Pneumococcal Pneumonia in Disguise: contribution of Streptococcus pneumoniae infections to morbidity and mortality during times of pandemics
Main Article Content
Abstract
Streptococcus pneumoniae is the major cause of community acquired pneumonia. The clinical picture of other respiratory infections such as influenza or SARS-CoV-2 may resemble that of pneumonia. During pandemics, such as the 1918 influenza pandemic and COVID-19, S. pneumoniae could come in disguise and contribute to overall morbidity and mortality. It is estimated that during the 1918 influenza pandemic up to 50% of deaths were due to S. pneumoniae co- or super-infections. A century later, during COVID-19 estimates are that pneumococcal pneumonia contributed to up to 10% of morbidity. Adequate diagnostic procedures and treatment, as well as optimalization of pneumococcal vaccination programs could reduce the burden of pneumococcal disease, also in times of pandemics.
Keywords:
Streptococcus pneumoniae, pneumococcal pneumonia, co-infection, pandemics, influenza, COVID-19
Article Details
How to Cite
RIJKERS, Ger; BENDIK, Lili; DE RAEVE, Deborah Nkiru.
Pneumococcal Pneumonia in Disguise: contribution of Streptococcus pneumoniae infections to morbidity and mortality during times of pandemics.
Medical Research Archives, [S.l.], v. 13, n. 3, mar. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6307>. Date accessed: 06 apr. 2025.
doi: https://doi.org/10.18103/mra.v3i3.6307.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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5. Rijkers G, Croon S, Nguyen TA. Rocking pneumonia and the boogie woogie flu. Eur Med J. 2019;4(1):48-54.
6. Rudd JM, Ashar HK, Chow VT, Teluguakula N. Lethal Synergism between Influenza and Streptococcus pneumoniae. J Infect Pulm Dis. 2016;2(2):10.16966/2470-3176.114. doi:10.16966/2470-3176.114
7. Mina MJ, Klugman KP. The role of influenza in the severity and transmission of respiratory bacterial disease. Lancet Respir Med. 2014;2(9):750-763. doi:10.1016/S2213-2600(14)70131-6.
8. Taubenberger JK, Kash JC, Morens DM. The 1918 influenza pandemic: 100 years of questions answered and unanswered. Sci Transl Med. 2019;11(502):eaau5485. doi:10.1126/scitranslmed.aau5485
9. Martini M, Gazzaniga V, Bragazzi NL, Barberis I. The Spanish Influenza Pandemic: a lesson from history 100 years after 1918. J Prev Med Hyg. 2019;60(1):E64-E67. doi:10.15167/2421-4248/jpmh2019.60.1.1205
10. Johnson NP, Mueller J. Updating the accounts: global mortality of the 1918-1920 "Spanish" influenza pandemic. Bull Hist Med. 2002;76(1):105-115. doi:10.1353/bhm.2002.0022
11. Morens DM, Taubenberger JK, Fauci AS. The persistent legacy of the 1918 influenza virus. N Engl J Med. 2009;361(3):225-229. doi:10.1056/NEJMp0904819
12. Taubenberger JK, Morens DM. 1918 Influenza: the mother of all pandemics. Emerg Infect Dis. 2006;12(1):15-22. doi:10.3201/eid1201.050979
13. Morens DM, Taubenberger JK, Fauci AS. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: implications for pandemic influenza preparedness. J Infect Dis. 2008;198(7):962-970. doi:10.1086/591708
14. Shanks GD, Brundage JF. Pathogenic responses among young adults during the 1918 influenza pandemic. Emerg Infect Dis. 2012;18(2):201-207. doi:10.3201/eid1802.102042
15. Chertow DS, Cai R, Sun J, Grantham J, Taubenberger JK, Morens DM. Influenza Circulation in United States Army Training Camps Before and During the 1918 Influenza Pandemic: Clues to Early Detection of Pandemic Viral Emergence. Open Forum Infect Dis. 2015;2(2):ofv021.
16. Chien YW, Klugman KP, Morens DM. Bacterial pathogens and death during the 1918 influenza pandemic. N Engl J Med. 2009;361(26):2582-2583. doi:10.1056/NEJMc0908216
17. Klugman KP, Chien YW, Madhi SA. Pneumococcal pneumonia and influenza: a deadly combination. Vaccine. 2009;27 Suppl 3:C9-C14. doi:10.1016/j.vaccine.2009.06.007
18. Klugman KP, Astley CM, Lipsitch M. Time from illness onset to death, 1918 influenza and pneumococcal pneumonia. Emerg Infect Dis. 2009;15(2):346-347. doi:10.3201/eid1502.081208
19. Brundage JF, Shanks GD. Deaths from bacterial pneumonia during 1918-19 influenza pandemic. Emerg Infect Dis. 2008;14(8):1193-1199. doi:10.3201/eid1408.071313
20. Tilghman RC, Finland M. Clinical significance of bacteremia in pneumococcic pneumonia. Arch Intern Med. 1937;59(4):602-619. doi:10.1001/archinte.1937.00170200044004
21. Kash JC, Walters KA, Davis AS, et al. Lethal synergism of 2009 pandemic H1N1 influenza virus and Streptococcus pneumoniae coinfection is associated with loss of murine lung repair responses. mBio. 2011;2(5):e00172-11. doi:10.1128/mBio.00172-11
22. McCullers JA. Insights into the interaction between influenza virus and pneumococcus. Clin Microbiol Rev. 2006;19(3):571-582. doi:10.1128/CMR.00058-05
23. Walters KA, D'Agnillo F, Sheng ZM, et al. 1918 pandemic influenza virus and Streptococcus pneumoniae co-infection results in activation of coagulation and widespread pulmonary thrombosis in mice and humans. J Pathol. 2016;238(1):85-97. doi:10.1002/path.4638
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27. World Health Organization COVID-19 dashboard [cited 2025 Jan 12]. Available from: https://data.who.int/dashboards/covid19/cases
28. Patton MJ, Orihuela CJ, Harrod KS, et al. COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation. Crit Care. 2023;27(1):34. doi:10.1186/s13054-023-04312-0
29. Aykac K, Ozsurekci Y, Cura Yayla BC, et al. Pneumococcal carriage in children with COVID-19. Hum Vaccin Immunother. 2021;17(6):1628-1634. doi:10.1080/21645515.2020.1849516
30. Stahlfeld A, Glick LR, Ott IM, et al. Detection of pneumococcus during hospitalization for SARS-CoV-2. FEMS Microbes. 2022;3:xtac026. Published 2022 Oct 16. doi:10.1093/femsmc/xtac026
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32. Im H, Ser J, Sim U, Cho H. Promising Expectations for Pneumococcal Vaccination during COVID-19. Vaccines (Basel). 2021;9(12):1507. Published 2021 Dec 20. doi:10.3390/vaccines9121507
33. Lewnard JA, Bruxvoort KJ, Fischer H, et al. Prevention of Coronavirus Disease 2019 Among Older Adults Receiving Pneumococcal Conjugate Vaccine Suggests Interactions Between Streptococcus pneumoniae and Severe Acute Respiratory Syndrome Coronavirus 2 in the Respiratory Tract. J Infect Dis. 2022;225(10):1710-1720. doi:10.1093/infdis/jiab128
34. Nunes MC, Cutland CL, Klugman KP, Madhi SA. Pneumococcal Conjugate Vaccine Protection against Coronavirus-Associated Pneumonia Hospitalization in Children Living with and without HIV. mBio. 2021;12(1):e02347-20. doi:10.1128/mBio.02347-20
35. Tavares DA, Handem S, Carvalho RJ, et al. Identification of Streptococcus pneumoniae by a real-time PCR assay targeting SP2020. Sci Rep. 2019;9(1):3285. doi:10.1038/s41598-019-39791-1
36. Suleiman AS, Islam MA, Akter MS, Amin MR, Werkneh AA, Bhattacharya P. A meta-meta-analysis of co-infection, secondary infections, and antimicrobial resistance in COVID-19 patients. J Infect Public Health. 2023;16(10):1562-1590. doi:10.1016/j.jiph.2023.07.005