Streptococci

 Facultativeanaerobes
 Fermentative
 Catalase negative
 Metabolically active
Classification
 Physiological development
 Hemolytic -10C nor 45 C ex. S.
pyogenes
 Viridans- 45C not in 10C ex. S. viridans
 Lactic- 10 C not 45 C ex lactic group
 Enterococci- both 10 C and 45C ex. S.
faecalis
 Peptostreptococci-obligate anaerobe
 Hemolytic activity
 Alpha
 beta
 gamma
 Serological classification
 A- s. pyogenes
 B- s. agalactiae
 C- s. faecalis
 D- s. pneumoniae
 E- s. viridans
 S. pyogenes
 Betahemolytic
 Non motile
 Non sporeformer
 Some with capsule
 Disease associated
 Sore throat- pharyngitis, tonsilitis
 Skin infecion- pyoderma, impetigo,
cellulitis
 Scarlet fever
 Puerperal sepsis
 ARF
 AGN
 Pathogenic determinants
 M- protein
 Presipitate
fibrinogen
 Clump platelets and WBC

 Toxin
 Hemolysin- streptolysin O
 Erythrogenic toxin/pyrogenic toxin
 Enzymes
 Nucleases
 Streptokinase-digest fibrin and other protein
 Hyaluronidase- splits hyaluronic acid
 Diphosphopyridine nucleotidase- kills WBC
 β -hemolytic S. pyogenes
12

 Most serious streptococcal pathogen

 Strict parasite
 Inhabits throat, nasopharynx,
occasionally skin
 Virulence Factors of β -hemolytic
13
S. pyogenes

Produces surface antigens:

C-carbohydrates – protect against lysozyme
Fimbriae - adherence
M-protein – contributes to resistance to
phagocytosis
Hyaluronic acid capsule – provokes no immune
response
 Virulence Factors of β -hemolytic
14
S. pyogenes
Extracellular toxins:
streptolysins – hemolysins; streptolysin O (SLO) and
streptolysin S (SLS) – both cause cell and tissue injury
pyogenic toxin (erythrogenic) – induces fever and typical
red rash
superantigens – strong monocyte and lymphocyte
stimulants; cause the release of tissue necrotic factor
 Virulence Factors of β -hemolytic
15 S. pyogenes
Extracellular enzymes
streptokinase – digests fibrin clots
hyaluronidase – breaks down
connective tissue
DNase – hydrolyzes DNA
 Epidemiology and
16
Pathogenesis
 Humans only reservoir
 Inapparent carriers
 Transmission – contact, droplets, food, fomites
 Portal of entry generally skin or pharynx
 Children predominant group affected for cutaneous and
throat infections
 Systemic infections and progressive sequelae possible if
untreated
Strep pyogenes
s. pyogenes
 Scope of Clinical Disease
19
Skin infections
 Impetigo (pyoderma) – superficial lesions that
break and form highly contagious crust; often
occurs in epidemics in school children; also
associated with insect bites, poor hygiene, and
crowded living conditions
 Erysipelas – pathogen enters through a break in
the skin and eventually spreads to the dermis and
subcutaneous tissues; can remain superficial or
become systemic
Throat infections
 Streptococcal pharyngitis – strep throat
20
Impetigo
Impetigo
23
 Scope of Clinical Disease
24

Systemic infections
 Scarlet fever – strain of S. pyogenes
carrying a prophage that codes for
pyrogenic toxin; can lead to sequelae
 Septicemia
 Pneumonia
 Streptococcal toxic shock syndrome
Scarlet fever
 Long-Term Complications of Group A
26
Infections
 Rheumatic fever – follows overt or
subclinical pharyngitis in children; carditis
with extensive valve damage possible,
arthritis, chorea, fever
 Acute glomerulonephritis – nephritis,
increased blood pressure, occasionally
heart failure; can become chronic leading to
kidney failure
 Cellulitis
 Diffuse inflammation
and infection of
superficial skin layers
 Localized, mildly
painful, swelling with
poorly demarcated
margins
 Cellulitis caused
primarily by
Streptococcus
pyogenes; roughly 10%
caused by S. aureus
 Necrotizing fasciitis
 Streptococcus pyogenes
 (flesh-eating bacterium)
 Pyogenic exotoxin– super Ag
 activates blood clot dissolving protein-plasminogen
(human specific)
 Streptococcal toxic shock-like
syndrome (STSS)
 Skinor wound
infection develop into
blood stream
infection, produce
pyogenic exotoxin
which cause fever,
rash and shock
(death rate 30%)
 Streptococcus agalactiae
 Betahemolytic organism
 Neonatal septicemia
 Congenital pneumonia
 Pathogenesis
 Invasion of grp A B-hemolytic Streptococcus
 Erysipelas
 Puerperal sepsis
 Sepsis: from post-surgical wounds
 Exudative tonsillopharyngitis: may cause Ag-Ab reaction resulting in
RHD
 Impetigo: may cause immunologic reaction resulting in acute
glomerulonephritis
  Periodontal infections caused by grp D Streptococcus: can
cause immunologic reactions leading to subacute bacterial
endocarditis (SBE)
 Diagnosis
 Gram stain
 C&S
 Serological tests
 Management
 Penicillin
 Erythromycin
 Streptococcus viridans
 Mouth
 URTI
 Gingival crevices
 Gastrointestinal
 Genital tract
Strep. viridans
 Other streptococci
 S. sanguis
 S. mutans
 S. Mitis
 S. milleri
 S. intermedius
 S. sanginosus
 Streptococcus pneumoniae
 Inpair or short chain
 Encapsulated
 Lancet shaped
 Acute bacterial pneumonia
 middle ear infection, sinusitis meningitis,
mastoiditis
 Pathogenic determinants
 Polyssacharide capsule
 Pneumolysin O – hemolytic activity
 Neuramidase- invasiveness of organism
s. pneumoniae
 Pnemoniae/ viridans
 Bilesolubility test
 Optochin test
 quellung test
 inulin fermentation
 Animal inoculation test