][3][4]. Even with modern antimicrobial treatment, survivors of invasive pneumococcal diseases Vaccines 2020, 8,187 2 of 20 usually develop long term complications such as hearing loss and neuropsychological impairments [5]. Still, these alarming figures of pneumococcal morbidity and mortality might underestimate the actual burden of pneumococcal diseases because many developing countries lack sensitive diagnostic tests for detecting the disease aetiology.…”

“…The use of these vaccines has led to a considerable reduction in mortality ascribed to pneumococcal infections [2]. These vaccines are designed to generate antibodies against the capsular polysaccharide of the pneumococcus [6] which is structurally distinct among S. pneumoniae strains [7,8]. Currently used PCVs were initially designed for use in Western industrialized countries.…”

“…Mutations in the endA gene in pneumococci have been reported to show decreased competence for natural transformation [26,27], thereby minimizing the potential for reversion of the constructed candidate vaccine strain into the wild-type. The goal of the current study was to Vaccines 2020, 8,187 3 of 20 determine the immune protection and attenuation of the constructed endA and cpsE gene knockout strains as a means of assessing their suitability as a candidate LAV.…”