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Microbio Lec 5 - Streptococcus

Microbio Lec 5 - Streptococcus

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MICROBIOLOGY LECTURE 5 \u2013 Genus Streptococcus
Notes from Lecture
USTMED \u201907 Sec C \u2013 AsM

Generalities

1. Gram positive cocci that grow in pairs or chains
2. Widely distributed in nature
3. 27 recognized species
4. Some are members of the normal human flora

5.Others are associated with important human disease
attributable to infection by streptococci and to
sensitization to them
6.The most important of the human pathogens:
a. Streptococcus pyogenes (Group A)
b.Streptococcus agalactiae (Group B)
c.Enterococcus faecalis(Streptococcus faecalis) (Group
D)
d. Streptococcus pneumoniae
e. some of the oral streptococci
7.Elaborates a variety of extracellular substances and
enzymes
8. Streptococci cause a wide variety of infections:
a.Streptococcus pyogenes (Group A) streptococci-

leading bacterial cause of pharyngitis and cellulitis; inciting factor of two important immunologic diseases: acute rheumatic fever and acute glomerunephritis

b. Streptococcus agalactiae (Group B streptococci)-
leading cause of neonatal sepsis and meningitis
c.Enterococcus faecalis \u2013 important cause of hospital
acquired urinary tract infections and endocarditis
d.Viridans group streptococci \u2013 most common cause of
endocarditis
e. Streptococcus bovis \u2013 may also cause endocarditis
9.Most species are facultative anaerobes; maybe strictly
anaerobic to capnophilic
10.Have complex nutritional requirements necessitating
blood or serum enriched medium for isolation
11.Carbohydrates are fermented with the production of lactic
acid but not gas
12.Catalase negative
13. Can be classified as to:
a.clinical presentation(pyogenic,oral,enteric)
b.serological properties (Lancefield grouping A-H, K-V)
based on the antigenic composition of cell wall
carbohydrates
\u2022
serogroups A,B,C,D and G \u2013 most commonly
found associated with human disease
c.Hemolytic patterns in blood agar plates
\u2022
Beta hemolysis \u2013 clear zone of hemolysis
around the colony as a result of complete
lysis of the red blood cells
\u2022
Alpha hemolysis \u2013 zone of partial hemolysis
with a greenish discoloration of the
medium
\u2022
Gamma hemolysis \u2013 no color change or
lysis of red blood cells ; nonhemolytic
d. Biochemical (physiological) properties
\u2022
Sugar fermentation reactions
\u2022
Tests for the presence of enzymes
\u2022
Tests for susceptibility or resistance to
certain chemical agents
e.antigenic specificity of the capsular polysaccharide
Beta hemolysis on 5% sheep blood agar

There is complete lysis of RBC surrounding the colony that can be seen macroscopically

There is a clear colorless zone around a streptococcal colony in which the RBC have undergone

complete
destruction
Alpha hemolysis on 5% sheep blood agar

an indistinct zone of partial lysis of red blood cells causing a green to greenish brown discoloration of the medium

immediately
surrounding the colony

Alpha hemolysis showing partially hemolyzed RBC immediately surrounding the colonoy

Gamma hemolysis on 5% sheep blood agar
Gamma denotes lack of
hemolysis;
the

RBC surrounding the colonies are intact

Macroscopically there is no apparent hemolytic activity or discoloration produced by the colony

CLASSIFICATION OF STREPTOCOCCI
1. Group A streptococcus \u2013 Streptococcus pyogenes
a.contains the group A antigen
b. beta hemolytic
c.main human pathogen associated with local or
systemic
invasion
and
poststreptococcal
immunologic disorders
d. PYR positive(hydrolysis of L-pyrrolidonyl-2-
napthylamide)
e. usually susceptible to bacitracin
2.Group B streptococcus \u2013 Streptococcus agalactiae
a. contains the group B antigen
b.members of the normal flora of the female
genital tract
c. an important cause of neonatal sepsis and
meningitis
d. beta hemolytic
e. hydrolyzes sodium hippurate
f.
gives a positive response to CAMP test
3. Groups C and G streptococci
a. occur sometimes in the nasopharynx
b.may cause sinusitis, bacteremia or endocarditis
c. beta hemolytic
d.identified by reactions with specific antisera for
groups C or G
4. Group D streptococci
a.enterococcal \u2013Enterococcus faecium
Enterococcus durans
\u2022
Part of the normal enteric flora
\u2022
Usually nonhemolytic; occasionally
alpha hemolytic
\u2022
PYR positive
\u2022
Grow in the presence of bile
\u2022
Hydrolyze
esculin
(bile
esculin
positive)
\u2022
Grow in 6.5% NaCl
\u2022
resistant to penicillin G
\u2022
Some strains are vancomycin resistant
b. Non-enterococcal \u2013 Streptococcus bovis
\u2022
Part of the enteric flora
\u2022
Occasionally cause endocarditis
\u2022
Sometimes cause bacteremia in
patients with colon carcinoma
\u2022
Nonhemolytic and PYR negative
\u2022
Grow in the presence of bile
\u2022
Hydrolyze
esculin
(bile
esculin-
positive)
\u2022
Do not grow in 6.5% NaCl
\u2022
Sensitive to penicillin
5.Streptococcus anginosus or Streptococcus milleri,
Streptococcus
intermedius,
Streptococcus

constellatus
a. part of the normal flora
b. may be beta, alpha or nonhemolytic

c. includes:
\u2022
Beta hemolytic streptococci that form

minute colonies (<0.5 mm in diameter) and react with groups A,C or G antisera

\u2022
All
beta
hemolytic
group
F
streptococci
\u2022
Voges Proskauer test positive
\u2022
Those that are group A are PYR
negative
\u2022
May
be
classified
as
Viridans
streptococci
6. Group N streptococci
a. rarely found in human disease states
b.produce normal coagulation (souring ) of
milk
7. Groups E,F,G,H and K-U streptococci
- occur primarily in animals
8. Streptococcus pneumoniae
a. alpha hemolytic
b.growth
inhibited
by
optochin
(ethylhydrocupreine hydrochloride)
c. colonies are bile soluble
9.Viridans
streptococci
\u2013
Streptococcus

mitis, Streptococcus salivarius, Streptococcus sanguis (Group H), Streptococcus mutans

a. typically alpha hemolytic ;
may be
nonhemolytic
b.
growth not inhibited by optochin
c.colonies are not soluble bile(deoxycholate)
d.most prevalent members of the normal
flora of the upper respiratory tract
e.important for the healthy state of the
mucous membranes
f.
may reach the blood stream due to trauma
g.a principal cause of endocarditis on
abnormal heart valves
h.Streptococcus mutans \u2013 synthesizes large
polysaccharides (dextrans and levans) from
sucrose which may lead to dental caries
10.Nutritionally variant streptococci or pyridoxal-
dependent streptococci \u2013 Streptococcus defectives,
Streptococcus adjacens
a. require pyridoxal or cysteine for growth on
blood agar
b.grow as satellite colonies around colonies
of staphylococci and other bacteria
c.usually
alpha
hemolytic;
may
be
nonhemolytic
d.part of the normal flora
e. occasionally
cause
bacteremia
or
endocarditis
f.
can be found in brain abscesses and other
infections
11. Peptostreptococcus
a.grow
only
under
anaerobic
or
microaerophilic conditions
b. variably produce hemolysis
c.part of the normal flora of the mouth,
upper respiratory tract, bowel and female
genital tract
d.often participate in mixed anaerobic
infections in the abdomen, pelvis, lung or
brain
Antigenic Structure of Group A Streptococcus
1.Capsule
-
hyaluronic acid; nonimmunogenic; antiphagocytic
2. Cell wall
a.group specific carbohydrates of group A \u2013 is a dimer
of N-acetylglucosamine and rhamnose
b. type specific protein antigens
i. M protein
o
a major antigen associated with virulent
streptococci
o
located at the end of the hairlike fimbriae
that are anchored in the cell wall and
extending through the capsule
o
antiphagocytic
o
anticomplimentary
ii. T or trypsin resistant protein
o
With
M
protein
\u2013
an
important
epidemiological marker of group A strains
o
no relationship to virulence
iii. R protein
c. Other surface antigens
i. F protein or fibronectin binding protein
o
Has a receptor for fibronectin
o
Major adhesin for bacterial attachment to
the epithelial cells of the pharynx and skin
ii. Lipoteichoic acid
o
Lipid moiety is implicated to binding to
fibronectin.
o
Possibly mediates adherence to epithelial
cells
Antigenic structure of Group B Streptococcus
PATHOGENESIS
Group A streptococci (Streptococcus pyogenes) cause disease
by three mechanisms:
-
pyogenic inflammation \u2013 induced locally at the site
of the organisms in tissue
-
exotoxin production \u2013 can cause widespread
systemic symptoms in areas of the body where there
are no organisms
-
immunologic \u2013 occurs when antibody against a

component of the organism cross-reacts with normal tissue or forms immune complexes that damage normal tissue

Inflammation-related enzymes produced by Group A
Streptococcus (Streptococcus pyogenes)
1.hyaluronidase(spreading factor)
-
degrades hyaluronic acid which is the ground
substance of the connective tissue
-
Facilitates spreading of the microorganisms
-

Antigenic \u2013 specific antibodies are found in the serum after infection with hyaluronidase producing organisms

2. streptokinase(fibrinolysin)
-

Transforms plasminogen of human plasma into plasmin, an active proteolytic enzyme that digests fibrin and other proteins

-
Given intravenously for treatment of pulmonary
emboli and of coronary artery and venous thromboses
3. streptodornase (streptococcal deoxyribonuclease)
-
Depolymerizes DNA in exudates or necrotic tissue
-

With streptokinase \u2013 used in enzymatic debridement; Helps liquefy exudates and facilitates removal of pus and necrotic tissue

-
Antibody to Dnase develops after streptococcal skin
infection (normal limit \u2013100 units)
Toxins and hemolysins produced by Group A streptococci
(Streptococcus pyogenes)
1. Streptococcal pyrogenic toxins
-
Three antigenically distinct toxins
a.Exotoxin C\u2013 classic erythrogenic toxin
\ue000
causes the rash in scarlet fever
\ue000
Produced
only
by

strains lysogenized by a bacteriophage carrying the gene for the toxin

\ue000

Dick test \u2013 The injection of a skin test dose of erythrogenic toxin gives a positive result (an erythematous reaction in the skin of nonimmune persons who lack antitoxins)

\ue000

Schultz Charlton reaction \u2013 antitoxin injected into the skin of a patient with scarlet fever causes localized blanching as a result

of
neutralization
of
erythrogenic toxin
Dick test \u2013 positive \u2013
erythema
surrounding
the injection site
Schultz

Charlton reaction. Convalescent serum from a scarlet

fever patient blanches the rash of a patient with scarlet fever

b. Exotoxin B
\ue000

a cysteine protease that rapidly destroys tissue and is produced by strains that cause necrotizing fasciitis

c. Exotoxin A
\ue000
May cause streptococcal toxic
shock syndrome
2. Hemolysins
a. Streptolysin S
\ue000

oxygen stable, nonimmunogenic cell bound hemolysin capable of lysing eryhtrocytes, leukocytes and platelets

\ue000
stimulate release of lysosomal
contents after engulfment
\ue000
responsible for the hemolytic
zones
around

streptococcal colonies growing on the surface of blood agar

\ue000
not antigenic
b. Streptolysin O
\ue000
a protein that is hemolytically
active in the reduced state
\ue000

responsible for the hemolysis seen when growth is in cuts deep into the medium in blood agar

\ue000

antigenic \u2013 antibodies are formed against streptolysin O following infection with streptococci that produce streptolysin O

\ue000
ASO serum titer in excess of 160-
200 units \u2013 suggests:
\u2022
Recent infection with
streptococci
\u2022
Persistently
high

antibody levels dueto an exaggerated immune response to an earlier exposure

in
a
hypersensitive person
Pathogenesis of Streptococcus agalactiae (Group B
streptococci)
a.
is based on the ability of the organism to induce
an inflammatory response
b.
no cytotoxic exotoxins are produced
c.

role of enzymes in the pathogenesis of infection is unknown \u2013 deoxyribonucleases, hyaluronidase, neuraminidase,

proteases,
hiuppurase
and
hemolysins
d.
no evidence for any immunologically induced
disease
e.
has a polysaccharide capsule \u2013 antiphagocytic
f.
anticapsular antibody is protective
CLINICAL FINDINGS
Types of diseases produced by Streptococcus pyogenes

1. Pyogenic diseases
a. pharyngitis
b. cellulitis and erysipelas
c. impetigo(pyoderma)

2. Toxigenic diseases
a. scarlet fever
b. toxic shock syndrome

3. Immunologic diseases
a. rheumatic fever
b. acute glomerunephritis

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