Damage to the lining of the airways (respiratory epithelium) and upper respiratory system caused by influenza may facilitate pneumococcal entry and infection. Other risk factors include smoking, injection drug use, Hepatitis C, and COPD. Virulence factors
S. pneumoniae expresses different virulence factors on its cell surface and inside the organism. These virulence factors contribute to some of the clinical manifestations during infection with S. pneumoniae. Polysaccharide capsule—prevents phagocytosis by host immune cells by inhibiting C3b opsonization of the bacterial cells
Pneumolysin (Ply)—a 53-kDa pore-forming protein that can cause lysis of host cells and activate complement
Autolysin (LytA)—activation of this protein lyses the bacteria releasing its internal contents (i.e., pneumolysin)
Hydrogen peroxide—causes damage to host cells (can cause apoptosis in neuronal cells during meningitis) and has bactericidal effects against competing bacteria (Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus)
Pili—hair-like structures that extend from the surface of many strains of S. pneumoniae. They contribute to  colonization of upper respiratory tract and increase the formation of large amounts of TNF by the immune system during sepsis, raising the possibility of septic shock
Choline binding protein A/Pneumococcal surface protein A (CbpA/PspA)—an adhesin that can interact with carbohydrates on the cell surface of pulmonary epithelial cells and can inhibit complement-mediated opsonization of pneumococci
Competence for genetic transformation likely plays an important role in nasal colonization fitness and virulence (lung infectivity)

Diagnosis
Depending on the nature of infection an appropriate sample is collected for laboratory identification. Pneumococci are typically gram-positive cocci seen in pairs or chains.
In the studies that have been performed, it is shown that there are no current known side effects post-op. However, a patient might have a slight edema for about a month or two. The only side effect would be an operation scar. Epidemiology
Webbed penis is considered to be a very uncommon condition, however, its prevalence is still unknown. Due to the fact that it occurs at birth, a high percentage of cases with the condition are found in young children. Research directions
Webbed penis is when the penis is partially or completely concealed beneath the scrotum or when there is excess skin or fat around the pubic area. Various research is being conducted on this condition: for example, Webbed penis: A new classification is a study that was conducted to suggest an operative method that can be planned based of the severity of the webbing condition. Other research has tried to test the introduction of a modified surgical procedure for repairing a concealed penis and compared the efficacy and feasibility of modified repair with traditional repair.An interesting research study was done between the years 2010 and 2014 to test a new surgical technique for concealed penis using an advanced musculocutaneous scrotal flap. The research showed that the advanced musculocutaneous scrotal flap technique for correcting concealed penis is technically easy and safe and the surgical method provided patients with a good cosmetic appearance, functional outcomes, and excellent postoperative satisfaction grades. See also
Buried penis


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