Date of Award

January 2021

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Anne L. Wyllie


Background. Streptococcus pneumoniae is a commonly found upper respiratory tract colonizer that can progress to more severe disease forms such as pneumonia. Interactions with respiratory viruses other than SARS-CoV-2 have been previously identified such that S. pneumoniae may sometimes enhance disease or occur as a secondary or co-infection. With the recent emergence of SARS-CoV-2 there is limited data available describing this specific pathogen relationship that could play a role in the breadth and severity of the pandemic. Methods. Inpatients and healthcare workers testing positive for SARS-CoV-2 March 2020-August 2020 were tested for S. pneumoniae through saliva culture enrichment and RT-qPCR as well as urine antigen detection (UAD) assays. A multinomial multivariate model was used to examine the relationship between pneumococcal presence and COVID-19 outcomes. Results. Among 126 subjects enrolled, the median age was 62 years; 54.9% of subjects were male; 88.89% were inpatients; 23.5% had an ICU stay; and 13.5% were deceased. S. pneumoniae was detected in 17 subjects (13.5%) by any method, including 5 subjects (4.0%) by RT-qPCR and 12 subjects (13.6%) by UAD. Detection by UAD was highly associated with both moderate and severe COVID-19 disease while RT-qPCR detected states were not significantly predictive of such outcomes. Despite being associated with more severe outcomes, UAD positives represented 0/14 deaths within the study population. Conclusions. Pneumococcal presence, particularly in a disease state, may be associated with more serious outcomes of SARS-CoV-2 infections. Concerns surround high levels of antibiotic usage that may diminish the ability to detect pneumococci, particularly in culture. Future studies should be performed to better characterize the relationship between these two pathogens across all levels of disease status.


This is an Open Access Thesis.

Open Access

This Article is Open Access