December Blog: Studying Streptococcus pneumoniae

Autumn sees the introduction of a ground-breaking research portfolio in AED and AMU.


The generic research team are working alongside colleagues from Infectious Diseases, AED and AMU, recruiting patients to a variety of important studies which will hopefully impact on the health of our local community, as well as having global implications.


Streptococcus pneumoniae presents a significant UK and global health issue. It is a principal cause of pneumonia, meningitis, blood stream infections and sepsis with high mortality rates. Community acquired pneumonia (CAP), which is by far the most common form of pneumococcal disease, leads to high rates of hospital bed usage in the UK: in 2013-2014 there were around 175,000 admissions for CAP. These figures are increasing year on year.

Worldwide, pneumococcal disease accounts for over 1.5 million deaths per annum. In 2013 global vaccine coverage was reported at just 25%.

As yet, pneumococcal disease remains the number one vaccine preventable cause of death in children and adults.


The SCAPA study, (led by Dr Neil French, Consultant in Infectious Diseases and  Dr Steven Aston, SPR in Infectious Diseases) is a population based, prospective cohort study of pneumococcal pneumonia in adults, following the introduction of childhood pneumococcal vaccination in the UK.

We hope to include every patient that is admitted with a diagnosis of community acquired pneumonia. We want to see if the number of patients catching pneumonia each year is changing following the introduction of the pneumococcal vaccine. We also want to find out if the numbers of cases due to the types of pneumococcus covered by the vaccine are falling, or are they being replaced by types not currently being covered by the vaccine?

Finally we want to assess the contact that patients with pneumonia have had with children, and look at the link between this and the type of pneumonia our patients have.


The APAS study, (led by Dr Neil French and Dr Natalie Beveridge, SPR in Infectious Diseases) is a  Single-Site Cross-Sectional Observational Pilot Study to examine the role of T cell-mediated Tolerance of Streptococcus pneumoniae in the nasopharynx in protection against pneumococcal disease in adults. It aims to identify what is happening between the bacteria and the immune system in patient’s noses. What causes the bacteria to spread from the nose and develop into pneumonia? We hope to recruit all patients between 30 and 65 with a definitive diagnosis of pneumonia.


Breathspec® is a multicentre prospective, observational, longitudinal cohort study in adult patients with suspected Upper or Lower Respiratory infection (URTI/LRTI) to identify a spectrum of biomarkers in exhaled breath to discriminate participants with bacterial RTI from participants without. (BreathSpec®). This study is collaboration between LSTM, RLH and the CRN taskforce.

We want to see if we can tell the difference between viral and bacterial chest infections by analysing chemicals in the breath, using the Breathspec machine. Patients will be asked to provide 2 breath samples, and a nasal and throat swab. This will hopefully lead to improved management of infections and reduce the use of antibiotics when inappropriate.


We are also involved in the UK Meningitis (TRIM) study led by Dr Fiona McGill  (SPR in Infectious Diseases) which will evaluate a new diagnostic blood  test for the detection of bacterial meningitis.

Bacterial meningitis remains a significant cause of morbidity and mortality in the UK and worldwide, and is a devastating disease. Delays in antibiotic treatment can have life altering and life limiting consequences. Conversely, overuse of antibiotics in patients who do not have bacterial meningitis is contributing to increasing resistance. At present there is no blood diagnostic test in routine clinical use that is able to distinguish bacterial meningitis from other clinically similar syndromes. We hope to recruit all patients admitted via AED with a diagnosis of suspected meningitis.


Finally we are awaiting the opening of the RAPID 1 trial, the first publically funded research into Acute Pancreatitis in the last 40 years.

Led by Professor Sutton, professor of Surgery, and Dr Subramanian, Consultant Gastroenterologist, this is a phase 2 double blind, placebo controlled, randomised treatment of acute pancreatitis with Infliximab.

Acute Pancreatitis, is an inflammatory disorder of the pancreas causing excruciating pain, GI dysfunction and multiple complications that can lead to organ failure and even death, and one of the commonest gastrointestinal causes of emergency admission to hospital. We aim to treat patients within 12 hours of admission to determine the efficacy of early initiation of treatment with Infliximab.



All of these studies provide an exciting opportunity to collaborate with colleagues across the trust and we hope that it will lead to more patient centred research in emergency admissions.

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