Streptococcal Diseases

Streptococcus pyogenes
 Streptococcus pyogenes
Pyogenes means pus producing

• One of the most important pathogens

• Gram positive cocci in chains

• Lancefield Serological Group A

• Beta Hemolytic on blood agar

Gram Stain of S. pyogenes
 Hemolysis on Blood Agar
Plates
• Alpha hemolysis-organism excretes
hemolysins which partially break down rbc
(incomplete hemolysis) thus a greenish zone
appears around colony. S. pneumoniae
• Beta hemolysis-organisms excretes potent
hemoysins which completely lyse rbc
(complete hemolysis) thus a clear zone
appears around colony. S. pyogenes
 S.pyogenes
S. pneumonia
Beta
hemolysis Alpha
hemolysis
Diseases caused by S. pyogenes
• Strep throat
• Impetigo
• Erysipelas
• Cellulitis
• Invasive Strep A infections
– Necrotizing fasciitis
– Myositis
– Toxic shock-like syndrome
 Erysipelas
• Acute infection and imflammation of the
dermal layer of skin.
• Painful red patches which enlarge and
thicken
• Treatment -penicillin or erythromycin
Erysipelas
 Strep Throat
• Most common of all Strep diseases
• Spread by saliva or nasal secretions
• Incubation period 2-4 days
• Sore throat, slight fever (101)
• Important to treat immediately to avoid
post strep diseases
Diagnosis and treatment of Strep Throat

• Tell tale symptoms are slight fever

associated with sore throat and visual of
pus in back of throat
• Quick diagnostic tests (Molecular)
available but must be confirmed by
throat swab and growth on blood agar
(beta hemolysis)
Diagnosis and treatment of Strep Throat

• If the strain of S. pyogenes is lysogenic

for a particular phage which expresses
an erythrogenic toxin the result is
Scarlet fever
• Rash appears and characteristic is the
strawberry colored tongue
Strawberry Tongue
 Treatment of Strep
• Penicillin G or Erythromycin are drugs
of choice
• Although the disease is self-limiting it is
important to treat immediately to avoid
post strep complications
 Poststreptococcal diseases
• Rheumatic Fever-autoimmune disease
involving heart valves,joints, nervous
system. Follows a strep throat
• Acute glomerulonehritis or Bright’s
Disease-inflamatory disease of renal
glomeruli and structures involved in
blood filter of kidney. Due to deposition
of Ag/Ab complexes
 Rheumatic Fever
• Most common cause of permanent
heart valve damage in children
• Exact cause not yet known but there
appears to be some antibody cross
reactivity between the cell wall of S.
pyogenes and heart muscle
 Rheumatic Fever
• Diagnosis is based on symptoms and is
difficult
• Occurs most frequently between ages
of 6 and 15
• US it is about 0.05% of pop having strep
infections
• 100x more frequent in tropical countries
 Rheumatic Fever
• Treatment is via salicylates (aspirin
derivatives) and corticosteroids to
decrease inflammation and fever.
 Glomerular Nephritis
• Diagnosis based on history of Strep
throat and clinical findings.
• Symptoms include fever,
malaise,edema, hypertension and blood
or protein in urine
• Occurs in 0.5% of those having strep
throat.
 Glomerular Nephritis
Treatment and Recovery

• Penicillin or erythromycin to eradicate

and residual strep infection
• 80-90% of cases recover with bed rest
lasting for months
• Kidney damage in the remainder is
often permanent resulting in chronic
glomerular nephritis
 Streptococcus Pneumonia
• Caused by infection with Streptococcus
pneumoniae
• Gram positive, alpha hemolytic, not of
lancefield serotype A
• Often part of normal flora of respiratory
track and becomes infective once hosts
resistance is lowered. Classified as an
endogenous infection.
Strep Pneumonia
Strep Pneumonia

S. pneumoniae
Alpha hemolysis
 Strep pneumonia
• Predisposing factors: upper respiratory
viral infection, diabetes, alcoholism

• 60-80% of all pneumonias

Strep Pneumonia
 Cause of strep pneumonia
• Primary virulence factor is the capsular
polysaccharide which protects the
organism against phagocytosis

• Pathogenesis is due to rapid growth of

bacteria in alveolar spaces
 Symptoms of Strep
Pneumonia
• Onset abrupt

• Chest pains

• Chills

• Labored breathing
Diagnosis of Strep pneumonia
• Chest Xray

• Culture and staining

• Biochemical tests of isolated organism

 Treatment of Strep
Pneumonia
• Typically treated with Penicillin G
cefotaxime, oflaxacin or for those
allergic to penicillins can be treated with
erythromycin or tetracycline
• Pneumococcal vaccine (Pneumovax 23
or Pnu-immune 23) is available for the
elderly
 Staphylococcal infections
• One of the most common of all
infections
• Staphylococcus are divided into
pathogens and non pathogens based
on possession of the enzyme coagulase
– Coagulase + are usually S. aureus and
pathogenic
– Coagulase - are organisms like S.
epidermidis are less invasive
Diseases of Staphylococcus
 Toxic Shock Syndrome
• Most in women using superabsorbant
tampons
• Staphylococcus aureus-Gram positive
cocci
• Low blood pressure, fever, diarrhea,
skin rash can be fatal
 Toxic Shock Syndrome
• Symptoms mainly caused by toxic
shock syndrome toxin 1(TSST1)

• Several other enterotoxins also involved

 Staph skin infections
• Most common cause of acne, boils,
furuncle and cabuncles

• Treatment can be difficult because of

antibiotic resistance.Usually can be
treated with methicillin,
cephalosporins,or vancomycin
• Methicillin resistant strains=MRSA
 Staph skin infections
Furuncle
Deep folliculitis (infected hair
follicle

superficialfolliculitis

Carbuncle
Multiple abcesses
Around many hair
follicles

Scalded skin
Staph impetigo syndrome
 Scalded Skin Syndrome
• Due to strains of S. aureus containing a
special toxin-exfoliatin
 Diagnosis
• Culture and stain-gram positive in
grape-like clusters

• Catalase and coagulase tests

• DNA fingerprinting
S. aureus