Streptococcus pneumoniae: causes, symptoms, diagnosis, treatment

Streptococcal pneumonia is rare. It can be caused by both group A beta-hemolytic streptococci and other types of streptococci. Streptococcal pneumonia usually develops as a complication of influenza, measles, chickenpox, and whooping cough.

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Symptoms of Streptococcal Pneumonia

Streptococcal pneumonia begins acutely and is quite severe. As a rule, fever, shortness of breath, cough, and chest pain appear suddenly. The cough is dry at first, then mucopurulent sputum appears, sometimes it contains blood. Thus, the onset of streptococcal pneumonia often resembles pneumococcal pneumonia, but, unlike the latter, chills are rarely observed.

Percussion and auscultation symptoms are not always clearly expressed due to the fact that pneumonic foci are small, they are more often localized in the lower and middle parts of the lungs. At first, one segment is affected, then the inflammatory process quickly spreads, the development of multiple foci of inflammation is possible, which can merge and give a picture resembling lobar pneumonia (pseudo-lobular pneumonia).

An extremely characteristic feature of streptococcal pneumonia is the development of exudative pleurisy with purulent exudate (pleural empyema). Its symptoms may appear as early as the 2nd or 3rd day of the disease. Abscessing of pneumonic foci is possible.

Streptococcal pneumonia is also characterized by high leukocytosis (up to 20-30 x 10 ⁹ /l) with a pronounced shift in the leukocyte formula to the left.

X-ray examination of the lungs reveals many small, sometimes merging foci, possibly affecting a lung lobe with the formation of an abscess (a cavity with a horizontal fluid level). With the development of pleural empyema, an intense homogeneous darkening with an oblique upper level appears.

Pleural puncture can yield purulent fluid, less commonly serous or serous-hemorrhagic fluid.

Diagnosis of streptococcal pneumonia

Streptococcal pneumonia is diagnosed based on the following provisions:

• development of pneumonia during or after measles, chickenpox, whooping cough, flu, scarlet fever, streptococcal pharyngitis;
• acute onset of pneumonia;
• the appearance of exudative pleurisy (especially pleural empyema) already at an early stage of pneumonia;
• detection in sputum smears stained by Gram of chains of gram-positive cocci that differ from Str. pneumoniae by their non-lanceolate shape and negative capsule swelling reaction after addition of polyvalent pneumococcal antiserum; JG Barlett (1997) indicates that beta-hemolytic streptococci of group A are similar to alpha-hemolytic streptococci that belong to the normal microflora of the oral cavity, therefore streptococci detected in sputum should be typed according to Lancefield. Pneumonia is most often caused by beta-hemolytic streptococci of group A;
• growth of antistreptolysin-O titers in the patient's blood over time.

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Treatment of streptococcal pneumonia

It is treated in the same way as pneumococcal pneumonia. A rare form of streptococcal pneumonia caused by Str. faecalys requires the administration of broad-spectrum penicillins (ampicillin, amoxicillin, etc.). In the presence of resistance or allergy to penicillin, vancomycin or its combination with aminoglycosides is indicated.

Vancomycin is administered intravenously in isotonic sodium chloride solution or 5% glucose solution at a concentration of 2.5-5 mg/ml (drip over 20-40 min). Prescribed at 0.5-1 g every 12 hours.

• Pneumonia - Treatment regimen and nutrition
• Antibacterial drugs for the treatment of pneumonia
• Pathogenetic treatment of pneumonia
• Symptomatic treatment of pneumonia
• Combating complications of acute pneumonia
• Physiotherapy, exercise therapy, breathing exercises for pneumonia
• Sanatorium and resort treatment and rehabilitation for pneumonia

Treatment with glycopeptide - teicoplant intramuscularly and intravenously at 3-6 mg/kg per day (1-2 administrations) is highly effective.