Microbiology

Third stage
Streptococci spp.

By Dr. Shatha Mohammed Ali

 Gram positive cocci ‫اﻟﻛرام ﺑوزﺗف ﻛوﻛﺎي‬

‫اﻟﺟﻧس ﻣﺎﻟﺗﮭﺎ ﻣن اﻟﺳﺗرﺑﺗوﻛوﻛس ﻋﻘدﯾﺔ‬

 Genus: Streptococcus
 General characteristics ‫ﺗظﮭر ﺑﺷﻛل ﺳﻠﺳﻠﺔ او ازواج‬ ‫ﻣﻌظم اﻧواﻋﮭﺎ ﺗﻛون اﻧﯾروﺑك ﻻھواﺋﯾﺔ اﻻﺧﺗﯾﺎرﯾﺔ‬
 Gram positive cocci that appear in chains or pairs ‫ﺑﺳﺗﺛﻧﺎء ﻣﺟﻣوﻋﺔ واﺣدة ﺗﻌﯾش ﻓﻲ اﻻﻣﻌﺎء و اﻟﺟﮭﺎز‬
‫اﻟﺗﻧﺎﺳﻠﻲ ﻟﻠﻔﯾﻣﯾل‬
 Most species are facultative anaerobes except one group "strict anaerobes" which inhabits the
intestinal tract and female genital tract.
 They are normal flora of humans and animals, They inhabit various sites, such as upper
‫ﻛل اﻟﺳﺗرﺑﺗوﻛوﻛﺎي‬ respiratory tract, and live harmlessly as commensals. ‫ﺗﻌﺗﺑر ﻧورﻣﺎل ﻓﻠورا ﻟﻼﻧﺳﺎن و اﻟﺣﯾوان ﺗﻛون ﻓﻲ‬
‫ﺗﻛون ﻧﻛﺗف ﻟﻠﻛﺎﺗﻼز‬ ‫ﻣواﻗﻊ ﻣﺧﺗﻠﻔﺔ ﻣﺛﻼ اﻻﺑر رﯾﺳﺑﺎﯾرﺗري ﺗراك و ﺗﻌﯾش‬
 All streptococci are catalase negative.
‫اﻟﻲ ھو اﻧزم ﻣﻧﺗﺷر‬ ‫ﺳﺎﻟﻣﺔ ﺗﺳوي اي اذى‬
‫ ﻓﻲ اﻟﻛﺎﺋن اﻟﺣﻲ‬ They are fastidious requiring many amino acids, vitamins, purine and pyrimidine bases.
‫ﺗﻛون ﺷدﯾدة اﻟﺣﺳﺎﺳﯾﺔ وﺗﺗطﻠب اﻟﻌدﯾد ﻣن اﻷﺣﻣﺎض‬
 Primary habitat of upper respiratory tract of human. ‫اﻷﻣﯾﻧﯾﺔ واﻟﻔﯾﺗﺎﻣﯾﻧﺎت وﻗواﻋد اﻟﺑﯾورﯾن واﻟﺑﯾرﯾﻣﯾدﯾن‬
 Non motile, Non spore forming bacteria.
‫ﻣوطﻧﮭﺎ اﻻﺳﺎﺳﻲ ﻓﻲ اﻻﺑر ﺗراك‬ ‫ﺗﻛون ﻋﺑﺎرة ﻋن ﺑﻛﺗﯾرﯾﺎ ﻏﯾر ﺗﺣرﻛﺔ و ﺗﺳوي ﺳﺑورات‬
‫ﻣﺎﻟت اﻟرﯾﺳﺑﺎﯾرﺗري ﻓﻲ اﻻﻧﺳﺎن‬
 ‫‪Classification‬‬
‫ﺑﺎﻻﻋﺗﻣﺎد ع اﻟﮭﯾﻣواﯾﺗك ﻓﻲ اﻟﺑﻠد اﻛﺎر ﺣﻧﺻﻧﻔﮭﺎ اﻟﻰ ‪ 3‬اﻧواع‬
‫‪ Depending on haemolytic behavior on blood agar:‬‬

‫‪ A-Alpha haemolytic / incomplete haemolysis, partial haemolysis,‬‬

‫اﻻﻟﻔﺎ ھﯾوﻻﯾﺗك اﻧﺣﻼل اﻟدم اﻟﻐﯾر ﻛﺎﻣل او ﻧﻛول ﻋﻠﯾﺔ اﻟﺑﺎرﺷﯾﺎل ﺟزي‬
‫ﻣﺛﻼ اﻟﺳﺗرﺑﺗوﻛوﻛﺎي ﻧوﻣوﻧﯾﺎ ‪eg; S. pneumoniae‬‬

‫‪ B- Beta haemolytic / complete haemolysis, clear zone around the‬‬

‫اﻟﺑﯾﺗﺎ ھﯾﻣوﻻﯾﺗك ﻧﺣﻼل اﻟدم اﻟﻛﺎﻣل ﯾﺳوﯾﻠﻲ ﻛﻠﯾر زون‬
‫‪colonies on Blood Agar, S. pyogenes‬‬ ‫ﺣول اﻟﻛوﻟﯾﻧﯾز ﻓﻲ اﻟﺑﻠد اﻛﺎر ﻣﺛﻼ اﻟﺳﺗرﺑﺗوﻛوﻛﺎي‬
‫ﺑﺎﯾوﺟﯾﻧز‬
‫‪ C- Gamma haemolytic / no haemolysis; no haemolysis/ no change in‬‬
‫‪RBC’s‬‬ ‫اﻟﻛﺎﻣﺎ ھﯾﻣوﻻﯾﺗك ھﻧﺎ ﻣﺎﻛو اي اﻧﺣﻼل وﻻ ﯾﺻﯾر اي ﺗﻐﯾر ع اﻟﻛرﯾﺎت اﻟدم اﻟﺣﻣراء ﻓﻲ‬
‫اﻟﺑﻠد اﻛﺎر‬
‫ھﻧﺎ ھﺎي اﻻﻣﺛﻠﺔ ﻋﻠﯾﮭﺎ و ﺑﺎﻋوا اﻟﺑﻠد اﻛﺎر ﺷون ﺑﻛل ﺣﺎﻟﺔ اﻟﺗﺣﻠل اﻟﻲ ﺻﺎﯾر‬
‫ﻟﻠدم ﺑﻲ ﺷﻠون‬
 ‫‪Group A streptococci (Streptococcus‬‬
‫ھﺳﺔ ﻧﺎﺧذ اول ﻛروب اﻟﺳﺗرﺑﺗوﻛوﻛس ﺑﺎﯾوﺟﯾن )‪pyogenes‬‬
‫اﻟﻣﺎرﻓوﻟﺟﻲ اﻟﺗﮭﺎ ﺷﻛﻠﮭﺎ ﺗﻛون ﻋﺑﺎرة ﻋن ﻣﻛورات ﻓردﯾﺔ ﺑﯾﺿوﯾﺔ او داﺋرﯾﺔ ﻏﯾر ﺗﺣرﻛﺔ و ﻏﯾر ;‪ MORPHOLOGY‬‬
‫ﻣﺑوﻏﺔ ﻣﺗﺳوي اﺑواغ ﺳﺑورات‬
‫‪ Individual cocci are spherical or oval, Non-motile & non sporing.‬‬
‫ﻣﻣﯾزات اﻟﻛﺎﻟﺟر اﻟوﺳط اﻟزرﻋﻲ ﯾﻌﻧﻲ‬
‫‪ CULTURAL CHARACTERISTICS‬‬ ‫ﺗﻛون اﯾرﺑوز ھواﯾﺋﺔ و ھم اﻧﯾروﺑز ﻓﺎﺳﯾﻠﯾﺗﯾﺗف ﻻھواﺋﯾﺔ اﺧﺗﯾﺎرﯾﺔ‬
‫اﻓﺿل ﻧﻣو اﻟﮭﺎ ﻓﻲ ‪ 37‬ﺳﻠﯾز ﺑس ھﻲ ﺗﻧﻣو ﻣن ‪ 22‬اﻟﻰ ‪47‬‬
‫‪ Aerobes as well as facultative anaerobes, Grown best at 37°C ( 22-42°C ).‬‬

‫‪ Grows in media rich in fermentable carbohydrates or enriched media with blood or serum.‬‬
‫ﺗظﮭر ﺑﺷﻛل ﺑﯾﺗﺎ ھﯾﻣوﻻﯾﺗك ﯾﻌﻧﻲ ﺗﺣﻠل ﻛﺎﻣل ﻓﻲ اﻟﺑﻠد اﻛﺎر‬ ‫ﺗﻧﻣو ﻓﻲ اﻻوﺳﺎط اﻟﻐﻧﯾﺔ ﺑﺎﻟﻛﺎرﺑوھﯾدرات اﻟﻣﺧﻣرة او اﻟوﺳﺎﺋط‬
‫‪ Shows beta hemolysis on blood agar.‬‬ ‫اﻟﻐﻧﯾﺔ ﻓﻲ اﻟدم و اﻟﺳﯾرم‬
‫‪ Some strains with capsule form mucoid colonies‬‬
‫ﺑﻌض اﻟﺳﻼﻻت اﻟﻲ ﺗﺣﺗوي ع ﻛﺑﺳول ﺗﺷﻛل ﻣﺳﺗﻌﻣرات ﻣﺧﺎطﯾﺔ‬
 ‫اﻟﺳﺗرﻛﺟر ﻣﺎﻟت اﻻﻧﺗﺟﯾن اﻟﻣﺳﺗﺿد‬

‫‪Antigenic structure‬‬
‫ﻋﺑﺎرة ﻋن ﻛﺎﺑﺳول و ﺟدار ﺧﻠﯾﺔ ﺑروﺗﯾﻧﻲ‬ ‫ﺑروﺗﯾن ﺗﻲ اﻟﻣﻘﺎوم ﻟﻠﺗرﺑﺳﯾن ﯾﻛون‬
‫‪ 1- Capsule.‬‬ ‫ﻣﻘﺎوم ﻟﻠﺣرارة و اﻟﺣﻣوﺿﺔ ﻟﻛﻧﺔ ﻣﻘﺎوم‬
‫‪ 2- Cell wall proteins:‬‬ ‫ﺑروﺗﯾن ام ﯾﻌﺗﺑر ﻛﻌﺎﻣل ﺧطورة ﻋن طرﯾق‬ ‫ﻟﻠﺗرﺑﺳﯾن اﻟﻲ ﯾﻛون ﻣوﺟود ﻓﻲ ﻣﻌظم‬
‫ﺗﺛﺑط اﻟﻔﺎﻛوﺳﺎﯾﺗوﺳﯾز اﻟﺑﻠﻌﻣﺔ‬ ‫اﻟﺳﺗرﺑﺗوﻛوﻛس ﺑﺎﯾوﺟﯾﻧز‬
‫‪ a) M protein: It acts as virulence factor by inhibiting phagocytosis.‬‬
‫‪ b) T protein: T (Trypsin-resistant) protein is heat and acid-liable but resistant to‬‬
‫‪trypsin present in many serotypes of S. pyogenes.‬‬
‫‪ c) Cell surface proteins: R protein, F protein (fibronectin binding), G protein binds‬‬
‫اﻟﺑﻠﻲ اﻟﻔﻣﺑرﯾﺎ ﻣﺛل اﻟﺷﻌر و‬ ‫‪the Fc portion of antibodies.‬‬
‫‪  3- Pili ( Fimbriae) :Hair like and project from capsule, Important in the attachment‬ﯾﻛون ﻧﺎزل ﻣن اﻟﻛﺑﺳول ﻣﮫ‬
‫ﻟﻼﻟﺗﺻﺎق اﻟﺳﺗرﺑﺗوﻛوﻛﺎي ﻓﻲ‬
‫اﻻﯾﺑﯾﺛﯾﻠﯾوم ﺳﯾل‬
‫‪of streptococci to epithelial cells.‬‬ ‫اﻟﺑروﺗﯾﺎت اﻟﻲ ﺗﻛون ع اﻟﺳﯾرﻓس ﻣﺎﻟت‬
‫ﺟدار اﻟﺧﻠﯾﺔ اﻟﻲ ھو ﻋﺑﺎرة ﻋن ﺑﺑﺗﺎﯾدوﻛﻼﯾﻛﺎن ‪ 4-Cell wall peptidoglycan‬‬ ‫اﻟﺧﻠﯾﺔ اﻻر ﺑروﺗﯾن و اﻻف ﺑروﺗﯾن‬
‫ﻋﺑﺎرة ﻋن اﻟﻔﺎﯾﺑروﺗﯾﻧك ﺑﺎﻧدﻧك و اﻟﺟﻲ‬
‫‪ 5-Cytoplasmic membrane antigens.‬‬ ‫ﺑروﺗﯾن ﯾرﺗﺑط ع اﻻف ﺳﻲ ﺑروﺗﯾن ﻓﻲ‬
‫اﻻﻧﺗﺟﯾن اﻟﻲ ﺑﺎﺳﺎﯾﺗوﺑﻼزﻣك ﻣﻣﺑرﯾن‬ ‫اﻻﺟﺳﺎم اﻟﻣﺿﺎدة‬
 ‫ﻣﻧﺗﺟﺎت اﻟﺧﺎرج اﻟﺧﻠوﯾﺔ ﻟﻠﺳﺗرﺑﺗوﻛوﻛﺎي‬
Extracellular streptococcal products
‫اﻟﺳﻣو اﻟﺧﺎرﺟﯾﺔ اﻟﺑﯾروﺟﯾن اﻟﻲ ﻣﻌروﻓﺔ ﺑﺎﻟﺳﻣوم اﻟﺣﻣرﯾﺔ‬
 1- Pyrogenic exotoxin (formerly known as Erythrogenic toxin):
 2- Cardiohepatic toxin and nephrotoxin. ‫ﺳﻣوم اﻟﻘﻠﺑﯾﺔ اﻟﻛﺑدﯾﺔ و ھم ﺳﻣوم اﻟﻛﻠوﯾﺔ‬
 3- Haemolysins: the haemolytic activity is due to the production of two distinct
extracellular haemolysins called streptolysin O (SLO called this name because is
oxygen liable toxin) and streptolysin S (SLS called by this name because is oxygen
stable toxin). ‫اﻟﮭﯾﻣوﻻﯾﺳﯾﻧز اﻟﻧﺷﺎط اﻻﻧﺣﻼﻟﻲ ﻧﺎﺗﺞ ﻋن اﻧﺗﺎج ﻧوﻋﯾن ﻣﻣﯾزﯾن ﻣن اﻟﮭﯾﻣوﻻﯾﺳﯾز ﺧﺎرج‬
‫ﻋواﻣل اﻻﻧﺗﺷﺎر‬
 4- Spreading factors: ‫اﻟﺧﻠﯾﺔ ﺗدﻋﻰ اﻟﺳﺗرﺑﺗوﻻﯾﺳﯾن او ﯾﺳﻣﻰ ھﯾﺞ ﻻن ﺑﺳﺑب اﻻوﻛﺳﺟﯾن ﻣﺳؤول ﻋن اﻟﺳم و‬
‫اﻟﮭﺎﯾرودﯾز‬ ‫اﻟﺳﺗرﺑﺗوﻻﯾﺳﯾن اس ﯾﺳﻣﻰ ھﯾﺞ ﺑﺳﺑب اﻻوﻛﺳﺟﯾن ﯾﻛون ﺳم ﻣﺳﺗﻘر‬
 a. Hyaluronidase:
 b. Protease ‫اﻟﺑروﺗﺎﯾز‬
 c. Nucleases(Causes depolymerization of DNA ,Pyogenic exudates contain large
amount of DNA derived from nuclei of necrotic cells). ‫ﻧوﻛﻠﯾﺎز ﯾﺳﺑب ازﻟﺔ اﻟﺑﻠﻣرة ﻟﻠدي ان اي‬
‫اﻻﻓرازات اﻟﻘﯾﺣﯾﺔ ﺗﺣﺗوي ع ﻛﯾﺔ ﻛﺑﯾرة ﻣن‬
 d. Other extracellular products: such as C5a peptidase. ‫اﻟدي ان اي اﻟﻣﺷﺗﻘﺔ ﻣن ﻧواة اﻟﺧﻠﯾﺔ‬
‫ اي ﺑﺑﺗﺎﯾز‬5 ‫اﻟﻣﻧﺗﺟﺎت اﻻﺧرى ﺧﺎرج اﻟﺧﻠﯾﺔ ﻣﺛل ال ﺳﻲ‬
 ‫طرﯾﻘﺔ ﺗطور اﻟﻣرض‬

Pathogenesis
‫ﺗﺣدث اﻷﻣراض اﻟﺣﺎدة اﻟﻣﺻﺎﺣﺑﺔ ﻟﻠﻣﻛورات اﻟﻌﻘدﯾﺔ اﻟﻣﻘﯾﺣﺔ ﺑﺷﻛل رﺋﯾﺳﻲ ﻓﻲ‬
‫اﻟﺟﮭﺎز اﻟﺗﻧﻔﺳﻲ أو ﻣﺟرى اﻟدم أو اﻟﺟﻠد‬
 Acute diseases associated with Streptococcus pyogenes occur chiefly in the
respiratory tract, bloodstream, or the skin.

 A- Non suppurative diseases: ‫اﻷﻣراض ﻏﯾر اﻟﻘﯾﺣﯾﺔ‬

 After a latent period of 1-4 weeks, Followed by rheumatic fever and acute
glomerulonephritis
‫ أﺳﺎﺑﯾﻊ ﺗﻠﯾﮭﺎ ﺣﻣﻰ روﻣﺎﺗﯾزﻣﯾﺔ وﺣﺎدة‬4-1 ‫ﺑﻌد ﻓﺗرة ﻛﺎﻣﻧﺔ ﻣن‬
‫اﻟﺗﮭﺎب ﻛﺑﯾﺑﺎت اﻟﻛﻠﻰ‬
 ‫اﻟﺣﻣﻰ اﻟروﻣﺎﺗﯾزﻣﯾﺔ‬
 1) Rheumatic fever ‫اﻟﻛوﻣﺑﻠﯾﻛﯾﺷن اﻟﻣﺿﺎﻋﻔﺎت اﻟﺳﺗﺎﻓﻠوﻛوﻛﺎي ﺑﺎﯾوﺟﯾن ﺑﺳﺑب اﻧواع ﻣﻌﯾﻧﺔ ﻣن‬
‫ﻧوع ام ﺑروﺗﯾن اﻟﻲ ﺗﻛون ﻓرﻋﯾﺔ‬
 Complication of S.pyogenes pharyngitis due to specific M protein types. As sub
cutaneous nodule.
‫ﯾﺳﺑب اﻟﺗﮭﺎﺑﺎت ﻓﻲ اﻟﻣﺎﯾروﻛﺎردﯾﺎل ﻟﯾﺷن‬
 Causes inflammatory myocardial lesion.

 Results in chronic and progressive damage to heart valves, and arthritis.

‫ﯾﻧﺗﺞ ﻋﻧﮫ ﺿرر ﻣزﻣن وﻣﺗزاﯾد ﻟﺻﻣﺎﻣﺎت اﻟﻘﻠب واﻟﺗﮭﺎب اﻟﻣﻔﺎﺻل‬
 ‫اﻟﺗﮭﺎب ﻛﺑﯾﺑﺎت اﻟﻛﻠﻰ‬
 2) Glomerulonephritis ‫ﺗﺣدث ﺑﺳﺑب ﺳﻼﻻت ﻛﻠوﯾﺔ ﻣﻌﯾﻧﺔ ﻣن اﻟﺳﺗرﺑﺗوﻛوﻛﺎي ﻛروب اي‬
 Caused by specific nephritogenic strains of group A streptococcus.

 Characterized by acute inflammation of renal glomeruli with edema, hypertension,

‫ﯾﺗﻣﯾز ﺑﺎﻟﺗﮭﺎب ﺣﺎد ﻓﻲ اﻟﻛﺑﯾﺑﺎت اﻟﻛﻠوﯾﺔ ﻣﻊ وذﻣﺔ وارﺗﻔﺎع ﺿﻐط اﻟدم‬
hematuria and proteinuria. ‫ﺑﯾﻠﺔ دﻣوﯾﺔ وﺑروﺗﯾﻧﯾﺔ‬
 ‫اﻟﻣﺿﺎﻋﻔﺎت اﻟﻘﯾﺣﯾﺔ‬
 Suppurative complications ‫اﻟﻣوﻗﻊ اﻻﺳﺎﺳﻲ ﻟﻼﻧﻔﯾﺷن اﻟﻐزو ھو اﻟﺛروث اﻟﺣﻠق ﯾﺳﺑب‬
‫اﻟﺗﮭﺎﺑﺎت اﻟﺟﮭﺎز اﻟﺗﻧﻔﺳﻲ‬ ‫اﻟﺗﮭﺎب اﻟﺣﻠق ﻣﺛل اﻟﺗﮭﺎب اﻟﻠوزﺗﯾن او اﻟﺑﻠﻌوم‬
 1. Respiratory infections : Primary site of invasion is throat causing sore throat ,May be localized
as tonsillitis or pharyngitis.

 Respiratory infections: Lipoteichoic acid covering surface pili binds to the glycoprotein
fibronectin on epithelial cells of pharynx ,From the throat, spreads to surrounding tissues leading
to suppurative complications like; ‫ ﺣﻣض اﻟﻠﯾﺑوﺗﯾﻛوﯾك اﻟذي ﯾﻐطﻲ اﻟﺷﻌرة‬:‫اﻟﺗﮭﺎﺑﺎت اﻟﺟﮭﺎز اﻟﺗﻧﻔﺳﻲ‬
‫اﻟﺗﮭﺎب اﻷذن اﻟوﺳطﻰ‬ ‫اﻟﺳطﺣﯾﺔ ﯾرﺗﺑط ﺑﺎﻟﺑروﺗﯾن اﻟﺳﻛري‬
 Otitis media ‫ ﯾﻧﺗﺷر إﻟﻰ‬، ‫ ﻣن اﻟﺣﻠق‬، ‫ﻓﯾﺑروﻧﯾﻛﺗﯾن ﻋﻠﻰ اﻟﺧﻼﯾﺎ اﻟظﮭﺎرﯾﺔ ﻟﻠﺑﻠﻌوم‬
‫اﻷﻧﺳﺟﺔ اﻟﻣﺣﯾطﺔ ﻣﻣﺎ ﯾؤدي‬
 Quinsy ‫ﻟﻣﺿﺎﻋﻔﺎت ﻗﯾﺣﯾﺔ ﻣﺛل‬

 Suppurative adenitis ‫اﻟﺗﮭﺎب اﻟﻐدد اﻟﻣﺗﻘﯾﺢ‬

 Meningitis(rare)
‫)اﻟﺗﮭﺎب اﻟﺳﺣﺎﯾﺎ )ﻧﺎدر‬
 ‫اﻟﺗﮭﺎب اﻟﺳﻛن و اﻟﺳوﻓت ﺗﺷﯾو‬

 2. Skin and soft tissue infection

‫اﻣﺑﯾﺗﻛو )ﺗﻘﯾﺢ اﻟﺟﻠد ﻋﻧد اﻷطﻔﺎل اﻟﺣﺻف‬
 a.Impetigo (pyoderma in children ‫الحصف‬

 b. Cellulites typically involves the skin and

subcutaneous tissue ‫ﻋﺎدة ﻣﺎ ﯾﺻﯾب اﻟﺳﯾﻠوﻟﯾت اﻟﺟﻠد و‬
‫اﻷﻧﺳﺟﺔ ﺗﺣت اﻟﺟﻠد‬
 c. Erysipelas ‫الطفح او االحمرار‬

 d. Necrotizing fasciitis ( streptococcal

gangrene)

 e. Sepsis f- Toxic shock

 ‫ﺷﻠون ﻧﺷﺧﺻﮭﺎ ﻓﻲ اﻟﻣﺧﺗﺑر‬

Laboratory Diagnosis
‫ﻧﺎﺧذ ﻋﯾﻧﺔ اﻣﺎ ﻣﺳﺣﺔ ﻣن اﻟﺣﻠق او ﻣﯾﺣﺔ ﻣن اﻟﺑس او ﺟﻣﻊ اﻻﻓرازات‬
 1. Specimen: Throat swab, pus swab or exudates are
collected. ‫اﻟﻔﺣص اﻟﻣﺟﮭري ﻛرام ﺳﺗﯾن ﻟﻠﺑس‬
 2. Microscopy: Gram-staining of pus can be examined.
‫وﺟود اﻟﻛرام ﺑوزﺗف ﻛوﻛﺎي ﻓﻲ ﺳﻠﺳﻠﺔ ﻣن اﻻداﺋل اﻻﻧدﻛﯾﺷن‬
 Presence of Gram-positive cocci in chains can be indication.

 3-Culture: Swab from the affected area is collected and are

either plated immediately or sent to laboratory in Pike’s
‫اﻟﻛﺎﻟﺟﯾر اﻟوﺳط اﻟزرﻋﻲ راح ﻧﺟﻣﻊ اﻟﺳواب ﻣن ﻣﻛﺎن اﻟﻣﺻﺎب اﻣﺎ ﻧﺳﺗﺧدﻣﮭﺎ‬
medium. ‫ﺑﺷﻛل ﻣﺑﺎﺷر ﻛﺑل ﻧﻔﺣص ﻋﻠﯾﮭﺎ او ﻧرﺳﻠﮭﺎ ﻟﻠﻣﺧﺗﺑر ﺑﺑﯾك ﻣﯾدﯾﺎ وﺳط ﺣﺎﻓظ‬

 The specimen should be plated on blood agar and incubated

at 37˚C anaerobically or under 5-10% CO2 ,as hemolysis
develops better. 10 ‫ اﻟﻰ‬5 ‫ اﻟﻼھواﺋﻲ او اﺛل ﻣن‬37 ‫ ﻻزم اﻟﺑﻠﯾت ﻣﺎﻟت اﻟﻌﯾﻧﺔ ﺗﻛون ع اﻟﺑﻠد اﻛﺎر ﻋﻧد درﺟﺔ ﺣرارة‬%
‫ﺛﺎﻧﻲ اوﻛﺳﯾد اﻟﻛﺎرﺑون ﺑﮭﯾﺞ ﺿروف ﯾﺻﯾر اﻧﺣﻼل ﻟﻠدم ﺑﺷﻛل اﻓﺿل‬
 Identification
‫اﻟﺗﻌرﯾف اﻷوﻟﻲ‬
 Preliminary identification:
 a) Haemolytic behaviour
 b) Bacitracin sensitivity
 c) Fluorescent antibody
 d) PCR.
 Treatment
‫اﻻدوﯾﺔ اﻟﻲ راح ﻧﺳﺗﺧدﻣﮭﺎ‬

 DRUGS USED:
‫ﻟﻠﺳﺗﺎﻓﻠوﻛوﻛﺎل ﻓﺎرﻧﺟﺎﺗﯾس راح ﻧﻧطﻲ اورال ﺑﻧﺳﻠﯾن ن اﻟف ﯾﻌﻧﻲ او ﻧﻧطﻲ اﻣوﻛﺳﯾﻠﯾن‬
 • For streptococcal pharyngitis: Oral penicillin V or amoxicillin.
‫ﯾﻣﻛن اﺳﺗﺧدام اﻟﺳﯾﻔﺎﻟوﺳﺑورﯾن اﻟﻔﻣوي أو اﻟﻣﺎﻛروﻟﯾدات ﻟﻠﻣرﺿﻰ اﻟذﯾن ﯾﻌﺎﻧون ﻣن ﺣﺳﺎﺳﯾﺔ ﻣن اﻟﺑﻧﺳﻠﯾن‬
 • Oral cephalosporin or macrolides can be used for penicillin sensitive patients

 • For severe, systemic infection: Combined use of intravenous penicillin with

protein synthesis inhibiting antibiotics(clindamycin) is recommended

 • Streptococcal pyogenes have developed resistance over tetracyclines and

sulfonamides, newer macrolides ‫اﻟﺳﺗﺎﻓﻠوﻛوﻛﺎي ﺑﺎﯾوﺟﯾن ﺗطورت ﺣﺗﻰ ﺗﻘﺎوﻣﻠﻲ اﻟﺗﺗراﺳﺎﯾﻛﻠﯾن‬
‫و اﻟﺳﯾﻠﻔوﻧﺎﻣﯾدات و اﻟﻣﺎﻛروﻟﯾدات اﻟﺣدﯾﺛﺔ‬
‫ﻓﻲ ﺣﺎل اﻟﻌدوى اﻟﺟﮭﺎزﯾﺔ اﻟﺳﯾﻔﯾر راح‬
‫ﻧﺳﺗﺧدم ﺷﻲء ﻣﺷﺗرك ﻟﻠﺑﻧﺳﻠﯾن ﻓﻲ‬
‫اﻟورﯾد ﻣﻊ اﻟﻣﺿﺎد اﻟﺣﯾوي اﻟﻣﺛﺑط ﻟﺗﺧﻠﯾق‬
‫اﻟﺑروﺗﯾن اﻟﻛﻠﯾﻧداﻣﺎﯾﺳﯾن‬
 ‫اﻟﻣﺟﺎﯾﻊ اﻻﺧرى ﻣن اﻟﺳﺗرﺑﺗوﻛوﻛﺎي ﻣﺛل‬
‫‪ Other groups:‬‬ ‫اﻟﻛروب ﺑﻲ وﺟدت ﻓﻲ اﻻورال ﻛﺎﻓﺗﻲ و اﻻﻧﺗﯾﺳﺗن ﺗراك و اﯾﺿﺎ اﻟﻔﺟﺎﯾﻧﺎ‬
‫اﻟﺳﺗرﺑﺗو اﻛﻼﻛﺗﯾن ﺗﻛون ﻣﺣﺎطﺔ ﺑﻛﺑﺳوﻟﺔ ﻣن اﻟﺑوﻟﯾﺳﻛراﯾد‬
‫‪ Group B Streptococci: they found in oral cavity, intestinal tract and vagina S.‬‬
‫‪agalactiae, which surrounded by a polysaccharide capsule.‬‬

‫‪ They cause neonatal meningitis by transporting to the baby during delivery, UTI,‬‬
‫ﺗﺳﺑب اﻟﺗﮭﺎب اﻟﺳﺣﺎﯾﺎ اﻟوﻻدي ﯾﻌﻧﻲ ﻣن ﯾﺟﺟﻲ طﻔل ﺑﻲ ھذا ﻣرض ﯾﺗﻘل‬
‫‪and puerperal fever.‬‬ ‫ﻟﻠطﻔل اﺛﻧﺎء اﻟوﻻدة و اﯾﺿﺎ اﻟﺗﮭﺎب اﻟﻣﺳﺎﻟك اﻟﺑوﻟﯾﺔ و اﻟﺣﻣﻰ اﻟﻧﻔﺎس او اﻟوﻟﯾد‬
‫اﻟﻲ ﺗﺳﺗﻣر ‪ 24‬ﺳﺎﻋﺔ ﺑﻌد اﻟوﻻدة‬
‫‪ Group C Streptococci: cause infections in many animals' species but rarely in‬‬
‫‪human. S.dysgalactiae, cause human illnesses such as endocarditis, pneumonia,‬‬
‫اﻟﺳﺗرﺑﺗوﻛوﻛﺎي ﻧوع ﺳﻲ ﺗﺳﺑب ﻋدوى ﻟﻠﻌدﯾد ﻣن اﻟﺣﯾواﻧﺎت و ﻧﺎدرا‬
‫ﻣﺗﺻﯾب اﻻﻧﺳﺎن اﻟﺳﺗرﺑﺗوﻛوﻛﺎي دﯾﺳﻛﻼﯾﺳﯾن ﺗﺳﺑب اﻻﻣراض اﻟﺑﺷرﯾﺔ ﻣﺛل ‪meningitis, and wound infections.‬‬
‫اﻟﺗﮭﺎب اﻟﺷﻐﺎف و اﻟﺗﮭﺎب اﻟرﺋوي و اﻟﺗﮭﺎب اﻟﺳﺣﺎﯾﺎ و اﻟﺗﮭﺎب اﻟﺟروح‬
‫‪ Group D Streptococci: alpha or gamma haemolytic on sheep blood agar, of‬‬
‫‪intestinal origin (Enterococci): Enterococcus faecalis, the latter is of medically‬‬
‫‪important since is causes UTI and abdominal lesions.‬‬
‫اﻟﺳﺗرﺑﺗوﻛوﻛﺎي ﻧوع دي ﺗﻛون اﻟﻔﺎ او ﻛﺎﻣﺎ ھﯾﻣوﻻﯾﺗك ع اﻟﺑﻠد اﻛﺎر ﻣﺎﻟت اﻟﺧراف اﻻﺻل ﻣﺎﻟﺗﺔ ﯾﻛون ﻓﻲ‬
‫اﻻﻧﺗﯾﺳﺗﻧﺎل اﻻﻧﺗروﻛوﻛﺎس ﻓﺎﯾزﯾﻠﯾز اﻟﻛوﻛﺎي اﻟﻣﻌوي اﻟﺑرازي ﯾﻛﻛون ﻣﮭم طﺑﯾﺎ ﻻن ﯾﺳﺑب اﻓﺎت ﻓﻲ اﻟﻣﺳﺎﻟك‬
‫اﻟﺑوﻟﯾﺔ و اﻟﺑطن‬
 ‫اﻟﺳﺗرﺑﺗوﻛوﻛس ﺑﯾﻧوﻣوﻧﯾﺎ‬
STREPTOCOCCUS PNEUMONIAE
 MORPHOLOGY
‫ھﺎي ﻋﺑﺎرة ﻋن ﻛوﻛﺎي رﺋوﯾﺔ‬
 Streptococcus pneumoniae (pneumococcus)

 Gram-positive, capsulated diplococcus or short

chain. ‫ﻛرام ﺑوزﺗف وﺗﻛون ﻛﺑﺳوﻟﺔ ﻣزدوﺟﺔ او ﺳﻠﺳﻠﺔ ﻗﺻﯾرة‬

 Small, slightly elongated cocci. ‫ﻗﺻﯾرة و ﻣﻣدودة ﻗﻠﯾﻼ‬

 One end broad or rounded and the other

pointed(lancet-shape).
‫واﺣد ﻣن ﻧﮭﺎﯾﺎﺗﮭﺎ ﻗﺻﯾر او ﻣدور و اﻻﺧر ﻣدﺑب‬
 ‫ﻣﻣﯾزات اﻟوﺳط اﻟزرﻋﻲ‬

CULTURAL CHARACTERISTICS
‫اﻟﻣﯾدﯾﺎ ﺗﻛون اﻧرﺟد‬
 Enriched media

 On Blood agar, colonies are small (0.5 – 1 mm), dome shaped and glistening with α
haemolysis. ‫ ﻣﻠم ع ﺷﻛل ﻗﺑﺔ و ﻻﻣﺎﻋﺔ ﺗﻛون ع‬1 ‫ اﻟﻰ‬0.5 ‫ع اﻟﺑﻠد اﻛﺎر اﻟﻛوﻟوﻧﻲ ﺗﻛون ﺻﻐﯾرة ﻣن‬
‫ﯾﻌﺗﺑر ﻛوﻟﯾﻧﻲ ﻣﺧﺎطﯾﺔ ﻛﺑﯾرة‬ ‫اﻟﻔﺎ ھﯾﻣوﻻﯾﺗك‬
 Large Mucoid colonies. ‫اﻟﺑﯾﺗﺎ ھﯾﻣوﻻﯾﺳﯾز ﻓﻲ اﻻﯾﻧﺎورﺑﯾك ﻛوﻧدﺷن ﺑﺳﺑب‬
‫اﻻوﻛﺳﺟﯾن اﻟﻣﺗﻐﯾر‬
 ß haemolysis in anaerobic conditions due to oxygen labile Hemolysin O.

 Glucose broth – uniform turbidity.

‫اﻟﻛﻠوﻛوز ﺑروث ﯾﻛون ﻋﻛرة ﻣوﺣدة‬
 ‫ﻣﯾزات اﻻﻧﺗﺟﯾن‬

‫‪ANTIGENIC PROPERTIES‬‬
‫ﯾﻛون ﻛﺑﺳول‬
‫‪ 1-Capsule.‬‬ ‫اﻟﺳواﺗك اﻧﺗﺟﯾن ﯾﻌﻧﻲ اﻟﻣﺳﺗﺿدات اﻟﺟﺳدﯾﺔ ﺳﻲ ﺑوﻟﯾﺳﻛراﯾد ﺗﻛن ﺧﺎﺻﺔ ﺑل اﻧواع‬
‫)‪ 2- somatic antigens.( C polysaccharide (species-specific‬‬

‫)‪ ‘C’ carbohydrate antigen (C – reactive protein (CRP) acute phase protein ( Beta globulin‬‬
‫)‪bacterial infections, inflammation, malignancy and tissue destruction‬‬
‫ﻣﺳﺗﺿد اﻟﻛﺎرﺑوھﯾدرﯾت ﺳﻲ ﻋﺑﺎرة ﻋن ﺑروﺗﯾن ﺗﻔﺎﻋﻠﻲ ﺳﻲ ار ﺑﻲ ﯾﻌﺗﺑر ﺑروﺗﯾن‬
‫اﻟﻣرﺣﻠﺔ اﻻﻛﯾوت ﺑﯾﺗﺎ ﻛﻠوﺑﯾﻠﯾن اﻻﻟﺗﮭﺎب اﻟﺑﻛﺗﯾري و اﻻﻟﺗﮭﺎب و اﻻورام اﻟﺧﺑﯾﺛﺔ و‬
‫ﺗدﻣﯾر اﻻﻧﺳﺟﺔ‬
 ‫اﻟﺳﻣوم وﻋواﻣل اﻟﺧطورة‬

TOXINS AND VIRULENCE FACTORS

‫ﻛﺑﺳول ﻋدﯾد اﻟﺳﻛﺎرﯾد ﯾﺣﻣﻲ اﻟﻣﻛورات ﻣن اﻟﺑﻠﻌﻣﺔ‬
 1-Capsular Polysaccharide Protects the cocci from phagocytosis.
‫اﻻﻧزﯾﻣﺎت‬ ‫ﻧﯾوراﻣﯾﻧﯾداز ﯾﺷطر او ﯾﻘﺳم ﺣﺎﻣض ان أﺳﯾﺗﯾﻠﻧﯾوراﻣﯾﻧﯾك اﻟطرﻓﻲ‬
 2- Enzymes:
‫اﻟﻲ ﯾﮭﺎﺟم اﻟﻧﯾزوﻓﺎرﻧﻛس‬
 a) Neuraminidase: cleaves terminal N-acetylneuraminic acid to invade nasopharynx.

 b) Proteases: degrades IgG, IgM & secretory IgA.

‫ اﻟﺳﻣوم‬ 3- Toxins ‫اﻟﺑﯾﻧوﻣوﻻﯾﺳﯾن ﺑروﺗﯾن ﯾﺣﻠل اﻟﺧﻼﯾﺎ ﻟﻠﺧﻼﯾﺎ اﻟﯾوﻛﺎرﯾوﺗك ﺣﻘﯾﻘﺔ اﻟﻧواة اﻟﻲ ﺗﺣﺗوي‬
‫ع اﻟﻛوﻟﯾﺳﺗرول ﻣﻛون ﻣن اﻏﺷﯾﺔ اﻟﺧﻼﯾﺎ و ﺧﺎﺻﺔ اﻟرﯾﺳﺑﺎﯾرﺗري اﯾﺑﯾﺛﯾﻠﯾوم‬
 a) Pneumolysin O (Ply): protein that is cytolytic to eukaryotic cells that have cholesterol as
a component of their cell membranes particularly the respiratory epithelium.

 b) Autolysin. ‫أوﺗوﻟﯾﺳﯾن‬
  4. Hydrogen peroxide: causes damage to host cells (can cause apoptosis in
neuronal cells during meningitis) and has bactericidal effects against competing
bacteria (Haemophilus influenzae, Neisseria meningitidis, Staphylococcus
aureus).

 5. Pili : hair-like structures that extend from the surface, contributes to

colonization of upper respiratory tract and increase the formation of large amounts
of TNF by the immune system during sepsis, raising the possibility of septic shock
‫ ﯾﺳﺑب ﺗﻠف اﻟﺧﻼﯾﺎ‬:‫ﺑﯾروﻛﺳﯾد اﻟﮭﯾدروﺟﯾن‬ ‫ ﺗﺳﺎھم ﻓﻲ‬، ‫ ﺗراﻛﯾب ﺷﺑﯾﮭﺔ ﺑﺎﻟﺷﻌر ﺗﻣﺗد ﻣن اﻟﺳطﺢ‬:‫ﺑﯾﻠﻲ‬
‫اﻟﻣﺿﯾﻔﺔ )ﯾﻣﻛن أن ﯾﺳﺑب ﻣوت اﻟﺧﻼﯾﺎ اﻟﻣﺑرﻣﺞ‬ ‫اﺳﺗﻌﻣﺎر اﻟﺟﮭﺎز اﻟﺗﻧﻔﺳﻲ اﻟﻌﻠوي وزﯾﺎدة ﺗﻛوﯾن ﻛﻣﯾﺎت ﻛﺑﯾرة‬
‫ﻓﻲ‬ ‫ﻣن ﻋﺎﻣل ﻧﺧر اﻟورم ﻣن ﻗﺑل اﻟﺟﮭﺎز اﻟﻣﻧﺎﻋﻲ أﺛﻧﺎء ﺗﻌﻔن اﻟدم‬
‫اﻟﺧﻼﯾﺎ اﻟﻌﺻﺑﯾﺔ أﺛﻧﺎء اﻟﺗﮭﺎب اﻟﺳﺣﺎﯾﺎ( وﻟﮭﺎ‬ ، ‫ﻣﻣﺎ ﯾزﯾد ﻣن اﺣﺗﻣﺎل ﺣدوث ﺻدﻣﺔ إﻧﺗﺎﻧﯾﺔ‬
‫ﺗﺄﺛﯾرات ﻣﺑﯾد ﻟﻠﺟراﺛﯾم ﺿد اﻟﻣﻧﺎﻓﺳﯾن‬
‫اﻟﺑﻛﺗﯾرﯾﺎ ﻛﺎل اﻟﮭﯾﻣوﻓﯾﻠﯾز اﻧﻔﻼوﻧزا و اﻟﻧﯾﺳﯾرﯾﺎ‬
‫ﻣﯾﻧﻧﺟﺎﯾﺗس و اﻟﺳﺗﺎﻓﻠوﻛوﻛﺎس اورﯾوس‬
 ‫اﻟﻣظﺎھر اﻟﺳرﯾرﯾﺔ ﻟﻼﻟﺗﮭﺎب اﻟرﺋوي‬

Pneumonia Clinical Features

‫ﺣﻣﻰ‬
 A. Fever. ‫رﻋﺷﺔ‬
 B. Shaking chill
 C. Productive cough. ‫ﺳﻌﺎل‬
 D. Chest pain. ‫اﻟم ﻓﻲ اﻟﺻدر‬
 E. Dyspnea, tachypnea, hypoxia.
‫ﺿﯾق ﻧﻔس او ﺗﺳﺎرع ﻧﻔس او ﻧﻘص اوﻛﺳﺟﯾن‬
 ‫ﻣرض اﻟﻣﻛورات اﻟرﺋوﯾﺔ‬
Pneumococcal Disease
IN CHILDREN
‫ﺗﺟرﺛم اﻟدم ﺑدون ﻣﻛﺎن ﻣﻌروف ﻟﻺﺻﺎﺑﺔ ﺑﺎﻟﻌدوى ھو اﻷﻛﺛر ﺷﯾوﻋًﺎ‬
 A-Bacteremia without known site of infection most common clinical presentation.

 B- S. pneumoniae leading cause of bacterial meningitis among children <5 years of age.
‫ﺳﺑب ﺷﺎﺋﻊ ﻻﻟﺗﮭﺎب اﻷذن اﻟوﺳطﻰ اﻟﺣﺎد‬ ‫اﺳﺗﺎﻓﻠوﻛوﻛﺎي ﺑﯾﻧوﻣﯾﻧﯾﺎ اﻟﻣﺳﺑب اﻟرﺋﯾﺳﻲ‬
 C- Common cause of acute otitis media.
‫ﻻﻟﺗﮭﺎب اﻟﺳﺣﺎﯾﺎ اﻟﺟرﺛوﻣﻲ ﻟدى اﻷطﻔﺎل أﻗل‬
‫ ﺳﻧوات ﻣن اﻟﻌﻣر‬5 ‫ﻣن‬
IN ADULT
‫اﻻﻟﺗﮭﺎﺑﺎت اﻟرﺋوﯾﺔ‬
 1. Pulmonary infections
(‫ اﻟﺗﮭﺎب اﻷذن اﻟوﺳطﻰ‬، ‫)اﻟﺗﮭﺎب اﻟﺟﯾوب اﻷﻧﻔﯾﺔ‬
 i. URTI (sinusitis, otitis media)
‫اﻟﺗﮭﺎب رﺋوي‬
 ii. Pneumonia.
‫)اﻟﺗﮭﺎﺑﺎت ﺧﺎرج اﻟرﺋﺔ )ﻣﺿﺎﻋﻔﺎت‬
 2. Extra-pulmonary Infections (complications).
‫ﺗﺟرﺛم اﻟدم‬ ‫اﻟﺗﮭﺎب اﻟﻌظم واﻟﻧﻘﻲ‬
‫اﻟﺗﮭﺎب اﻟﺳﺣﺎﯾﺎ وﺧراج اﻟﻣﺦ‬
 i. Meningitis, brain abscess ii. Pericarditis, Endocarditis iii. Bacteremia iv. Osteomyelitis, septic
arthritis.. ‫اﻟﺗﮭﺎب اﻟﺗﺎﻣور واﻟﺗﮭﺎب اﻟﺷﻐﺎف‬
‫اﻟﺗﮭﺎب اﻟﻣﻔﺎﺻل‬