Semin Respir Crit Care Med 2016; 37(06): 806-818
DOI: 10.1055/s-0036-1592074
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Role of Streptococcus pneumoniae in Community-Acquired Pneumonia

Charles Feldman
1   Division of Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
2   Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Ronald Anderson
3   Department of Immunology, Institute for Cellular and Molecular Medicine, Pretoria, South Africa
4   Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
› Author Affiliations
Further Information

Publication History

Publication Date:
13 December 2016 (online)


Streptococcus pneumoniae (the pneumococcus) remains one of the most common causes of bacterial community-acquired pneumonia (CAP), encompassing infections mild enough to be treated on an outpatient basis, as well as those requiring hospital care, or even intensive care unit admission. This microorganism is associated with a significant burden of disease, causing substantial morbidity and mortality worldwide, and generating considerable health-care costs. The reason that pneumococcal CAP remains such a common cause of disease relates to the presence of several risk factors for this infection in patients throughout the world. Such risk factors include extremes of age, lifestyle factors, including smoking and alcohol abuse, and various underlying comorbid conditions, including congenital and acquired immunodeficiencies. This article will review various aspects of pneumococcal CAP, including the burden of pneumococcal disease, risk factors for pneumococcal infection, the occurrence of cardiovascular events in patients with pneumococcal CAP, the apparently pivotal role of pneumolysin, a major virulence factor of the pneumococcus, in the pathogenesis of severe infection and associated cardiac dysfunction, empiric antibiotic treatment for pneumococcal CAP, as well as adjunctive therapies, specifically those which target pneumolysin, and, finally, the mortality of such infections.