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Streptococcus pyogenes
General properties
Local/Systemic invasion and poststreptococcal immunologic disorder
Penicillin-sensitive
Clinical infestations
Bacterial Pharyngitis & Tonsilitis
Necrotizing fasciitis
TSS
Post Streptococcal Sequelae
Most Serious: Rheumatic Fever)
Pyodermal infections
Impetigo
Superficial and localized skin infection
Most common pyoderm disease
Erysipelas
Fiery red, advancing erythema on face & lower neck
Puerperal fever
Septicemia originating in the infected wound following childbirth
Scarlet fever
Pharyngitis & diffuse rash (chest, toe, extremities)
- Post Streptococcal Sequelae: can lead to heart disease, acute glomerulonephritis, rheumatic heart fever
- Enteric fever: Salmonella typhi
Lab diagnosis
Taxo A/Bacitracin susceptible
ASO (Anti- streptolysin O)
Serologic test
Principle: Latex agglutination
(+) result: agglutination
Streptococcus agalactiae
Often isolated from:
Oral cavity
Intestinal tract
Vagina
Newborns
Significant cause of invasive disease in newborns
Virulence factors
Capsular material interferes with phagocytic activity and complement cascade action
Stain (Capsule): India ink
Clinical infestations
Vertical Transmission (mother-to-newborn)
Neonatal sepsis & meningitis
Lab diagnosis
CAMP (Christie, Atkins Munch-Peterson) test
(+) result: arrowhead hemolysis
Treatment:
Penicillin (DOC)
- S. aureus in CAMP: produce -lysin
Group C & G Strep
S. dysaglactiae subsp, Equisimilis
Large-colony forming β-hemolytic isolates
S. anginosus grp
Small colony forming β-hemolytic isolates
S. pneumoniae
Nonmotile
Encapsulated
Capnophilic
Fastidious cocci
Normal inhabitants of URT
Alpha-hemolytic, “crater-like” colony
G (+) diploccoci, Cat (-)
Lancet shaped
Common name: Pneumococcus
- G (-) diploccoci: Neisseria gonorrhea
Virulence factors
Polysaccharide capsule
Anti-phagocytic property
IgA protease
Inactivates IgA abs.
Autolysin
Release of intracellular virulence factor
Pneumolysin
Ability to lyse mammalian cell membrane
Clinical infestations
Bacterial pneumonia
aka primary lobar pneumonia
Community acquired pneumonia
Meningitis
Otitis Media (ear infection in children)
Bacteremia
- Reiter's disease: staph. aureus
- Taxo N: novobiocin
Lab diagnosis
Neufeld reaction/ Quellung test
(+) Quellung: capsular swelling
Taxo-P/ Optochin
Reagent: ethyl hydrocupreine hydrochloric acid
Media: BAP
Incubation:
o 35C
o 18-24 hrs
o 5% CO2
Susceptible: > 14 mm zone of inhibition
Bile solubility
Treatment:
Penicllin
Vancomycin
Vaccine:
PCV7
PCV13 (routine vaccination)
PS23 (23-valent vaccine)
- Disease of S. pneumoniae: primary lobar pneumonia
Enterococcus
Normal flora in GIT & oral cavity
Causes nosocomial infection due to multiple antibiotic resistance
Virulence factors
Adhesin
Serine protease Colonization of species and adherence
Gelatinase
- uncinariasis: Necator americanus
- oxyuriasis: Enterobius vermicularis
Associated disease
Nosocomial infection
UTI
Bacteremia
Endocarditis
Lab diagnosis
Growth in 40% bile & 6.5% salt
Trimethoprim/sulfamethoxazole
1.25 g
(+): All (except Grp A or B and C, F, G)
(-): Group A & B
Hippurate Hydrolysis
Test for ability to hydrolyze hippuric acid (Sodium hippurate) to benzoic acid & glycine
Glycine can be detected with Ninhydrin reagent
(+):deep blue (purple) – group B [S. agalactiae]
(-): colorless or very slight purple - group A [S. pyogenes]
PYR Test
Tests for the ability of the organism to hydrolyze the substrate L-pyrrolidonyl-B-napththylamide
(+): cherry red [S. pyogenes (group A) and Enterococcus]
(-): Group D Non-enterococcus
Lap test
Test for the ability to hydrolyze Leucine-β-napthylamide by enzyme leucine aminopeptidase to
β-napthylamide
Reagent: Cinnamaldehyde reagent
(+): Red Color (w/in 1 min); [S. pneumonia, S. pyogenes, Enterococcus, Pediococcus]
(-): No color change/ Slightly yellow color [Aerococcus, Leuconostoc]