Pyrogenic (also called erythrogenic ) toxins stimulate leukopytes to release

cytokines that turn stimulate fever, rash, and shock.

Streptolysins lyse erythrocytes, leukocytes, and platelets. One strain of group C
Streptococcus (also called S. Equisimilis, ek-wi- si-mi- lis ), is also a pathogenic
beta- hemolytic bacterium unlike group A strep throat, this kind of group
Cpharyngitis does not lead to scarlet or rheumatic fevers.
Pathogenesis
Streptococci cause a variety of illnesses depending on the virulence factors
present in the vorious strains, S. Pyogenes frequently infects the pharynx, but
the resulting disease is usually temporary, lasting only until adaptive immune
responses against bacterial antigens ( particularly M protein and streptolysins )
clear the pathogen, usually within a week. Typically, strep throat and
streptococcal bronchitis occur only whwn normal, competing mikrobiota are
missing, when a large inoculum enables the bacterium to gain a rapid foothold
before antibodies are formed against it, or whwn adaptive immunity is impaired.
S. Pyogenes can invade deeper tissues and organs through a break in a mucous
membrane to couse necrotizing fasciitis.
Epidemiology
People spread S. pyogenes via respiratory droplets. Most cases of streptococcal
pharyngitis occur during the winter and spring among elementary and middle
school children, problaby because of crowded conditions such as those in
classroms and day care centers. One person can spread sufficient bacteria to
cause disease by coughing or sneezing within a radius of about 1.5 meters of
another person.
Group A Streptococcus formerly claimed the lives of millions, but because it is
sensitive to antimicrobial drugs, its significance as a deadly pathogen has
declined. Nevertheless, the bacterium still sickens thousands of Americans
annually.
The incidence of rheumatic fever has also declined significantly, from 7491 cases
in 1964 to 112 cases in 1994, the last year rheumatic fever was nationally
reportable. Epidermiologists do not understand fully the reason for this decline,
but the introduction of antimicrobial drugs, which limit the growth of the
bacterium and thereby the severy of streptococcal pharyngitis, likely played a
role. It also appears that there has been a decline in the strains of Streptococcus
that cause rheumatic fever.
Diagnosis, treatment, and prevention
Microbiologists estimate that fewer than 50% of patients diagnosed with strep
throat actually have it; the rest have viral pharyngitis. Given that the
manifestations of bacterial and viral pharyngitis are nerly identical, a sure
diagnosis requires serological testing. Correct diagnosis is essential because

bacterial pharyngitis is treatable with antibacterial drugs, whereas viral

pharyngitis is not.
Since alpha-hemolytic and nonhemolytic streptococci are normally in the
pharynx, the presence of streptococci in a respiratory sample is of little
diagnostic value. Physicians of betahemolytic strains of Streptococcus.
Penicilin is very effective against both S. pyogenes and S. equisimilis. Physicians
prescribe erythromycin or cephalosporin to treat penicillin-sensitive
patients.antibodies against M protein provide long-term protection against the M
protein or one strain provide no protection against other strains. For this reason,
a person can have strep throat more than once.
TERJEMAHKAN YAA PENO, MAKASIHHH......

(izza)
Streptococcal respiratory diseases
Learning Objectives

Describe four respi ratory diseases caused by

Streptococcus.
Identify the structures, enzymes, and toxins of group A
Streptococcus (S.Pyogenes) that enabel this bacterium to
survive against the bodys defenses and cause disease.
Physicians recognize a variety of diseases of the respiratory
system and associated organs caused by species of
Streptococcus, depending on the site of infection, the strain of
bacteria, and the immune responses of the patient.
Signs and Symptoms
Strep throat, or streptococcal pharyngitis, (Strepto-kokal farin-ji tis) is an infalamination of the pharynx caused by
streptococci. The back of the pharynx appears red, with
swollen lymph nodes and purulent (pus-containing) abscesses
covering the tonsils (see disease at a Glance 22.1 on p.673).
Usually, fever, malaise, and headache accompany pharyngitis.
If bacteria spread into the lower respiratory tract, they may
cause imflammation of the larynx or bronchi, conditions known
as laryngitis and bronchitis, respectively. Laryngitis
manifests as hoarseness; bronchitis reduces airflow,
encourages mucus accumulation in the lungs, and triggers
coughing.
The disease scarlet rever, also known as scarlatina, can
accompany pharyngitis caused by a strain of Streptococcus

carrying a lysogenic bacteriophage that codes for pyrogenic

(erythrogenic) toxins. Typically, after one to two days of
pharyngitis, such streptococci releaase their toxins, triggering
fever and a rash that begins on the chest and spreads across
the body. The tongue usually becomes strawbwrry red. The rash
disappears after about a week, and the skin sloughs off in a
manner reminiscent of staphylococcal scalded skin syndrome.
Complications of some cases of untreated streptococcal
pharyngitis are acute glomerulonephritis, a disease of the
kidneys considered in chapter 24, and rheumatic rever, in
which inflammation leads to damage of heart valves and
muscle. Though the exact cause of such damage is unknown, it
appears that this disease is an autoimmune response in which
antibodies directed against streptococcal antigens cross-react
with heart antigens. In many patients, surgeons must replace
dammaged heart valves whwn the patient reaches middle age.
Heart failure and death can occur.
Pathogen and Virulence Factors
The bacterial genus Streptococcus is a diverse
assemblage of Gram-positive, facultatively anaerobic cocci
arraged in pairs or chains. Researchers differentiate
streptococci using several different, overlapping schemes,
including serological classification based on the reactions of
antibidies to specific bacterial antigens, type of hemolysis, and
physiological properties as revealed by biochemical test. A
serological classification scheme developed in 1938 by Rebecca
Lancefield (1895-1981) divides streptococci into serotype
groups based on the bacterias antigens (known as lancefield
antigens).
Lancefield group A Streptococcus (synonymously known
as S.pyogenes, pi-oj en-ez) is the major cause of bacterial
pharyngitis and scarlet an rheumatic fevers. The bacterium
shows betahemolysis after 24 hours on blood agar plates (see
figure 6.13). in contrast, harmless streptococci of the upper
respiratory system are either nonhemolytic or alpha-hemolytic.

Strains of group A Streptococci have a number of

structures, enzymes, and toxins that enable them to survive as
pathogens in the body. These include the following:

M proteins destabilize complement component C3b,

thereby interfering with opsonization and lysis (see Figure
15.9)
The hyaluronic acid capsule may camoflage the
bacterium from phagocytes.
Streptokinases are enzymes that break down blood clots,
presumably enabling group A streptococci to spread
rapidly through damaged tissues.
C5a peptidase is an enzyme that breaks down
complement protein C5a, which is a chemotatic factor.
With this enzyme, S.pyogenes decreases the movement
of leukocytes into the site of infection.