STREPTOCOCCI
Definition: Gram +ve cocci
arranged in chains.
All Catalase test -ve #
[ staphylococci] .
All Oxidase negative #
[Neisseria]
STREPTOCOCCI
-hemolytic streptococci -hemolysis streptococci Non-hemolytic streptococci
Complete hemolysis of RBCs. Incomplete hemolysis of RBCs
(-hemolysis)
1- Str. pyogenes (grp A) 1- Str.viridans. Strep. faecalis (D)
Follicular tonsillitis. Normal oral flora ( subacute BE (SABE))
Scarlet fever. 2- Str. pneumoniae.
ABE (acute bacterial endocarditis) Pneumonia.
Rheumatic fever. 3- Strep. faecalis (D)
Post streptococcal glomerulonephritis.
Streptococcal TSS.
2- Strep. agalactiae (B)
flora in o genital tract→
Neonatal
sepsis & meningitis.
Pneumonia, endocarditis,
arthritis.
3- Strep. faecalis (D)
Gram positive cocci in chains
streptococci
Gram positive cocci in chains
streptococci
Gram positive lanceolated diplococci
(pneumococci)
Staphylococci streptococci pneumococci
Pigmented golden White colonies
yellow
α- hemolytic streptococci on BA
β- hemolytic streptococci on BA
β- hemolytic streptococci on BA
β- hemolytic streptococci on BA
β- hemolytic streptococci on BA
α- hemolytic streptococci on BA
Hemolytic staphylococci on BA
β- hemolytic streptococci on BA
Hemolytic staphylococci on BA
Catalase Oxidase
ve+ ve-
Differential Characteristics
Catalase
2H2O2 O2 + 2H2O
Streptococci vs. Staphylococci
Catalase POS
Staphylococcus
Catalase NEG
Differential
Characteristics
Optochin test-
bacitracin test
Optochin test
Heat resistance test+ve
strept faecalis
ASO titre
22
STREPTOCOCCI
-hemolytic streptococci -hemolysis streptococci Non-hemolytic streptococci
Complete hemolysis of RBCs. Incomplete hemolysis of RBCs
(-hemolysis)
1- Str. pyogenes (grp A) 1- Str.viridans. Strep. faecalis (D)
Follicular tonsillitis. Normal oral flora ( subacute BE (SABE))
Scarlet fever. 2- Str. pneumoniae.
ABE (acute bacterial endocarditis) Pneumonia.
Rheumatic fever. 3- Strep. faecalis (D)
Post streptococcal glomerulonephritis.
Streptococcal TSS.
2- Strep. agalactiae (B)
flora in o genital tract→
Neonatal
sepsis & meningitis.
Pneumonia, endocarditis,
arthritis.
3- Strep. faecalis (D)
2-Serology ( Lancefield ) grouping :
Antigenic composition of group specific cell wall carbohydrates and
biochemical reactions.
3- DNA –DNA hybridization
-Peptostreptococci (anaerobic)
Normal flora in gut &female genital tract.
Anaerobic infections in abdomen, pelvis, lung, brain.
-Strep. faecalis (D)---enterococcus
Pharyngitis and tonsillitis
25
Scarlet Fever
Caused by Erythrogenic
Toxin secreted by
S. pyogenes
C. Schultz-Charlton Reaction
Used for the diagnosis of scarlet fever.
27
Streptococcal skin infections
28
Antigenic structure
Beta-haemolytic streptococci can be divided into 20
different serologic groups according to C antigen and
certain groups can be subdivided into types according to M
and T protein-antigens:
1- Capsule
The hyaluronic acid of the capsule is non
antigenic presumably because of its similarity
to hyaluronic acid of the animal connective
tissue. So no anticapsular antibodies are
formed.
2- Cell wall
a- Group specific carbohydrate (C-Ag)
This antigen is contained in the cell wall of many streptococci and forms
the basis of serologic grouping known as Lancefield groups A-H and
K-U.
b- Proteins
Streptococcus pyogenes produces 3 surface protein antigens (M,T and
R) that are useful in serotyping. Of these three, M proteins is the
most important. It acts as a virulent factor by inhibiting phagocytosis
and is also immunogenic with the formation of anti M antibody after
infection which then enhances phagocytosis.
Toxins* & enzymes of -strept
1- Streptokinase
2-Streptodornase (Streptococcal DNAase)
It depolymerizes DNA. Mixture of streptodornase and
streptokinaese help to liquefy exudates and facilitate
removal of pus and necrotic tissue, antimicrobial
drugs thus gain better access and infected surface
recover more quickly.
3- Hyaluronidase (spreading factor)
It splits hyaluronic acid, an important component of
the ground substance of connective tissue. Thus,
hyaluronidase aids in spreading infecting micro
organisms.
4- Streptococcal pyrogenic exotoxin (SPE)
There are 3 antigenically distinct toxins: A, B
and C. Type A corresponds to the classic
erythrogenic toxin which is associated with the
rash in scarlet fever. Both types A and C are
encoded by bacteriophage gene during
lysogenic conversion, while type B is encoded
by chromosomal genes.
These 3 toxins are superantigens, in addition to
scarlet fever they have been associated with
streptococcal toxic shock syndrome and
necrotizing fasciitis.
Scarlet Fever
Caused by Erythrogenic
Toxin secreted by
S. pyogenes
Scarlet Fever
The erythrogenic
toxin is coded by a gene
lysogenic bacteriophage
within the genome of
S. pyogenes
Rash is an inflammatory reaction to
the toxin
5- Haemolysins
-haemolytic group A streptococci elaborate two
haemolysins (streptolysins).
(a) Streptolysin O (SLO)
It is inactivated in the presence of oxygen (oxygen
labile), it is antigenic and antibody to streptolysin O
develops after infection.
An antistreptolysin O (ASO) serum titre in excess of 160-
200 units is considered abnormally high and suggests
either recent infection with streptococci or persistently
high antibody levels due to an exaggerated immune
response to an earlier exposure in a hypersensitive
person. ASO titre helps in the diagnosis of
rheumatic fever.
Streptococcal tests
36
b) Streptolysin S (SLS)
it is not inactivated by oxygen (oxygen
stable), it is responsible for the haemolytic
zones around streptococcal colonies on
blood agar plate incubated aerobically. It is
not antigenic.
Group A Strep
Capsule -resistant
to phagocytosis
Enzymes damage
host cells
M protein adhesin
The M protein has many antigenic varieties
and thus, different strain of S.pyogenes
cause repeat infections
Character Pneumococci Viridans streptococci
Short or long chains of
Morphology Lanceolated diplococci.
rounded cocci
Capsule Present Usually absent
Optochin sensitivity Sensitive viRidans Resistant
Bile solubility +ve -
Inulin fermentation +ve -
+ve
Mice pathogenicity Intraperitoneal die in -
48 hour.
Infected
Middle
Ear
(otitis
media)
Bacterial Pneumonia
Bacterial, viral or fungal infection can cause
Inflammation of the lung with fluid filled
alveoli
42
The course of bacterial
pneumonia
43
View of ear anatomy indicating
route of infection
44
Bacterial Endocarditis
Figure 23.4
