STREPTOCOCCI

General character

 Gram positive cocci arranged in chains

 Catalase test negative
 Fastidious
 Facultative anaerobes
 Penicillin sensitive (Streptococcus faecalis )
 Resistant to AG (GENTAMICIN )
GROUP A STREPT

STREPTOCOCCUS
PYOGENES
 Most important pathogen
 Distinguished by bacitracin test (sensitive)
 Some are capsulated (hyaluronic acid)
epidemiology

 Acquired through infected respiratory droplet

 Direct contact _ Skin , hand
 Indirect contact _contaminated objects
 Spread enhanced by poverty
overcrowding
poor ventilation
Source of infection

A - Patient with active disease – tonsillitis

 Convalescent carriers – throat

B - Asymptomatic carriers (20% -school

children ) – throat

 Prevalent in children – 3 – 8 yrs

VIRULENCE FACTORES

A- CELL ASSOCIATED
1- M protein (antiphagocytic) -
originates from cytoplasmic membrane
produces protective type specific abs
2- lipoteichoic acid adhesion factor for
attachment
3- hyaluronic acid capsule - antiphagocytic
3- STREPTOKINASE (fibrinolysin)
 Thrombotic disease – coronary thrombosis
4- DNAases A , B , C , D.
 AntiDNAase B - DIAGNOSE SKIN infections

5- HYALURONIDASE – spread factor

6- LIPOPROTEINASE – opacity factor
B- EXTRACELLULAR PRODUCTS
B- EXTRACELLULAR PRODUCTS
1- SREPTOLYSINS OR HAEMOLYSIN
 Streptolysin o antigenic , ASO ,
oxygen labile
 Streptolysin s oxygen stable, non
antigenic
2- Erythrogenic toxin (SPE )
 SUPERANTIGEN
 Bacteriophage
– 3 types , A – B- C .
 SCARLET FEVER
DISEASES
A - SAPURATIVE

A- SAPURATIVE
1- TONSILITIS / PHARINGITIS
2- PERITONSILAR ABSCESS(QUINSY)
3- OTITIS MEDIA
4- ADENITIS
5- IMPETIGO (PYODERMA)
6- SCARLET FEVER
7- CELLULITIS
8- PUERPERAL SEPSIS
9- INVASIVE SOFT TISSUE INFECTIOS
NECROTISING FASCITIS , MYOSITIS , TSS
10 - BACTERIMIA
 B-NON SUPPURATIVE (DELAED
SEQUELAE)
B- NON- SUPPURATIVE (DELAYED SEQUELAE)
1- RHEUMATIC FEVER :
autoimmune disease
follows throat infection only
recur (M – SEROTYPES)

2- ACUTE GLOMERULONEPHRITIS
Ag – Ab complexes
May follow both throat or skin infection
NO recurrence
LABORATORY DIAGNOSIS

SPECIMEN
THROAT SWAB
PUS
WOUND
BLOOD
ASPIRATES
SERUM – SEROLOGY : ASO TITRE
MICROSCOPY

 GRAM – STAIN

– GRAM-POSITIVE COCCI IN CHAIN

– USELESS IN THROAT SWAB

CULTURE - IDENTIFICATION

 BLOOD-AGAR (AEROBIC- ANAEROBIC)

 BETA- HAEMOLYSIS (COMPLETE )
 ID
– BACITRACIN SENSITIVITY
– LANCEFIELDS GROUPING (CELL WALL CHO-
Ag)
– STREPTEX
SEROLOGY

 ASO-TITRE
– RHEUMATIC FEVER
– ACUTE GLOMERULONEPHRITIS

 Anti-DNAase B
– RECENT GROUP -A INFECTIONS (SKIN)
TREATMENT

 PENICILLIN – 10 DAYS

 ALLERGY-
– ERYTHROMYCIN
– CEPHALOSPORINS
 CEPHRADIN
 CEFUROXIME
GROUP C AND G STREPT.

 SORE THROAT
 SKIN INFECTION
 WOUND INFECTION
 SOFT – TISSUE
 GENITAL – INFECTION
 CELLULITIS
 SEPTICAEMIA
 GROUP-B STREPTOCOCCUS
(SREPT. AGALACTIAE)

 RESERVOIR- COLON (RECTUM)

 10-40 % FEMALE . CARRIER (VAGINA)
 70% - NEOBORN – COLONISED DURING
BIRTH
 < 1% GET INVIASIVE INFECTION
DISEASES

A – EARLY ONSET (24 – 48 h )

RISK – FACTORS
RUPTURED MEMBRANES (>18h
PREMATURITY
PROM (< 37 WEEKS)
MULTIPLE BIRTH (TWINS)
LOW BIRTH WEIGHT
CLINICAL PICTURE

 RESPIRATORY DISTRESS SYNDROME

 SEPTICAEMIA
 MENINGITIS
 MORTALITY :
B- LATE – ONSET

HOSPITAL- AQUIRED (NOSOCOMIAL)

MENNGITIS IN FULL – TERM NEONAT.
BETTER PROGNOSIS
MORTALITY
DIAGNOSIS

 CLINICAL
 LATEX – AGGLUTINATION
 CULTURE
 ID
– CAMP – TEST
– STREPTEX (GROUPING)
INFECTIONS IN ADULTS

 POST-PARTUM SEPSIS
 CHORIOAMNIONITIS
 IMMUNOCOMPROMISED
– SEPSIS
– CELLULITIS
– ARTHRITIS
– PNEUMONIA
 TREATMENT
PREVENTION

 PENICILLIN OR AMPICILLIN + GENTAMICIN

 SCREEN- PREGNANT W. (35-37 W)
 CARRIER – PROPHYLAXIES
– IV- PENICILLIN – AT LABOUR
GROUP – D STREPT.
NORMAL INTESTINAL FLORA

A- ENTEROCOCCI
GROW IN 40% BILE-ACID,6.5% NACL
PENICILLIN RESISTENT
AMPICILLIN SENSITIVE
- E. FAECALIS : 80% - 90% INFECTI.
- E. FAECIUM : MANY AMPICILLIN R.
B- NON-ENTEROCOCCI
PENICILLIN SENSETIVE
STREPT . BOVIS
DISEASES

 URINARY TRACT INFECTIONS

 ENDOCARDITIS
 WOUND INFECTIONS

TREATMENT
AMPICILLIN + GENTAMICIN
VANCOMYCIN ( VRE )
ALPHA – HEMOLYTIC
STREPTOCOCCI

S.PNEUMONIAE
VIRIDANS
S.PNEUMONIAE

 PNEUMONIA  OTITIS MEDIA

 BACTEREMIA  SINUSITIS
 MENINGITIS  CONJUNCTIVITIS
 SEPTIC  BRONCITIS
ARTHRITIS
 PERITONITIS
GRAM POSITIVE DIPLOCOCCI

 POLYSACCHARIDE CAPSULES (85)

 ANTIPHAGOSITIC
 OPSONIZING ANTIBODIES
 ANTCAPSULAR AB. ARE PROTECTIVE
 PNEUMOLYSIN
RISK FACTORS

 CEREBRAL IMPAIRMENT
 VIRAL INFECTION
 OLD AGE
 HEART FAILURE
 SPLENECTOMY
 SCA , MULTIPLE MYLOMA , HIV
 SKULL FRACTURE
DIAGNOSIS
SPUTUM , BLOOD , CSF

 MICROSCOPY
 QUELLUNG REACTION
 BILE SOLUBLE
 OPTOCHIN SENSETIVE
 BLOOD CULTURE + IN 15%
 LATEX AGGLUTINATION
 SENSETIVITY TEST
TREATMENT , PREVENTION

 CEFTRIXONE +
VANCOMYCIN  VACCIN

 PENICILLIN

 ERYTHROMYCIN
 CLINDAMYCIN
VIRIDANS

 NORMAL FLORA
– OROPHARYNX
– SKIN
– GIT
ENDOCARDITIS
FEVER , ANEMIA , HEART MURMUR

 S. MUTANS –POLYSACCHARIDES
(DEXTRAN) – DENTAL CARIES
 S.SANGUIS
 S.SALIVARIUS
 S.MITIS
 S. BOVIS ( CA. COLON )
 S.INTERMEDIUS ( MILLERI)
– DENTAL , BRAIN , ABDOMINAL ABSCESSES