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Streptococci (Gram
positive cocci)
Lecture 45
Faculty: Dr. Alvin Fox
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Key Words
Lancefield groups
Hemolysis (alpha, beta, gamma)
Group A streptococcus (S. pyogenes)
- Bacitracin susceptibility test
- M, T, R proteins
- Streptolysins O and S
- F protein/lipoteichoic acid
- Rheumatic fever/carditis/arthritis
- Glomerulonephritis
- Scarlet fever
- Toxic shock-like syndrome
- Bacteremia
- Flesh-eating bacteria
- Pyrogenic toxin
- Erythrogenic toxin
Group B streptococcus (S.agalactiae)
- Neonatal septicemia/meningitis
- CAMP test
- Hippurate hydrolysis test
Group D streptococcus
- Urinary tract infection
- Endocarditis
- Bile-esculin test
- Enterococci
- Non-enterococci
Large colony
Minute colony
Viridans streptococci
Dental caries/endocarditis
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Streptococci
facultative anaerobe
Gram-positive
usually chains (sometimes pairs)
catalase negative
(staphylococci are catalase positive)

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Streptococcus in chains (Gram stain)
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Streptococcus pneumoniae (diplococcus). Fluorescent stain
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Identification : Lancefield groups
- carbohydrate antigens


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groupable streptococci
A, B and D
frequent
C, G, F
less frequent

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Non-groupable
S. pneumoniae
pneumonia

viridans streptococci
e.g. S. mutans
*dental caries
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hemolysis reaction - sheep blood agar
(alpha)
partial hemolysis
green color
(beta)
complete clearing

(gamma)
- no lysis
White colonies
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Hemolysis
Groups A an B

Group D
or
S. pneumoniae and viridans


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Identification:
hemolysis reaction
+one biochemical characteristic

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Group A streptococcus (S. pyogenes)
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Group A streptococcal infections affect all ages
peak incidence at 5-15 years of age

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S. pyogenes -suppurative
non-invasive
pharyngitis
skin infection, impetigo

invasive bacteremia
toxic shock-like syndrome
"flesh eating" bacteria
pyrogenic toxin
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Pyrogenic toxin
Superantigen
Non-specific activation of T cells
Cross-link antigen presenting
cells (MHC) and T cell receptor
Cytokine production

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Scarlet fever
rash
erythrogenic toxin
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non-suppurative
rheumatic fever
inflammatory disease
life threatening
chronic sequalae
fever
heart
joints
rheumatic NOT rheumatoid arthritis



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Rheumatic fever -etiology
M protein
cross-reacts heart myosin
autoimmunity

Cell wall antigens
poorly digested in vivo
persist indefinitely



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Rheumatic fever
penicillin
- terminates pharyngitis
- decreases carditis


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Acute glomerulonephritis
immune complex disease of kidney
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Major pathogenesis factors
lipoteichoic acid/F protein
fimbriae
binds to epithelial cells

M protein
anti-phagocytic


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S. pyogenes
fibronectin
lipoteichoic acid
F-protein
epithelial cells
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M protein
M protein
fibrinogen
r r
r
peptidoglycan
r r
r
IgG
Complement
IMMUNE
NON-IMMUNE
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M protein
major target
natural immunity
strain variation
antigenicity
re-infection
occurs with different strain



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Capsules
Anti-phagocytic
mucoid strains
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Isolation and identification
hemolytic colonies
bacitracin inhibits growth

hemolytic colonies
group A antigen

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hemolysis
hemolysin O
sensitive oxygen
hemolysin S
insensitive oxygen

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Modern Rapid Strep Test
Throat swab extract
(+/- streptococcal antigen)
Antibody
Liposome
+
-
Streptococcal antigen
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Post-infectious diagnosis
(serology)
antibodies to streptolysin O
important if delayed clinical
sequelae occur
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Traditional serotyping of
proteins:
- M
- T
- R
Typing
Current:
- Sequencing of M protein gene
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Group B streptococcus
neonatal meningitis
septicemia
transmission
vaginal flora
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Group B streptococcus
- identification
hemolysis
hippurate hydrolysis
CAMP reaction
increases hemolysis of S. aureus
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Group D streptococcus
Growth on bile esculin agar
black precipitate

6.5% saline
grow
enterococci
no growth
non-enterococci
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Enterococci
distantly related to other streptococci
genus Enterococcus
gut flora
urinary tract infection
fecal contamination
opportunistic infections
particularly endocarditis
most common E. (S.) faecalis
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Enterococci
resistant to many antibiotics
including vancomycin
terminal D-ala replaced by D-lactate

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Minute colony streptococci
Various groups/hemolysis (e.g. group A)
genetically distinct
from large colony (e.g. S. pyogenes)
no rheumatic fever
Large colony
Minute colony
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Viridans streptococci
diverse species
oral
dental caries
hemolytic and negative for other tests
non-groupable.
includes S. mutans
occassional endocarditis after tooth extraction