{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T21:22:49Z","timestamp":1790457769319,"version":"4.1.0"},"reference-count":33,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T00:00:00Z","timestamp":1443657600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            <jats:named-content content-type=\"genus-species\">Streptococcus pneumoniae<\/jats:named-content>\n            colonizes the nasopharyngeal mucus in healthy people and causes otitis media, pneumonia, bacteremia, and meningitis. In this study, we analyzed an\n            <jats:named-content content-type=\"genus-species\">S. pneumoniae<\/jats:named-content>\n            strain that caused 7 repeated pneumonia episodes in an 80-month-old patient with cerebral palsy during a period of 25 months. A total of 10\n            <jats:named-content content-type=\"genus-species\">S. pneumoniae<\/jats:named-content>\n            strains were obtained from sputum samples, and serotype 6B was isolated from samples from the first 5 episodes, whereas serotype 6A was isolated from samples from the last 2. Whole-genome sequencing showed clonality of the 10 isolates with 10 single nucleotide polymorphisms (SNPs) in the genomes. Among these SNPs, one single point mutation in the\n            <jats:italic>wciP<\/jats:italic>\n            gene was presumed to relate to the serotype switching from 6B to 6A, and the other mutations in\n            <jats:italic>parC<\/jats:italic>\n            and\n            <jats:italic>gyrA<\/jats:italic>\n            were related to fluoroquinolone resistance. These results suggested that an\n            <jats:named-content content-type=\"genus-species\">S. pneumoniae<\/jats:named-content>\n            strain, which asymptomatically colonized the patient's nasopharynx or was horizontally transmitted from an asymptomatic carrier, caused the repeated pneumonia events. Phenotypic variations in the capsule type and antimicrobial susceptibility occurred during the carrier state. Hyporesponsiveness to serotypes 6B and 6A of\n            <jats:named-content content-type=\"genus-species\">S. pneumoniae<\/jats:named-content>\n            was found even after vaccination with the 7-valent pneumococcal conjugate vaccine and the 23-valent pneumococcal polysaccharide vaccine. After an additional vaccination with the 13-valent pneumococcal conjugate vaccine, opsonic activities for both serotypes 6A and 6B significantly increased and are expected to prevent relapse by the same strain.\n          <\/jats:p>","DOI":"10.1128\/jcm.01222-15","type":"journal-article","created":{"date-parts":[[2015,8,13]],"date-time":"2015-08-13T02:29:43Z","timestamp":1439432983000},"page":"3318-3324","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":28,"title":["Capsule Switching and Antimicrobial Resistance Acquired during Repeated Streptococcus pneumoniae Pneumonia Episodes"],"prefix":"10.1128","volume":"53","author":[{"given":"Bin","family":"Chang","sequence":"first","affiliation":[{"name":"Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiyoshi","family":"Nariai","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Yokohama Minami Kyosai Hospital, Kanagawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Sekizuka","sequence":"additional","affiliation":[{"name":"Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukihiro","family":"Akeda","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention, Graduate School of Medicine, Osaka University, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Kuroda","sequence":"additional","affiliation":[{"name":"Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazunori","family":"Oishi","sequence":"additional","affiliation":[{"name":"Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Ohnishi","sequence":"additional","affiliation":[{"name":"Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)61204-6"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199508243330802"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2008.09.029"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/142.6.923"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(04)00938-7"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1586\/erv.12.53"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e31828701ea"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa022823"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.16.2043"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(14)70032-3"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0039927"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/pit057"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e318161434d"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.7883\/yoken.67.40"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1128\/CVI.00435-09"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2015.07.069"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.11.010"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268811001592"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1099\/00221287-144-11-3049"},{"key":"e_1_3_3_21_2","volume-title":"CLSI document M100-S18","author":"Clinical and Laboratory Standards Institute","year":"2008","unstructured":"Clinical and Laboratory Standards Institute. 2008. 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