lecture (4)

content
Streptococci (types of streptococcal bacteria, Streptococcal
diseases, important properties ,transmission , pathogenesis,
clinical finding, diagnosis and treatment).
 GENERAL CHARACTERISTIC
* G+ve cocci , arrange in chains or
pairs.
* Some strains are capsulated
* Majority are facultative anaerobic,
few are obligatory anaerobic.
* Catalase –ve
* Non motile.
* Non spore forming
* Fastidious microorganism
Classification Based on Lancefield Proteins: Rebecca Lancefield, working
with various streptococcal species, discovered proteins in the cell wall that were
unique to certain organisms. These proteins were labeled Group A, Group B, Group
C, and so on through Group M. Currently three Lancefield Groups are of medical
importance: Group A, Group B, and Group D
Group A Strep--Streptococcus pyogenes
Group B Strep--Streptococcus agalactiae
Group D Strep--Streptococcus bovis, Enterococcus (Streptococcus) faecalis
Streptococcus pneumoniae does not possess Lancefield proteins and is not classified in
one of the Lancefield groups.
Viridans streptococci are the term applied to alpha hemolytic Streptococcus species
that lack Lancefield proteins.
Lancefield Classification- β hemolytic
Pathogenesis & Virulence Factors
Structural components
– M protein inhibits phagocytosis of
bacteria
– Lipo teichoic acid helps in adhesion of
bacteria
– Capsule- camouflages bacteria

Enzymes
– Streptokinases- fibrinolysin
Facilitate spread of
– Deoxyribonucleases
streptococci in tissues
– Hyaluronidase

Pyrogenic / Erythrogenic exotoxin

Hemolysins
– Streptolysin O- Oxygen labile, antigenic
– Streptolysin S- serum soluble
Hemolysis on BA
– -hemolysis
Partial hemolysis
Green discoloration around colonies
S. pneumoniae & S. viridans
– -hemolysis
Complete hemolysis
Clear zone of hemolysis around colonies
Lancefield Group A & B (S. pyogenes & S. agalactiae)

– -hemolysis
No hemolysis
Group D (Enterococcus sp.)
Hemolysis on Blood Agar
Disease caused by S. pyogenes (Group A)
Disease caused by S. pyogenes
(Group A)
Suppurative
Non-Invasive

▪ Pharyngitis - inflammation of
the pharynx, tonsillitis, otitis
media, mastoiditis, rarely
meningitis
Disease caused by S.
pyogenes (Group A)
Erysipelas
Suppurative
Non-Invasive NOTE:
erythema
Pyoderma- Impetigo-
localized pus-producing bullae
lesions usually occur on
face, arms, or legs
Disease caused by S.
pyogenes (Group A)
Suppurative
Invasive
Erysipelas- an acute, sometimes
recurrent disease caused by a
bacterial infection. It is characterized
by large, raised red patches on the
skin, especially that of the face and
legs, with fever and severe general
illness Cellulitis
Wound Infections
Cellulitis- infection of skin &
subcutaneous tissue, Deeper
invasion with systemic
symptoms
 Disease caused by S. pyogenes
(Group A)
Suppurative
Invasive
Necrotizing fasciitis:(“flesh-eating bacteria”):
Infection deep in subcutaneous tissues
that spreads along fascial planes, (“flesh-eating bacteria”)
destroying muscle and fat; Initially
cellulitis followed by bullae (fluid filled
blisters; bulla is singular), gangrene,
systemic toxicity, multiorgan failure and
mortality in more than 50% of patients
 Disease caused by S. pyogenes
(Group A)
Other Suppurative Diseases
1-Puerperal & neonatal sepsis
Puerperal fever was a devastating
disease. It affected women within the
first three days after childbirth and
progressed rapidly, causing acute
symptoms of severe abdominal pain,
fever and debility.
2-Lymphangitis: Inflammation of
lymphatic vessel(s)
3-Pneumonia : pleuritic chest
 Disease caused by S. pyogenes (Group A)
Systemic Disease
Streptococcal Toxic Shock Syndrome (TSS):
Multisystem toxicity following soft tissue
infection progressing to shock and organ failure
(not to be confused with Staphylococcal Toxic
Shock Syndrome where hyper absorbent
tampons have been identified as an important
risk factor)
Bacteremia
Scarlet fever- rash begins
on chest & spreads across body
 •Scarlet fever is rare in
children under the age of
2, because substances
from the mother’s
immune system
(antibodies) protect the
child up to that age.

Scarlet fever is
contagious to people
who come into close Scarlet fever
contact with an Fever, chills, body
infected child. aches, nausea,
Complications are rare vomiting, and
but can include deeper loss of appetite
tissue infections, may occur.
rheumatic fever, and
kidney disease.
 Streptococcal Toxic Shock
Syndrome (TSS):
Women who have preexisting staphylococcal
colonization of the vagina and who leave tampons or
other devices (eg, contraceptive sponges, diaphragms)
in the vagina
Mechanical or chemical factors related to tampon use
probably enhance production of the exotoxin or
facilitate its entry into the bloodstream through a
mucosal break or via the uterus. Estimates suggest
about 3 cases/100,000 menstruating women still occur
 Non Suppurative complications or sequelae

– Rheumatic fever: following pharyngitis

carditis, poly arthritis, damage to heart valves
potentially fatal

– Acute Glomerulonephritis- following skin infection

Immune complex mediated disease
inflammation of glomeruli due to Ag-Ab complex
deposit on basement membrane
Clinically- Hematuria, Proteinuria, Hypertension
Good prognosis
Glomerulonephritis
 Lab Diagnosis
Sample -Throat swab, pus / swab
Gram Stain- GPC in chains, catalase negative
Primary culture by pour or streak plate, beta
hemolytic colonies, Domed,grayish/
Culture on Blood agar- opalescent colonies, Encapsulated cells
produce mucoid colonies ,

Bacitracin test : It is used to determine its effect of a small amount (0.04

IU or 0.05 IU not higher) on different microorganisms. presumptively
distinguishing between Group A beta-hemolytic streptococci (bacitracin
POS) and other beta-hemolytic streptococci that are isolated from
pharyngeal swabs (95% sensitivity for Grp A strep)
 Streptococcus
pneumoniae Diplococcus

Commonly referred
to as pneumococcus
• Formerly
Diplococcus
pneumoniae
Streptococcus pneumoniae

gram-positive, alpha-hemolytic,
aerobic, capsulated diplococci
 Streptococcus pneumoniae

Community-acquired pneumonia is defined as pneumonia that is

acquired outside the hospital. The most commonly identified
pathogens are Streptococcus pneumoniae

Symptoms and signs are fever, cough, sputum production, pleuritic chest
pain, dyspnea, tachypne, otitis media, pneumonia, sepsis, meningitis, and
death.

Diagnosis is based on Gram stain and culture,clinical presentation and

chest x-ray, Optochin sensitivity (Taxo P disc).

Treatment depends on the resistance profile and includes either a beta-

lactam, a macrolide, a respiratory fluoroquinolone, a pleuromutilin, or
sometimes vancomycin.
pleuritic chest pain
Group B Streptococcus
Streptococcus agalactiae
 Group B
Streptococcal
Infections
 Enterococcus faecalis
Enterococcus faecium

• GI tract of humans and animals

• Group D carbohydrate cell wall antigen
• Formerly Streptococcus
Group D
Enterococcus
Streptococci treatment
penicillin or amoxicillin is the drug of choice for both
mild and severe disease. For penicillin-allergic
patients with mild illness, erythromycin can be used,
although occasional resistance has been seen. For
people who are allergic to penicillin and penicillin-
based antibiotics, the recommended treatment is
cephalexin or other similar cephalosporins,
clindamycin, or azithromycin