Prof.

Beata Sobieszczańska
Wrocław Medical University
Dept. of Microbiology
 Staphylococcus
Coagulase enzyme
production

Coagulase - positive Coagulase - negative

Staphylococcus S. epidermidis
aureus S. saprophiticus
 A protein, coagulase (CF),
peptidoglycan (LTA),
S. aureus capsule, adhesins

Coagulase, catalase, enzymes

(hyaluronidase, fibrinolysin)
Toxins: TSST-1, hemolysins,
leukocidin Panton-Valentine,
exfoliating toxins, enterotoxins
 Superantigens
• Toxic shock syndrome toxin-1
(TSST-1) some strains of Staphylococcus aureus
• Staphylococcal enterotoxins (SE)
• Staphylococcal exfoliatin toxins (ETA,
ETB)
• Pyrogenic exotoxin (Spe) – toxic shock-like
syndrome (TSLS) – rare invasive strains and
scarlet fever strains of Streptococcus pyogenes
(group A)
Diseases:
Skin-wounds: SSSS, bullous impetigo,
folliculitis, furuncles, carbuncles
Blood: bacteremia, sepsis, catheter-
related blood stream infections
(CRBSI), staphylococcal toxic shock
syndrome, endocarditis
RTI: pneumonia, otitis media
UTI, osteomyelitis
Food-poisoning
 Toxin-mediated (toxin-related)
disease – clinical symptoms are
caused by toxin
Purulent Toxin-mediated
Skin &
Pyogenic
wound
/purulent = pus producing
Food
infections poisoning
Endocarditis SSSS
Pyrogenic
Pneumonia
= inducing fever
TSS
Bacteremia
cellulitis
 folliculitis

carbuncle

furuncle
carbuncle
Staphylococcal scaled skin syndrome/
staphylococcal epidermal necrolysis/
Ritter’s disease
Bullous impetigo
 Infections from
S.
epidermidis prosthetic implants
(catheters, heart valves)

S.
Saprophiticus Urinary tract infections:
Urease-
producer Cystitis in young women
 Streptococci
Lancefield classification
(β-hemolytic) A, B, C, D, E, F, G …….
 Group A – Str. pyogenes (GAS)
 Group B – Str. agalactiae (GBS)
α-hemolytic:
 Oral (viridans) streptococci
 Str. pneumoniae
non-hemolytic:
 Enterococci (α, β, Ɣ)
 M protein
Streptococcus hyaluronic acid capsule
pyogenes

Toxins:Pyrogenic
streptococcal exotoxins PSE:
A, B, C; streptolysin O
Enzymes: hyaluronidase,
streptokinase
No spread
to blood

PSE+ strain
Post-streptococcal rheumatic fever (ARF) =
autoimmune disease
Acute rheumatic fever
Post-streptococcal rheumatic fever (ARF) =
autoimmune disease
Post-streptococcal acute glomerulonephritis
= immune complexes
 Streptococcus pyogenes
The most common cause of bacterial
pharyngitis or pharyngotonsilitis
 Streptococcus pyogenes
Scarlet fever/scarlatina (pyrogenic exotoxin (PSE) in
non-immunized individuals)
 Streptococcus pyogenes
• Erysipelas
• Streptococcal toxic shock syndrome (PSE)
• Bacteremia, sepsis, septic shock
• Pneumonia
Streptococcal skin infectionsinfections
Flesh eating bacteria
Other streptococci
Streptococcus agalactiae (GBS)
 Meningitis and septicemia in neonates
 Infections in adults: endometritis in postpartum
women, septicemia, pneumonia in
immunosupressed individuals, UTI, soft tissue
infections, endocarditis, bone & joints infections
Virulence factors:
 Glycocalix & pili - attachment
 Glycosyltransferase – invasion of blood-brain barrier
 Polysaccharide capsule – anti-phagocytic
Other streptococci
Streptococcus pneumoniae - diplococci
Capsule – anti-phagocytic (>90 serotypes)
Hyaluronidase
IgA protease

Diseases:
Pneumonia
Sinusitis
Otitis media
Meningitis
Other
 STREPTOCOCCUS PNEUMONIAE

Serotypes:
2, 3, 5, 8, 14

Purulent: INVASIVE:
Otitis media meningitis
sinusitis sepsis
pneumonia endocarditis

Mortality:
15-25%
Anti-pneumococcal vaccines
Prevents any type of pneumococcal disease
Two types:
1. Polysaccharide (PPSV23, Pneumovax) – for people
2 through 64 years old with certain medical
conditions and 19 through 64 years old who smoke
cigarettes – ineffective in children <2 years old
(against 23 different serotypes)
2. Conjugate (PCV13 capsular polysaccharide +
diphtheria toxoid) against 13 different serotypes –
for all children younger than 2 years old and adults
 Streptococcus agalactiae
Hyaluronidase; toxic
polysaccharides

Diseases:
Neonatal menigitis
and sepsis
Blood infections,
UTI, septic arthritis
 Streptococci in oral cavity
Streptococcus: mitis, mutans, salivarius,
sanguis, milleri
► endogenous infections: dental carries,
endocarditis, mixed infections within oral
cavity (e.g. abscesses)
 ENTEROCOCCI:
virulence factors
► proteins binding ECM = colonization
► lipoteichoic acid = fibronectin binding,
induction of cytokines
► hyaluronidase = invasion into tissue
Most common infections: UTI,
endocarditis, catheter-related blood
infections
Other: intraabdominal and pelvic infections,
bacteremia, postoperative wounds
infections, meningitis – uncommon
(neurosurgical procedures)
 S. aureus S. epidermidis Enterococci
Reservoir Humans Humans Humans

Habitat Oropharynx, Skin Intestines

skin
Transmission Direct contact NO NO
Indirect Endogenous Endogenous
contact infections infections
Arrangement Clusters Clusters Single, diploid,
short chains
 Str. Str. Str.
pyogenes pneumoniae agalactiae Str. orale
Reservoir Humans Humans Humans Humans
Habitat Oropharynx Oropharynx Genital Oral cavity
tract
Transmission Air-borne Air-borne NO NO
route route Endogenou Endogenou
s infection s infection
Arrangement Chains Pairs Chains Chains
Diplococci
Thank you for your
attention