Chapter 14 : A Pathogenetic Categorization of Clinical Syndromes Caused by

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

A Pathogenetic Categorization of Clinical Syndromes Caused by , Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555816537/9781555812973_Chap14-1.gif /docserver/preview/fulltext/10.1128/9781555816537/9781555812973_Chap14-2.gif


This chapter discusses clinical syndromes caused by , categorizing them based on pathogenesis and immune response. The current understanding of hematogenous infection is based on an expanded understanding of events in which pneumococci “settle out in” or “seed” various body sites. The resulting infections include meningitis, primary peritonitis, septic arthritis, osteomyelitis, and soft tissue infection. Important in the pathogenesis of acute sinusitis is congestion of the mucosal membranes caused by allergy or viral infection; resulting obstruction at the osteomeatal complex prevents clearance of bacteria. Not surprisingly, the bacteriology of acute maxillary sinusitis is similar to that of otitis media, with and/or being isolated in the great majority of cases. The majority of patients with pneumococcal pneumonia do not have detectable bacteremia, and it is very uncommon for the laboratory to isolate pneumococci from sputum of a patient who does not have a clear clinical picture of pneumonia or acute purulent tracheobronchitis. Empyema, the most common complication of pneumococcal pneumonia in the preantibiotic era, occurred in about 5% of cases and remains the most common today, with an incidence of approximately 2%. , despite its somewhat limited array of tissue-damaging enzymes and toxins, remains a prominent cause of infection with a surprisingly broad array of manifestations.

Citation: Musher D. 2004. A Pathogenetic Categorization of Clinical Syndromes Caused by , p 211-220. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch14
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


1. Anstadt, M. P.,, C. K. Guill,, E. R. Ferguson,, H. S. Gordon,, E. R. Soltero,, A. C. Beall, Jr., and D. M. Musher. 2003. Surgical vs. nonsurgical treatment of empyema: an outcomes analysis. Am. J. Med. Sci. 326: 8 14.
2. Barker, J. H.,, D. M. Musher,, R. Silberman,, H. M. Phan,, and D. A. Watson. 1999. Genetic relatedness among nontypeable pneumococci implicated in sporadic cases of conjunctivitis. J. Clin. Microbiol. 37: 4039 4041.
3. Barrett-Connor, E. 1971. The nonvalue of sputum culture in the diagnosis of pneumococcal pneumonia. Am. Rev. Respir. Dis. 103: 845 848.
4. Burman, L. A.,, R. Norrby,, and B. Trollfors. 1985. Invasive pneumococcal infections: incidence, predisposing factors, and prognosis. Rev. Infect. Dis. 7: 133 142.
5. Chang, J. L.,, and J. M. Mylotte. 1987. Pneumococcal bacteremia: updated from an adult hospital with a high rate of nosocomial cases. J. Am. Geriatr. Soc. 35: 747 754.
6. Chodosh, S. 1987. Acute bacterial exacerbations in bronchitis and asthma. Am. J. Med. 82: 154 163.
7. Chodosh, S.,, J. McCarty,, S. Farkas,, M. Drehobl,, R. Tosiello,, M. Shan,, L. Aneiro,, S. Kowalsky, and The Bronchitis Study Group. 1998. Randomized, double-blind study of ciprofloxacin and cefuroxime axetil for treatment of acute bacterial exacerbations of chronic bronchitis. Clin. Infect. Dis. 27: 722 729.
8. DiNubile, M. J.,, M. A. Albornoz,, R. J. Stumacher,, B. L. Van Uitert,, S. A. Paluzzi,, L. M. Bush,, S. C. Nelson,, and A. R. Myers. 1991. Pneumococcal soft-tissue infections: possible association with connective tissue diseases. J. Infect. Dis. 163: 897 900.
9. Dowell, S. F.,, J. C. Butler,, G. S. Giebink,, M. R. Jacobs,, D. Jernigan,, D. M. Musher,, A. Rakowsky,, and B. Schwartz. 1999. Acute otitis media: management and surveillance in an era of pneumococcal resistance—a report from the Drug-resistant Streptococcus pneumoniae Therapeutic Working Group. Pediatr. Infect. Dis. J. 18: 1 9.
10. Dowell, S. F.,, R. L. Garman,, G. Liu,, O. S. Levine,, and Y. H. Yang. 2001. Evaluation of Binax NOW, an assay for the detection of pneumococcal antigen in urine samples, performed among pediatric patients. Clin. Infect. Dis. 32: 824 825.
11. Dowell, S. F.,, C. G. Whitney,, C. Wright,, C. E. Rose, Jr., and A. Schuchat. 2003. Seasonal patterns of invasive pneumococcal disease. Emerg. Infect. Dis. 9: 573 579.
12. Dugi, D. D., III, D. M. Musher, J. E. Clarridge III, and R. Kimbrough. 2001. Intraabdominal infection due to Streptococcus pneumoniae. Medicine (Baltimore) 80: 236 244.
13. Faden, H.,, L. Duffy,, R. Wasielewski,, J. Wolf,, D. Krystofik,, and Y. Tung. 1997. Relationship between nasopharyngeal colonization and the development of otitis media in children. Tonawanda/Williamsville Pediatrics. J. Infect. Dis. 175: 1440 1445.
14. Fainstein, V.,, D. M. Musher,, and T. R. Cate. 1980. Bacterial adherence to pharyngeal cells during viral infection. J. Infect. Dis. 141: 172 176.
15. Fang, G. D.,, M. Fine,, J. Orloff,, D. Arisumi,, V. L. Yu,, W. Kapoor,, J. T. Grayston,, S. P. Wang,, R. Kohler,, R. R. Muder, et al. 1990. New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases. Medicine (Baltimore) 69: 307 316.
16. Franco, M.,, and D. M. Musher. 1982. Thoracic empyema: The impact of management on outcome. Am. Rev. Respir. Dis. 124: 82. (Abstract.).
17. Gluckman, S. J.,, V. C. Dvorak,, and R. R. MacGregor. 1977. Host defenses during prolonged alcohol consumption in a controlled environment. Arch. Intern. Med. 137: 1539 1543.
18. Gray, B. M.,, G. M. Converse III,, and H. C. Dillon, Jr. 1980. Epidemiologic studies of Streptococcus pneumoniae in infants: acquisition, carriage, and infection during the first 24 months of life. J. Infect. Dis. 142: 923 933.
19. Gray, B. M.,, and H. C. Dillon, Jr. 1988. Epidemiological studies of Streptococcus pneumoniae in infants: antibody to types 3, 6, 14, and 23 in the first two years of life. J. Infect. Dis. 158: 948 955.
20. Grigoriadis, E.,, and W. L. Gold. 1997. Pyogenic brain abscess caused by Streptococcus pneumoniae: case report and review. Clin. Infect. Dis. 25: 1108 1112.
21. Gutierrez, F.,, M. Masia,, J. C. Rodriguez,, A. Ayelo,, B. Soldan,, L. Cebrian,, C. Mirete,, G. Royo,, and A. M. Hidalgo. 2003. Evaluation of the immunochromatographic Binax NOW assay for detection of Streptococcus pneumoniae urinary antigen in a prospective study of community-acquired pneumonia in Spain. Clin. Infect. Dis. 36: 286 292.
22. Gwaltney, J. M. J.,, C. D. Phillips,, R. D. Miller,, and D. K. Riker. 1994. Computed tomographic study of the common cold. N. Engl. J. Med. 330: 25 30.
23. Gwaltney, J. M. J.,, W. M. Scheld,, M. A. Sande,, and A. Sydnor. 1992. The microbial etiology and antimicrobial therapy of adults with acute community-acquired sinusitis: a fifteen-year experience at the University of Virginia and review of other selected studies. J. Allergy Clin. Immunol. 90: 457 462.
24. Heffron, R. 1939. Pneumonia, with special reference to pneumococcus lobar pneumonia. Harvard University Press, Cambridge, Mass. (Reprint, 1979.).
25. Hodges, R.,, and C. MacLeod. 1946. Epidemic pneumococcal pneumonia. II. The influence of population characteristics and the environment. Am. J. Hyg. 44: 193 206.
26. Hook, E. W. I.,, C. A. Horton,, and D. R. Schaberg. 1983. Failure of intensive care unit support to influence mortality from pneumococcal bacteremia. JAMA 249: 1055 1057.
27. Jones, E. E.,, P. L. Alford,, A. L. Reingold, et al. 1998. Predisposition to invasive pneumococcal illness following parainfluenza type 3 virus infection in chimpanzees. J. Am. Vet. Med. Assoc. 185: 1351 1353.
28. Kim, P. E.,, D. M. Musher,, W. P. Glezen,, M. C. Rodriguez-Barradas,, W. K. Nahm,, and C. E. Wright. 1996. Association of invasive pneumococcal disease with season, atmospheric conditions, air pollution, and the isolation of respiratory viruses. Clin. Infect. Dis. 22: 100 106.
29. Light, R. W.,, W. M. Girard,, S. G. Jenkinson,, and R. B. George. 1980. Parapneumonic effusions. Am. J. Med. 69: 507 512.
30. Lindberg, J.,, J. Prag,, and H. C. Schonheyder. 1998. Pneumococcal endocarditis is not just a disease of the past: an analysis of 16 cases diagnosed in Denmark 1986-1997. Scand. J. Infect. Dis. 30: 469 472.
31. Lipsky, B. A.,, E. J. Boyko,, T. S. Inui,, and T. D. Koepsell. 1986. Risk factors for acquiring pneumococcal infections. Arch. Intern. Med. 146: 2179 2185.
32. Martin, M.,, J. H. Turco,, M. E. Zegans,, R. R. Facklam,, S. Sodha,, J. A. Elliott,, J. H. Pryor,, B. Beall,, D. D. Erdman,, Y. Y. Baumgartner,, P. A. Sanchez,, J. D. Schwartzman,, J. Montero,, A. Schuchat,, and C. G. Whitney. 2003. An outbreak of conjunctivitis due to atypical Streptococcus pneumoniae. N. Engl. J. Med. 348: 1112 1121.
33. Metlay, J. P.,, R. Schulz,, Y.-H. Li,, D. E. Singer,, T. J. Marrie,, C. M. Coley,, L. J. Hough,, D. S. Obrosky,, W. N. Kapoor,, and M. J. Fine. 1997. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch. Intern. Med. 157: 1453 1459.
34. Morley, P. K.,, R. G. Hull,, and M. A. Hall. 1987. Pneumococcal septic arthritis in rheumatoid arthritis. Ann. Rheum. Dis. 46: 482 484.
35. Mowat, A. G.,, and J. Baum. 1980. Chemotaxis of polymorphonuclear leukocytes from patients with diabetes mellitus. N. Engl. J. Med. 142: 869 875.
36. Murphy, T. F.,, and B. C. Fine. 1984. Bacteremic pneumococcal pneumonia in the elderly. Am. J. Med. Sci. 288: 114 118.
37. Musher, D. M., Streptococcus pneumoniae. In G. L. Mandell,, J. E. Bennett,, and R. Dolin (ed.), Mandell, Douglass, and Bennett’s Principles and Practice of Infectious Diseases, 6th ed., in press. John Wiley & Sons, New York, N. Y..
38. Musher, D. M.,, I. Alexandraki,, E. A. Graviss,, N. Yanbeiy,, A. Eid,, L. A. Inderias,, H. M. Phan,, and E. Solomon. 2000. Bacteremic and nonbacteremic pneumococcal pneumonia. A prospective study. Medicine (Baltimore) 79: 210 221.
39. Musher, D. M.,, K. R. Kubitschek,, J. Crennan,, and R. E. Baughn. 1983. Pneumonia and acute febrile tracheobronchitis due to Haemophilus influenzae. Ann. Intern. Med. 99: 444 450.
40. Musher, D. M.,, R. Mediwala,, H. M. Phan,, G. Chen,, and R. E. Baughn. 2001. Nonspecificity of assaying for IgG antibody to pneumolysin in circulating immune complexes as a means to diagnose pneumococcal pneumonia. Clin. Infect. Dis. 32: 534 538.
40.a. Musher, D. M.,, R. Montoya,, and A. Wanahita. Reliability of microscopic examination of gram-stained sputum and sputum culture in patients with bacteremic pneumococcal pneumonia. Clin. Infec. Dis., in press.
41. New England Journal of Medicine. 1990. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 49-1990. A 47-year-old Cape Verdean man with pericardial disease. N. Engl. J. Med. 323: 16141624.
42. Nuorti, J. P.,, J. C. Butler,, M. M. Farley,, L. H. Harrison,, A. McGeer,, M. S. Kolczak,, R. F. Breiman, and Active Bacterial Core Surveillance Team. 2000. Cigarette smoking and invasive pneumococcal disease. N. Engl. J. Med. 342: 681 689.
43. Ort, S.,, J. L. Ryan,, G. Barden,, and N. D’Espopo. 1983. Pneumococcal pneumonia in hospitalized patients. Clinical and radiological presentations. JAMA 249: 214 218.
44. Perlino, C. A. 1984. Laboratory diagnosis of pneumonia due to Streptococcus pneumoniae. J. Infect. Dis. 150: 139 144.
45. Perlino, C. A.,, and D. Rimland. 1985. Alcoholism, leukopenia, and pneumococcal sepsis. Am. Rev. Respir. Dis. 132: 757 760.
46. Peters, N. S.,, S. J. Eykyn,, and A. G. Rudd. 1989. Pneumococcal cellulitis: a rare manifestation of pneumococcaemia in adults. J. Infect. 19: 57 59.
47. Powderly, W. G.,, S. L. Stanley, Jr., and G. Medoff. 1986. Pneumococcal endocarditis: report of a series and review of the literature. Rev. Infect. Dis. 8: 786 791.
48. Quagliarello, V. J.,, and W. M. Scheld. 1997. Treatment of bacterial meningitis. N. Engl. J. Med. 336: 708 716.
49. Rahav, G.,, L. Ben-David,, and E. Persitz. 1991. Postmenopausal pneumococcal tuboovarian abscess. Rev. Infect. Dis. 13: 896 897.
50. Rahav, G.,, Y. Toledano,, D. Engelhard,, A. Simhon,, A. E. Moses,, T. Sacks,, and M. Shapiro. 1997. Invasive pneumococcal infections: a comparison between adults and children. Medicine (Baltimore) 76: 295 303.
51. Raz, R.,, G. Elhanan,, Z. Shimoni,, R. Kitzes,, C. Rudnicki,, Y. Igra,, A. Yinnon, and the Israeli Adult Pneumococcal Bacteremia Group. 1997. Pneumococcal bacteremia in hospitalized Israeli adults: epidemiology and resistance to penicillin. Clin. Infect. Dis. 24: 1164 1168.
52. Repine, J. E.,, C. C. Clawson,, and F. C. Goetz. 1980. Bactericidal function of neutrophils from patients with acute bacterial infections and from diabetics. J. Infect. Dis. 6: 869 875.
53. Robinson, E. N. J. 1990. Pneumococcal endometritis and neonatal sepsis. Rev. Infect. Dis. 12: 416 422.
54. Rodriguez Barradas, M. C.,, D. M. Musher,, R. J. Hamill,, M. Dowell,, J. T. Bagwell,, and C. V. Sanders. 1992. Unusual manifestations of pneumococcal infection in human immunodeficiency virus-infected individuals: the past revisited. Clin. Infect. Dis. 14: 192 199.
55. Ross, J. J.,, C. L. Saltzman,, P. Carling,, and D. S. Shapiro. 2003. Pneumococcal septic arthritis: review of 190 cases. Clin. Infect. Dis. 36: 319 327.
56. Ryczak, M.,, M. Sands,, R. B. Brown,, and J. H. Sklar. 1987. Pneumococcal arthritis in a prosthetic knee. A case report and review of the literature. Clin. Orthop. 1987: 224 227.
57. Schwartz, L. E.,, and R. B. Brown. 1992. Purulent otitis media in adults. Arch. Intern. Med. 152: 2301 2304.
58. Sethi, S.,, N. Evans,, B. J. Grant,, and T. F. Murphy. 2002. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N. Engl. J. Med. 347: 465 471.
59. Turner, D. P.,, V. C. Weston,, and P. Ispahani. 1999. Streptococcus pneumoniae spinal infection in Nottingham, United Kingdom: not a rare event. Clin. Infect. Dis. 28: 873 881.
60. Watanakunakorn, C.,, and T. A. Bailey. 1997. Adult bacteremic pneumococcal pneumonia in a community teaching hospital, 1992-1996. A detailed analysis of 108 cases. Arch. Intern. Med. 157: 1965 1971.
61. Westh, H.,, L. Skibsted,, and B. Korner. 1990. Streptococcus pneumoniae infections of the female genital tract and in the newborn child. Rev. Infect. Dis. 12: 416 422.
62. Yangco, B. G.,, and S. C. Deresinski. 1980. Necrotizing or cavitating pneumonia due to Streptococcus pneumoniae: report of four cases and review of the literature. Medicine (Baltimore) 59: 449 457.


Generic image for table

Classification of infections caused by according to pathogenetic principles

Citation: Musher D. 2004. A Pathogenetic Categorization of Clinical Syndromes Caused by , p 211-220. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch14
Generic image for table

Factors predisposing to pneumococcal infection

Citation: Musher D. 2004. A Pathogenetic Categorization of Clinical Syndromes Caused by , p 211-220. In Tuomanen E, Mitchell T, Morrison D, Spratt B (ed), The Pneumococcus. ASM Press, Washington, DC. doi: 10.1128/9781555816537.ch14

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error