Occurrence of Rough Pneumococci in Lungs of Patients with Lobar Pneumonia

Abstract

“S” and “R” forms of pneumococci are considered, in a general way, to represent respectively virulent and avirulent phases of the organism. It seemed reasonable to suspect that degradation from “S” to “R” forms might take place in the mechanism of recovery from pneumococcus infection in living tissues. Wadsworth and Sickles recovered attenuated pneumococci from the blood stream and heart valves of horses previously immunized to pneumococci. Reimann, demonstrated the very occasional occurrence of “R” forms in the sputum of patients with lobar pneumonia. Paul produced “R” forms in vivo under certain experimental conditions in dogs. In the present communication is reported the recovery, by direct lung puncture, of “R” variants of the pneumococcus from the lungs of a majority of lobar pneumonia patients studied. Clear cut cases only of lobar pneumonia were studied. Punctures were made at points of maximum consolidation. Lung puncture, in pneumonia, has been shown to be a safe procedure. Material obtained by lung puncture was cultured at once in glucose broth and upon blood agar plates. For the latter, following the work of Sia and Chung, 5% dog blood was used to facilitate recognition of “R” and “S” forms. Colony studies were made after 18-22 hours incubation, longer incubation being used only when growth was retarded. Smears of the lung puncture material were studied with Gram's and Hiss capsule stains. In several cases portions of the puncture specimen were inoculated intraperitoneally into white mice. Identification of organisms was based upon cultural and microscopic characteristics, and in most cases upon bile solubility and type specific agglutination. In the majority of cases of typical lobar pneumonia, pure cultures were obtained upon lung puncture.