Specific Infections Caused by S. Pneumoniae S. pneumoniae causes infections of the middle ear, sinuses, trachea, bronchi, and lungs (Table 128-2) by direct spread from the nasopharyngeal site of colonization. Infections of the central nervous system (CNS), heart valves, bones, joints, and peritoneal cavity usually arise by hematogenous spread. Peritoneal infection may also result from ascent via the fallopian tubes. The CNS may also be infected by drainage from nasopharyngeal lymphatics or veins or by contiguous spread of organisms (., through a tear in the dura). Primary pneumococcal bacteremia—., the presence of pneumococci in the blood with no apparent.
