NOTES
NOTES
STREPTOCOCCUS
MICROBE OVERVIEW
Morphology ▪ Produce extracellular substances
▪ Spherical, Gram-positive bacteria; appear in (e.g. cytolysins, enzymes) → enhance
chains/pairs; catalase, coagulase negative pathogenicity
STREPTOCOCCUS AGALACTIAE
(GROUP B STREP)
osms.it/streptococcus-agalactiae
▪ Direct cytotoxicity to host phagocytes
PATHOLOGY & CAUSES
Common infectious agent
▪ AKA Group B Streptococcus (GBS) ▪ Adults (nonpregnant)
▪ Encapsulated, facultative anaerobe ▫ Broad spectrum of infections
▪ Colonizes human genital, gastrointestinal ▪ Pregnant individuals
(GI) tracts; upper respiratory tracts of young ▫ Chorioamnionitis
infants
▪ Neonates
▪ Beta-hemolytic
▫ GBS infection, sepsis
▫ Blood agar plates, hemolysins degrade
lipid membranes → colonies surrounded
by narrow zone of hemolyzed cells → RISK FACTORS
complete (beta-)hemolysis ▪ Adults (nonpregnant)
▫ Chronic disease (e.g. diabetes, liver
Virulence factors disease, malignancy; > age 65, esp.
▪ Complex capsular polysaccharides residents of nursing homes)
▫ Inhibit complement deposition on ▪ Pregnancy
microbe surface components ▪ Neonates
▪ Hypervirulent GBS adhesin (HvgA) ▫ Ascending infection from mother (e.g.
▫ ↑ ability to invade blood-brain barrier rupture of membranes, chorioamnionitis)
▪ Cluster of virulence responder/sensor ▪ Hospitalization
(CovR/S) mutation ▫ Nosocomial/hospital-acquired infections
▫ Accelerate failure of amniotic barrier
→ ↑ ability to penetrate chorioamniotic
membranes
▪ Pilins
▫ Act as adhesins → ↑ ability to invade
central nervous system, form biofilm
552 OSMOSIS.ORG
Chapter 99 Streptococcus
COMPLICATIONS ▪ Hippurate hydrolysis test
▪ Cystitis, pyelonephritis, urethritis, ▫ Detections hippurate hydrolysis by GBS
prostatitis; osteomyelitis, septic arthritis;
endocarditis; meningitis; pneumonia; sepsis;
toxic shock-like syndrome
OTHER DIAGNOSTICS
▪ Clinical history, physical examination
▪ Neonates
▫ Preterm birth, bacteremia, sepsis,
pneumonia, meningitis, neonatal TREATMENT
mortality
MEDICATIONS
SIGNS & SYMPTOMS ▪ Antibiotics (e.g. penicillin G, ampicillin)
▪ Fever, chills; malaise; cough OTHER INTERVENTIONS
▪ Local tissue infection ▪ Prenatal screening
▫ Red, warm, swollen, presence of
drainage
DIAGNOSIS
LAB RESULTS
Identification of microbe
▪ E.g. blood, cerebrospinal fluid
▪ Gram stain, characteristic morphology
▪ Culture
▫ Beta-hemolysis on blood agar
Figure 99.1 The three classes of
▪ CAMP test streptococcus cultured on a blood agar plate.
▫ Identifies presence of CAMP factor Alpha (left) shows partial hemolysis, beta
▪ Latex agglutination tests (centre) shows complete hemolysis and
▫ Detects antibodies produced in gamma (right) shows no hemolysis.
response to GBS
STREPTOCOCCUS PNEUMONIAE
osms.it/streptococcus-pneumoniae
▪ Virulence factors
PATHOLOGY & CAUSES ▫ Resistance to phagocytosis (conferred
by 92 polysaccharide serotypes)
▪ Causative agent for numerous clinical
▫ Adherence proteins
syndromes in children, older adults
▫ Biofilm formation
▪ Alpha-hemolytic, lancet-shaped diplococci
▫ Pneumolysin toxin
▪ Lysis by bile (deoxycholate), optochin
sensitive ▪ Asymptomatic colonization → direct spread
from site of colonization,hematogenous
▪ Fastidious; prefers 5% carbon dioxide
spread → clinical syndromes
▪ Pyogenic
OSMOSIS.ORG 553
▪ Typical infections caused by S. pneumoniae
range from mucosal to invasive diseases DIAGNOSIS
▫ Meningitis
DIAGNOSTIC IMAGING
▫ Otitis media
▫ Pneumococcal community-acquired Chest X-ray
pneumonia ▪ Infiltration, consolidation (pneumonia)
▫ Sinusitis
LAB RESULTS
RISK FACTORS
Identification of organism
▪ Age (< 2, ≥ 65 years)
▪ Gram-positive diplococci, positive culture,
▪ Underlying disease (e.g. liver, kidney, heart,
polymerase chain reaction (PCR)
lung, diabetes, malignancies)
▪ Urine antigen analysis (bacteremia)
▪ Crowded conditions (e.g. daycare centers,
military camps, prisons)
▪ Immunodeficiency (e.g. HIV, genetic OTHER DIAGNOSTICS
immune defects, solid organ/bone ▪ Clinical history, physical examination
transplant)
▪ Smoking, alcohol abuse
TREATMENT
COMPLICATIONS MEDICATIONS
▪ Pneumococcal endocarditis, empyema, ▪ Antibiotics
bacteremia, sepsis
▫ Pneumonia: beta-lactam antibiotic
▫ Otitis media: amoxicillin-clavulanate
SIGNS & SYMPTOMS (children)
▫ Sinusitis: amoxicillin (amoxicillin–
▪ Common clinical presentation clavulanic acid may be preferable)
▫ Fever, altered mental status, malaise
▪ Typical findings related to clinical syndrome OTHER INTERVENTIONS
▫ Meningitis: headache, neck stiffness
Prevention
▫ Otitis media: ↓ tympanic membrane
▪ Pneumococcal vaccine
mobility/bulging membrane, otorrhea,
pain
▫ Pneumonia: cough, bronchial breath
sounds, rales
▫ Sinusitis: purulent rhinitis, mucous
membrane edema, headache
554 OSMOSIS.ORG
Chapter 99 Streptococcus
STREPTOCOCCUS PYOGENES
(GROUP A STREP)
osms.it/streptococcus-pyogenes
▪ Pyrogenic exotoxins (type A, B, C)
PATHOLOGY & CAUSES ▫ Induce fever, act as superantigens
→ T-cell proliferation → ↑ cytokine
▪ AKA Group A Streptococcus (GAS) production → promotes shock
▪ Colonizes human skin, mucous membranes ▪ Streptococcal inhibitor of complement (SIC)
▪ Cell-wall structure ▫ Inactivates complement membrane
▫ Peptidoglycan backbone + lipoteichoic attack complex
acid components → structural stability ▪ Opacity factor (OF)
▪ Beta-hemolytic ▫ Lipoprotein lipase
▫ Blood agar plates, hemolysins degrade
lipid membranes → colonies surrounded Causative agent in several disorders
by clear zone of hemolyzed cells → ▪ Pyogenic diseases
complete (beta-) hemolysis ▫ Pharyngitis, cellulitis (abscess formation
▪ Primarily infects skin, soft tissue in dermis, subcutaneous fat layers),
necrotizing fasciitis (progressive
Virulence factors destruction of deep soft tissue),
▪ Vary with specific strain impetigo
▪ M proteins ▪ Toxigenic disease
▫ Protect microbe from humoral ▫ Scarlet fever, toxic shock syndrome,
immune surveillance, phagocytosis by GAS endometritis (puerperal sepsis)
polymorphonuclear leukocytes ▪ Immunologic disease
▪ Binding proteins ▫ Rheumatic fever (antibodies against
▫ Bind to IgG, IgM, IgA → may interfere streptococcal cell cross-react with
with complement activation cardiac tissue); poststreptococcal
▫ Protein F: binds to fibronectin → ↑ glomerulonephritis (immune complexes
adherence to epithelial surfaces deposited in glomeruli)
▪ Cytolysins
▫ Streptolysins: bind to cholesterol on RISK FACTORS
eukaryotic cell membranes → cell lysis ▪ Susceptible host + encounter with
▫ Hyaluronidase: hydrolyzes hyaluronic streptococcus expressing specific virulence
acid → facilitates infection spread factors
▫ Streptokinase: proteolytically converts
bound plasminogen to active plasmin
→ cleavage of fibrin; medically useful as
COMPLICATIONS
clot-busting drug ▪ Local spread (e.g. otitis media, sinusitis,
mastoiditis); tissue destruction; valvular,
▫ Nicotinamide adenine dinucleotidase
renal disease; sepsis, shock, multiorgan
(NADase): exact function unclear; likely
failure; disseminated intravascular
↑ invasiveness
coagulation; pediatric autoimmune
▫ Deoxyribonuclease: promotes neuropsychiatric disorder associated with
production of anti-deoxyribonuclease group A streptococci (PANDAS)
(DNase) antibody following pharyngeal/
skin infections
OSMOSIS.ORG 555
SIGNS & SYMPTOMS DIAGNOSIS
▪ Pharyngitis LAB RESULTS
▫ Acute onset of sore throat, fever,
Identification of microbe
pharyngeal edema, patchy tonsillar
exudates ▪ Gram positive cocci
▪ Cellulitis ▪ Positive culture
▫ Erythema, edema, abscess formation ▪ Blood studies
▪ Impetigo ▫ Rapid antigen detection test (RADT) for
GAS
▫ Papules, vesicles, pustules surrounded
by erythema pustules → breaks down,
forms crusts OTHER DIAGNOSTICS
▪ Scarlet fever ▪ Clinical history, physical examination
▫ Erythematous rash
▪ Toxic shock syndrome
▫ Shock, multiorgan failure
TREATMENT
▪ GAS endometritis MEDICATIONS
▫ Postpartum fever, uterine tenderness ▪ Antibiotics (e.g. penicillin G, clindamycin)
SURGERY
▪ Surgical debridement
STREPTOCOCCUS VIRIDANS
osms.it/streptococcus-viridans
infections (e.g. abdominal, central
PATHOLOGY & CAUSES nervous system, lung, skin, soft tissue,
sepsis)
▪ Heterogeneous collection of alpha/ ▫ Abscess formation
nonhemolytic streptococci, cause variety of
▫ Viridans streptococcal shock syndrome
diseases
▪ Some species produce greenish color on
blood agar plates RISK FACTORS
▪ Not bile soluble, optochin resistant ▪ Immunocompromised state
▪ Approx. 30 species classified into six ▪ Periodontal disease
groups ▪ More common in children than adults
▪ Part of microbiome of oropharynx, GI, ▪ Comorbidities (e.g. mucositis, cystic fibrosis,
genitourinary tract malignancies)
▪ May be invasive, produce variety of ▪ Altered microbiome
diseases
▫ Dental caries, periodontal disease,
maxillofacial infections, exudative SIGNS & SYMPTOMS
pharyngitis, infective endocarditis
▫ Invades circulation → systemic ▪ Clinical presentation varies widely
depending on infection
556 OSMOSIS.ORG
Chapter 99 Streptococcus
DIAGNOSIS
LAB RESULTS
Identification of organism
▪ Gram-positive cocci, positive culture
OTHER DIAGNOSTICS
▪ Clinical history, physical examination
TREATMENT
MEDICATIONS
▪ Antibiotics (depending on sensitivity,
resistance)
▫ Penicillin + aminoglycoside; broad-
spectrum cephalosporin, vancomycin
SURGERY
▪ Abscess debridement/drainage
OSMOSIS.ORG 557
