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ENTEROCOCCUS
Pepy Dwi Endraswari, dr., M.Si., Sp.MK
Kuliah D3 ATLM FK UNAIR Semester 2
Tahun 2021

• Enterococci were previously classified as group D streptococci

(Lancefield)
• This group consists of gram-positive cocci that are natural
inhabitants of the intestinal tracts of humans and animals.
• >38 species
• The commonly identified species in clinical specimens are E. faecalis
and E. faecium.
• Enterococcus gallinarum and Enterococcus casseliflavus have also
been studied because they are inherently vancomycin-resistant and
colonized human gastrointestinal.

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CHARACTERISTIC
• Most enterococci are nonhemolytic or α-hemolytic, although some
strains show β-hemolysis.
• Katalase negative, but sometimes exhibit a pseudocatalase
reaction—weak bubbling in the catalase test.
• Identification of the different species is based on biochemical
characteristics.

• Enterococci have the ability to grow under extreme conditions:

• in the presence of bile or 6.5% NaCl
• at 45°C (growing at as low as 5°C, as high as 50°C, and even surviving at 60°C
for as long as 30 min)
• alkaline Ph (growing optimally at pH 7.5, but surviving pH extremes as low as
4.8 and as high as 9.6)
• The ability of enterococci to hydrolyze PYR is useful for differentiating
them from group D streptococci

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LABORATORY DIAGNOSIS AND

IDENTIFICATION

Laboratory Diagnosis
• Standard procedures for collection and transport of blood, urine, or
wound specimens should be followed.
• The specimens should be cultured as soon as possible with minimum
delay.
• Trypticase soy or brain-heart infusion agar supplemented with 5%
sheep blood is routinely used to culture enterococci.
• Enterococci grow well at 35°C in the presence of CO2 but do not
require a high level of CO2 for growth.

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Enterococcus spp. are identified based on

(1) ability to produce acid in carbohydrate broth
(2) ability to hydrolyze arginine
(3) tolerance of 0.04% tellurite
(4) utilization of pyruvate
(5) ability to produce acid from methyl-α-D-glucopyranoside
(6) Motility

Most enterococci are nonhemolytic or α-hemolytic, although

some strains show β-hemolysis.

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• PRESUMTIVE
IDENTIFICATION
OF GRAM
POSITIVE COCCI

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REVIEW

Members of the genus Enterococcus are capable of growing in

the presence of 4% bile and hydrolyzing esculin to glucose
and esculetin. Esculetin combines with ferric ions to produce a
black complex visible as black zones around colonies.
Cultivation 24 hours in an aerobic atmosphere, 37°C.

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Most enterococci are nonhemolytic or α-hemolytic,

although some strains show β-hemolysis.

Most enterococci are nonhemolytic or α-hemolytic, although

some strains show β-hemolysis.

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MOLECULAR IDENTIFICATION
Although phenotypic and biochemical tests may help in the
presumptive identification of the Enterococcus genus, nucleic acid
sequencing and molecular methods are required to differentiate one
Enterococcus species from another

Pulsed-field gel electrophoresis, contourclamped homogeneous

electric-field electrophoresis, ribotyping, and PCR-based typing
methods have been used mainly to type Enterococcus spp. in
epidemiologic studies and investigations of vancomycin-resistant
enterococci (VRE)

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Virulence Factors
• The virulence factors that contribute to the pathogenicity of enterococci
are incompletely understood.
• can grow in extreme conditions
• resistant to multiple antimicrobial agents
• E. faecalis: Extracellular surface adhesin proteins, extracellular serine
protease, and gelatinase  play a role in the colonization and adherence
to heart valves and renal epithelial cells.
• E. faecalis: produces a twosubunit toxin (cytolysin)  Hemolytic protein
associated with bacteremic strains; bacteriocin that inhibits growth of
Gram-positive bacteria (facilitates colonization); can lyse macrophages and
neutrophils (gain additional nutrients and escape immune clearance)

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CLINICAL MANIFESTATION

Antimicrobial Resistance
• Enterococcus spp. show resistance to several of the commonly used
antimicrobial agents, so differentiation from Streptococcus and
susceptibility testing are important.
• Enterococci have intrinsic or acquired resistance to several
antimicrobial agents: including aminoglycosides, β-lactams, and
glycopeptides.
• Resistance of enterococci to glycopeptides such as vancomycin and
teicoplanin were first described in the late 1980s. Of the six
vancomycin-resistant phenotypes (VanA to VanE and VanG),

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AEROCOCCUS

Streptococcus-like Organisms
• Resemble viridans streptococci :
• Aerococcus
• Gemella
• Lactococcus
• Leuconostoc
• Pediococcus
• These bacteria have been isolated in clinical specimens and are
associated with infections similar to those caused by enterococci and
streptococci.

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Aerococcus
• a common airborne organism.
• It is a widespread, opportunistic pathogen associated with
bacteremia, endocarditis, and UTI in immunocompromised patients.
• Aerococcus urinae and Aerococcus sanguinicola have been shown to
cause invasive human infections such as sepsis with a urinary tract
focus and infective endocarditis (IE)

Species of Aerococcus
• The Aerococcus genus now includes eight species
1. A. viridans (1953) was the one originally described.
2. A. urinae (1992)
3. A. christensenii (1999)
4. A. urinae hominis (2001)
5. A. sanguinicola (2001)
6. A. urinae equi (reclassification of Pediococcus urinae equi, 2005)
7. A. suis (2007)
8. A. vaginalis (2014)
• A. suis (from pigs), A. urinae equi (from horses) and A. vaginalis (from beef cow)
• All exept above species have been found as pathogens in human clinical situation:
such uas:
• urogenital infections (UTI)
• bacteremia/septicaemia
• infective endocarditis

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Characteristics
• Aerococci resemble viridans streptococci on culture but are
microscopically similar to staphylococci in that they occur as tetrads
or clusters.
• Katalase negative, but sometimes show a weak catalase or
pseudocatalase reaction.
• grow in the presence of 6.5% NaCl  be confused with enterococci.

Upper part of the figure shows a blood isolate of Aerococcus urinae grown for 24 h on blood agar in
5% CO2. The small colonies with clear α-haemolysis can be seen. Lower part of the panel shows a
blood isolate of Aerococcus sanguinicola grown on the same plate. The colonies are larger, whiter
and the haemolysis is not as pronounced.

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•C

Culture of Aerococcus urinae on Blood agar

showing a- haemolysis.

SELAMAT BELAJAR
Question? Pepy.dr@fk.unair.ac.id

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