J Korean Med Sci.  2013 Jan;28(1):4-15. 10.3346/jkms.2013.28.1.4.

Clinical Implications of Pneumococcal Serotypes: Invasive Disease Potential, Clinical Presentations, and Antibiotic Resistance

  • 1Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea. infection@korea.ac.kr
  • 2Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
  • 3Department of Microbiology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
  • 4Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.


Streptococcus pneumoniae can asymptomatically colonize the nasopharynx and cause a diverse range of illnesses. This clinical spectrum from colonization to invasive pneumococcal disease (IPD) appears to depend on the pneumococcal capsular serotype rather than the genetic background. According to a literature review, serotypes 1, 4, 5, 7F, 8, 12F, 14, 18C, and 19A are more likely to cause IPD. Although serotypes 1 and 19A are the predominant causes of invasive pneumococcal pneumonia, serotype 14 remains one of the most common etiologic agents of non-bacteremic pneumonia in adults, even after 7-valent pneumococcal conjugate vaccine (PCV7) introduction. Serotypes 1, 3, and 19A pneumococci are likely to cause empyema and hemolytic uremic syndrome. Serotype 1 pneumococcal meningitis is prevalent in the African meningitis belt, with a high fatality rate. In contrast to the capsule type, genotype is more closely associated with antibiotic resistance. CC320/271 strains expressing serotype 19A are multidrug-resistant (MDR) and prevalent worldwide in the era of PCV7. Several clones of MDR serotype 6C pneumococci emerged, and a MDR 6D clone (ST282) has been identified in Korea. Since the pneumococcal epidemiology of capsule types varies geographically and temporally, a nationwide serosurveillance system is vital to establishing appropriate vaccination strategies for each country.


Streptococcus pneumoniae; Polysaccharides, Bacterial; Bacterial Capsules; Serotyping; Pneumococcal Infections

MeSH Terms

Drug Resistance, Multiple, Bacterial
Hemolytic-Uremic Syndrome/etiology
Pneumococcal Infections/complications/*immunology
Pneumonia, Pneumococcal/immunology
Streptococcus pneumoniae/*classification/pathogenicity

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