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Encyclopedia > Streptococcus pneumoniae
Streptococcus pneumoniae
SEM micrograph of S. pneumoniae.
SEM micrograph of S. pneumoniae.
Scientific classification
Domain: Bacteria
Phylum: Firmicutes
Class: Bacilli
Order: Lactobacillales
Family: Streptococcaceae
Genus: Streptococcus
Species: S. pneumoniae
Binomial name
Streptococcus pneumoniae
(Klein 1884)
Chester 1901

Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, alpha-hemolytic diplococcus bacterium and a member of the genus Streptococcus.[1] A significant human pathogen, S. pneumoniae was recognized as a major cause of pneumonia in the late 19th century and is the subject of many humoral immunity studies. Image File history File links Streptococcus_pneumoniae. ... Low temperature SEM magnification series for a snow crystal. ... A micrograph is a photograph or similar image taken through a microscope or similar device to show a magnified image of an item. ... Scientific classification or biological classification is a method by which biologists group and categorize species of organisms. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... Classes Bacilli Clostridia Mollicutes The Firmicutes are a division of bacteria, most of which have Gram-positive cell wall structure. ... Orders Bacillales Lactobacillales The term bacilli (singular bacillus) is used to refer to any rod-shaped bacteria. ... Families Aerococcaceae Carnobacteriaceae Enterococcaceae Lactobacillaceae Leuconostocaceae Streptococcaceae The Lactobacillales are an order of Gram-positive bacteria that comprise the lactic acid bacteria. ... Genera Lactococcus Lactovum Pilibacter Streptococcus The Streptococcaceae is a family of Gram-positive bacteria, placed within the order of Lactobacillales. ... Streptococcus is a genus of spherical shaped Gram-positive bacteria, belonging to the phylum Firmicutes[1] and the lactic acid bacteria group. ... This article does not cite any references or sources. ... Gram-positive bacteria are those that are stained dark blue or violet by gram staining, in contrast to gram-negative bacteria, which are not affected by the stain. ... Examples of alpha (top), beta (middle), and gamma (bottom) hemolysis on sheep blood agar plates Hemolysis is used in the empirical identification of microorganisms based on the ability of bacterial colonies grown on agar plates to break down red blood cells in the culture. ... Phyla/Divisions Actinobacteria Aquificae Bacteroidetes/Chlorobi Chlamydiae/Verrucomicrobia Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Nitrospirae Omnibacteria Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Bacteria (singular, bacterium) are a major group of living organisms. ... For other uses, see Genus (disambiguation). ... Streptococcus is a genus of spherical shaped Gram-positive bacteria, belonging to the phylum Firmicutes[1] and the lactic acid bacteria group. ... A pathogen or infectious agent is a biological agent that causes disease or illness to its host. ... Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed and flooded with fluid. ... Humoral immunity is the aspect of immunity that is mediated by secreted antibodies, produced in the cells of the B lymphocyte lineage (B cell). ...


Despite the name, the organism causes many types of infection other than pneumonia, including acute sinusitis, otitis media, meningitis, osteomyelitis, septic arthritis, endocarditis, peritonitis, pericarditis, cellulitis, and brain abscess. Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed and flooded with fluid. ... Otitis media is an inflammation of the middle ear: the space behind the ear drum. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Osteomyelitis is an infection of bone, usually caused by pyogenic bacteria or mycobacteria. ... Septic arthritis is the proliferation of bacteria in joints and resultant inflammation. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ... Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... Brain abscess (or cerebral abscess) is an abscess caused by inflammation and collection of infected material coming from local (ear infection, infection of paranasal sinuses, infection of the mastoid air cells of the temporal bone, epidural abscess) or remote (lung, heart, kidney etc. ...


S. pneumoniae is the most common cause of bacterial meningitis in adults and children, and is one of the top two isolates found in otitis media.[2] Pneumococcal pneumonia is more common in the very young and the very old.


S. pneumoniae can be differentiated from Streptococcus viridans, which is also alpha hemolytic, using an optochin test, as S. pneumoniae is optochin sensitive. The encapsulated, gram-positive coccoid bacteria have a distinctive morphology on gram stain, the so-called, "lancet shape." It has a polysaccharide capsule that acts as a virulence factor for the organism; 91 different capsular types are known, and these types differ in virulence, prevalence, and extent of drug resistance. Streptococcus viridans is a large group of generally non-pathogenic Streptococcus that are all alpha hemolytic and produce a green (hence the name) coloration on blood agar. ... Optochin is the component of P disk. ...

Contents

History

In 1881, the organism, then known as the pneumococcus for its role as an etiologic agent of pneumonia, was first isolated simultaneously and independently by the U.S Army physician George Sternberg and the French chemist Louis Pasteur. George Miller Sternberg (1838 - 1915) was a U.S. bacteriologist and physician. ... Louis Pasteur (December 27, 1822 – September 28, 1895) was a French chemist best known for his remarkable breakthroughs in microbiology. ...


The organism was termed Diplococcus pneumoniae from 1926 because of its characteristic appearance in Gram-stained sputum. It was renamed Streptococcus pneumoniae in 1974 because of its growth in chains in liquid media. Gram staining is a method for staining samples of bacteria that differentiates between the two main types of bacterial cell wall. ... This article does not cite any references or sources. ... Year 1974 (MCMLXXIV) was a common year starting on Tuesday (link will display full calendar) of the 1974 Gregorian calendar. ...


S. pneumoniae played a central role in demonstrating that genetic material consists of DNA. In 1928, Frederick Griffith demonstrated transformation of live, harmless pneumococcus into a lethal form by co-inoculating the live pneumococci into a mouse along with with heat-killed, virulent pneumococci. In 1944, Oswald Avery, Colin MacLeod, and Maclyn McCarty demonstrated that the transforming factor in Griffith's experiment was DNA, not protein as was widely believed at the time.[3] Avery's work marked the birth of the molecular era of genetics.[4] The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ... Frederick Griffith (1879 - 1941) was a British medical officer. ... It has been suggested that this article or section be merged into Transfection. ... Virulence is a term used to refer to either the relative pathogenicity or the relative ability to do damage to the host of an infectious agent. ... Oswald Theodore Avery (October 21, 1877–1955) was a Canadian-born American physician and medical researcher. ... Colin Munro MacLeod (1909 – 1972) was a Canadian-American geneticist. ... Maclyn McCarty (June 9, 1911–January 2, 2005) was an American geneticist. ... Griffiths experiment was conducted in 1928 by Frederick Griffith which was one of the first experiments suggesting that bacteria are capable of transferring genetic information, otherwise known as the “transforming principle”, which was later discovered to be DNA. Griffith used two strains of Pneumococcus (which infects mice), a S...


Pathogenesis

S. pneumoniae is normally found in the nasopharynx of 5-10% of healthy adults, and 20-40% of healthy children.[1] It can be found in higher amounts in certain environments, especially those where people are spending a great deal of time in close proximity to each other (day cares, army barracks). It attaches to nasopharyngeal cells through interaction of bacterial surface adhesins. This normal colonization can become infectious if the organisms are carried into areas such as the Eustachian tube or nasal sinuses where it can cause otitis media and sinusitis, respectively. Pneumonia occurs if the organisms are inhaled into the lungs and not cleared (again, viral infection, or smoking-induced ciliary paralysis might be contributing factors). Once the organism makes its way to a site where it is not normally found, it activates the complement protein group, stimulates cytokine production, and attracts white blood cells (specifically neutrophils). The organism's polysaccharide capsule makes it resistant to phagocytosis, and if there is no pre-existing anticapsular antibody, alveolar macrophages cannot adequately kill the pneumococci. The organism spreads to the blood stream (where it can cause bacteremia) and is carried to the meninges, joint spaces, bones, and peritoneal cavity, and may result in meningitis, brain abscess, septic arthritis, or osteomyelitis. The nasopharynx (nasal part of the pharynx) lies behind the nose and above the level of the soft palate: it differs from the oral and laryngeal parts of the pharynx in that its cavity always remains patent (open). ... Adhesin Adhesins are antigens that may exist on the surface of microbes. ... The Eustachian tube (or auditory tube) is a tube that links the pharynx to the middle ear. ... The paranasal sinuses are eight (four pairs) air-filled spaces, or sinuses, within the bones of the skull and face. ... Otitis media is an inflammation of the middle ear: the space behind the ear drum. ... Sinusitis is an inflammation of the paranasal sinuses, which may or may not be as a result of infection, from bacterial, fungal, viral, allergic or autoimmune issues. ... The cigarette is the most common method of smoking tobacco. ... A complement protein attacking an invader. ... Cytokines are a group of proteins and peptides that are used in organisms as signaling compounds. ... A scanning electron microscope image of normal circulating human blood. ... This article does not cite any references or sources. ... Polysaccharides (sometimes called glycans) are relatively complex carbohydrates. ... Phagocytosis is a form of endocytosis wherein large particles are enveloped by the cell membrane of a (usually larger) cell and internalized to form a phagosome, or food vacuole. ... A macrophage of a mouse stretching its arms to engulf two particles, possibly pathogens Macrophages (Greek: big eaters, makros = long, phagein = eat) are white blood cells, more specifically phagocytes, acting in the nonspecific defense as well as the specific defense system of vertebrate animals. ... Bacteremia (Bacteræmia in British English, also known as blood poisoning or toxemia) is the presence of bacteria in the blood. ... The meninges (singular meninx) are the system of membranes that envelop the central nervous system. ... Grays Anatomy illustration of a human femur. ... In higher vertebrates, the peritoneum is the membrane that forms the lining of the abdominal cavity - it covers most of the intra-abdominal organs. ... Meningitis is the inflammation of the protective membranes covering the central nervous system, known collectively as the meninges. ... Brain abscess (or cerebral abscess) is an abscess caused by inflammation and collection of infected material coming from local (ear infection, infection of paranasal sinuses, infection of the mastoid air cells of the temporal bone, epidural abscess) or remote (lung, heart, kidney etc. ... Septic arthritis is the proliferation of bacteria in joints and resultant inflammation. ... Osteomyelitis is an infection of bone, usually caused by pyogenic bacteria or mycobacteria. ...


S. pneumoniae has several virulence factors, including the polysaccharide capsule mentioned earlier, that help it evade a host's immune system. It has pneumococcal surface proteins that inhibit complement-mediated opsonization, and it secretes IgA1 protease that will destroy secretory IgA produced by the body.


The risk of pneumococcal infection is much increased in persons with impaired IgG synthesis, impaired phagocytosis, or defective clearance of pneumococci. In particular, the absence of a functional spleen, through congenital asplenia, splenectomy, or sickle-cell disease predisposes one to a more severe course of infection (Overwhelming post-splenectomy infection) and prevention measures are indicated (see asplenia). The spleen is an organ located in the abdomen, where it functions in the destruction of old red blood cells and holding a reservoir of blood. ... Congenital Asplenia is a condition in which a newborn baby is missing its spleen. ... A splenectomy is a procedure that involves the removal of the spleen by operative means. ... Sickle-cell disease is a group of genetic disorders caused by sickle hemoglobin (Hgb S or Hb S). ... Overwhelming post-splenectomy infection or OPSI is a rapidly fatal septicaemia infection due to the absence of spleen (asplenia) protection against certain bacteria. ... Asplenia refers to the absence (a-) of normal spleen function and is associated with some risks. ...


Virulence Factors

S. pneumoniae expresses different virulence factors on its cell surface and inside the organism. These virulence factors contribute to some of the clinical manifestations during infection with S. pneumoniae.

  • Polysaccharide capsule -prevents phagocytosis by host immune cells by inhibiting C3b opsonization of the bacterial cells
  • Pneumolysin (Ply) -a 53-kDa protein that can cause lysis of host cells and activate complement
  • Autolysin (LytA) -activation of this protein lyses the bacteria releasing its internal contents (i.e. pneumolysin)
  • Hydrogen peroxide -can cause apoptosis in neuronal cells during meningitis
  • Pili -needle-like structures that extend from the surface of many strains of S. pneumoniae; enhances colonization of upper respiratory tract and is required for release of large amounts of TNF, which is involved in septic shock[5]
  • Choline binding protein A (CbpA) -an adhesin that can interact with carbohydrates on the cell surface of pulmonary epithelial cells
  • Protective Antigen (PspA) -can inhibit complement-mediated opsonization of pneumococci

Image of bacteriological pili or fimbriae A pilus (Latin; plural : pili) is a hairlike structure on the surface of a cell, especially Gram-negative bacteria, a protein appendage required for bacterial conjugation. ... Tumor necrosis factors (or the TNF-family) refers to a group of cytokines family which can cause apoptosis. ... Septic shock is a serious medical condition causing such effects as multiple organ failure and death in response to infection and sepsis. ...

Humoral immunity

In the 19th century, it was demonstrated that immunization of rabbits with killed pneumococci protected them against subsequent challenge with viable pneumococci. Serum from immunized rabbits or from humans who had recovered from pneumococcal pneumonia also conferred protection. In the 20th century, the efficacy of immunization was demonstrated in South African miners. Alternative meaning: Nineteenth Century (periodical) (18th century — 19th century — 20th century — more centuries) As a means of recording the passage of time, the 19th century was that century which lasted from 1801-1900 in the sense of the Gregorian calendar. ... Genera Pentalagus Bunolagus Nesolagus Romerolagus Brachylagus Sylvilagus Oryctolagus Poelagus Rabbits are small mammals in the family Leporidae of the order Lagomorpha, found in several parts of the world. ... Blood plasma is the liquid component of blood, in which the blood cells are suspended. ... (19th century - 20th century - 21st century - more centuries) Decades: 1900s 1910s 1920s 1930s 1940s 1950s 1960s 1970s 1980s 1990s As a means of recording the passage of time, the 20th century was that century which lasted from 1901–2000 in the sense of the Gregorian calendar (1900–1999...


It was discovered that the pneumococcus's capsule made it resistant to phagocytosis, and in the 1920s it was shown that an antibody specific for capsular polysaccharide aided the killing of S. pneumoniae. In 1936, a pneumococcal capsular polysaccharide vaccine was used to abort an epidemic of pneumococcal pneumonia. In the 1940s, experiments on capsular transformation by pneumococci first identified DNA as the material that carries genetic information. The 1920s is a decade that is sometimes referred to as the Jazz Age or the Roaring Twenties, usually applied to America. ... 1936 (MCMXXXVI) was a leap year starting on Wednesday (link will take you to calendar). ... This article or section does not cite any references or sources. ... The structure of part of a DNA double helix Deoxyribonucleic acid, or DNA, is a nucleic acid molecule that contains the genetic instructions used in the development and functioning of all known living organisms. ...


In 1900, it was recognized that different serovars of pneumococci exist, and that immunization with a given serovar did not protect against infection with other serovars. Since then over ninety serovars have been discovered, each with a unique polysaccharide capsule which can be identified by the quellung reaction. Because some of these serovars cause disease more commonly than others, it is possible to provide reasonable protection by immunizing with less than 90 serovars; the current vaccine contains 23 serovars (i.e., it is "23-valent"). Äž: For the film, see: 1900 (film). ... A serovar or serotype is a grouping of microorganisms or viruses based on their cell surface antigens. ... Quellung reaction This reaction allows the capsule of a bacterium to be seen by means of antibodies produced against it. ...


The serovars are numbered according to two systems: the American system, which numbers them in the order in which they were discovered, and the Danish system which groups them according to antigenic similarities.


Treatment

Historically, treatment relied primarily on β-lactam antibiotics. In the 1960s, nearly all strains of S. pneumoniae were susceptible to penicillin, but since that time, there has been an increasing prevalence of penicillin resistance, especially in areas of high antibiotic use. A varying proportion of strains may also be resistant to cephalosporins, macrolides (such as erythromycin), tetracycline, clindamycin and the quinolones. Penicillin-resistant strains are more likely to be resistant to other antibiotics. Most isolates remain susceptible to vancomycin, though its use in a β-lactam-susceptible isolate is less desirable because of tissue distribution of the drug and concerns of development of vancomycin resistance. More advanced beta-lactam antibiotics (cephalosporins) are commonly used in combination with other drugs to treat meningitis and community-acquired pneumonia. In adults, recently developed fluoroquinolones such as levofloxacin and moxifloxacin are often used to provide empiric coverage for patients with pneumonia. Susceptibility testing should be routine, with empiric antibiotic treatment guided by resistance patterns in the community in which the organism was acquired, pending the results. There is currently debate as to how relevant the results of susceptibility testing are to clinical outcome.[6][7] There is slight clinical evidence that penicillins may act synergistically with macrolides to improve outcomes.[8] The 1960s decade refers to the years from January 1, 1960 to December 31, 1969, inclusive. ... Penicillin nucleus Penicillin (sometimes abbreviated PCN) refers to a group of β-lactam antibiotics used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. ... Antibiotic resistance is the ability of a micro-organism to withstand the effects of an antibiotic. ... Staphylococcus aureus - Antibiotics test plate. ... The cephalosporins, are a class of β-lactam antibiotics. ... The macrolides are a group of drugs (typically antibiotics) whose activity stems from the presence of a macrolide ring, a large lactone ring to which one or more deoxy sugars, usually cladinose and desosamine, are attached. ... Tetracycline (INN) (IPA: ) is a broad-spectrum antibiotic produced by the streptomyces bacterium, indicated for use against many bacterial infections. ... Clindamycin (rINN) (IPA: ) is a lincosamide antibiotic used in the treatment of infections caused by susceptible microorganisms. ... Nalidixic acid Ciprofloxacin Levofloxacin Trovafloxacin The quinolones are a family of broad-spectrum antibiotics. ... Crystal structure of a short peptide L-Lys-D-Ala-D-Ala (bacterial cell wall precursor, in green) bound to vancomycin (blue) through hydrogen bonds. ... The cephalosporins, are a class of β-lactam antibiotics. ... Levofloxacin is an advanced generation fluoroquinolone antibiotic, marketed by Ortho-McNeil under the trade name Levaquin in the United States. ... Moxifloxacin is a synthetic fluoroquinolone antibiotic agent. ...


Prevention

Vaccination in the USA

In the USA, a heptavalent pneumococcal conjugate vaccine vaccine (PCV 7) (e.g. Prevnar) is recommended since 2000 for all children aged 2-23 months and for at-risk children aged 24-59 months. The normally 4-doses series is given at 2, 4, 6 & 12 - 14 months of age. Protection is good against deep pneumococcal infections (especially septicemia and meningitis). Similar 9- and 13-valent vaccines are being tested. Yet, if the child is exposed to a serotype of pneumococcus that is not contained in the vaccine, he/she is not afforded any protection. This limitation, and the ability of capsular-polysaccharide conjugate vaccines to promote the spread of non-covered serotypes, has led to research into vaccines that would provide species-wide protection. A conjugate vaccine is created by covalently attaching a poor antigen to a carrier protein, thereby conferring the immunological attributes of the carrier on the attached antigen. ... To meet Wikipedias quality standards, this article may require cleanup. ...


Pneumococcal polysaccharide vaccine (Pneumovax™ is one brand) gives at least 85% protection in those under 55 years of age for five years or longer. Immunization is suggested for those at highest risk of infection, including those 65 years or older, and generally should be a single lifetime dose (high risk side effects if repeated). The standard 23-valent vaccines are ineffective for children under two years old. Pneumococcal polysaccharide vaccine (PPV), also known as Pneumovax, is a vaccine used to prevent Streptococcus pneumoniae (pneumococcus) infections such as pneumonia and septicaemia. ...


The current guidelines of the American College of Physicians call for administration of the immunization between ages 2 and 65 when indicated, or at age 65. If someone received the immunization before age 60, the guidelines call for a one-time revaccination. The American College of Physicians (ACP) is a national organization of doctors of internal medicine (internists) -- physicians who specialize in the prevention, detection and treatment of illnesses in adults. ...


Revaccination at periodic intervals is also indicated for those with other conditions such as asplenia or nephrotic syndrome. Asplenia refers to the absence (a-) of normal spleen function and is associated with some risks. ...


Vaccination in the UK

It was announced in February 2006 that the UK government would introduce vaccination with the conjugate vaccine in children aged 2, 4 and 13 months.[9][10] This is expected to start on September 4, 2006 and is to include changes to the immunisation programme in general.[11] is the 247th day of the year (248th in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ...


Vaccine research

There is currently research into producing vaccines than can be given into the nose rather than by injection.[12] [13] It is believed that this improves vaccine efficacy and also avoids the need for injection.


The development of serotype-specific anticapsular monoclonal antibodies has also been an area of vaccine research in recent years. These antibodies have been shown to prolong survival in a mouse model of pneumococcal infection characterized by a reduction in bacterial loads and a suppression of the host inflammatory response.[14][15]


Interaction with Haemophilus influenzae

Both H. influenzae and S. pneumoniae can be found in the human upper respiratory system. A study of competition in a laboratory revealed that, in a petrì dish, S. pneumoniae always overpowered H. influenzae by attacking it with a hydrogen peroxide and stripping off surface molecules that H. influenzae needs for survival. Binomial name Haemophilus influenzae (Lehmann & Neumann 1896) Winslow 1917 Haemophilus influenzae, formerly called Pfeiffers bacillus or Bacillus influenzae, is a non-motile Gram-negative coccobacillus first described in 1892 by Dr. Richard Pfeiffer during an influenza pandemic. ... Hydrogen peroxide (H2O2) is a very pale blue liquid which appears colourless in a dilute solution, slightly more viscous than water. ...


When both bacteria are placed together into a nasal cavity, within 2 weeks, only H. influenzae survives. When both are placed separately into a nasal cavity, each one survives. Upon examining the upper respiratory tissue from mice exposed to both bacteria, an extraordinarily large number of neutrophils immune cells were found. In mice exposed to only one bacteria, the cells were not present. Neutrophil granulocytes (commonly referred to as neutrophils) are a class of white blood cells and are part of the immune system. ...


Lab tests show that neutrophils that were exposed to already dead H. influenzae were more aggressive in attacking S. pneumoniae than unexposed neutrophils. Exposure to killed H. influenzae had no effect on live H. influenzae.


Two scenarios may be responsible for this response:

  1. When H. influenzae is attacked by S. pneumoniae, it signals the immune system to attack the S. pneumoniae
  2. The combination of the two species together sets off an immune system alarm that is not set off by either species individually.

It is unclear why H. influenzae is not affected by the immune system response.[16]


References

  1. ^ a b Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology, 4th ed., McGraw Hill. ISBN 0-8385-8529-9. 
  2. ^ Dagan R. "Treatment of acute otitis media - challenges in the era of antibiotic resistance". Vaccine 19 Suppl 1: S9-S16. PMID 11163457. 
  3. ^ Avery OT, MacLeod CM, and McCarty M (1944). "Studies on the chemical nature of the substance inducing transformation of pneumococcal types." J Exp Med 79:137-158.
  4. ^ Lederberg J (1994). "The transformation of genetics by DNA: an anniversary celebration of Avery, MacLeod and McCarty (1944)". Genetics 136 (2): 423-6. PMID 8150273. 
  5. ^ Barocchi M, Ries J, Zogaj X, Hemsley C, Albiger B, Kanth A, Dahlberg S, Fernebro J, Moschioni M, Masignani V, Hultenby K, Taddei A, Beiter K, Wartha F, von Euler A, Covacci A, Holden D, Normark S, Rappuoli R, Henriques-Normark B (2006). "A pneumococcal pilus influences virulence and host inflammatory responses". Proc Natl Acad Sci U S A 103 (8): 2857-2862. PMID 16481624. 
  6. ^ Peterson LR (2006). "Penicillins for treatment of pneumococcal pneumonia: does in vitro resistance really matter?". Clin Infect Dis 42 (2): 224-33. PubMed. 
  7. ^ Tleyjeh IM, Tlaygeh HM, Hejal R, Montori VM, Baddour LM (2006). "The impact of penicillin resistance on short-term mortality in hospitalized adults with pneumococcal pneumonia: a systematic review and meta-analysis". Clin Infect Dis 42 (6): 788-97. PubMed. 
  8. ^ Martínez JA, Horcajada JP, Almela M, et al. (2003). "Addition of a Macrolide to a β-Lactam based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia". Clin Infect Dis 36: 389–395. PMID 12567294. 
  9. ^ "Children to be given new vaccine" BBC News, February 08, 2006, retrieved August 25, 2006
  10. ^ "Pneumococcal vaccine added to the childhood immunisation programme" February 08, 2006
  11. ^ "Changes to the immunisation programme in the UK" Meningitis Research Foundation, retrieved August 25, 2006
  12. ^ Hanniffy SB, Carter AT, Hitchin E, Wellsa JM. (2007). "Mucosal delivery of a Pneumococcal vaccine using Lactococcus lactis affords protection against respiratory infection". J Infect Dis 195: 185-193. 
  13. ^ Malley R. Lipsitch M, Stack A, Saladino R, Fleisher G, Pelton S, Thompson C, Briles D, Anderson P. (2001). "Intranasal immunization with killed unencapsulated whole cells prevents colonization and invasive disease by capsulated pneumococci.". Infect Immun 69: 4870-4873. 
  14. ^ Burns T, Abadi M, Pirofski L (2005). "Modulation of the lung inflammatory response to serotype 8 pneumococcal infection by a human immunoglobulin m monoclonal antibody to serotype 8 capsular polysaccharide". Infect Immun 73 (8): 4530-8. PMID 16040964. 
  15. ^ Fabrizio K, Groner A, Boes M, Pirofski L. "A Human Monoclonal IgM Reduces Bacteremia and Inflammation in a Mouse Model of Systemic Pneumococcal Infection". Clin Vaccine Immunol. PMID 17301214. 
  16. ^ Lysenko ES, Ratner AJ, Nelson AL, Weiser JN (2005). "The role of innate immune responses in the outcome of interspecies competition for colonization of mucosal surfaces". PLoS Pathog 1 (1): e1. PMID 16201010.  Full text

  Results from FactBites:
 
Streptococcus pneumoniae - Wikipedia, the free encyclopedia (1391 words)
Streptococcus pneumoniae is a species of Streptococcus that is a major human pathogen.
It was renamed Streptococcus pneumoniae in 1974 because of its growth in chains in liquid media.
In 1936, a pneumococcal capsular polysaccharide vaccine was used to abort an epidemic of pneumococcal pneumonia.
  More results at FactBites »

 
 

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