BACTE LEC – MIDTERMS

STREPTOCOCCUS ➢ Other streptococcus species are classified as

‘non-Lancefield streptococci’
→ The Streptococcaceae consist of a large family
of medically important species in the genus
Streptococcus.
→ Streptococcus are generally catalase-negative,
gram-positive cocci with 0.5 to 1.2 um in
diameter and arranged predominantly in pairs
or chains, with some forming irregular clusters
→ The word Strep means “Chains” while the word
coccus means “Spherical”, so basically the word
streptococcus comes from its morphological
characteristics “String of Pearls”
→ These organisms can be differentiated based
on:
• Cell wall structure
• Hemolytic patterns on blood agar (beta,
alpha or gamma)
• Reaction of antibodies to specific
bacterial antigen
• Lancefield Classification scheme
• Biochemical identification relating to LANCEFIELD CLASSIFICATION: (GROUP)
physiologic characteristics ➢ G.A – rhamnose-N-acetylglucosamine
→ Most commonly encountered streptococci ➢ G.B – rhamnose-glucosamine polysaccharide
infections in humans: ➢ G.C – rhamnose-N-acetylglucosamine
• S. pyogenes ➢ G.D – glycerol teichoic acid containing alanine
• S. agalactiae and glucose
• S. pneumoniae ➢ G.F – glucopyrasonyl-N-acetylgalactosamine
• Viridans streptococci group
→ In some cases with molecular analysis of the ENTEROCOCCUS
16S ribosomal ribonucleic acid (rRNA)
→ The genus Enterococcus includes organisms that
sequences.
were previously included in the Streptococceae
CLASSIFICATION: (G - GROUP) family. However, due to the introduction of
molecular methods, these organisms have been
➢ G.A – Streptococcus Pyogenes placed in a separate family, the Enterococcaceae.
➢ G.B – Streptococcus Agalactiae → The members of this genus microscopically
➢ G.C – Streptococcus Equisimus, produce cocci arranged in pairs, short chains, or
Streptococcus Equi, Streptococcus small irregular clusters and are commensal
Zooepidemicus, Streptococcus Dysgalactiae organisms of the human gastrointestinal (GI)
➢ G.D – Enterococci, streptococcus bovis tract that cause a variety of opportunistic
➢ G.E – Streptococcus Milleri and Mutans infections.
➢ G.F – Streptococcus Anginosus → Like the streptococci, organisms within this
➢ G.H – Streptococcus Sanguis genus produce hemolysis on sheep blood agar
➢ G.L – Streptococcus Dysgalactiae (beta, alpha or gamma); however, the hemolytic
➢ G.N – Lactococcus Lactis patterns vary within a single species and are
➢ G. R&S – Streptococcus Suis therefore not as useful in the identification of a
specific species.

= RABG = 1

→ E. faecalis and E. faecium are the most common
species encountered in human infections.
HABITAT
→ Many of these organisms are commonly
found as part of the normal human
microbiome of the pharynx, mouth, lower
GI tract, and vagina
• G. A = skin and oropharynx
• G. B = female genital tract, colon
• G. D = colon
• Viridans = oropharynx, colon
• S. pneumoniae = Nasopharynx
• Enterococcus = gastrointestinal
MODE OF TRANSMISSION
❖ Mode of transmission
→ Methods of transmission are spread person
to person by various means and,
subsequently, establish a state of
colonization or carriage; infections may then
develop when colonizing strains gain
entrance to normally sterile sites.
→ In some instances, this may involve trauma
(medically or nonmedically induced) skin or
mucosal surfaces or, as in the case of S.
pneumoniae pneumonia, may result from
aspiration into the lungs of organisms
colonizing the upper respiratory tract.
ALPHA HEMOLYTIC STREPTOCOCCUS
Streptococcus pneumoniae
Viridans strep
Streptococcus pneumoniae
→ S. pneumoniae is still one of the leading causes
of morbidity and normality.
→ The organism is the primary cause of community-
associated bacterial pneumonia, meningitis, and
otitis media.
= RABG =
BACTE LEC – MIDTERMS
→ The organism may harmlessly inhabit the upper
respiratory tract, with a 5% to 75% carriage rate
in humans. S. pneumoniae is capable of
spreading to the lungs, paranasal sinuses and
middle ear.
→ In addition, this organism accesses the
bloodstream and the meninges to cause acute,
purulent, and often life-threatening infections.
→ S. pneumoniae is capable of mobilizing
inflammatory cells mediated by its cell wall
structure, including peptidoglycan, teichoic
acids, and a pneumolysin. The pneumolysin
activates the classic complement pathway. The
pneumolysin mediates suppression of the
oxidative burst in phagocytes, providing for
effective evasion of immune clearance.
MORPHOLOGY
• Shape
→ Lancet shaped diplococci in chains
• Arrangement
→ It comes in pairs and short chains,
sometimes irregular clusters
• Diameter
→ 0.5 to 1.2 um
• Color
→ When stained it depicts purple
colorization, when cultures in a blood agar
media a white colony is seen surrounded
by green zone.
• Structurally
o No flagella
→ Non motile bacteria
o Capsule made out of polysaccharide
→ Helps in the antiphagocytic ability of
the bacteria
o Cell wall
→ Teichoic acid is present
o Cell membrane
→ Energy generation
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 BACTE LEC – MIDTERMS

TRANSMISSION ❖ TOXINS
1. IgA protease
➢ Being a part of normal flora not much
→ Cleaves mucosal IgA causing mucosal
communicable
infection
➢ Depends on the type of disease
→ Meningitis
• Pneumonia –> through respiratory
→ Otitis media
droplet –> coughing and sneezing
→ pneumonia
• Sinusitis –> aerosols
→ sinusitis
• Otitis media –> if surrounded by many
2. Autolysin
infected individual –> airborne
→ Destruction of bacteria and release of
internal components
→ Can easily infect individuals with weaker immune
→ Local inflammation
system and defenses
→ Destruction of host tissue
o Age: infants and elderly
3. Pneumolysin
o Others: HIV, diabetes, malignancy,
→ The pneumolysin activates the classic
alcohol, smoking
complement pathway.
→ Binds to cholesterol in cell membrane and
form a spore causing cell lysis resulting to
PATHOGENESIS
destruction of pneumocytes and alveolar
1. Polysaccharide capsule capillaries
2. Biofilms → The pneumolysin mediates suppression of
3. Pneumococcal surface protein A the oxidative burst in phagocytes, providing
4. Toxins for effective evasion of immune clearance.

PATHOGENESIS
❖ CAPSULE
• Protects bacteria from phagocytosis • Pneumonia
• Principal virulence factor of streptococcus • Rhinosinusitis
pneumoniae bacteria • Otitis media
• Due to this it can cause death in asplenic • Mastoditis
individuals • Meningitis
o OPSI (overwhelming post splenectomy → In sever cases once S. pneumonia infects
infection) the blood it can now cause: pneumococcal
endocarditis, purulent endocarditis,
❖ BIOFILMS meningitis, septic arthritis, peritonitis and
1. Bacteria enter the body sepsis from patient with no spleen.
2. Attach to mucosal surfaces
3. Forms biofilm
CLINICAL FINDINGS

❖ Pneumococcal Surface Protein A • Labor pneumonia

• It inhibits complement activation 1. Chill
2. Fever
3. Cough
4. Chest pain
5. Rusty sputum

= RABG = 3
 BACTE LEC – MIDTERMS

LAB DIAGNOSIS VIRIDANS STREP

→ The viridans group includes a large and complex
• Samples:
group of human streptococci that are not
o Sputum, pus, peritoneal fluid
groupable by Lancefield serology.
• Microscopy
→ The viridans group of streptococci includes five
o Gram stain = purple
groups, each containing several species.
o Shape = lancet shape or diplococci in
→ The groups include:
chains
• The mutans group
o Size in diameter: 0.5 to 1.2 um
• Salivarius group
• Culture:
• Bovis group
1. Blood agar plate
• Anginosus group (previously S. Milleri group),
→ Check for hemolysis
the only beta hemolytic viridans strep
→ Check for characteristics (mucoid colony
• Mitis group
with flattened and depressed centers
“umblicate”)
❖ S. mutans
• S. mutans have been isolated from the
human oropharynx including S. cricetid,
CATALASE TEST
and S. downei.
→ Negative for streptococcus • S. mutans and S. sobrinus are the most
→ No bubbles formation commonly isolated species associated
with dental carries.
❖ S. salivary
OPTOCHIN DISC TEST / Taxo P Disc Test • S. salivarius group organisms are
isolated firmly from the oropharynx and
Viridans strep –> resistant blood.
S. pneumoniae –> susceptible • S. salivarius has been reported in
bacteria, endocarditis, and meningitis.
❖ S. bovis
BILE SOLUBITLITY TEST • S. bovis group may be isolated in cases
of bacteremia, septicemia, and
Viridans –> insoluble endocarditis.
❖ S. anginosus
S. pneumoniea –> a soluble
• S. anginosus group are normal
microbiota in the oropharynx,
urogenital, and GI tract.
PREVENTION
• Small-colony (<0.5 mm) beta-hemolytic
• Infection with S. pneumoniae can be prevented group A, C, F and G (or no group)
through a series of vaccinations. There are two organisms are considered normal
vaccines currently available, a 13-valent microbiota of the throat and typically
conjugate vaccine and a 23-valent capsular not reported when screening for beta
polysaccharide vaccine. Vaccine use has hemolytic streptococcus of the throat.
reduced the nasopharyngeal carrier rate and However, they can cause bacteremia
the number of invasive infections associated and disseminated deep-seated
with the organism infectious, especially in
immunocompromised patients.

= RABG = 4

❖ S. mitis
• Are also commensals of the oropharynx,
urogenital, and GI tract
• They may also be transient colonizers of
the skin and identified as contaminants
in blood cultures. These organisms may
be isolated in cases of endocarditis.
Immunocompromised patients may
develop septicemia or pneumonia.
Infections with organisms in the S. mitis
group maybe difficult to treat due to the
presence of penicillin resistance.
-BETA HEMOLYTIC STREPTOCOCCI-
Group A Streptococcus (GAS)
→ Group A S. pyogenes, the most clinically
important Lancefield group A, produces several
factors that contribute to its virulence; it is one
of the most aggressive pathogens encountered
in clinical microbiology laboratories.
→ Streptococcus = chains spherical, Pyo means
Pus, Genes = Forming
NOTE: GAS is not considered as part of the normal
flora
MODE OF TRANSMISSION:
→ Transmission can occur through airborne
droplets, hand contact with nasal discharge
or with objects or surfaces contaminated
with bacteria, skin contact with
contaminated lesions, or contaminated food
sources.
= RABG =
BACTE LEC – MIDTERMS
Virulence Factors
• M. protein –> it acts as the primary antigenic
part
• Streptokinase –> contributes in the fibrinolytic
activity in prevention of clots
• Hyaluronidase –> spreading factor
• Pyogenic toxins –> responsible for streptococcal
toxic shock syndrome
• Hyaluronic acid capsule –> hyaluronic acid is
normally found in the body therefore our
antigens do not detect this as antigens
Virulence factors
❖ HEMOLYSIN
• Streptolysin S
→ Streptolysin S is an oxygen-stable,
nonimmunogenic hemolysin capable of
lysing erythrocytes, leukocytes, and platelets
in the presence of room air.
• Streptolysin O
→ Streptolysin O is immunogenic, capable of
lysing the same cells and cultures cells, is
inactivated by oxygen, and will produce
hemolysis in the absence of room air.
→ Also inhibited by cholesterol in skin lipids,
resulting in the absence of the development
of protective antibodies associated with skin
infection
PATHOGENESIS
• Group A- streptococcus can cause disease on 3
different mechanisms:
1. Pyogenic inflammation –> generation of pus
2. Exotoxin production –> a toxin generated by
bacteria
3. Immunologic response –> when antibodies
of an individual cross react with tissue
Pyogenic inflammation
• Pharyngitis
• Cellulitis
• Impetigo (honey-crusted lesions)
• Erysipelas
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 BACTE LEC – MIDTERMS

Streptococcal pharyngitis

• 15-30% of pharyngitis are due to strep pyogenes

bacteria, while other cause of pharyngitis are
because of viral infections
• How?
• Bacteria adhere to pharyngeal epithelium via
pili
• Pili are composed of lipoteichoic acid and M
protein
• Most common bacterial

Toxigenic

• When they invade the deeper layer of tissue

GAS now can induce Scarlet fever and
Necrotizing fasciitis

Scarlet fever

• This is rash followed by pharyngitis

• Skin reaction to erythrogenic

Toxic Shock Like Syndrome

• This is due to release of pyrogenic exotoxin A

• The SPEs act as superantigens, activating
macrophages and T-helper cells and inducing the
release of powerful immune mediators,
including interleukin (IL) – 1, IL – 2, IL – 6, tumor
necrosis factor (TNF) – alpha, TNF – beta,
interferons, and cytokines, which includes shock
and organ failure.
• Streptococcal toxic shock syndrome, typified by
multisystem involvement including renal and
respiratory failure, rash, and diarrhea, is a
serious disease mediated by production of
potent SPE.

= RABG = 6