Culture and identification
source of outbreaks.
Grows acrobically a yellow or gold
colonies on blood agar catalase-positive (this
differentiates them from the catalase-negative
streptococci).
Other test used to differentiate the
more virulent S.aureus from the less pathogenic
S.epidermidis include the following.
Coagulase test . S. aureus coagulates
dilute human serum or rabbit plasma (i.e. it is
coagulase-positive), whereas S. epidermidis
does not (coagulase-negative). This test could
be done either in a test tube (the tube test),
wich requires overnight incubation, or on a slide
( the slide test), wich is a rapid test.
Ptotein A-latex agglutination test.
Protein A, synthesized by almost all stains of
S.aureus, has a special affinity to the Fc
fragment of immunoglobulin G (IgG). Hence
when latex particles coated with IgG (and
fibrinogen) are mixed with an emulsified
suspension of S.aureus on a glass slide, vivible
agglutination of the latex particles occurs; no
such reaction is seen with S. epidermidis
Other tests. These include the
phosphatase test, DNAase test and mannitol
fermentation test (most strains of S. aureus
form acid from mannitol, while few S.
epidermidis do so)
Typing of Staphylococcus aureus
Typing is important to determine the source of
an outbreak of infection. This was commonly
done by the pattern of suspectibility to a set of
more than 20 bacteriophages phagestyping
and sero typing. These methods are currenty
ceptibility pattern are also helpful in tracing the
Pathogenicity
A variety of enzymes and toxins are produced
by Staphylococcus aureus, although no one
strain produces the whole range listed Table
11.2. The two mostb important are coagulase
and enterotoxin. Coagulase is the best correlate
of pathogenicity. Some of the diseases caused
by S. aureus are:
Superficial infection: common agent of
boils, carbuncles, pustules, abscesses,
conjunctivitis and wound infections;
rarely causes oral infections; may cause
angular cheilitis (together with the
yeast Candida) at the angles of mouth
Food-posioning (vomiting and diarrhea)
caused by enterotoxins
Table 11.2 Toxxin and
enzymes produced by
Staphylococcus aureus
Toxin/enzymes Activity
Toxins
Cytotoxins (, , , )
Leucocidin
Toxic shock syndrome, also caused bya
an enteroxin
Deep infection: osteomyelitis,
endocarditis, septicaemia, pneumonia
Predisposing factors for infection are minor and
major breaks in the skin, foreign bodies such a
sutures, low neurotrophil levels and injecting
drug abuse.
Treatment and prevention
The vast majority (>80%) of strains are resistant
to -lactam drugs, and some to a number of
antibiotics. The latter phenomenon
(multiresistance) is common, particularly in
strains isolated from hospitals; these cause
hospital (nosocomial) infection. Penicilin
resistance is due to the production of -
lactamase encoded by plasmids. The enzyme
destroys the efficacy of antibiotics with a -
lactam ring (i.e. the penicillin group drugs).
Antibiotics actives against
Staphylococcus aureus include penicillin for
sensitive isolates, flucloxacillin (stable againts -
lactamase), erythromycin, fusidle acid (udeful
for skin infections ), cephalosporins and
vancomycin.
Cleanliness, hand-washing and aseptic
management of lesions reduce the spread of
staphylococci.
Antibiotic resistance on staphylococci
This is a global problem of much concern and
falls into several classes.
Resistance to -lactam drugs (see
above)
Resistance to methicilin (and to nafcilin
and macilin) independent of -
laktamase. The spread of methicillin
resistance Staphylococcus aureus
(MRSA) worldwide is posing problems
in many community and hospital setting
Resistance to vancomycin, one of the
last-line defences against staphylococci
and the emergence of vancomycin
resistant S. aureus (VRSA). The
mechanism of resistancce here is due to
alteritation inn the cell wall
'tolerance, where the organism is
inhibited but not killed by the
antibiotic(i.e. there is a large difference
between minimum inhibitory
concentration and minimum
bactericidal concentration), leading to
prolonged course of infections (e.g.
staphylococcal infactive endocarditis)
Staphylococcus epidermidis
Habitat and tranmision
This species found on the skin surface, and is
spread by contact
Cluture and identification
Grows as white colonies on blood agar, hence
the earlier name S albus; catalase-positive;
catalase negative; biochemically characterized
by commercially available kits (e.g. APIStaph).
Pathogenicity
Being a normal commensal of the skin, this
bacterium causes infection only when an
opportunity aries(it is an opportunist
pathogen). Common examples are catheter-
related sepsis, infection of artificial joints and
urinary tract infection.
Treatment
S. epidermidis exhibits resistance to a number
of drugs (multi resistance), including penicillin
and methicilin. It is sensitive to vancomycin.
Staphylococcus ssaprophyticus
This organism causes urinary tract infection in
women, an infection especially associated with
intercourse. It has the ability to colonize the
periurethral skin and the mucosa. The
organism can be differential from S. epidermidis
(both grow as white colonies on blood agar) by
the mannitol fermentation reaction and other
biochemical test.
MICROCOCCI
Micrococci are catalase-positive organism
similar to staphylococc. They are coagulase-
negative and usually grow as white colonies on
blood agar , although some species are brightly
pigmented-pink, orange or yellow.
Stomatococcus mucilagenosus,
formerly classified in the genus Micrococcus, is
found in abundance on the lingual surface. This
species has the ability to produce an
extracellular slime wich correlates with its
predilection for the lingual surface. Its role in
disease. If any, is unknown.
KEY FACT
Streptococci are Gram-positive and
appear as spherical or oval cocci in
chains and pairs
Streptococci can be classified
according to: (1) the degree of
haemolysis on blood agar (, mild; ,
complete; , no haemolysis); and (2)
the cell wall carbohydrate antigens
into Lancefield groups (20)
Lancefield group A contains the
important human pathogen
streptococcus pyogenes; the latter
infection leads to rheumatic fever and
rheumatic carditis which makes the
endocardium susceptible to future
episodes of infection
Oral streptococci are a mixed group of
organisms and typically show -
haemolysis on blood agar
Oral streptococci can be devided onto
four main species groups and, of
these, the mutants group bacteria are
the major agents of dental caries
Staphylococci resemble streptococci in
appearance but are arranged in grape-
like clusters and are all catalase-
positive (all streptococci are catalase-
negative)
Staphylococcus aureus in a common
pathogen causing localized skin
infection and serious systemic
infection; it produces numerous toxins
and enzymes as virulence factors
Antibiotic resistance in sthapylococci, a
problem of worldwide concern, has led
to the emergence of methicillin-
resistant Stahpylococcus aureus
(MRSA), vancomycin resistant S.
aureus (VRSA) and antibiotic-tolerant
isolates
Review question
Please indicates which answer are true, and
which are false.
11.1 Which the following statements on
streptococci are true
A. Some are Gram-positive and
anaerobic
B. Can be primarily differentiated by
their haemolytic reaction on blood
agar
 C. Can cause caries in the absence of
sucrose
D. Mutans-group streptococci cause
caries
E. Oral atreptococci typically show -
haemolysis on blood agar

11.2 Staphylococcus aureus can be differetiated

from S epidermidis by:

A. The coaguase test

B. Protein A latex agglutination test
C. Manitol fermentation test
D. Gram stain
E. Oxidase test

11.3 An 18-year-old male patient has a abscess

from which a -lactamse-positive
Staphylococcus aureus strains was
cultured. This organism:
A. Is resistant to penicillin
B. Is coagulase-positive
C. Is -haemolytic
D. May possess the ability to cause
diarrhea
E. May cause rheumatic carditis
11.4 Common staphylococcal infections include:
A. Suppurative skin infection
B. Food-posioning
C. Toxic shock syndrome
D. Osteomyelitis
E. pharyngitis