Abstract:
Despite innovative advances in anti-infective therapies and vaccine development technologies,
community-acquired pneumonia (CAP) remains the most persistent cause of infection-related
mortality globally. Confronting the ongoing threat posed by Streptococcus pneumoniae (the pneumococcus),
the most common bacterial cause of CAP, particularly to the non-immune elderly, remains
challenging due to the propensity of the elderly to develop invasive pneumococcal disease (IPD),
together with the predilection of the pathogen for the heart. The resultant development of often
fatal cardiovascular events (CVEs), particularly during the first seven days of acute infection, is
now recognized as a relatively common complication of IPD. The current review represents an
update on the prevalence and types of CVEs associated with acute bacterial CAP, particularly IPD.
In addition, it is focused on recent insights into the involvement of the pneumococcal pore-forming
toxin, pneumolysin (Ply), in subverting host immune defenses, particularly the protective functions
of the alveolar macrophage during early-stage disease. This, in turn, enables extra-pulmonary dissemination
of the pathogen, leading to cardiac invasion, cardiotoxicity and myocardial dysfunction.
The review concludes with an overview of the current status of macrolide antibiotics in the treatment
of bacterial CAP in general, as well as severe pneumococcal CAP, including a consideration of the
mechanisms by which these agents inhibit the production of Ply by macrolide-resistant strains of
the pathogen.
