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  Table of Contents  
CORRESPONDENCE
Year : 2012  |  Volume : 30  |  Issue : 1  |  Page : 112
 

Serotype 19A Streptococcus pneumoniae among Indian isolates is a cause for concern


1 Department of Microbiology, V. P. Chest Institute, University of Delhi, Delhi - 110 007, India
2 Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi - 110 029, India

Date of Submission27-Sep-2011
Date of Acceptance17-Oct-2011
Date of Web Publication22-Feb-2012

Correspondence Address:
M Shariff
Department of Microbiology, V. P. Chest Institute, University of Delhi, Delhi - 110 007
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.93085

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How to cite this article:
Shariff M, Zahoor S, Deb M. Serotype 19A Streptococcus pneumoniae among Indian isolates is a cause for concern. Indian J Med Microbiol 2012;30:112

How to cite this URL:
Shariff M, Zahoor S, Deb M. Serotype 19A Streptococcus pneumoniae among Indian isolates is a cause for concern. Indian J Med Microbiol [serial online] 2012 [cited 2019 Sep 17];30:112. Available from: http://www.ijmm.org/text.asp?2012/30/1/112/93085



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Streptococcus pneumoniae is found to colonise the nasopharynx of healthy children and adults. The progression of the bacteria from the nasopharynx to the sterile sites such as lungs, blood and brain can lead to serious invasive pneumococcal disease (IPD). Streptococcus pneumoniae is the most commonly identified bacterial cause of meningitis, otitis media and community-acquired pneumonia, and it is a frequent cause of bacteraemia. A 7-valent conjugate vaccine (PCV-7) was introduced in the United States of America in 2000 in order to control the infections caused by this organism. However, this has led to a gradual increase in the prevalence of penicillin-resistant 19A serotype, not present in the PCV-7 vaccine. [1] This serotype was previously thought to be a commensal of the upper respiratory tract flora. The prevalence and characterisation of 19A serotype has been reported from USA and Europe where the vaccine is in use. It has also been shown that post PCV-7 the carriage of serotype 19A has increased in the nasopharynx of children. [2] Except for Korea and Taiwan, PCV 7 vaccine is not implemented in many Asian countries including India. Even if licensed in some of these countries, the coverage of vaccine is very low. In spite of this, serotype 19A strain is well documented in these countries and predominantly a multi-drug-resistant clone of 19A ST 320 has been reported including India. [3]

In the present study done in Delhi, the authors report 5/60 (8%) of isolates to be of 19A serotype. Two of these isolates were from CSF, one from bronchial aspirate and two were from naso- pharynx. The isolates from CSF were sensitive to penicillin, one being resistant to ciprofloxacin. However, the isolate from bronchial aspirate was resistant to penicillin (MIC= 2), erythromycin (MIC>4) and intermediate sensitive to ciprofloxacin (MIC=2). However, 34% of the Asian 19A isolates showed resistance to penicillin. [3] The sequence types of two of the isolates revealed in the present study were of types 1796 (2000, USA) and 4217 (1996, India) which were not the same as ST 320 predominantly seen in Asian isolates. [3] These observations led us to conclude that 19A serotype has the potential to cause invasive pneumococcal disease and also is showing resistance to penicillin. At present, there are only two studies which have reported 19A serotype in Indian isolates. [3],[4] More studies should be undertaken to serotype the Indian isolates so that the prevalence of the 19A and other serotypes can be determined. At present, PCV- 7 vaccine has not been introduced in the extended program of immunisation schedule and its use is optional. If introduction of the vaccine is considered in the future then the prevalence of 19A has to be kept in mind and an appropriate vaccine containing 19A (Prevenar 13) should be considered instead of PCV-7.

 
 ~ References Top

1.Moore MR, Gertz RE Jr, Woodbury RL, Barkocy-Gallagher GA, Schaffner W, Lexau C, et al. Population snap shot of emergent Streptococcus pneumoniae serotype 19A in the United States. J Infect Dis 2008;197:1016.  Back to cited text no. 1
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2.van Gils EJ, Veenhoven RH, Hak E, Rodenburg GD, Keijzers WC, Bogaert D, et al. Pneumococcal Conjugate Vaccination and Nasopharyngeal Acquisition of Pneumococcal Serotype 19A Strains. JAMA 2010;304:1099-106.   Back to cited text no. 2
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3.Shin J, Boek JY, Kim SH, Song JH, Ko KS. Predominance of DT320 among Streptococcus pneumoniae serotype 19A isolates from 10 Asian countries. J Antimicrob Chemother 2011;66:1001-4.   Back to cited text no. 3
    
4.Song JH, Jung SI, Ko KS, Kim NY, Son JS, Chang HH, et al. A. High Prevalence of Antimicrobial Resistance among Clinical Streptococcus pneumoniae Isolates in Asia (an ANSORP Study). Antimicrob Agents Chemother 2004;48:2101-7.  Back to cited text no. 4
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