Streptococcus pneumoniae
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Direct answer
Streptococcus pneumoniae, the pneumococcus, is a Gram-positive, lancet-shaped diplococcus that is optochin sensitive and bile soluble, and it is a leading bacterial cause of community-acquired pneumonia. Its polysaccharide capsule is the main virulence factor, and more than 90 capsular serotypes are recognised. Laboratory identification depends on optochin sensitivity, bile solubility and the quellung reaction.
What you must remember
- Morphology: lancet-shaped Gram-positive diplococci in pairs or short chains, forming alpha-haemolytic colonies with a central depression, the draughtsman appearance.
- Optochin test: a 5 microgram disc produces a zone of inhibition of 14 mm or more, which marks the organism as optochin sensitive.
- Bile solubility: bile salts activate the pneumococcal autolysin, so colonies dissolve in sodium deoxycholate, a result viridans streptococci do not show.
- Quellung reaction: swelling of the capsule with type-specific antiserum, which identifies the serotype and confirms the organism.
- Virulence factors: the capsule resists phagocytosis, pneumolysin damages ciliated epithelium and host cells, and IgA1 protease cleaves secretory IgA.
- Diseases: community-acquired pneumonia, otitis media, sinusitis, meningitis and bacteraemia, with higher risk in young children, older adults and people without a functioning spleen.
- Prevention: pneumococcal conjugate vaccines and the 23-valent polysaccharide vaccine target capsular serotypes, and conjugate vaccines are part of India's Universal Immunisation Programme.
Where the exam tries to catch you
Pneumococcal questions often hinge on the Gram stain and the single confirmatory test, so precision in the answer matters.
- Trap: calling any alpha-haemolytic colony from sputum a pneumococcus Correct: optochin sensitivity and bile solubility are needed, since viridans streptococci look similar on blood agar.
- Trap: treating penicillin resistance as meaning ceftriaxone never works Correct: most penicillin-resistant pneumococci remain ceftriaxone sensitive, though meningeal isolates are judged against stricter breakpoints.
- Trap: confusing pneumococcal meningitis with meningococcal disease Correct: pneumococci are Gram-positive lancet-shaped diplococci, whereas meningococci are Gram-negative kidney-shaped diplococci.
Frequently asked questions
Which two tests confirm Streptococcus pneumoniae in the laboratory?
Optochin sensitivity and bile solubility confirm Streptococcus pneumoniae in the laboratory. A zone of inhibition of 14 mm or more around an optochin disc, together with colony dissolution in bile salts, separates pneumococci from viridans streptococci.
What does the quellung reaction demonstrate in pneumococcal identification?
The quellung reaction demonstrates swelling of the pneumococcal capsule when the organism is mixed with type-specific antiserum under the microscope. It identifies the capsular serotype, which is important for epidemiology and vaccine surveillance.
Why are pneumococcal conjugate vaccines important in India's immunisation programme?
Pneumococcal conjugate vaccines are important because they target the capsular serotypes that cause pneumonia, otitis media and meningitis in young children. They are part of the Universal Immunisation Programme, which aims to reduce these severe disease burdens.
Why does asplenia raise the risk of pneumococcal sepsis?
Asplenia raises the risk of pneumococcal sepsis because the spleen normally clears encapsulated bacteria from the blood. Surgical asplenia and functional asplenia, as in sickle cell disease, both carry a high risk of overwhelming Streptococcus pneumoniae infection.
How does the polysaccharide capsule of Streptococcus pneumoniae affect immunity?
The polysaccharide capsule of Streptococcus pneumoniae resists phagocytosis, so antibodies against the capsule are needed for effective opsonisation. This is why vaccines target capsular serotypes rather than the whole organism.