STREPTOCOCCUS

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Strepto-cocci

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 Commensals or Parasites of man & animals
 or
 Saprophytes of decaying matter

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 Genus Streptococcus

Gram-Positive Cocci in Pairs or Chains

v/s

Staph – gram positive cocci in clusters (grape like)

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Gram-Positive
Streptococcus

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 Gram positive cocci in clusters

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Classification
 On the basis of their growth characteristics on
blood agar
 Alpha hemolytic
 Beta hemolytic
 Gamma hemolytic

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Example –
Streptococcus viridans (Viridans = green)
Streptococcus pneumoniae
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Example – enterococcus group

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Beta hemolytic streptococci
Lancefield grouping
 Group A to Group V without I and J
 Divided according to differences in Cell wall
carbohydrate antigen
 Out of all these, those of Group A known as
streptococcus pyogenes produce majority
of human infections
 Group B are known as S agalactiae

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Group A beta hemolytic streptococci /
strep pyogenes
 These are further subdivided according to sell
surface M, T and R antigens
 Griffith typing

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Streptococcus Pyogenes
(Group A beta hemolytic)

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Morphology
 Cocci in long chains

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Growth characteristics
 Facultative anaerobe, grows best in presence
of 10% CO2
 Grows on enriched media only
 Beta hemolysis around colonies on blood
agar

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Biochemical reactions
 Ferment sugars – produce acid , no gas
 Catalase negative
 Catalase helps to differentiate staphylococci
from streptococci

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Catalase test

 Add hydrogen peroxide to culture material

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Resistance
 Most are still susceptible to penicillin and
erythromycin

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Pathogenicity and virulence
 Antigenic structure
 Antigens on surface of strep cross react with body proteins

Capsular hyaluronic acid – human joints – autoimmune arthritis

Carbohydrate antigen – cardiac valves – rheumatic heart
disease
 Toxins
 Enzymes
 Streptolysin O – ASO titre for diagnosis
 Streptolysin S – for hemolysis around colonies
 Streptokinase – lysis of clots – given iv for treatment of MI
 DNA ase – Anti DNAase is useful for diagnosis of S.
pyogenes skin infection
 Hyaluronidase – breaks down tissues – helps in spread of
strep infection

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Epidemiology
 Source – human upper respiratory tract –
throat, pharynx, nose
 Transmission – direct contact, fomites

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Diseases caused
 Pus producing (suppurative)
 Respiratory infections
 Skin and soft tissue infections
 Genital infections

 Non suppurative
 Acute rheumatic fever
 Rheumatic heart disease
 Acute glomerulonephritis (kidney)

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Respiratory infections
 Tonsillitis
 Pharyngitis

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 tonsillitis 34
 pharyngitis 35
Skin and soft tissue infections
 Skin
 Erysipelas – involves lymphatics – older pts
 Impetigo – young children
 Pyoderma

 Soft tissue
 Cellulitis
 Necrotising fascitis

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Erysipelas

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Impetigo

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Pyoderma

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Cellulitis

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Necrotising fascitis
flesh eating bacteria (anaerobes)

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Non suppurative complications

After 1-3 weeks of primary infection

Due to cross reactivity

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Acute rheumatic fever
 Follows streptococcal sore throat

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Acute glomerulonephritis
 Cross reaction between streptococci and
kidney tissues

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Rheumatic heart disease

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Suppurative infections
 Examination of pus/throat swabs
 Microscopy, staining and culture
 Gram stain
 Blood agar

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Non suppurative infections
 Demonstration of antibodies
 Like ASO and anti DNA ase B

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Treatment
 Penicillin
 Erythromycin
 Drugs have no effect if non suppurative
complications have developed

 Prophylaxis – can prevent rheumatic fever,

not glomerulonephritis

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 OTHER STREPTOCOCCI

BETA HEMOLYTIC - GROUP B

AND GROUP D

ALPHA HEMOLYTIC (VIRIDANS

GROUP)– STREPTOCOCCUS
PNEUMONIAE

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 Group B Streptococcus

Streptococcus agalactiae

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Group B Streptococcus
S. agalactiae
1. Infect newborns
2. Infection acquired through maternal vagina during
birth
3. Presents as meningitis, pneumonia or septicemia

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Diagnostic Laboratory Tests

 CAMP factor positive

 Hippurase positive

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 CAMP (Christie, atkins, munch-
peterson) Factor Test S. aureus
Group B
Streptococcus (Spingomyelinase C)

(CAMP Factor)
Group A
Streptococcus

Enhanced
Zone of
Hemolysis 55
 Viridans group
Streptococcus pneumoniae

• Commonly referred to as pneumococcus

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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 Lancet shaped (one end broad, other
pointed)
 Capsulated
 Diplococci

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S. pneumoniae: lancet-shaped diplococcus

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S. pneumoniae
• Diplococcus

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Capsular stain Indian Ink prep

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Growth characteristics
 Alpha hemolysis on blood agar
 On further incubation, the colonies become
flat with raised edges and central elevation
resembling carrom coins / draughtsman

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Example –
Streptococcus viridans (Viridans = green)
Streptococcus pneumoniae
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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Biochemical reactions
 Hiss serum water – fermentation of inulin
 Bile solubility

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Inulin fermentation

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Resistance
 Pneumococcus is sensitive to optochin –
used for typing
 Resistance to penicillin – third generation
cephalosporin like ceftriaxone
 May be resistant to third gen ceph also

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Pathogenicity and virulence
 Capsule
 Toxins – pneumolysin
 C reactive protein

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Capsule

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Pneumolysin
 Membrane damaging toxin
 Cytotoxic activity

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C reactive protein
 Abnormal immunoglobulin against C protein
of S. pneumoniae appears in serum of
patients
 Also seen in acute phase of infections and
inflammations
 CRP titre is tested in acute infections

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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 Epidemiology

 Source – respiratory tract of humans

 Spread – droplets
 Carriers – pharynx
 Low immunity is responsible for fulminant
infections
 RSV infection, pulmonary congestion, stress,
malnutrition, alcoholism
 Splenectomy
 Sickle cell disease
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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Diseases caused
 Middle ear – otitis media
 Para nasal sinuses – sinusitis
 Respiratory tract – pneumonia, bronchitis,
empyema
 Meningitis is secondary to otitis media,
penumonia, sinusitis and conjunctivitis

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 Pneumococcal Pneumonia
Clinical Features
Abrupt onset
Fever
Shaking chill
Productive cough
Pleuritic chest pain
Dyspnea, tachypnea, hypoxia
11/24/24 Dr.T.V.Rao MD 82
Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Laboratory diagnosis
 Sample
 sputum – pneumonia
 septicemia - blood culture
 Otitis media - fluid from middle ear
 Meningitis - CSF

 Method
 Gram stain, microscopy
 culture

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 Latex agglutination for pneumococcal antigen
in serum of patients

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Description headings
 Morphology
 Growth characteristics
 Biochemical reactions
 Resistance
 Pathogenicity and virulence
 Epidemiology
 Diseases caused
 Laboratory diagnosis
 Treatment

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Treatment
 Penicillin
 Amoxycillin
 ceftriaxone/ceftazidime
 Vancomycin

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Prophylaxis
 Pneumococcal conjugate vaccine is available

 Given to splenectomy patients, sickle cell

anemia patients and susceptible individuals

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 GROUP D STREPTOCOCCI
Enterococcus faecalis
Enterococcus faecium

• GI tract of humans and animals

•Formerly Streptococcus

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 Cause UTI, wound infection
 Endocarditis
 Intra abdominal abcesses

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