Need help with talkative daughter

[trggirl]

Hi, My daughter started ticcing last October and I was thrown into the tourettes world. After reading and reading, I found a doctor that did Neurotransmittor testing and hair analysis. This is what came back:

 

Hair:

 

Calcium was off the chart high.

Magnesium was high, but just slightly (the ratio between the two was way off because of the high Calcium)

Sodium, Potassium, Iron were all a bit low.

Copper was normal

Manganese was high

Chromium and Selenium were low

 

The only toxic metal that showed up was Aluminum and it was not terribly high.

 

 

Neurotransmittors:

 

Norepinephrine was off the chart high

Serotonin was a bit low

Dopamine normal

Epinephrine normal

Gaba a bit high

Glutamate a bit high

histamine a bit high

 

 

I started her on Kids Calm 85mg, I stopped dairy completely, and I just kept a watch on the Calcium intake. She still gets Calcium from diet, I just don't let her eat food with high Calcium. The motor tics have stopped. The doctor is trying to find a Calcium source she can tolerate because she needs more for a growning body. The problem is that when I increase the Kids Calm dose, she gets OCD tendencies. Anyway, we are working on that, but fortunately the motor tics are gone for now.

 

Our problem is the focus and excessive talking. She has an absolutely fantastic memory, but she can't sit still and focus long enough to do any school work beyond just straight memory. She struggles to read a book. She will say a line over and over and her body is just fidgeting while she sits and reads. She can't stand it for long. It is like an internal restlessness that won't let her relax. And her talking....oh boy! She can't stop. From morning to night, she talks and talks. It is really getting her in trouble at school and is hurting her socially because she won't stop long enough to listen to friends. I would almost say it is manic-like but she never experiences downs so I don't think she is bipolar. Anyway, I am looking for some help. My gut tells me it stems from the high Norepinephrine and when I look at that metabolism, it is usually B12, folic acid, Methionine, and SAMe. I just don't know where to start.

 

Oh, forgot to add that she is having some vocal tics. She says "yes, yes, yes" over and over. And she has been sniffing for several months

 

Looking for advise! Please help!

[faith]

trq girl,

Interesting about calcium being considered too high. How old is she again? Did you do this test on your own or thru a practitioner? what is their reccommendation? I'm not too confident about total reliability of these tests. just my opinion.

 

So you are saying by restricting calcium and dairy foods, the motor tics have calmed? but not the vocal? That could be just from staying away from dairy in general due to some sensitivity, not necessarily the calcium. what do you think? (you were giving magnesium "lactate" prior, correct?) because I'd guess that also contains calcium? don't know for sure tho. So the Kids Calm you feel increases her ocd stuff? interesting. have you tried just the regular Natural Calm adult version with no flavor? you could just add a splash of some juice. Anything else you could offer here re the motor tics resolving, I'd be interested, as I'm sure others here would be too, maybe we can figure something out for our own kids.

 

Re what you describe about her talking and reading, just something to throw out there, could she possibly be dyslexic? I don't know, just what you describe about her being fidgety while reading and the reading lines over again sounds a little like possible symptoms of dyslexia. you could do a little search. Does she have any other issues like ADHD, the excessive talking could have something to do with that.

 

The more parents here describe characteristics of their children, the more I see that most of our kids seem to hve alot of the same traits. Wish I could give advice about the talking, but I would just say constant gentle reminders might help a little, just so she is mindful when too much talking is not appropriate, such as in school. Is she good at writing?, perhaps giving her a pretty journal to write down her thoughts everyday might give her something to concentrate on and get what's on her mind out in that way.

 

 

Faith

[sf_mom]

Seems like PANDAS to me. Does she have any OCD behavior? Was she sick last Oct when she started ticcing?

 

She sounds very similar to my son who couldn't sit still or stop talking. His inability to sit still was causing him to fall off various different chairs in our house (it was actually becoming an issue because he was getting hurt). He also went Um, Um, Um, before starting a sentence or when he would lose his train of thought. He just completed IVIG five days ago and all of that has stopped and has only one remaining slight tic when he is tired. No other medications other than antibiotics.

 

I recommend reviewing post under PANDAS heading or going to PANDAS Network.org.

[trggirl]

Faith, we are doing our testing through a Chiropractor.

 

My daughter started ticcing in the fall. When I first started these changes, it was in the springtime. To go into more details, we got the results back from the chiropractor (using neuroscience for the neurotransmittor testing) and he and the company suggested Calcium, Magnesium, and Zinc. We gave the Lactate version and it did not agree with her. After reading about tourettes and muscle contractions, and knowing her Calcium and Magnesium were out of balance, I really felt she needed the Magnesium. I know I am simplifying the whole thing, but if you look at a muscle contraction, Calcium contracts and Magnesium relaxes. So, I decided to cut the dairy due to the high Calcium content and added spinach every day because it was high in Magnesium and my daughter loves it. Keep in mind, I was just experimenting to see if anything would happen. Amazingly, vocal and motor tics stopped completely after doing this for two weeks.

 

Summer then arrived. I knew my daugher was thoroughly sick of spinach so my goal was to try another Magnesium supplement. That is when I started the Kids Calm. The motor tics have not returned, but the vocals came back. It is so frustrating to me because I really feel that something in the spinach stopped the vocals but clearly, it was not the magnesium which was my original thinking.

 

There is another experiment that I did this summer that you might find of interest. My daughter has a focus issue. I started reading about Lecithin increasing Acetylcholine which is good for focus. I read somewhere that Norepinephrine is a noisy focus (lots of static) whereas Achetylcholine is a strong focus. That makes total sense to me when I think about my daughters personality and learning style. As I mentioned, she has an amazing memory, but she gets distracted and has a hard time focusing to use the memory. For example, at home when it is quiet, she is fast as lightening at doing her math facts. At school though, her math grades are all over the page because she hears a noise that distracts her. The teacher is constantly sending me notes home to work with her on this or that but when I do, my daughter knows the material amazingly well. She just doesn't display it at school because there is too much going on. Anyway, back to my experiment... I was nervous about supplements so after reading about Lecithin, I saw that one egg contains close to 300mg of Lecithin. I decided to give her three eggs a day (900mg lecithin) for about a week just to see if anything would happen. She also loves hard-boiled eggs and I was more comfortable with giving eggs than giving the supplement. After about 4 days, my husband and I were amazed at her focus. For the first time in her life, she sat at the dinner table through a whole meal without me having to remind her to sit. The bad news was that her tics started increasing. So, something in the eggs helped her focus and something in the eggs caused her to tic. My thinking was that the Lecithin helped the focus and the Omegas caused the tics, but I finally tried the Soy Lecithin and I think it made her tic. I quit it quickly but may try again later just to make sure.

 

You mentioned dyslexia. I don't think she has dyslexia. She reads fine. She just has to say a sentence or word over and over. I think I have read that it can be an OCD thing but I really don't know.

 

 

SF Mom - My daughter did have strep three weeks before the tics started. Originally, I was convinced it was PANDAS, but I had her strep tested and sent the culture off to grow and it came back negative. I will definitely check out the PANDAS threads and the PANDAS site though.

 

Anyway, still lookin for suggestions. I feel like I need something to calm and relax her brain. I just don't know what.

[sf_mom]

TRG, DO NOT WASTE ANY TIME she is definitely PANDAS if she had strep three weeks prior to tics starting. It took our son about two to three weeks for the tics set in after his strep infection. His ASO titers were positive post infection and did not have him cultured at the time of illness 6/24/09. He was shoulder shrugging, head tilting, flicking of the back, eye blinking, jaw wagging, arm swinging, coughing/clearing of throat, grunting while eating, etc. He was writing his name backwards in a mirrored fashion... So if you held it up in a mirror his name would read correctly. I didn't notice the OCD behavior at first.... I actually didn't even know what OCD was at the time. A Tourette's Specialist had to tell me what OCD was over the phone. By the way, he was getting better on his own 4 to 5 weeks post his illness but the ticking was always there. He is now 'almost' fully recovered after non-stop antibiotics since August 8th and IVIG treatment a week ago. It a miracle.

 

You need to read, read, read on PANDAS and learn more about strep tests and titers...... oftentimes they are negative. Read 'Saving Sammy', he is an extreme case but he didn't ever have a reported strep infection but his titers were through the roof. Read Panda's Network in detail at least three times. The cases posted there are extreme but its what you can expect if you don't seek the proper help.

 

Her need to to say something over and over is OCD. It will only continue to get worse for your daughter and especially if she is exposed to strep again. Wishing you all the best.

[trggirl]

SF Mom, I am headed over to the PANDAS forum now to start reading. Thank you!!

[sf_mom]

You won't be sorry..... The earlier your daughter gets treatment the better the success they've been having long term. I recommend posting your story (if you haven't already) I'm positive you'll get a resounding answer that your daughter is PANDAS.

[faith]

SF Mom,

I am guessing you are going by symtoms, but what do you do when the strep tests, both quick and cultured, plus the titers being tested at normal? My son had a strep diagnosis once a couple years ago and the behavior he exhibited that weekend was pretty on the mark for PANDAS. He did respond to the antibiotics, but after that, any time he exacerbated, he tested negative. and we did have titers checked twice, about 9 months apart. Also we have tried antibiotics again after that and it didn't seem to help. What do you do after that? My son's symptoms are mostly tics, both motor and vocal, with vocal being the prominent one now. he has displayed ocd in the way of repetitive erasing about 6 months ago. I have not followed this angle because of the dead ends. What advice would you give?

 

thanks

Faith

[sf_mom]

If the antibiotics are helping that is an indication right there. I would document your child's history, request a CaM Kinase test kit from Madeleine Cunningham's office. This will specifically tell you if your child is PANDAS or not. It measures the CaM Kinase protein in the blood that is activated by strep infections. You can find out more about it under the PANDAs section here or at PandasNetwork.org Also many of the Dr.s who are treating PANDAS will look at the clinical picture. Two specific Dr's that are the experts and treating at least several patients weekly are Dr. Kovacevic in Chicago and Dr. Latimer out of DC area. Here is also a link to helpful threads regarding PANDAS http://www.latitudes.org/forums/index.php?showtopic=3928. Once you get your results and if they are PANDAS I would recommend consulting with one of the two mentioned Dr.'s for treatment plan and not wasting your time trying to explain or finding a Dr. who does not understand. I'm around and check ACN forum daily if you have anymore questions.

 

Madeleine W. Cunningham, Ph.D.

George Lynn Cross Research Professor

Microbiology and Immunology

Director, Immunology Training Program

University of Oklahoma Health Sciences Center

Biomedical Research Center Room 217

975 NE 10th Street

Oklahoma City, OK 73104

Tel 405-271-3128

Lab 405-271-2133 X47455

FAX 405-271-2217

 

 

Here is some information about titers.

 

1) Is PANDAS a reaction to elevated ASO or AntiDNAseB titers?

The research indicates no. ASO and AntiDNAseB are responses to Group A Beta-Hemolytic Streptococci. PANDAS is thought to be a reaction to another antibody that's created in response to the streptococci. The theory from Cunningham and Kirvan is that there is a monoclonal antibody that is created that targets a particular carbohydrate sequence on the streptococci. This monoclonal antibody is supressed in most people but for some reason it is not supressed in PANDAS kids.

 

2) What amount of streptococcus is necessary to cause a detectable rise in ASO and AntiDNAseB?

This is unknown. Some people respond with high antibody counts while others have low counts. It is just not understood. Studies in 2003 by Kurlan indicate that ASO rises in 53% of patients with culturable strep, AntiDNAseB rises in 45% of patients with culturable strep, and either ASO or AntiDNAseB rises in 60% of patients with culturable strep (i.e., 40% don't have such a rise).

 

3) Does an elevated ASO or AntiDNAseB indicate a persistant strep infection?

Apparently not. Some people keep high AntiDNAseB for years. The rate of fall is just not known.

 

4) Is a high ASO or AntiDNAseB bad?

It is unclear, it indicates the body is still producing antibodies to antigens from strep, but PANDAS is likely related to a different antibody and it is not at all clear if the rise/fall of this antibody is linked to the ASO or AntiDNAseB titer.

 

5) Is there a test for this antibody associated with PANDAS?

Not yet. There remains considerable debate about the antibody and whether the antibody causes inflammation or just interference with basal ganglia function. Swedo and others thought the debate over PANDAS would end when the antibody was discovered. Unfortunately, others have not properly repeated Kirvan and Cunningham's experiment and others have had difficulty correctly identifying PANDAS patients.

[sf_mom]

Even more information on titers. A child needs to be on antibiotics for about a month to see a true impact and sometimes it matters as to what type of antibiotic. There are certain strains of strep that are difficult to eradicate. I'm in the Bay Area, my son was originally exposed to Scarlet Fever and he is responding azithromycin. Some respond to other types of antibiotics.

 

 

 

 

In reading through multiple posts, it seems there is a lot of confusion about titers and carriage of streptococcal infection. As a parent struggling to understand the medical information, I wanted to post what I've learned thus far and I hope it will be of use to you.

 

1) Titers need to be compared to a baseline. Direction is much more important than absolute value.

Some people produce very significant antibody responses, some don't. Some have high baselines, some don't. Since most often there isn't a test result from the prior month to compare against, most doctors (and labs) use a measure known as the "upper limit of normal" [uLN] as defining the baseline for ASO tests. Then if your single sample is > 130%-150% (depends on lab) of this baseline, they consider the test positive.

 

2) So this begs the question of what is the ULN for ASO? There are lots of studies here but what is important is that the studies have a very large range. For example in one study, kids not suspected of GABHS strep in the 5-10 year range, had

48% had titers below 100

6.8% had titers of 100

10.6% between 101-125

7.6% between 126-156,

22.1% between 157-195

and 4.5% in 196-244

 

Unfortunately, even in this study, there didn't seem to be a second measurement taken within 1-2 weeks to look for rise/decline.

 

3) This begs the question of "what level of response consistitutes a positive?." Could a result of <100 still be an indication of a recent strep infection?

The answer appears to be yes, but only if you have a prior value done by the same lab, using the same technique. Most studies show that subjects will have a response 2-4x their baseline, this statistically could still fall within this "normal" range depending on the individual. So again, the importance is to look at trends and not absolute values.

 

4) What about falling titers? Does a high number indicate a current strep infection?

The answer seems to be no. There is just no good study about how fast ASO titers fall and what drives the rate of fall. Thus a single sample really gives no good indication of direction. Most studies agree that the rise is within a week of infection with a peak at 4 weeks, but there isn't a study of whether this peak remains if the initial infection goes untreated. So could someone with an untreated strep infection have a declining ASO titer? -- the answer appears to be yes.

 

For example, the most recent study by Kurlan [June 2008 - Pediatrics] has one subject that has positive throat cultures for 23 of 25 months but the ASO titers are falling within this entire time. What does this mean? No one knows.

 

5) Do all strains of strep produce an ASO reponse?

 

The best study I've found on this is Kaplan's 2003 paper "Immune Response to Group A streptococcal C5a Peptidase in Children: Implications for Vaccine Development." What this paper shows is that despite positive strep cultures on day 1, at a subsequent visit 4 weeks later,

46% of subjects presented no ASO rise,

55% presented no Anti-DNAseB rise,

and 37% presented no rise of either ASO nor Anti-DNAseB

 

There also seems to be good research indicating that skin GABHS infections does not produce ASO response despite producing Streptolysin O.

 

What does this mean?

Does this mean that the test was bad? That some strains don't produce the streptolysin O protein? That some people don't mount a high immune response? That the individual is a strep carrier? That the strep was going on for some time and the ASO titers have already fallen? That skin GABHS infection differs from pharangytis GABHS? The answer is that the scientific community doesn't know. There has been no careful study of the decline rate of ASO titers and the entire field of "strep carriers" is not at all clear.

 

So summarizing,

a rising ASO titer (regardless of absolute value) is an indication of GABHS strep; however, you need a baseline to be sure it is rising.

A falling ASO titer indicates that there was strep, but no one knows when.

A high ASO titer could be anything including that the titer is falling, rising, or just a high baseline. Statistically it is likely to be a falling titer.

Most will treat a titer of > 400 IU's as a falling titer (i.e., that there was once a strep infection sometime in the past). But the exact time of the infection is not known.

The interpretation of a low ASO titer is unclear. There could have been an infection and the titer has already fallen, the baseline for the person could be low, the individual may not respond with a strong immune response, the strain may not produce significant amounts of streptolysin O.

 

One final comment, Swedo does not require high ASO titers or even rising ASO titers to diagnose PANDAS. The titers are checked only when a positive strep culture is not available and you are retroactively looking for an indication of past infection. The flaw with using titers as an indication of prior strep infection is (as I stated above) that "low" values can still be associated with prior strep infections since the rate of ASO titer decline is not known, most people only have a single sample, and the ASO response is variable across individual and strep type.

 

Regards,

 

Buster

[trggirl]

SF Mom, thank you for all your information. It is truly appreciated. I will definitely update!

[sf_mom]

I just want you to know someone did the same for me shortly after my son sick in June and he is BETTER!!! Almost symptom and tic free 13 days post IVIG. I also believe in my heart the early treatment is hugh in the success and recovery for the children that are afflicted. I've attached a brief outline of my son's illness along side his friends.

 

• Novemember 2007 (IMPORTANT HISTORY): Sunday, Novemember 4, 2007 we had a playdate with a boy named Adrian who had a swollen gland on the left side of his neck the size of a golf ball. Exactly 10 days after playdate our son had what looked like pink eye in both eyes and a high fever for 4 or 5 days. Eactly 10 days after the start of our son's illness our 5 ½ month old baby boy started showing signs of a similar illness. However, our 5 1/2 month old symptoms seemed to be much worse with extreme restlessness and vomiting even after IV fluids. Within 24 hours of him getting sick he was admitted to the hospital and eventually diagnosed with Kawasaki’s. I believe the bacteria was stopped in its track due to the IVIG treatment provided to our son at day 5 of high fever. I asked if Kawasaki’s was contagious and explained my older sons symptoms. I was told that they didn’t think Kawasaki’s was contagious and it was highly unlikely our other son had Kawasaki’s the week prior. I have recently discovered that our son‘s friend had peeling palms and feet (skin coming off in sheets) with a prior fever and rash at the time of playdate as well as the swollen gland. The peeling palms and feet was not communicated to Adrian‘s Dr. when his mother sought treatment for swollen neck gland. Adrian was diagnosed with strep throat Monday, Novemeber 5th, 2007 and treated with several courses of antibiotics. It was eventuallly determined he had weak immune system, sinitis and irritated adenoids that were eventually pulled June of 2008. THE SWOLLEN GLAND DID NOT RESOLVE ITSELF UNTIL ADRIAN’S ADENOIDS WERE PULLED. Our sons friend, still suffers from headaches, daily joint pain, weak immune system, extreme shyness, seperation anxiety, OCD behavior, TICS, chapped lips with cold sores and is repeating Kindergarden. Our son's CaM Kinase score 124 – lower range PANDAS, blood draw taken 11 days post Predisone Burst which might have lowered his score. We had our son's STREP PNEUMOCOCCAL ANTIBODY TITER checked and he is deficient in 10 of 14 serotypes, ADRIAN’S CaM Kinase score 147 – mid range PANDAS. Adrian’s STREP PNEUMOCOCCAL ANTIBODY TITER were tested in 2008 and he has similar deficiencies. Thankfully, our other younger son who was diagnosed with Kawasaki’s seems to be fine. He is 2 years, 4 months old now.

 

• July 2008: We believe that our son at 4 ½ years old contracted strep again but went undiagnosed. All I remember was, he was sick, had an ongoing cough/clearing of throat for 3 weeks so we finally took him to the Dr. He was diagnosed with sinusitis prescribed Amoxicillian, one to two days after starting amoxicilian he had a full body rash, neck to ankle and was switched to Azithromycin. Cough/clearing of the throat continued to persist so we took him back to the Dr. and was told at the time the clearing of throat was psychosamatic and that it would eventually go away (no additional antibiotics were perscribed)… Cough/clearing of throat did eventually wane after another 6 to 8 weeks but would crop up occasionally throughout year. He had NOT been prescribed antibiotics prior to this time frame. He was healthy, healthy… Only prior illnesses were Croup x 3, Flu – March 2006, Illness/Flu November 2007 outlined above.

 

• June 24th -27th, 2009: High Fever and Sore Throat. Had to sleep in his room to get him to settle. I thought he was restless due to fever.

 

• July 1st - 4th, 2009: Noticed Tic Behavior: Rapid eye blinking, clearing of throat, inability to sleep, moodiness. We had company this particular week so I might have missed some of his symptoms. Our son had a playdate on the 1st with a friend who immediately took ill afterwards. Rowan’s illness consisted of headaches, fever, full body rash but was never formly diagnosed of anything.

 

• July 2nd, 2009: I remember that our son was very moody this particular day – I took him to the Academy of Science Museum. On our way home, he slept the entire way which is very unusual for him to nap during the day.

 

• July 6th – 17th, 2009: Multiple-Tics: Shrugging of shoulders, heading tilting to left, flicking back of ears, clearing of throat, grunting, eye blinking, etc. OCD Behavior: sneeking off to wash hands (does not know why), insistant that he has to clean his hands prior to touching baby blanket (does not want to get germs on it), concerned about germs from a friend who spent the night. Other Symptoms: moody liability, separation issues at school, ongoing fears of a story about a snake, inability to fall asleep, bad dreams, night waking, complaining of aches, pains and itchiness every morning. I was so concerned I video taped his behavior at this time.

[faith]

sf mom,

when you mentioned s. pneumonia, did you mean the kind of pneumonia that one gets like from a bad cold or upper respiratory illness like bronchitis that sometimes turns into pneumonia or "walking pneumonia"?

 

Faith

[sf_mom]

Yes, there are 90 serotypes or strains and some more difficult to eradicate then others. One thing they look at in PANDAS children is how sick were they as babies with ear infections, sore throats, pneumonia, sinusitis and any strep related illness like Scarlet Fever, RF, Syndenham Chorea even in the family tree. One thing that is becoming extremely common is the deficiencies in the 'STREP PNEUMOCOCCAL ANTIBODY TITERS'. Its easy to have them tested by an Immunologist.

 

Streptococcus pneumoniae, or pneumococcus, is Gram-positive, alpha-hemolytic, bile soluble aerotolerant anaerobe and a member of the genus Streptococcus.[1] A significant human pathogenic bacterium, S. pneumoniae was recognized as a major cause of pneumonia in the late 19th century and is the subject of many humoral immunity studies.

Despite the name, the organism causes many types of pneumococcal infection other than pneumonia, including acute sinusitis, otitis media, meningitis, bacteremia, sepsis, osteomyelitis, septic arthritis, endocarditis, peritonitis, pericarditis, cellulitis, and brain abscess.

S. pneumoniae is the most common cause of bacterial meningitis in adults and children, and is one of the top two isolates found in ear infection, otitis media.[2] Pneumococcal pneumonia is more common in the very young and the very old.

 

S. pneumoniae can be differentiated from other members of Viridans Streptococci, some of which are also alpha hemolytic, using an optochin test, as S. pneumoniae is optochin sensitive. S. pneumoniae can also be distinguished based on its sensitivity to lysis by bile. The encapsulated, gram-positive coccoid bacteria have a distinctive morphology on gram stain, the so-called, "lancet shape." It has a polysaccharide capsule that acts as a virulence factor for the organism; more than 90 different serotypes are known, and these types differ in virulence, prevalence, and extent of drug resistance.

 

Coccoid Bacteria Important human pathogens caused by coccoid bacteria include staphylococci infections, some types of food poisoning, some urinary tract infections, toxic shock syndrome, gonorrhea, as well as some forms of meningitis, throat infections, pneumonias, and sinusitis.[4]

[sf_mom]

Yes, there are 90 serotypes or strains and some more difficult to eradicate then others. One thing they look at in PANDAS children is how sick were they as babies with ear infections, sore throats, pneumonia, sinusitis and any strep related illness like Scarlet Fever, RF, Syndenham Chorea even in the family tree. One thing that is becoming extremely common is the deficiencies in the 'STREP PNEUMOCOCCAL ANTIBODY TITERS'. Its easy to have them tested by an Immunologist.

 

Streptococcus pneumoniae, or pneumococcus, is Gram-positive, alpha-hemolytic, bile soluble aerotolerant anaerobe and a member of the genus Streptococcus.[1] A significant human pathogenic bacterium, S. pneumoniae was recognized as a major cause of pneumonia in the late 19th century and is the subject of many humoral immunity studies.

Despite the name, the organism causes many types of pneumococcal infection other than pneumonia, including acute sinusitis, otitis media, meningitis, bacteremia, sepsis, osteomyelitis, septic arthritis, endocarditis, peritonitis, pericarditis, cellulitis, and brain abscess.

S. pneumoniae is the most common cause of bacterial meningitis in adults and children, and is one of the top two isolates found in ear infection, otitis media.[2] Pneumococcal pneumonia is more common in the very young and the very old.

 

S. pneumoniae can be differentiated from other members of Viridans Streptococci, some of which are also alpha hemolytic, using an optochin test, as S. pneumoniae is optochin sensitive. S. pneumoniae can also be distinguished based on its sensitivity to lysis by bile. The encapsulated, gram-positive coccoid bacteria have a distinctive morphology on gram stain, the so-called, "lancet shape." It has a polysaccharide capsule that acts as a virulence factor for the organism; more than 90 different serotypes are known, and these types differ in virulence, prevalence, and extent of drug resistance.

 

Coccoid Bacteria Important human pathogens caused by coccoid bacteria include staphylococci infections, some types of food poisoning, some urinary tract infections, toxic shock syndrome, gonorrhea, as well as some forms of meningitis, throat infections, pneumonias, and sinusitis.[4]