ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesView all Images (7)
Streptococcus pneumoniae pneumonia - Pulmonary
Print Captions OFF
Other Resources UpToDate PubMed

Streptococcus pneumoniae pneumonia - Pulmonary

Print Images (7)
Contributors: Susan Voci MD, Sumanth Rajagopal MD, William Bonnez MD
Other Resources UpToDate PubMed

Synopsis

Streptococcus pneumoniae (pneumococcus), an encapsulated aerobic gram-positive diplococcus, is the most common cause of community-acquired pneumonias in adults. Ninety different serotypes have been identified based on antigenic differences in their capsular polysaccharides.

S. pneumoniae can be found colonizing the oropharynx of 5–10% of healthy adults and up to 40–60% of toddlers and young children in day care centers. Invasive disease (defined by the isolation of S. pneumoniae from normally sterile sites such as blood, CSF) occurs worldwide at a rate of about 15 per 100,000 persons per year, but a 10 fold higher incidence has been noted in African Americans, Native Americans, and Australian Aborigines. Pneumococcus may be transmitted from individual to individual when there is extensive and close contact, such as in military camps, prisons, shelters, nursing homes, and day care centers. However, isolating individual patients with infection is not routinely recommended.

The single most important risk factor for invasive pneumococcal disease is the inability, either congenital or acquired, to mount an antibody response. Patients with congenital agammaglobulinemia, multiple myeloma, chronic lymphocytic leukemia, lymphoma, or HIV infection are at high risk. Those with defective neutrophil function as with alcohol use disorder, diabetes mellitus, cirrhosis of the liver, chronic corticosteroid treatment, or impaired renal function are also at a high risk. Overwhelming pneumococcal sepsis is a major threat in patients who are anatomically (from surgical resection) or functionally (due to sickle-cell anemia) asplenic.

Infection may be seen in all age groups, although it is more common in infants younger than 2 and elderly subjects older than 65. Upper respiratory viral infections, coexisting allergies, and smoking may all inhibit ciliary defense mechanisms and promote spread of the organism from the nasopharynx to the middle ear, sinuses, and the lungs from where hematogenous dissemination may occur to the brain, heart, the peritoneal cavity and other areas of the body.

Pneumococcal pneumonia often starts as a single shaking chill. Fevers, cough with sputum, fatigue, and chest pain are common symptoms. Fever may be absent in elderly patients. Examination may reveal crackles on the affected side and signs of consolidation, like dullness to percussion and tubular breath sounds. Also present may be signs of a pleural effusion. Any new heart murmur should raise the suspicion for endocarditis. Otitis media, sinusitis, meningitis, and endocarditis are the other manifestations of pneumococcal infection.

Codes

ICD10CM:
J13 – Pneumonia due to Streptococcus pneumoniae

SNOMEDCT:
34020007 – Streptococcal pneumonia

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Other causes of community-acquired pneumonia, like:
Other causes:

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Updated: 06/08/2018
Copyright © 2019 VisualDx®. All rights reserved.
Streptococcus pneumoniae pneumonia - Pulmonary
Captions OFF Print 7 Images
View all Images (7)
(with subscription)
Streptococcus pneumoniae pneumonia : Chills, Fatigue, Fever, Pleuritic chest pain, Productive cough, Dyspnea, Rhonchi
Imaging Studies image of Streptococcus pneumoniae pneumonia
Frontal chest x-ray demonstrating a right middle lobe consolidation.
Copyright © 2019 VisualDx®. All rights reserved.