Bacteriology:

Streptococcus spp.
Streptococcus pneumoniae
Streptococcus pneumoniae
• Alpha-hemolytic streptococci

METABOLISM
• Bile and optochin-sensitive: OVRPS (overpass)
o *Optochin sensitivity differentiates Strep
pneumoniae from Viridans strep (since
both are alpha-hemolytic)
RESERVOIR
• Upper respiratory tract
TRANSMISSION
• Respiratory droplets
Streptococcus pneumoniae
VIRULENCE FACTORS
• Polysaccharide Capsule: stops phagocytosis; major
virulence factor

CLINICAL SYNDROMES
• Pneumonia: most common cause of CAP in adults;
rust-colored sputum
• Otitis Media: most common cause in children
• Bacterial Meningitis: most common cause in adults
• Sinusitis
Streptococcus pneumoniae
DIAGNOSIS
• Gram-positive "lancet-shaped" cocci in pairs
or chains
• Alpha-hemolytic
• Positive Quellung reaction: capsular swelling
when mixed with a small amount of
antiserum (serum with antibodies to the
capsular antigens) and methylene blue
Streptococcus pyogenes
Streptococcus pyogenes
• Group A Beta-hemolytic streptococcus

VIRULENCE FACTORS
• Hyaluronidase: degrades hyaluronic acid
(spreading factor)
• DNase (streptodornase): degrades DNA in
exudates or necrotic tissue
o *Anti-DNAse B to document
antecedent Skin infection
Streptococcus pyogenes
TOXINS
• Erythrogenic toxin: produces scarlet fever
• Streptolysin O: highly antigenic, causes Ab
formation; destroys RBCs and WBCs; and
is the reason for the beta hemolysis
o *ASO Titers to document antecedent
Pharyngitis
• Exotoxin B: protease that rapidly destroys
tissue → necrotizing fasciitis
Streptococcus pyogenes
CLINICAL SYNDROMES

PYOGENIC:
• Impetigo Contagiosa: perioral blisters with
honey-colored crust
• Cellulitis: deeper infection involving
subcutaneous/dermal tissues; facilitated by
hyaluronidase (spreading factor)
• Pharyngitis: most common bacterial cause of
sore throat
Streptococcus pyogenes
TOXIGENIC:
• Scarlet Fever:
o due to erythrogenic toxin; fever
strawberry tongue, sandpaper-like
centrifugal rash
Streptococcus pyogenes
IMMUNOLOGIC:
• Acute Rheumatic Fever
o Post-pharyngitic
o Joint, heart, and brain tissue
• Post Streptococcal Acute
Glomerulonephritis (PSAGN)
o Post-pharyngitic OR post-impetigo
o M protein
o S/S: Hypertension, periorbital edema,
hematuria
Streptococcus agalactiae
Streptococcus agalactiae
• Group B beta-hemolytic streptococcus

RESERVOIR
• Vagina

TRANSMISSION
• Transvaginally
• Transplacentally
Streptococcus agalactiae
CLINICAL SYNDROMES

• Neonatal Pneumonia and Meningitis:

Group B Streptococcus is the most common
cause; predisposing factors include:
• Intrapartum fever >38°C
• PROM
• Vaginal colonization
Streptococcus agalactiae
TREATMENT/PREVENTION
• DOC: Penicillin G
o Penicillin G + Aminoglycoside for serious infections
• All pregnant women should be screened for GBS colonization at 35-37 wks
AOG; if (+), chemo-prophylaxis with IV penicillin or Ampicillin 4h prior to
delivery
Viridans Streptococci
Viridans streptococci
METABOLISM
• Catalase-negative
• Bile and optochin-resistant

VIRULENCE FACTORS
• Glycocalyx enhances adhesion to
damaged heart valves
• Protected from host defenses within
vegetations
Viridans streptococci
CLINICAL SYNDROMES
• Dental caries: S. mutans
• Subacute Bacterial Endocarditis:
S. sanguis – most common cause of
subacute and native valve endocarditis