Pneumonia

Streptococcus pneumoniae (pneumococcus)

A 33 year old female in the hospital recovering from a splenectomy presents with sudden onset of chills, cough, and pleuritic pain. On further examination, she has a fever and produces rusty-colored sputum. There is dullness to percussion, bronchial breath sounds, and tactile fremitus with egophony and inspiratory crackles.

Labs: Gram stain of sputum shows gram positive diplococci and numerous WBCs. Culture of blood and sputum gives an organism is alpha-hemolytic, bile soluble and sensitive to optochin.

Discussion: Diagnosis is made by laboratory identification. As there are 85 antigenically distinctive types of pneumococci, the quellung reaction can be used to identify this particular type of pneumococci. Students should be familiar with the term "quellung reaction" for the boards. There is no lancefield group designation for Streptococcus pneumoniae. Patients with splenectomy are at a greater risk. Streptococcus pneumoniae causes pneumonia that is preceded for a few days by coryza. Early symptoms are chills, fever, dyspnea, chest pain, and cough which becomes productive with pinkish and rusty sputum within several hours. A chest x-ray should be taken to further work-up the patient.

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