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Streptococcus pyogenes is one of the most frequent pathogens of humans. As normal flora, Streptococcus pyogenes can infect when defenses are compromised or when the organisms are able to penetrate the constitutive defenses.
Video: Animated microscopic view of Streptococcus sp.

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Gram-positive, non-spore forming, non-flagellated Over 30 identified species Members of this genus cause a variety of diseases but they are also quite common as members of the normal flora.
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Figure: Streptococcus pyogenes (after gram staining)

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Most of the species are catalase-negative. The organism may be aerobic, facultative anaerobic or caprophilic (growth requiring CO2) Requires enriched medium containing blood in order to grow. Group A streptococci typically have a capsule composed of hyaluronic acid .
Figure: Catalase test
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On the Basis of Hemolysis on Blood Agar

On the Basis of carbohydrate antigen (Lancefild Group)

A,B,C,..V
(I & J omitted)

On the Basis of protein antigen (Griffiths types)

-Hemolytic -Hemolytic -Hemolytic

1,2,3,4,5.etc

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Based on the type of hemolysis observed when grown on blood agar plates.

-Hemolytic: Partial hemolysis which gives a greenish appearance. Ex. Viridans Streptococci -Hemolytic: Clear zone indicating lysis of red blood cells. Ex. Streptococcus pyogenes -Hemolytic: No hemolysis is observed.
Figure: Hemolysis on Blood Agar
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 Most of the streptococcal antigens are located in its cell wall. The cell wall has three principle layers. They are, 1. Protein antigen: The outermost layer. Composed of i. M-protein ii. T-protein iii. R-protein 2. Carbohydrate antigen(the middle layer) 3. Mucopeptide (the innermost layer)
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M, T, R

Figure: Structure of a Streptococcus sp.

Points
Acid stability
Heat stability

M
Stable
Resistant(in acid pH) Protective antigen

T
Unstable
Sensitive

R
Unstable
Resistant(in alkaline pH) Not a protective antigen

Protection

Not a protective antigen

Association with virulence

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Associated

Not associated Not associated

Major success as a pathogen to its ability to colonize and rapidly multiply and spread in its host. Serious diseases that associated with Streptococcus pyogenes occur chiefly in the respiratory tract, bloodstream, or the skin. Generally, streptococcal isolates from the pharynx and respiratory tract do not cause skin infections.
Figure: The pharynx
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Four steps are involved, these are

1.

2.

3.

4.

Entry: when defenses are compromised or when the organisms are able to penetrate the constitutive defenses. Spread: Strains that cause skin infections are spread via skin contact. Strains that cause respiratory infections are spread via respiratory droplets. Disease: Disease develop depends on where Streptococcus pyogenes takes up residence in the body (show in Figure). Exit: Direct contact or self inoculation .
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Figure: Four steps of Pathogenesis

By the National Institutes of Health reports, the bacterium known as Streptococcus pyogenes produces infections that can cause strep throat, scarlet fever, impetigo and other illnesses. some of them are serious that describe in below, Symptoms With Strep Throat When Streptococcus pyogenes causes strep throat, symptoms can include sore throat, rash, fever, headache.

Figure: Symptoms With Strep Throat

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Symptoms With Scarlet Fever Scarlet fever typically manifests as a bright red rash over much of the person's body. Other symptoms include fever (101 degrees Fahrenheit),vomiting, and headaches.
Figure: Symptoms With Scarlet fever

Symptoms With Impetigo It generally occurs in children. It produces red, blister-like sores. The blisters are filled with pus.

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Figure: Symptoms With Impetigo

Additional tests are required for proper identification. The patients serum may be tested for the presence of M-antigen (Mprotein) by a variety of serological tests.

Figure: Serological test

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The throat culture is the standard method for diagnosis, with the main disadvantage being a 24 to 48 hour delay in culture results. The throat culture is performed by culturing swabs of bacteria collected from the back of the throat. The bacteria are allowed to grow on special plates called blood agar plates. When the bacteria is grown on blood agar, a clearing of the red blood cells on the petri-dish indicates positive identification of the Streptococcus pyogenes bacteria.
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Figure : Bacteria are collected from the back of the throat.

Virulence Factor
Streptolysin - S

Action
Lyses leukocytes, platelets, and erythrocytes

Streptolysin - O Streptokinase Streptodornase

Hyaluronidase Dnase (Diphosphopyridin e nucleotidase)
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Same as Streptolysin- S but it is immunogenic Can cause liquefaction of clotted blood Antigenic and depolymerizes cell-free DNA
Breaks the ground substance (proteoglycans, glycoproteins and etc) of the connective tissue Depolymerizes cell-free DNA

Initially

colonizes skin and

pharynx Person to person spread Strains that cause skin infections are spread via skin contact Strains that cause respiratory infections are spread via respiratory droplets Less common is food or waterborne.
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Figure: Spread via skin contact

Streptococcus pyogenes is very sensitive to penicillin, and resistance is almost unknown. A ten-day course is recommended. Erythromycin, Clindamycin Vancomycin are also useful in patients.
Figure: Streptococcus pyogenes growth is inhibited by penicillin.
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The spread of all types of infection can be reduced by good hand washing, especially before preparing foods or eating. Do not share toothbrushes and other personal things. No effective vaccine has been produced.
Figure: Hand washing
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