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Chapter 1 : The History of Pneumococcal Disease
Category: Bacterial Pathogenesis; Immunology
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This chapter reviews some of the major events in the history of Streptococcus pneumoniae—events that have led to our modern understanding of the pathogenesis, diagnosis, treatment, and prevention of pneumococcal disease. Manifestations of primary infection involved the respiratory tract, including pneumonia, acute purulent tracheobronchitis, otitis media, and acute purulent sinusitis. Pneumococcal pneumonia was a driving force behind clinical and microbiologic research. Until the 1880s and 1890s, pneumonia had been regarded as a respiratory affliction rather than an infectious disease, with no specific therapy other than supportive care and various ineffectual potions and poultices. To provide serum treatment outside the academic medical centers, an ambitious new infrastructure of pneumonia control programs was developed with the intention of providing serum, usually at no cost, to treat the largest number of people possible. The general impression was that penicillin had conquered the pneumococcus: it eliminated the need for serotyping, for serum therapy, and for the further development of vaccines. The reality was that the very young and the very old continued to have high rates of mortality. Capsular type switching, originally observed in experiments with mice, has now been implicated in humans and may play an important role in the expansion of nonvaccine serotypes.
Part of Fig. 28, “Examination of sputum and cultures,” from Bullowa’s handbook (reference 16 , p. 83). Reproduced with permission of Oxford University Press.
Fever curve and treatment details from a patient, “Male, aged 25 years, 5th day single dose (120 cc.) (Processed Rabbit serum Pn. I) temperature normal in 6 hours.” (Bullowa’s Fig. 114, p. 348 [ 16 ].) Note X-ray and culture results and tests for type I agglutinins in serum. Reproduced with permission of Oxford University Press.
Mortality rates from pneumococcal pneumonia by age in the period before antibiotics (Boston 1929–1930), from Heffron’s monograph ( 61 ); in the early antibiotic era (Brooklyn, 1952–1962), from Austrian and Gold ( 11 ); and after well-established use (Chicago 1967–1970), from Mufson et al. ( 87 ). (Figure by Daniel Musher.)