Streptococci

STREPTOCOCCUS
Strepto-cocci
Commensals or Parasites of man & animals
or
Saprophytes of decaying matter
Genus Streptococcus
Gram-Positive Cocci in Pairs or Chains v/s Staph gram positive cocci in clusters (grape like)
Gram-Positive Streptococcus
Gram positive cocci in clusters

6
Classification
On the basis of their growth characteristics on
blood agar Alpha hemolytic Beta hemolytic Gamma hemolytic
Example Streptococcus viridans (Viridans = green)

Streptococcus pneumoniae
8
Example enterococcus group
10
11
12
Beta hemolytic streptococci Lancefield grouping

Group A to Group V without I and J
Divided according to differences in Cell wall
carbohydrate antigen Out of all these, those of Group A known as streptococcus pyogenes produce majority of human infections Group B are known as S agalactiae
13
Group A beta hemolytic streptococci / strep pyogenes

These are further subdivided according to sell
surface M, T and R antigens Griffith typing
14
15
Streptococcus Pyogenes (Group A beta hemolytic)
16
Description headings

Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
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Morphology
Cocci in long chains
18

19
Growth characteristics
Facultative anaerobe, grows best in presence
of 10% CO2 Grows on enriched media only Beta hemolysis around colonies on blood agar
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21

22
Biochemical reactions
Ferment sugars produce acid , no gas
Catalase negative
Catalase helps to differentiate staphylococci
from streptococci
23
Catalase test
Add hydrogen peroxide to culture material
24

25
Resistance
Most are still susceptible to penicillin and
erythromycin
26

27
Pathogenicity and virulence

Antigenic structure
Antigens on surface of strep cross react with body proteins

Capsular hyaluronic acid human joints autoimmune arthritis Carbohydrate antigen cardiac valves rheumatic heart disease
Toxins Enzymes
Streptolysin O ASO titre for diagnosis Streptolysin S for hemolysis around colonies Streptokinase lysis of clots given iv for treatment of MI DNA ase Anti DNAase is useful for diagnosis of S. pyogenes skin infection Hyaluronidase breaks down tissues helps in spread of strep infection
28

29
Epidemiology
Source human upper respiratory tract
throat, pharynx, nose Transmission direct contact, fomites
30

31
Diseases caused
Pus producing (suppurative)
Respiratory infections Skin and soft tissue infections Genital infections

Acute rheumatic fever Rheumatic heart disease Acute glomerulonephritis (kidney)
Non suppurative

32
Respiratory infections
Tonsillitis
Pharyngitis
33
tonsillitis
34
pharyngitis
35
Skin and soft tissue infections

Skin
Erysipelas involves lymphatics older pts Impetigo young children Pyoderma

Cellulitis Necrotising fascitis
Soft tissue

36
Erysipelas
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Impetigo
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Pyoderma
39
Cellulitis
40
Necrotising fascitis flesh eating bacteria (anaerobes)
41
Non suppurative complications

After 1-3 weeks of primary infection Due to cross reactivity
42
Acute rheumatic fever

Follows streptococcal sore throat
43
Acute glomerulonephritis
Cross reaction between streptococci and
kidney tissues
44
Rheumatic heart disease
45

46
Suppurative infections
Examination of pus/throat swabs
Microscopy, staining and culture

Gram stain Blood agar
47
Non suppurative infections

Demonstration of antibodies
Like ASO and anti DNA ase B
48

49
Treatment
Penicillin
Erythromycin
Drugs have no effect if non suppurative
complications have developed

Prophylaxis can prevent rheumatic fever,
not glomerulonephritis
50
OTHER STREPTOCOCCI
BETA HEMOLYTIC - GROUP B AND GROUP D
ALPHA HEMOLYTIC (VIRIDANS GROUP) STREPTOCOCCUS PNEUMONIAE
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Group B Streptococcus Streptococcus agalactiae
52
Group B Streptococcus S. agalactiae

1. Infect newborns 2. Infection acquired through maternal vagina during birth 3. Presents as meningitis, pneumonia or septicemia
53
Diagnostic Laboratory Tests

CAMP factor positive Hippurase positive
54
Group B Streptococcus
(CAMP Factor)
CAMP (Christie, atkins, munchpeterson) Factor Test S. aureus

(Spingomyelinase C)
Group A Streptococcus
Enhanced Zone of Hemolysis
55
Hippurase NEG
Streptococcus agalactiae not added
56
Grp B Streptococci
Hippurase POS
57
Viridans group Streptococcus pneumoniae

Commonly referred to as pneumococcus
58

59
Lancet shaped (one end broad, other
pointed) Capsulated Diplococci
60
S. pneumoniae: lancet-shaped diplococcus
61
S. pneumoniae Diplococcus
62
Capsular stain
63

64
Growth characteristics
Alpha hemolysis on blood agar
On further incubation, the colonies become
flat with raised edges and central elevation resembling carrom coins
65
Example Streptococcus viridans (Viridans = green)

Streptococcus pneumoniae
66

67
Biochemical reactions
Hiss serum water fermentation of inulin
Bile solubility
68
Inulin fermentation
69
70

71
Resistance
Pneumococcus is sensitive to optochin
used for typing Resistance to penicillin third generation cephalosporin like ceftriaxone May be resistant to third gen ceph also
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73

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Pathogenicity and virulence

Capsule
Toxins pneumolysin
C reactive protein
75
Capsule
76
Pneumolysin
Membrane damaging toxin
Cytotoxic activity
77
C reactive protein
Abnormal immunoglobulin against C protein
of S. pneumoniae appears in serum of patients Also seen in acute phase of infections and inflammations CRP titre is tested in acute infections
78

79
Epidemiology
Source respiratory tract of humans
Spread droplets Carriers pharynx
Low immunity is responsible for fulminant
infections

RSV infection, pulmonary congestion, stress, malnutrition, alcoholism Splenectomy Sickle cell disease
80

81
Diseases caused
Middle ear otitis media
Para nasal sinuses sinusitis

Respiratory tract pneumonia, bronchitis,
empyema Meningitis is secondary to otitis media, penumonia, sinusitis and conjunctivitis
82

83
Laboratory diagnosis
Sample
sputum pneumonia septicemia - blood culture Otitis media - fluid from middle ear Meningitis - CSF
Method
Gram stain, microscopy culture

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Latex agglutination for pneumococcal antigen
in serum of patients
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86
Treatment
Penicillin
Amoxycillin
ceftriaxone/ceftazidime Vancomycin
87
Prophylaxis
Pneumococcal conjugate vaccine is available Given to splenectomy patients, sickle cell
anemia patients and susceptible individuals
88
GROUP D STREPTOCOCCI
Enterococcus faecalis Enterococcus faecium

GI tract of humans and animals Group D carbohydrate cell wall antigen Formerly Streptococcus
89
Cause UTI, wound infection
Endocarditis
Intra abdominal abcesses
90
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Streptococci

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Streptococci

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STREPTOCOCCUS

Commensals or Parasites of man & animals

Gram positive cocci in clusters

blood agar Alpha hemolytic Beta hemolytic Gamma hemolytic

Example Streptococcus viridans (Viridans = green)

Example enterococcus group

Beta hemolytic streptococci Lancefield grouping

Divided according to differences in Cell wall

Group A beta hemolytic streptococci / strep pyogenes

surface M, T and R antigens Griffith typing

Streptococcus Pyogenes (Group A beta hemolytic)

Add hydrogen peroxide to culture material

Pathogenicity and virulence

Antigens on surface of strep cross react with body proteins

throat, pharynx, nose Transmission direct contact, fomites

Respiratory infections Skin and soft tissue infections Genital infections

Skin and soft tissue infections

Erysipelas involves lymphatics older pts Impetigo young children Pyoderma

Necrotising fascitis flesh eating bacteria (anaerobes)

Non suppurative complications

Acute rheumatic fever

Rheumatic heart disease

Microscopy, staining and culture

Non suppurative infections

Like ASO and anti DNA ase B

complications have developed

BETA HEMOLYTIC - GROUP B AND GROUP D

ALPHA HEMOLYTIC (VIRIDANS GROUP) STREPTOCOCCUS PNEUMONIAE

Group B Streptococcus Streptococcus agalactiae

Group B Streptococcus S. agalactiae

Diagnostic Laboratory Tests

CAMP factor positive Hippurase positive

CAMP (Christie, atkins, munchpeterson) Factor Test S. aureus

Enhanced Zone of Hemolysis

Viridans group Streptococcus pneumoniae

Lancet shaped (one end broad, other

pointed) Capsulated Diplococci

S. pneumoniae: lancet-shaped diplococcus

On further incubation, the colonies become

Example Streptococcus viridans (Viridans = green)

Pathogenicity and virulence

Low immunity is responsible for fulminant

Para nasal sinuses sinusitis

empyema Meningitis is secondary to otitis media, penumonia, sinusitis and conjunctivitis

Gram stain, microscopy culture

Latex agglutination for pneumococcal antigen

anemia patients and susceptible individuals

Enterococcus faecalis Enterococcus faecium

Cause UTI, wound infection

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