title: Clonal and capsular types decide whether pneumococci will act as a primary or opportunistic pathogen.
abstract: BACKGROUND
  Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide. The role of the different capsular and clonal types in invasive disease severity remains to be defined.
  
  
  METHODS
  Disease severity and disease type were correlated to age, underlying disease, capsular serotype, and clonal type of the causative agent for 494 adult patients with invasive pneumococcal disease.
  
  
  RESULTS
  Pneumococcal isolates of serotypes 1 and 7F were genetically homogenous, had the highest potential to infect previously healthy individuals, and were not causing deaths. Also, type 1 isolates were only found among younger adults, whereas other serotypes were mainly found among elderly persons (e.g., type 23F). Some serotypes and/or clones were more prone to cause more-severe disease, as observed by high APACHE II scores calculated at admission, and were also associated with a high mortality (e.g., clones of type 3 and 11A). We found no evidence of an impact of penicillin resistance on disease severity and disease type.
  
  
  CONCLUSIONS
  We suggest that clones with capsular types 1 and 7F, which are known to have a high invasive disease potential, behave as primary pathogens, whereas clones with other capsular types with a lower relative risk of causing invasive disease are more opportunistic, primarily affecting patients with underlying disease. Disease caused by the latter group, however, was more severe, even in previously healthy individuals.
authors.affiliation: Department of Bacteriology, Swedish Institute for Infectious Disease Control, Karolinska University Hospital, Solna, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Sjöström
authors.forename: C
authors.initials: C
authors.lastname: Spindler
authors.forename: A
authors.initials: A
authors.lastname: Ortqvist
authors.forename: M
authors.initials: M
authors.lastname: Kalin
authors.forename: A
authors.initials: A
authors.lastname: Sandgren
authors.forename: S
authors.initials: S
authors.lastname: Kühlmann-Berenzon
authors.forename: B
authors.initials: B
authors.lastname: Henriques-Normark
mesh_terms: D000328:Adult; D016667:Bacterial Capsules / Q000145:classification*; D015373:Bacterial Typing Techniques; D002353:Carrier State / Q000382:microbiology; D002999:Clone Cells / Q000145:classification*; D006305:Health Status Indicators; D006801:Humans; D007113:Immunity, Innate / Q000276:immunology; D008826:Microbial Sensitivity Tests; D009894:Opportunistic Infections / Q000150:complications / Q000382:microbiology*; D010403:Penicillin Resistance; D011008:Pneumococcal Infections / Q000150:complications / Q000382:microbiology*; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification / Q000472:pathogenicity*