Streptococci

General characteristics

1. Gram stain: Gram + cocci, round / oval shape,

pair or chain.
2. Growth character:
• Facultative anaerobic
• Catalase negative.
Objectives

1. Describe the general characteristics of Streptococcus spp.

2. Explain the Lancefield classification system for Streptococcus.
3. Describe the patterns of hemolysis for clinically significant
species.
4. List the virulence factors & explain the pathogenic activities of
Streptococcus pyogenes.
5. Explain the significance of S agalactiae in perinatal infections.
6. Identify the major virulence factors of S pneumoniae.
7. List the virulence factors of S suis.
8. Describe the techniques for the identification of clinically
significant streptococci.
Classification

1. Hemolytic patterns on sheep blood agar: α, β, 

2. Lancefield classification scheme (1933):
Antigens of carbohydrate C from cell wall;
20 groups: A→ H, K→ W
3. Biochemical characteristics
4. Molecular analysis of the 16S rRNA sequences
5. Protein M of cell wall.
β-hemolytic

α-hemolytic

Cell wall:
carbohydrate & proteins
 Grouping based on 16S rRNA sequences

- pyogenic: 10 species (spp.): S pyogenes, S agalactiae, ...

- anginosus (milleri): S anginosus, S constellatus, S intermedius.
- mitis: 7 spp.: S pneumoniae, S oralis, S mitis, …
- salivarius: S salivarius, S vestibularis, S thermophilus.
- bovis: S bovis, S equinus, S alactolyticus.
- mutans: 7 spp.: S mutans, …

Streptococcus suis, …..

Habitat

- Streptococci are ubiquits.

- Some are members of normal microbiota of the skin,
upper respiratory tract, lower gastrointestinal tract,
vagina.
- Enterococci & some α-hemolytic streptococci:
→ sources of contamination of clinical specimens.
Pathogenicity
1. S. pyogenes (GAS)
- Localized:
• Acute pharyngitis, sinusitis, otitis media (viêm tai giưã), …
• Impetigo, cellulitis, myositis,…
- Systemic:
- Scarlet fever, acute endocarditis, meningitis, bacteremia,
streptococcal toxic shock syndrome
- poststreptococcal sequelae: acute arthritis, acute glomerulo-
nephritis (viêm cầu thận cấp).

Groups C, F & G β-hemolytic streptococci cause similar

infections, usually in immunocompromised adults.
 Virulence factors of S pyogenes

- Protein F mediates epithelial cell attachment.

- Hyaluronic acid capsule inhibits phagocytosis.
- Protein M is antiphagocytic.
- Several enzymes & hemolysins destroy tissues:
streptokinase, DNase, hyaluronidase,
streptolysin O (oxygen-labile, pore-forming toxin, antigenic),
streptolysin S (oxygen-stable, β hemolytic exotoxin).
- Erythrogenic toxin.
Impetigo Pharyngitis

Necrotizing fasciitis

Scarlet fever
Pathogenicity
2. S. agalactiae (GBS)

- In neonates & infants: respiratory distress (rối loạn hô hấp),

meningitis (viêm màng não), sepsis.
- In adults: bacteremia, pneumonia, endocarditis, arthritis,
osteomyelitis, postpartum infections (nhiễm khuẩn hậu
sản)
Pathogenecity of S pneumoniae
 Meningitis, pneumonia, bacteremia, sinusitis, otitis media.
 Diseases in children usually by the serotypes 6,14,19 & 23;
in adults by the serotypes 1-8.
 Virulence factors: polysaccharide capsule that inhibits
phagocytosis; pneumolysin; sIgA protease.

Signs on skin of meningitis

Pinterest
 Pathogenicity of S suis
Streptococcus suis: (liên cầu lợn)
- Gram pos., oval shaped; single / pair / short chain.
- 29 (true) serotypes; types 2.
- Zoonotic disease transmitted to human.
Meningitis deafness, diplopia, bacteremia. Endemic.
- Virulence factors: polysac. capsule, enzyme system breaching
blood-brain barrier.
 Pathogenicity

3. Group D streptococci, non-agglutinated S viridans, &

Enterococci
- bacteremia
- endocarditis
- urogenital infections
- dental caries: S. mutans, S. salivarius, S. sanguis, S.
milleri.
 Enterococci

General characteristics

1. Morphology: Gram-positive cocci, single or pair or short chain

2. Metabolism:
- catalase negative; PYR positive
- able to grow under extreme conditions: bile; 45oC; 6,5%
NaCl
3. Hemolysis: α or β or  .
≠ Group D Streptococcus: tiêu huyết α; PYR -.
PYR = pyrrolidonyl arylamidase
Bacteriologic diagnosis

Collection of specimens:
Blood, Cerebrospinal fluid, Urine, Pharyngeal swab / fluid, Pus,
Vaginal fluid, Amniotic fluid
Culture – isolation:
Blood agar. Incubating at 35-37oC in 5% CO2.
Identification:
based on bacteriologic characteristics.
MALDI-TOF MS (matrix-assisted laser desorption ionization
time-of-flight mass spectrometry)
Non-culture assays: Ag detection, molecular methods.

Latex agglutination
 Summary

1. Many species of streptococci are clinically important

pathogens, in particular S pyogenes, S agalactiae, S
pneumoniae.
2. These pathogens cause large spectrum of infections involving
localized and systemic infectious diseases in humans of all
ages, thank to a variety of specific virulence factors.
3. Laboratory diagnosis helps identifying the pathogenic agents
based on different bacteriological characteristics, antigenic
traits and molecular assays.