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Pneumococcal pneumonia in adults

Thomas J Marrie, MD
Elaine I Tuomanen, MD
Section Editor
Daniel J Sexton, MD
Deputy Editor
Anna R Thorner, MD


Of the approximately four million cases of pneumonia each year in the United States, the pneumococcus (Streptococcus pneumoniae) is the most common agent leading to hospitalization in all age groups [1]. For many decades, bacteremic pneumococcal pneumonia has accounted for 9 to 18 cases per 100,000 adults [1-3]. (See "Epidemiology, pathogenesis, and microbiology of community-acquired pneumonia in adults".)

A general overview of pneumococcal pneumonia will be presented here. The epidemiology, microbiology, diagnosis, and treatment of community-acquired pneumonia are discussed separately. (See "Diagnostic approach to community-acquired pneumonia in adults" and "Epidemiology, pathogenesis, and microbiology of community-acquired pneumonia in adults" and "Treatment of community-acquired pneumonia in adults in the outpatient setting" and "Treatment of community-acquired pneumonia in adults who require hospitalization".)


Although S. pneumoniae is the most common cause of community-acquired pneumonia (CAP), many studies have reported isolation of the organism in only 5 to 18 percent of cases. The rate of isolation increases when more invasive methods are used for obtaining specimens, such as transtracheal aspiration, which eliminates contaminating oropharyngeal flora [2]. It is currently believed that many culture-negative cases of CAP are caused by pneumococcus. The following observations support this belief:

The sputum culture is negative in about 50 percent of patients with concurrent pneumococcal bacteremia [4].

A discriminant functional analysis, in which cases of unknown etiology were evaluated according to the clinical characteristics of S. pneumoniae, Mycoplasma pneumoniae, or other organisms, predicted that the majority of cases were due to pneumococcus [5].


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