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Abstract:
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Pneumococcal pneumonia is the explosive pulmonary and systemic inflammatory consequence of a disrupted host-pathogen relationship normally compartmentalised and optimally balanced as nasopharyngeal carriage. Pathogen, host and environmental factors combine to allow proliferation of pneumococci in the alveolar space. The local threat and the related threat of bacterial invasion resulting in sepsis are met with brisk responses from epithelium and alveolar macrophages resulting in massive neutrophil ingress and loss of alveolar integrity. This immune response comes at the temporary cost of severely impaired respiratory function but in most cases is characterised by regulated resolution resulting in restoration of normal pulmonary architecture and function as well as protection against future infection. The pathophysiology of pneumococcal pneumonia is informative in both treatment strategy and in vaccine design. This review summarises recent discoveries in both host defence and pathogen virulence relating these subjects to future vaccination and treatment.
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