Streptocococci en

GRAM POSITIVE COCCI
Genus Streptococcus
Remember
Genus Streptoccocus
 Large number of species

- Members of normal flora
 Oropharynx,
 skin,
 gastrointestinal tract.
– Pathogenes: Streptococcus pyogens
General characteristics
 Gram positive cocci

 forms linear chains
 catalase negative
 facultative aerobic
 capsule:
– hyaluronic acid : Streptococcus -hemolytic
group A
– Pollisacharides : Streptococcus pneumoniae
 anaerobes Streptococii
– genus Peptostreptococcus
Classification
A. – by hemolysis on blood agar
 hemolysis β:
complete lysis of
erythrocytes
= β - hemolytic
streptococci
 hemolysis  -
incomplete, green
 γ - non hemolytic
streptococci
B. Classification according with their determinants
of antigenicity (classified by Rebecca Lancefield) :
 Polysacharide “C”
– part of cell wall
– grouping of streptococci in Lancefield groups: A - T
Group A - the most important for human
pathologie
 !!!! Group A streptococci are grouped

according with M protein into > 80 subtypes.
 Capsular polysaccharide allows grouping of
pneumococci into 83 capsular types.
-hemolytic Streptococci
 complete hemolysis on blood agar

 Streptococcus pyogenes = streptococus -
hemolytic group A Lancefield (GAS)
 S. anginosus (GAS) – human infections
appear to be uncommon
 Streptococcus agalactiae = streptococcus

-hemolytic group B Lancefield, (GBS)
– pathogen for new borns
-hemolytic Streptococci
 incomplet hemolysis, green

 Streptococcus viridans: (mutans, salivarius)
- in oropharynx of healthy persons
– Endocarditis
- dental caries
 Streptococcus pneumoniae (pneumococcus)
- bacterial pneumonia, pneumococcal meningitis
 Enterococcus faecalis, E.faecium
 nosocomial infections,
 urinary tract infections
 Streptococcus bovis (group D): meningitis,
endocarditis, UTI.
α hemolysis (incomplete)
ɤ -hemolytic Streptococci
 - nonhemolytic
 - not pathogenic
 - Streptococcus lactic
Streptococcus pyogenes - Diseases :
– Pharyngitys, tonsillitis (pus formation)

– Otitis, sinusitis
– Endocarditis
– Erysipelas
– Impetigo
– Scarlet fever
– Puerperal fever
– Fasciitis
pharyngitis
Scarlet fever
erysipelas
Post streptococcal diseases
nonsuppurative complications :
1.Rheumatic fever
2.Acute poststreptococcal
glomerulonephritis
3. Erythema nodosum
Laboratory diagnosis
A. Direct diagnosis
1. Sample collection
 pharyngeal exudate,
 exudates from other locations ~ symptoms
 rarely pus
2. MO examination of the sample
- irrelevant because of saprobic streptococci
3. Isolation on culture media
- blood agar !!!!!
4. Identification - microscopic characteristics
pure culture pathological product
4. Identification of streptococci
- cultural properties
 colonies
 Small,
 translucent
 Bacitracin
– Group A strept. –susceptible
to Bacitracin
 CAMP test
– Group B strept.
4. Identification of streptococci
- antigenic properties
5. Antibiogram
 β-hemolytic Streptococcus group A

(Streptococcus pyogenes) = susceptible
to Penicillin
– Erythromycin – patient allergic to P
 Other streptococci
– group B streptococci Ampicillin
 drug of choice
– cephalosporines
B. Indirect diagnosis
 Serologic
– ASLO test
 Biologic by Dick intradermal reaction IDR
 epidemiological purpose
– 0.1ml of erythrogenic toxin (= 1 STD skin toxic dose)
– inoculated in the forearm
– Result: after 24 hours
 (+) reaction
– inflammatory reaction bigger than 10 mm
– the person do not have antibodies to neutralize the toxin
– (it has not been exposed to erythrotoxin producer strains)
 (-) reaction
– inflammatory reaction smaller than 10 mm
– the person has been exposed to erythrotoxin producer strains
(e.g. she/he had scarlet fever ).
Streptococcus pneumoniae
general characteristics
 ovoid cocci, lancet-shaped

 Gram pozitive
 pairs (diplococci),
 capsuled : 90 antigenic types
 on blood agar -  hemolysis

– (incomplete)
Diseases
 Pneumococcal pneumonia
 sinusitis, otitis
 meningitis
 endocarditis, pericarditis
DISEASES PRODUCED BY S.PNEUMONIAE
Community-acquired pneumonia (CAP):
pneumonia acquired outside hospital,
limited to a single lob.
S.pneumoniae vs. S.aureus
 Community-acquired  Nosocomial pneumonia ,

pneumonia (CAP) Hospital- acquired
pneumonia (HAP)
 Immunocompetent
 Immunocompromised
host host
 Limited to a single lob  Diffuse pneumonia,
abcesses.
Blood agar
Chocolate agar
Media with proteins media with proteins
for fastidious bacteria for fastidious
bacteria
Cultural proprieties
CO2 5-10%
Identification of pneumococci
 S. pneumoniae is susceptible (S) to Optochin

 S. viridans is resistant (R) to Optochin
 lysed by bile
 Identification of serological type:
– Quellung reaction:
 capsular polysaccharide - corresponding antibody
changes the optical properties of the capsule,
causing it to appear swollen under the microscope.
Treatment - Antibiogram
 Penicillin G, but there are resistance strains

=> antibiogram
 Cephalosporins III
 Vancomicina
Control and prevention
 Polyvalent vaccine,
– capsular polysaccharides
 23 serological groups
– recommended for high-risk individuals.
– Protection: at least 5 years
Streptococcus agalactiae
 Streptococcus Group B
 part of normal vaginal flora
 30% of women
 significant cause of neonatal infections:
bacteriemia, pneumonia, meningitis
 β- hemolysis on blood agar
Identification of streptococci
– CAMP test- enhanced

hemolytic activity
Group D
– Streptococcus bovis
– Streptococcus suis
 S. bovis
– Bacteremia
– Endocarditis (in patient with colon carcinoma)
Genus Enterococcus
 antigen group D in the cell wall

 Enterococcus faecalis
 Enterococcus facium
 normal flora from
– gastro-intestinal tract,
– vagina, urethra
 nosocomial infections
Enterococcus – diseases
– Urinary tract infections

– Bacteriemia
– endocarditis
– Meningitis
– Abdominal and pelvic infections
 bile-esculine Test
Growth in 6.5% NaCl

medium:
Enterococcus +
Enterococcus
– Antibiogram !!!
– natural resistance to Cephalosporine
– Ampicillin, Vancomicin, Aminoglicoside
– VRE : Linezolid
– Standard of water quality

Thank you!

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GRAM POSITIVE COCCI

 Large number of species

 Gram positive cocci

 !!!! Group A streptococci are grouped

 complete hemolysis on blood agar

 Streptococcus agalactiae = streptococcus

 incomplet hemolysis, green

– Pharyngitys, tonsillitis (pus formation)

 β-hemolytic Streptococcus group A

 ovoid cocci, lancet-shaped

 capsuled : 90 antigenic types

 on blood agar -  hemolysis

 Community-acquired  Nosocomial pneumonia ,

 S. pneumoniae is susceptible (S) to Optochin

 Penicillin G, but there are resistance strains

– CAMP test- enhanced

 antigen group D in the cell wall

– Urinary tract infections

Growth in 6.5% NaCl

– Standard of water quality

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