Immune ageing and susceptibility to Streptococcus pneumoniae

Streptococcus pneumoniae is a complex Gram-positive bacterium comprising over 90 different serotypes and is a major cause of pneumonia. Susceptibility to S. pneumoniae is remarkably age-related being greatest in children under 5 years old and adults over 65. Whilst the immaturity of the immune system is largely responsible for poor immunity in the former, the underlying causes of susceptibility in older adults is complex. Immunity to S. pneumoniae is mediated predominantly through the inflammatory response in the nasopharyngeal mucosa recruiting phagocytes (neutrophils and monocyte/macrophages) which recognise the pathogen via TLR2 and ingest and kill the bacteria, with the induction of Th17 cells being required to maintain neutrophil recruitment and ensure clearance of the infection. In this review we discuss the impact of ageing upon these aspects of immunity to S. pneumoniae, as well as age-related changes to the serotypes present in the adult nasopharyngeal tract which could further influence susceptibility to infection.