Pneumococcal pneumonia and influenza: A deadly combination

Klugman, Keith P.; Chien, Yu Wen; Madhi, Shabir А.

doi:10.1016/j.vaccine.2009.06.007

Cited by 126 publications

(101 citation statements)

References 62 publications

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“…Therefore, it remains unclear if the identified mechanisms generally apply to strains of different pneumococcal serotypes. Importantly, blood cultures from living cases of the 1918 IAV pandemic revealed a higher prevalence of less invasive serotypes in secondary pneumococcal infections than the common pathogenic serotypes found at that time (2,26). This observation implicates a preference for otherwise colonizing strains to cause severe infections in IAV-infected individuals and strongly supports the hypothesis that a preexisting IAV infection influences the pathogenic effect of these strains.…”

supporting

confidence: 57%

Influenza A Virus Infection Predisposes Hosts to Secondary Infection with Different Streptococcus pneumoniae Serotypes with Similar Outcome but Serotype-Specific Manifestation

et al. 2016

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e Influenza A virus (IAV) and Streptococcus pneumoniae are major causes of respiratory tract infections, particularly during coinfection. The synergism between these two pathogens is characterized by a complex network of dysregulated immune responses, some of which last until recovery following IAV infection. Despite the high serotype diversity of S. pneumoniae and the serotype replacement observed since the introduction of conjugate vaccines, little is known about pneumococcal strain dependency in the enhanced susceptibility to severe secondary S. pneumoniae infection following IAV infection. Thus, we studied how preinfection with IAV alters host susceptibility to different S. pneumoniae strains with various degrees of invasiveness using a highly invasive serotype 4 strain, an invasive serotype 7F strain, and a carrier serotype 19F strain. A murine model of pneumococcal coinfection during the acute phase of IAV infection showed a significantly increased degree of pneumonia and mortality for all tested pneumococcal strains at otherwise sublethal doses. The incidence and kinetics of systemic dissemination, however, remained bacterial strain dependent. Furthermore, we observed strain-specific alterations in the pulmonary levels of alveolar macrophages, neutrophils, and inflammatory mediators ultimately affecting immunopathology. During the recovery phase following IAV infection, bacterial growth in the lungs and systemic dissemination were enhanced in a strain-dependent manner. Altogether, this study shows that acute IAV infection predisposes the host to lethal S. pneumoniae infection irrespective of the pneumococcal serotype, while the long-lasting synergism between IAV and S. pneumoniae is bacterial strain dependent. These results hold implications for developing tailored therapeutic treatment regimens for dual infections during future IAV outbreaks. Infection with secondary bacterial pathogens is attributed to be the major cause of excessive mortality during influenza A virus (IAV) outbreaks. This lethal synergism has been recognized as early as during the 1918-1919 IAV pandemic with an estimated global death toll of 50 to 100 million (1, 2). Retrospective studies disclosed that 71% of the fatal cases during this pandemic were positive for Streptococcus pneumoniae (also called pneumococcus), providing the first epidemiological evidence for viral-bacterial coinfections (2). A clear predisposition to bacterial disease was also evident in all of the succeeding influenza pandemics, including the more recent 2009 H1N1 outbreak, which had a 10 to 55% higher incidence of hospitalizations and mortality due to bacterial pneumonia (3). Pneumococcal colonization is transient and asymptomatic in immunocompetent individuals and most commonly occurs in early childhood (4). At the same time, however, pneumococci are able to cause a variety of diseases ranging from mild sinusitis and otitis media to more-severe infections like sepsis and meningitis. Even though the introduction of the polyvalent pneumococcal conjugate vaccines...

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supporting

confidence: 57%

Influenza A Virus Infection Predisposes Hosts to Secondary Infection with Different Streptococcus pneumoniae Serotypes with Similar Outcome but Serotype-Specific Manifestation

et al. 2016

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“…Accordingly, overrepresentation of influenza A (H1N1) is a limitation. Also, some community-acquired paediatric pneumonias may be indicative of both viral and bacterial infections [23,24]. Blood bacteria culture was negative in our study, but false negativity should be considered.…”

Section: Radiological Findings Of Viral Pneumonia In Childrenmentioning

confidence: 50%

Radiological findings in 210 paediatric patients with viral pneumonia: a retrospective case study

Guo

Wang²,

Sheng³

et al. 2012

BJR

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Objective: The objective of this study was to assess the radiological presentations of different types of viral pneumonia in children. Methods: Nasopharyngeal swab specimens and bronchial aspirate samples from children with acute respiratory infections were obtained and tested for influenza B, adenovirus, respiratory syncytial virus and parainfluenza (Types 1, 2 and 3) by direct immunofluorescence assay, or for influenza A (Subtype H1N1) by quantitative real-time polymerase chain reaction. The chest radiographs of the 210 confirmed cases of viral pneumonia were analysed retrospectively by two independent radiologists for the identification, characterisation and description of the distribution of imaging abnormalities. The cases were divided into six groups on the basis of confirmed causative viral agent, and radiographic findings were compared, analysed and presented. Results: The abnormal chest radiograph findings consisted of bilateral patchy areas of consolidation (n5133), interstitial lung disease (n533), diffuse areas of air space consolidation (n529) and lobar consolidation (n515). The abnormalities were distributed bilaterally in 195 cases and observed more frequently in the lower zones than in other regions. The radiological findings varied significantly among the six groups (p50.0050). Pairwise comparison showed significant difference between influenza A (H1N1) and adenovirus (p50.0031) only. Conclusion: The predominant radiological finding in paediatric viral pneumonia was bilateral patchy areas of consolidation. The radiological findings differed significantly only between adenovirus and influenza A pneumonia. The diagnosis of the specific causative organism requires laboratory confirmation.

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“…In fact, in a large series of 80 bacteremic pneumonia previously described, no co-infection was detected (24). It is known that influenza virus can facilitate pneumococcal diffusion from upper airways to blood stream (25), but usually a single serotype can be found in bacteremic pneumonia. The finding of a co-infection due to the two serotypes which are more frequently associated with pneumonia complications may at least in part explain the severe picture of our case .…”

Section: Discussionmentioning

confidence: 93%

Severe Necrotizing Pneumonia Complicating Influenza A (H1N1): The Role of Immunologic Interaction

Guidi¹,

Osimani²,

Azzari

et al. 2011

Int J Immunopathol Pharmacol

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This report describes the successful management of a documented necrotizing pneumonia due to Streptococcus pneumoniae in a child with pandemic influenza A (H1N1). The importance of early recognition of bacterial superinfection in patients with influenza and the immunologic interactive mechanisms between viruses and bacteria in determining respiratory diseases are highlighted. The role of modern molecular techniques in improving diagnostic microbiology sensitivity and informing consequent clinical care is emphasized.

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Pneumococcal pneumonia and influenza: A deadly combination

Cited by 126 publications

References 62 publications

Influenza A Virus Infection Predisposes Hosts to Secondary Infection with Different Streptococcus pneumoniae Serotypes with Similar Outcome but Serotype-Specific Manifestation

Influenza A Virus Infection Predisposes Hosts to Secondary Infection with Different Streptococcus pneumoniae Serotypes with Similar Outcome but Serotype-Specific Manifestation

Radiological findings in 210 paediatric patients with viral pneumonia: a retrospective case study

Severe Necrotizing Pneumonia Complicating Influenza A (H1N1): The Role of Immunologic Interaction

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