Host Factors and Capsular Typing of Body Fluid Isolates in Fulminant Pneumococcal Infections

Ronald M. Shapera, John M. Matsen
1972 Infection and Immunity  
A 10-year retrospective study was made to determine the spectrum of underlying disease in, and the capsular types of pneumococci isolated from, blood and body fluids of 140 hospitalized patients. Fifteen serotypes were found among 82 typed isolates, 53% of which were types 8, 14, or 23. There was a predominance of males and a high incidence of underlying pneumonia, chronic liver disease, nephrotic syndrome, cerebrospinal fluid rhinorrhea, and malignancy. Mortality rates were higher among the
more » ... y young and aged, and the immunologically comprised host at either extreme of life was more susceptible to disseminated pneumococcal infection. Pneumococci of the higher capsular types were prominent in children, and those of the lower types in adults, a finding in agreement with other recent studies. Overwhelming systemic infections due to Diplococcus pnewnoniae are frequent despite this organism's continued susceptibility to penicillin, and thus pneumococcus remains an important cause of morbidity and mortality. Renewed interest in the epidemiology, pathogenesis, and prophylaxis of pneumococcal infections has prompted us to review the past 10 years of experience with serious infections caused by this agent at the University of Minnesota Hospitals. The purpose of this study was to (i) determine the types of pneumococci isolated from blood and body fluids of hospitalized patients from 1961 to 1970, for purposes of comparison with similar data from studies done in different localities and in different years; (ii) ascertain if the capsular types of pneumococci isolated from blood and body fluids are similar to types reported to have been isolated from the sputum of patients with pneumonia and from the upper respiratory tract of asymptomatic carriers; (iii) confirm the role of host factors such as age and underlying disease in the pathogenesis of disseminated pneumococcal infection. MATERIALS AND METHODS The patients chosen for study were those hospitalized at the University of Minnesota Hospitals from January 1961 to December 1970 from whom pneumococci were isolated from blood, spinal, pleural, or peritoneal fluids. Pneumococci were identified by colonial morphology, hemolysis, Gram stain, optochin sensitivity, and the Quellung (capsular swelling) reac-tion by using antisera (Lederle and Difco) to types 1 to 33. Isolates from the respiratory tract were not typed. Patients with pneumococci obtained at autopsy or from mixed infections were excluded from analysis. Charts of patients from whom pneumococci were isolated from body fluids were reviewed to obtain the following data: age and sex incidence, presence of pneumonia with pneumococci in the sputum preceding or during dissemination, mortality rate in relation to age and to specific pneumococcal types, distribution of pneumococci according to age, predilection of certain types to localize in certain body cavities, and the spectrum of underlying disease in this hospitalized population. An attempt was also made to assess the role of pneumococcal infection as a cause of death, by correlating the clinical picture with X ray, autopsy, and bacteriological culture reports. RESULTS During this retrospective study covering a span of 10 years, 140 patients had pneumococci isolated from their blood or body fluids. Some patients harbored pneumococci in several body sites, or possibly on several occasions from a single site, so that a total of 168 isolates was recovered, 82 of which were typed ( Table 1) . The remaining isolates included 65 which were not typed and 21 which were untypable by our battery of types 1 to 33 antisera. All 82 typed isolates fell among 15 types, none higher than type 23 ( Table 2) ; 125 of the 168 isolates were from blood (Table 1) . Of the 62 typed-blood isolates, 35 (57%) were types 8, 14, or 23. No predominant types were noted among 12 cere-132 on March 23, 2020 by guest Downloaded from
doi:10.1128/iai.5.1.132-136.1972 fatcat:42gogawm3jd2vcwvegmsmitcde