e/re/20L4

4{-',:,
\\ Af GRAM-POSITIVE COCCI
,n -)
Al FAMILY Streptococcaceae (catalase negative)
tutttl
lr"r )21",vl'rP
p-hemolytic JLIep
A: p-ttEtilutYL.L
Group F\. Strep'^ .- - -\-1
'
t STAPHYLOCOCCUS';-,
l Group B: p-hemolytic (occa
p-hemolytic (a or
L: p-nemotyttc
.z broup
f/ Group C: or 'M fismilis
", \
=.: )), Group D: G or y hemolytic (p) S. bovis
.o"r4'-()
& ,1. Group F: p-hemolytic S. anginosus
l9roup G: p -hemolytic
)Group -hemolyti S. anginosus
zViridans streptococci: (no group specific CHO)
STREPTOCOCCUS .[rc, or y hemolytic S. mutans and
us, S. sansuis, S. mitis and s,'fuIDifi
,G 2::/1:i,
9roups
n t -',

CHq (F*\-A
l(

-( "\.rStrep toco ccu s

: $emolytic)
pneu m o n ia e (n
\-A J,
o g ro u p cHo)($F -L.
1\
-r1\
.( )nterocoirr, (Group D CHo)
cHO)
CHO) y hemolytii(q.dr6-4
hemolvtiq'(q.dr-ff
hemolyticf(qlQ-r h
,,,,trnrcrococcus
obnterococcus
t, Enterococcus faecalis, E, faecium :?V\=
E. faecium lL_ .

FAMILY Micrococcaceae (catalase positive)

4-ilDiplococcus
Morphology .;.
1.t-^ O -------) OO (
'r oa
Coagulase-positive
'/? Coagulase-negative
:

Snpnylococcus epictQrmrQis,
->
:

-p'gpt:r --)
,l5o'o"o"" -OO atOO ---------->Lf:
,\
A\

''-)
sta p h y t o co cc ur
>\J'.--.( --+
.5"'__-
hi
1r oo___> E
I .\,- ,
Sarcina

a
\
,'3n''""*""-oo ------> , ------) l g

ylococcus Streptococcus

';\r"51

Staph & Strep.doc.LA FK Unlam

 e/Le/20L4

Staphylococcus

l* 10 pm
r
fr'
*'
f lv'
l(
rt
Copsule or polysocchoride
slime loyer
Peptidoglycon loyer \-
)
Polysocchoride A
i: (cichoic ocidI (
A
\
t
Prolein 1
Cytoplosmic

r"* membrqne

(l
f,
/ l
.1
Cytoplosm Clumping
foctor {,
)v L^

\AT
4;f.u:;. ..,! tmloq&io
althodlS qrul
*'/\
't
,\
A^,/ii"
3.t thod
lotr rFd.d ..
L,\--l
\-\vd ,-\ {. . ji{ I

TABTE Z2-2. Snpbyloacttt. *Iioocxtut, Stonntotuau, tnd Alloioconscnd 'llcir

ri't/t+
f)iscascr

Stoilrykrwtrt, txteur lirrin-p1..11.,.*l lfrxx.l p,rirorring, roric slr.ck

',r.,,l,,riEif.,,rr,,-,u.
,,r,,,o,i[ffi1,;.*
. lItcunt(,,ltt,
Snfutlooctrn

li to pbfl awta r n
cpillnnilh
rrnisnr irrfi:c.
.'\
^(
snpbllxrnts
popb-v t rt

':l,pitit
t
rronin. honr. :r
-?
snpgluvcrat tttenutrti.,s tl':',1*.,ffi.1.i:L:liLi::il|,'n.j"[':"11 clirrnr, rr'unr.r inrcccionl rnrr ,rp;xrnu.istic i.. .,..

infr.rctionr
;"'
,!['rncr.r,r s1p.
mucihginot
Stoaato'rgclll.t
(\rrrrnuniitic infectiorrs
[t:icicrrrnin. cnrlcrznliris, rlPp.rrnrnisric infi.cdons
A---
'I,
rllhiutt'tu otitilil Chronic nri.l<llr cor irrfcriorr. r...
Y
'1.)
\ .t
.^\

TABI,E 22-3. srapfyn".- | orr,.Lt \tnrterc s'rctolr

/l\FA .

Uldrcr C..trr tr L* CItGtr -.

^

&grlc+r
.:Gpdc lnlrilirr rlrcnr,rlrrir rxl phrg,xlrreiq inhil*s pcolifcr:rion o{ ouronuclcer c6r, frcili-
I j_ urcr nlhcrcnrr to forcign hxlics
l/Rpo,Ltlh*rn Pnryidcr nsnrni lrliliry:; ninruletg rrcrlucdou of cndrxtorg rnnracn (crr.lor,xjl_li\r
'l'cirfrric ocid xYrodr
Prortin '\ Fc rtr'cpto6;
(f,rrrplrnnb ordnlnru
heti< rnd n:spin_ n Drreprococcus L I A-M protearr complex
.^{ f.rf ,coccus pneumoniae Protein
Cyrxrdnr b,9,6, t,
i lt-l'lcrtrid:D)
l'orb &rt
lilroblas
meoy cclln incfuding leokocrc+ cr.utfiroc;tcr mrfioghrsel plrrclctr, rnd
ichia coli Type 1 fimbriae
Fi(rlirdsc trrrinr Scrirxpote.rsuthrrrflirrlrcrgtcrc||g|rebrid;crinttr*rrtumg1rrru|<,runcpidcrllir>
OTA ET8) CFA 1 fimbriae
., Errrrrrnira (A-E, sopcnntrrt'l-(strrmrllcr Srnrlifrrrin rf r crclls rnrl ntcrr of ryrlin."r), srirurtettr t P fimbriae
'(;l) rtlcesc c{ infa:nnrerocy modirun rn mrrr cclb, incteering rnrc.riinrl pcrirnlrir rrxl Fuirl !
Irrss, ;ri rctl r! rurl*a ud rr46i1;1g Type 1 fimbriae
-lirric Sh:d
Suryjr.crnc soyn.otigtn (rdmuhrcr prrlife'ti<n <f 'l'celh rlrd rcbxc <rf cJn:*'rcs); prrxlurer
forin- l Irrbgr. or ellulr dsrnrctin rrf cndpdxlid cclh
Fimbriae
Eallr
(irgubr (inltrts tibr rnogto :o 6hin P1, P2, P3
Lrtelrc
IfrzIur<ni,lsr
Ce..:lrzcr rcrrrrn'rl uf hrdrrycrr p:<nxlc Cell surface lectin
Illrlnrlltcs h-vcluronic rci\b il rvonrastjrc tir:uc, prumrting the ryud r{ cryhylocorri
in t irqrc .l
A
Protein P1 Siatic ae( Y '/^
- F,+nio.rly-irt f-)rs..'lvts 6bnn r{,ls
LiJrerer Ilyrlnrhrcr lipr.! Type 4 pili Fua$
, Nrr{crrrs Ilyrlrullzcr I)NA
' Frndllinrc llJdroly,rcri pca rcillim

Staph & Strep.doc.LA FK Untam

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\
-iAssoci ,$gl..ngg Factors
ated Vi ru en ce qe.ellular
SII Enzymes
i:ffi
I

re
tuA- \

'-^l)
.\
t;.
j.' n
O
o
Capsule or slime layer
Peptidoglycan (PG)

aureus ribitol teichoic acid

O S. aureus
(polysaccharide
\Pvly>oLLllql ltlE tii,
A)
acid
(glycocalyx)
{ "4,{
\

ffi
o Teichoic acid is covalently linked to PG and is species s}beff.' ':-(
_.1:^
)

J#,
lv'g.1,,
\

u/l ^
{
,(..
\,
'.-^.
O Coagulases (bound or free)
O Antigenlc
O Hyaluronidase
o "spreadlng factor" of S, aureus
2;1o Nuclease
*a
f .l-! ^
[t O S.^(oolr.t.ccharideA)
epldermldls glycerol telcholc acld
acld )=.$ lf^,1r ,'i it! o Cleaves DNA and RNA in S. aureus
;3 (polysaccharide B) ( )1)-.1".
nt\t Protein A is covalently linkecl to PG
Protease
O Staphylokinase
.l ' brlnolysln)
(fl

1,., o Clumping factor (bound coagulase) XS .M ) '4")

o
.;./( _X,7
Y_a, Lipases
L :- o
\ r.\
:/ \ esterases

\V
i>J 4
/

lp$ttolytic (cytotoxins; cytoltt,Q:,

$ f(
\'-'aTt
\ ^ O Alpha toxin - hemolysin
OReacts with RBCs
O Beta toxin
OSphingomyelinase
\-? O Gamma toxin
OHemolytic activity
I I O Delta toxin
O Cytopathic for:
O RBCS
O Mlcroghages
O Lymphocytes
O Neutrophlls
O Pl.telts
O Enterotoxic activity

O Leukocidin

\A
/^$',t4 nical
lxBathogenesis

O Pass skin - first line of defense

\o Benign infection
O Phagocytosis
o Antlbody
O Inflammatory response
impetigo (bullous & pustular)
O Chronic infections scalded skin syndrome
O Delayed hypersensitivity .Neonates and children under 4
yea rs

Staph & Strep.doc.LA FK Unlam

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\\/
tdtr^nica | ,r,):
"
a{\\ :.^
lmdn
]r^rfnat.a|.i^Fra
1r.rr
ifestati o n s/ D
/hian-Fn
i sea se .C^tylt
-- i )iiZ' 1.n-D4eta stati c I n fecti o n s

(\ ,-\ \'-t
\:
*a ),-\_( k
. Bacterem ia

,lf:Osteomyelitis
2t /dasease of growing
t'.._4lJ!il
-[bone ts
n\o&utmonary and cardiovascular infection

lq /( Y-t,
m\' -t-'v
<'i:iJ;1.', /
/
=N'At-\4

4^.f.4.-r
Cqab u lase- Negative Zl - 2, Su]-rrory of Coo6ulrrc-Ncgrtisc Strphy'rrrrctrl In fertioru

ta phylococci lirullrrrivs incerrbc G:plblo of rcruhic und rracrobic

Q Staphylococcus epidermidis
..\s wirh S. turas infisdons; ,,'
liernnJihurnrn f,uro on slirr nntl muctxd surfnr'es.
O S. saprophyticus (.)r6lnisnrs utn sun'ivr on dry surlicrs lir lonc
p:rioil:;
lt..6on.io.lrrgorr sprerd drrOugh ilircCt mnrrcr or erF}-
rinu ur: urnominrtcd fomi ci {dthbugh mast nfcrtions r rc
i succcrsful trcrtmcrrt
rrid: rhc peticnCr osrr org;nnirmr). Prrxnpt tlcronort for cn,loirrdlrir o1 1iur1 irrbcd.gnr it
Eationts ot risk rrt tho* wirh frrrcipr lxxlics (c.9. su- necesr:Iry ro prsvent frrnher tic$e dcnr3p or- bununt
tru:i. prrthsi<, shunr. crthctcr), cornplcr fomrtion
'l'ic orgrnilnr rrc utriquituru, so drcrc srrc nr) Ho(F Mrintclence of stcrilc intrlr,lrri]l., c.ihcrttt hclp prc^
5npitiu or sc;rxnrl linritrtiuns. vurrt infcctionr.
\

Snvlococcal Lab ID &

\ o Lab isolation
-)};q
' ., rrrt oCUAUUfase
-gOagUESe positive
X.l { S. aureus

Staph & Strep.doc.LA FK Unlam 4

 elLe/2014

$rfferential
A)
Characte
t*h-.r1

Catalase
H2O2)c2+2H2O
Streptococci vs.
Staphylococci

.4

^"F{fferentiat
Cfqaiacteristics

\.> \.-\
.5-& '' . .lr'v '

I-XLrrrsr rL
T{gltment
(,
<_!{lra"')? iHention
O Drain infected area \ z^. \-r t
O Deep/metastatic infections 1,^-r)r-Ll -t
>iA , o

,\ O semi-synthetic penicllins t_y \_1 \o

O cephalosporins '-ito
. 7, o erYthromYcin ir,

---Y O clindamYcin

Staph & Strep.doc.LA FK Unlam

 e/Le/20L4

.n!+ /L\]
(')^li'Z t.
STAPHYLOCOCCI ,-.,

"'

- =---4hi,/-\
v

'lzl( Coagulase-negative staphylococcus; rrei6)fti i

inVolved in ilosocomidl dnd opporturn+itc-.'}-( t
r'
\- llinfections
| | eULlOtlS \\-
)),
o i. - lives on skin and rrJf4-,1 =i
'\ "i,,J"r^idisendocarditis, bacteremia,'Y.T{'-(
merhbranes;

-\glands J4' . <

|"r'ti'All
.$5: - live on scalp, face, externdt=B$i*
capitis
3 ma.y cause wqund i.nfections by ..h ;
-\"lo penetrating through broken skin ' '-4( -
-
.,

lq 4
,
\
S. sap.rophyticu.s . .rnfrequently livesC;ft,-1,
intestinei, vagina; UTI 1'til 1._/
.( .12

<)l:;
i%-\

*6nera I Cha racteristics of

t ie.staphylococci
OCommon inhabitant of the
mucous membranes
O Spherical cells arranged in
clusters
O Gram- positive
OLack spores and flagella
"*{
-.1.
\.) O May have capsules
'
4, O 31 species

\,:
Tf,1" phylococcus
Ocrows in large, round, opaque
OOptimum temperature of 37oC
O Facultative anaerobe
Withstands high salt, extremes in
nd high temperatures
O Produces many virulence factors

{tt

Staph & Strep.doc.LA FK Unlam

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v TABTE 22-3. Srrrp+yc'carr.rrrnrr Virulcrrc F.rcron

Vlrdrlcr Frtorr

Copsule or polysocchoride
slime loyer
Pepfidoglycon lqyer \-
Polysocchoride A
SmnrCqtlt
(iprulc lnhibits chern,xetis rrxl plr:gx,r'nxi* iabihitr grJifrn*n r.rt nrxrcrrrrjcrr ctlh frdli-
trtcs rdhscnct ur forcign bodicr a
) Pcptid,o$t'rn Pnrvirlo rxrxrti<':rrlUliryi r.tinruhrer prxlucriru o{ a&4ornr groSco (endotcin-lilc I
.fiiriq/ilolncytcch.mcttrr(rnt(rlxcr:sinnrtirnlirhilfuphlgrxltiit
L xid
Tcictroic Itcgulrrc crrbnic concttrrndcr rr cc0 mcmbnnc; tindc to fibmmctia L
\
hurcio A lahilns utitrorb'-mcrliertl cherrre br9 lxndag l!(ir, ItGr, .rld f;C. lt rcoapan
Clroplrrnir; mcntlm;r
ll- Clropfrnic
lc0hq'tc c'irrnantgt'tml: rnuAxaplcrntntrly
()rrurb lnrricr; rcgulla rrlrrqxrt intn enl oor of cclt ritt of lio,+atcoc
lioaatcoc orl r4in- \
) utry cnttrns
urlY cnrtTlclr
r
.,

(cichoic ocid) ( '(

'( rr"rt
rr"a,
Cyrrrorias G, 8,6, y, 'Furk f:r nrny t'dh, irrcluling kubxrra. cryrlurlgrei, fi-flf*ngr,
"
fl+rlcr, rnd
P-t, lx\oridir)

A
\ I
F.rftrlirtiw torinr
(E',r,t F:l"Bl
i, liarot<xin* (A-1.',
Sbrnblrss
Scriac pr>trus thet qJit rftr inrrrcdlulrr bridgcs io thc rurnrn Srrauloam cpid<noit

Protein 1 -i G- f)
SuJrrrarigu:r (simulrrcr pmliftndon of T cclb rnd rdnox .rf <.vtfinch rdqruhrr
.ilc*t .if ioll-unar<rr
:
rnodirrrrr in nrarr ctlb, rncrceeirrg intccind grcrkrlsb rrd f,dtl \
Cytoplosmic /\
1 t'rrir Slxr! Snlnnr ot'f cc& &d ftfc.F of etobncr); prrdocer
membrone ^ 'furin-l trnhclie! cclk
C.f
()nsrrrc hlrrirrqrn ro 6brin
Cytoplosm Clumping -, Corprlrr
(:tr|rrt (rnllzs runod of hylnrgen Fnxide
loclor Hr:lrrnrri,hr t1il.li.:, hyelunrrric ecids in corrncrtrvc rircsc, Jrrcrnotinl thc sprcrd <f strglrylo<rxci
T r
- F'lni,r,rlr,,i' ul*ll,T*r". *,.
Uprr> ll;-drohzcs lililr
, Nrrlcr.er llvtlnolvzcr Dr*J\
' ltnkillinlc l lv,lnrlwer guririllirn

\.>
ifAlence factors of s,
I

-J

, ,'KExroilaftve toxin - separates the

foliative foxtn
m the dermis
Toxic shock syndrome toxin
induces fever, Vomiting, shock,
organ damage

and pathosenesis
{tremiotosy ,(ifk
( - \i+u^-t
,1 O Present in most environments frequenFed(/ i
d humans \-^-..)r-tl
f O Readily isolated from fomites \-5:,
t)
^,h^--J:|..
:-^t-L- ) G---- E--:r--- 1 )-

o Carriage rate for healthy adults is 2o-#"/W\ )

t\:::--,::: :r
,J'-O ,^ _^^&,..
is mostly in :^ ^ala-i ^"^-"^;; skin, - "-(
anterior nares,
-4 Carriage nasopfiJrynx,-int5stine ,{'Z,,-.-
'O9redisoosition poqr^ys l";"1
'
o-"'Q.lredisposition to infection include: Doqr^J l"
.a}rygienq.and n.utrition,-tissue inj.u5V,. ( Br,t
v' Preextsunq.pnmary irifection,
\"""pieexistilg-.pfimary otaoetesi -i
tnrecttofl, diaUetes)
n

\^ :rtunooerrcrency
1r,
t! r rr r rL.r !\.rL.\,t -/\\-/
!\,r\,! !\,t/

-'-\ (O Increase in-community acquired m

resistance MRSA
y'' t2
./

\
'l

Staph & Strep.doc.LA FK Unlam

 e/Le/20L4

\:
. C.z\ --
.4-
ls
1-n.-,^

2t--x
A i(t Cuffir:Lrtrrm
t'.L iirprtigo. burb,
corhxlrl
arSth
I r SloC

1lq

Cutaneous lesions of S. aureus \,-\

Dis.ry,:#
l'C-a-

i$t phylococca I

,\ ^(
Dt o Systemlc infections
,^1\ o !3lgomyelitis - Infection is established in the
{"1r(
85r
metaphysii)J t.-(
Tt{ , \)
-? ,' abscess forms

? tI, o v Eacteremia -- Plllllqly

esvfElEllllq primary l,l19lll bacteria from
origin l)is UclL(EIlO lllJlll another
Ollt,,LllEl Infected ,,
llllEL|'g(l
S/'-L:
>1 .,"\,
-'r_
endocarditis possible
\J,

..1"{,' , It
.l.,i'
7

iq
,fl --t
site or medical devices;
devicei; eniocarditis
r(ft
)'-);,uiB|
)'-.)).
nN

I
'1 {(,
l.t?t\.t -C-
. \:

1>

T"*- p hy I ococca I D i sea sq'."i,{

t\- \i
o roxigenic disease X'
j\ o - ingestion of heat
Food intoxication enterotoxinrh.?-",
enterotoxinrlVd
gastrointestinaldlstress
stable - , \ )
7 \ V'( t'-(
\ o staphylococcal scalded skin syndrome - toxtn induc", h,tnt
'.*-\ red flush, bllsters, then desquamation of the epldermis
-4.
" ra'ure
;;;;;;ock syndrome - toxemia teadrns to shock and orsan ,J{,4>
A-+
1.ur.-^it I-$#*
o\ '"7
I )
(
tr ,,1,
/^

Staph & Strep.doc.LA FK Unlam

 s/Le/20L4

\\
staghyloOoccal
toxfuitn\kin

lq
49

\.>
a^f.^-r
L)
t.'rtrSS Treatment

OClean any obvious wounds

O 8-12 h post infection remove any foreign bodies
O Fever
\
A<

-? O Susceptibility to Endotoxins
O Prescription of appropriate
antibiotics to eliminate bacteria
O Hypotension
O Diarrhea O Monitor and manage all other
O Multiple Organ System Failure symptoms, e.g. administer IV
$,. O Erythroderma (rash)

\ \

\A
tification of q'eatalase test
Ar
itY'samples t/a-
cooi'ry'|": llrril(i'hi'rl'ul:ffrF

,1 '11
)

C ,-. : #t r,,at .
f:ll I rrr,'t,?,. ,- t..\;/. r'.,

Staph & Strep.doc.LA FK Unlam

 e/Le/20L4

Cof.V'tgn: : fhe L4co.Jw i.trll Lo,:rotrics tr; Fsrrrtr,ar' !x).teilot rerpruurrliw of d,sday

Separation of Clinically lmportant

Specles of Stophylococcus

| ;;:':i,:,,i;;,';;
| 'T:l::
i

v2 i

I Llfttir.so I Nir uh:).'tso i

I Procltrctrott I p rc,iiiichon i
t............. .. I

s P ytnn",
-
lq I
I
t"r*,"l,rr ,'u, ,r,n.'",''i
m.ln:oso | iuo".mnn::c:c
Sla/.)hf,roclucrrs
I t
St.itphylrxoccus
i
'tntt'u
i

cqidemtxlis silptrophyt'ctls
/56

Concerns and Treatment ffievention of Sta phylococca I

ffnical iai,< Iutections

-? O Some strains have resistance to all major drug groups except . ;1n-
"'\" vancomycin
, 2,,
I,-f:t
l+
_-$Ot.esses have to be surgically
pedorated )--l)r{"{''
,.rl0^\Systemic infections require intensive lengthy therapy \ v''l/\

:
\)
[ <-\
v- 7
;V.?-\
'.'J-g.t(.-*t

ii t/ .^l\- -1t/ ,,r

l-$i$,)i,

I Cha racteristics of \A
{Fepsh ly isolated
^.Sepera
Streptococci \
, OGigm-po.sitive spherical/ovoid cocci a'i
in long chains; commonly in pairs I1
Non-spore-forming, nonmoti le
O Can form capsules and slime layers
\O Facultative a naerobes \
-p Do not form catalase, but have a
,' ';Ystem
|-Olflost parasitic forms are fastidious N-..
1.t
\N"nriched media v
O Small, nonpigmented colonies
Sensitive to drying, heat, and
59
/It
f'

Staph & Strep.doc.LA FK Unlam 10

 e/Ls/20L4

y4'{
T
\
)

1L
\-
)
Pnourpnia ....- -(
4^
2.
ig
*-..\.
lmplrgo
;rustpr'lCg -.-.-
l*A
.{
Sae crE
hY)\ A PLe:9eIal letcr 1_
M';csrts
)

lq lq 4,
/
+.t

\r 5.r

\A
"tF gsh ly isolated ptococci
\

''\.,.

\A
*F& .
StrePtococcal
ifllnun
)1 OS, pyogenes
OS, agalactiae
5'-oVi rid a ns stre ptococci
f
'ZQs,pneumoniae
$rn,"roroccus faecaI is

Staph & Strep.doc.LA FK Unlam LL

 e/Le/20L4

remolYtic s'
2
:L
)O
'-f, Uort serious streptococcal pathogen
r,r,o parasite

i.,"' O (tghabits throat, nasopharyoX, occasionally skin

*--X
l" tr^\

'i

"\
r\\
r1\|i

Jrqrar
rtj\

u.
r,

,hdJ!:
r

ql rr r:.J

) .A*-*i_/
)q
67 WdV (- 68

A* \2
-i>=A a

\'\ \^
4^\{:.4-. ..n! sSn--. .,\
of p-Hemolytic
Factors ur
* Vrr urenue rdcLurs p-nernuryL!u{:_' iYI:* of sroup A Streptococ_9ryt)rs,
*S Pyogenes
i"Erulence
1 (,i'' )k
,t'(
\'#+ Cogtriglrt il
C'i;/t+
lhe l'lo3ra*-Hi! Con:panies :nc Pa.rrlssion rcluired lor regrocucCo, or dsoLty.

Afffarlence Factors of B-Hemolytic

b;y;iin"'
ki+yogenes '
*frq,lence Factors of B-Hemolytic
' /,"(!=
<_$rr^\ 1$LRyogenes
-(. i
)
-,t"'::-1:]:r.:::::;amn,.rainc. 5^.)\-Ll
I_.I -"6iii':-6oth - hemolysins; a]ran]a,rreia
Streptolysins streptolysin O ,c,.r\ and
^ (SLO) *.-)IfJ
-^, strepqlysiffi
--'-'-y*t \ i
\ cause cbttanb tiss'ue tirlury "-( r-- rf xtracellu la r enzymes
",*o,"'fr::,:"
- ffiil1" i:,;,*,:: ffi*,' rfe ,,
l*
streptoklnase - dlgests fibrln clots

iJR
K_--!) factor'
iause thE release of tissue neirotic I-5-- ,t{*
i "Y'
r l\Hyaluronldase
DNase -
-
hydrolyzes DNA
breaks down connectlve tissue

Staph & Strep.doc.LA FK Unlam L2

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\^ \^
,A,LSz\:-
ttOemiology and Pathogenesis (iiii, $5cgpe
-)' oI
qScppe of Cllnlcal Dlsease
Clinical Disease / t
i.'l'?7
Jh".ns onty reservoir 'C"t#\
tKt_,i .li';?rorrinnc 'A(
'31477i"
)za
"
lO Inapparent carriers
u.,,sliiffifections
Q
roo)5}\1: _9
\-' o
IL - Jransmission
fomi[es--
- - contact,
contact, droplets,
'&,,\ ) t'\
'\ o Portal of entry generally skin or pharynh..J '-(
predominant orouo affected
's for o r'r-- {iving conditions .,e{_'?
and throat i-nfections
nfection,
J.,f, , 1
*
rsqusrqc possible if ?,lg-pl?gl"rsive,IE-n|'t* '3n?, [,fl' ! fl 3"&3 I [i !i, iT; i$m,#l
i

\ i \"$y;1ffi
-1') untreated the dermis and subcutaneous tissue* qah
a,") remain superficial or become systemiY"t\ r.- ''

.1\t
1"il<
(,-
-,,:tV'-.'.
-\ : ')\tlroat
- *t^-^rl l^G^^$lA-^
infections
/ !

3ll,\r' ./pStreptococcal pha ryng itis - str

\A
of
\'r clinical
vrrr rr\'\'' Disease
v'r'\'\'!'\' ,'-1,)! ,ry.ton g -Term Com pl ication
^i'Sape lGrbup A Infections
lI;tv
<_\x/^\
< \{t-r;{
i
,
.
5^.)\-L{ \)
\#' ;\
ri
tnfections ', )vd'
D.,

\
-ts
:ttj"t':
-.I o
- Scarlet fever -
;htt il;;ior
Septicemia
\,,A^6Aa? r;ea'aa
strain of S. pyogenes
erytnrogenic toxin; can lead to t"q[.6"XJ$r*
,}.14
\ I
carrying a propn&e V
"-(
il"-fr
,. -'?rPn"umonia
I l9l llo
, .,,'- -KtlEul
f--o$treptococcal toxic shock syndrome
l. Na^t
v

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\-A
$Ggoup B: Streptococcus ,,-!n
1*{gia lactiae .^.{ir)il,

O Regularly resides in human vagina, pharynx, and large

]4,
b".tfo6\-('
=i

particular
urlnary, wound, and skln infectlons, RarticularlVqpZ,r-

IF*%F a, frequently isolated from upper r"tp(.tor$1-.rtr

*Jtf3
-*r
L
\.'v\yvuulru oru )Kllr lrrrLLrur) oru rr.'reLorurLr) r, .r=,r,litat!J. OJU}S-'

\
zry;{
.,t'.J\ {:7
--1 '.

h$ft;"
Vdh ( L
-\(, - r
.*r
1
\P||Gr|y||9|L|J,9|L'|l|E|.r|onephrit|s,bacteremia'>

\ 80
*a4;.
., r.i[A._,/
La[. A-
ss'trj{, 5J,i

1> \-\
*f-Ihentification +if8$eptococcal tests
t u-^
l-,.)

L/r
--r
cwe* '
'I"lilT;-ll.; *d;?i.:'-* - :ed. u 'o''r 'n!D !' ilp',

A<
,\
^(

+,
,e
A-.--
1.rN' nN

-tt
nt \ 82

\A Scheme for Differentiating

Ad'fr+ yti c stre ptococci Beta- Hernolyti< Streplococci
Al )
e m ol
tA..-.l
c-cgtr.thl 6 f he l'rc&a* Hrll Coflperes lrc PerrB3sror raq!(i,d'l.u rcgiduCc|) cr d,t2lay

\
(*)
CANIP lst

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\\
A#Catment and Prevention Streptococci 1
*lUemolytic
l$''j'_r-l--u.'r,r,j ,,);+
lutt-,-q V.ldidans Group .^ltz',(
'ffi t, \
l), o Large complex group {t1. I
s sativarus' )
,( " :'.":,:*:'::::':'^?::"'' =h.]'\..-('
l_j..
-4 MostS. sanguis, S. milleri, S. mitis
numerous widespread residents
and gums of the anO tegql'ai
:,_r. 'Loral cavity, and also found in nasopharynx, genital tract, skir!-l-', 1
N
,L.r.lA ;;;".rive ; denta I or su rs ica I proced u r#;' l.I,i;$ihJi.l

]t
1\
16
-<Ya
1'*'*4::/
(-
1,a1\,
k

\-\ 1>
'Sfilidans
A-"i Group T.tiridans croup
./Y
(A_-r {,.' )? 17.--r

-lzit
Q S. mutans produce slime layers that adhere to teeth, U')si:#''
plaque J "A ,1 )
\ o
Involved in dental caries i*Y\'-(
lining or valves -]O Persons with preexisting heart conditions should receive * y'L--
,.7*.rgroghylactic antibiotics before surgery or dental procedurer
,.:,""Q1persons with
preexisting heart disease are at high risk
Colonization of heart by forming biofilms
\G -'f
ir$Jx*
Jq,^. {

{'ri' ,7V?.-
tr.yyfi
LoY*-e-
-W4= \

AAru,o effects of streptococcal

iRfu n i z a tj"orr ,r, ic'A,r{r r.c p.dc,,s,,.qu*e., !q,.p.urxr.i d o'ohy

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\^
'-fDrgpnosi n g Sfre ptococcu s pneu mon iae
1 bcpy,rsrn'c rhe M:Gravz
'..,
per'.' ssror re?u:reo ff,r
"rfi:lil;S::i
;il;.;jrc '/7.-\-5
?'
2 \s.-t
.\
4

--
n\'

lq
/n'

\-tA

pathology
"fpidem iology a nd
4,.

{" /':<]

t
\-o
t\
oes not survive
+
s.O
\ eJderly,. immun
r lung:olseases
Ilqqg,otseasqs
t!!1_e9L-!9r_r!. llersons lMinQ.]n-dose quarters are
- la . sf--: .4 ,

'fg,,l;, p
a.n g,
i

':^ I T.u$r,ffu,]
'l( tif45
Hr-ao
d indr."'ln
Ory respOnse \ n('
ar by way of eufiVtq
t'.-\-3j
t' 9-l

K[v
5,\

a nd Diag nosis

O Gram stain of specimen - presumptive identification

{.tt- O Quellung test or capsular swelling reaction

,.
r O o-hemolytic;
Y Ll-l lgl I lvlyLlL, optochin sensitivity, bile solubility,
-> fermentation

N._-+
-l,.rl.^it

.a)
-\ I

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 elLel20L4

O ConJugate vacclne br chlldren 2 to 23 months

Staph & Strep.doc.LA FK Unlam L7