MICROBIOLOGY UNIT NO.

STREPTOCOCCUS

• Streptococcus is a genus comprising of Gram-Positive cocci having an important place

in industry and medicine.
• They form a part of normal flora and some are pathogenic and cause various types of
diseases.

Morphology

• Gram positive cocci

• Arranged in chains and arrangement is so because streptococci divide in one plane
without separating.
• Non motile and non sporing

Classification of streptococci

• Streptococci are divided into two types based on need of oxygen. i.e. Aerobic and
Anaerobic
• Further classification done based on growth on the blood agar into three types
1. α-hemolytic: in this partial breakdown of RBCs and produces greenish coloration when
grows on blood agar and are known as viridans group. These organisms lives as non
pathogens in normal flora of throat and can turn opportunistic pathogens.
2. β-hemolytic: Complete lysis of RBCs. A clear zone of hemolysis is formed around
colony. Pathogenic streptococci comes under this group.

PREPARED BY: MR. SHIVARAJ KUMBAR, ASSOCIATE PROFESSOR, GIMS GOVERNMENT COLLEGE OF NURSING, GADAG 1
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3. γ-hemolytic: These are non hemolytic Enterococcus faecalis which is present in faeces
belongs to this group.
Further serotyping is done by lancefield technique, in which group specific
carbohydrate present in the cell wall is a basis for serotyping β-hemolytic streptococci
to 21 serological groups from A to W without I and J.
Most of the pathogenic hemolytic streptococci belongs to group A. These
groups can be further classified on the basis of protein antigens M. T and R present on
the cell surface. This is known as Griffth typing. There are more than 100 subtypes of
streptococcus pyogens.

PREPARED BY: MR. SHIVARAJ KUMBAR, ASSOCIATE PROFESSOR, GIMS GOVERNMENT COLLEGE OF NURSING, GADAG 2
 MICROBIOLOGY UNIT NO. 3

Cultural Characteristics:

• These are aerobes but most of the species are facultative anaerobe
• Needs enriched medium with blood or Serum
• Small, circular and low convex disk like colonies appear on incubation at 370 C on
blood agar
• Colonies are surrounded by clear zone of β-hemolysis

Pathogenicity:

• Mode of infection is through inhalation of droplets

• Even direct contact with the objects contaminated with respiratory secretions can infect
the person
• The diseases caused by streptococcus pyogens are

A. Suppurative Infections
1. Respiratory Infections:
• Throat infection or pharyngitis and laryngitis
• Scarlet fever
2. Skin infections:
• Impetigo
• Acute spreading skin lesion
• Cellulitis
• Puerperal sepsis

PREPARED BY: MR. SHIVARAJ KUMBAR, ASSOCIATE PROFESSOR, GIMS GOVERNMENT COLLEGE OF NURSING, GADAG 3
 MICROBIOLOGY UNIT NO. 3

Throat Infection

Skin rash and strawberry tongue in scarlet fever

Cellulitis

B. Non suppurative infections:

• Sinusitis
• The infection of middle ear
• Acute rheumatic heart fever
• Acute glomerulonephritis

PREPARED BY: MR. SHIVARAJ KUMBAR, ASSOCIATE PROFESSOR, GIMS GOVERNMENT COLLEGE OF NURSING, GADAG 4
 MICROBIOLOGY UNIT NO. 3

Laboratory Diagnosis:

• Samples can be collected from the site of infection like throat swab, sputum,
nasopharyngeal swab, blood and CSF
• Streptococci can be visualized in gram stained smear as gram positive cocci arranged
in chains.
• The organism can be isolated from clinical samples by inoculating on blood agar having
sheep blood as a source of enrichment. Incubation at 37 degree C overnight results in
colonies that are pinpoint, convex, dry and surrounded by a clear zone of β-hemolysis
• Dick Test / Skin Test: It is laboratory test that is done to know the immune status of a
patient for scarlet fever. This test was introduced by George Dick and Gladys Dick in
1920.
To perform the Dick test, 0.2ml of toxin derived from a culture of scarlet fever
is injected in one forearm of a person and similar amount of heat inactivated or
neutralized toxin is injected in another forearm.
If bright red rash appears in the forearm injected with toxin within 6 – 24 hours,
it indicates that the person is susceptible to scarlet fever. There will be no reaction in
control arm.
• Counter immunoelectrophorosis and optical electrophoresis are among the modern
days tests being used for quick diagnosis of streptococcal infections.

Treatment:

• Streptococci show resistance worldwide. The drug of choice is Penicilline G. If the

person is allergic to penicillin then erythromycin may be given.
• Other antibiotics used are methicillin, naficillin, dicloxacillin and oxacillin
• In case of the patient with rheumatic heart disease, prophylactic measure must be taken
before undergoing any surgical procedure.
• Antibiotics have no effect once glomerulonephritis occurs.

Nursing Interventions:

• Patient should be given prescribed antibiotics

• Patient is advised to gargle with tolerably hot saline water

PREPARED BY: MR. SHIVARAJ KUMBAR, ASSOCIATE PROFESSOR, GIMS GOVERNMENT COLLEGE OF NURSING, GADAG 5
 MICROBIOLOGY UNIT NO. 3

• Educate patient o apply ice callor incase of severe throat infection and to take soft and
liquid diet.
• Encourage good mouth care.
• Avoid spicy and junk food

STREPTOCOCCUS PNEUMONIAE

• George Sternberg and Louis Pasteur independently isolated this organism in 1881.
• It was named as Pneumococcus in 1886 because it causes Pneumonia.
• In 1920 it was named as diplococcus pneumoniae and in 1974 it was again named as
streptococcus pneumoniae due to similarities with streptococci.
• S.pneumoniae is normal inhabitant of the respiratory tract but can cause pneumonia.
• S.pneumoniae is main prevailing organism in pneumonia and otitis media in children.

Morphology:

• These are gram positive diplococci

• Arranged in pairs having broad ends opposite to each other and pointed ends away from
each other.
• They appear as flame shaped
• The pairs of cocci are enclosed in a capsule made up of polysaccharide that can be seen
as a clear halo around pairs of cocci by Indian Ink staining method.

Cultural Characteristics

• They are aerobes and facultative anaerobes

• Grow at 37 degree C and pH 7.6
• They are α-hemolytic

PREPARED BY: MR. SHIVARAJ KUMBAR, ASSOCIATE PROFESSOR, GIMS GOVERNMENT COLLEGE OF NURSING, GADAG 6
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• Enriched medium is required to grow these cocci like blood agar on which small
colonies with green discolouration α-hemolysis are formed after overnight incubation.
• Capsule protects the cocci from phagocytosis and act as virulence factor

Pathogenicity:

• The organism causes sinusitis, meningitis, pneumonia, bronchitis and bacteremia.

• Virulence is due to polysaccharide capsule, which protects the organism against
phagocytosis.
• The organisms get attached to nasopharyngeal cells, migrate to the peribronchial
lymphatics through bronchial mucosa
• Inflammation occurs in alveoli and due to outpouring of fibrinous fluid, the lungs get
consolidated and this led to respiratory illness like lobar pneumonia and
bronchopneumonia
• The direct infection to paranasal sinus and middle ear could be cause leading to otitis
media and sinusitis
• Blood may take infection to meninges and cause meningitis which is most serious
condition.

PREPARED BY: MR. SHIVARAJ KUMBAR, ASSOCIATE PROFESSOR, GIMS GOVERNMENT COLLEGE OF NURSING, GADAG 7
 MICROBIOLOGY UNIT NO. 3

Lab Diagnosis:

• Sample can be collected from exudates, sputum blood or CSF

• The organism can be observed under microscope by doing gram staining of the sample.
• The capsule is seen with the help of India ink preparation as a clear halo
• Inoculation in blood agar at 37 degree C produces colonies with alpha hemolysis
• Serological tests include agglutination and co-agglutination tests.

Treatment and prevention:

• The infection is most common in persons with weak immune system, diabetic and
elderly people.
• Penicillin and sulfonamide are drug of choice. Vancomycin is also used and is effective
too.
• In meningeal infections cephalosporins are given.
• Pneumococcal vaccine is being used in many countries and it is successful
• Pneumococcal vaccine 0.5ml is administered intramuscularly (IM) to the recipient
• The Age for first dose of vaccine administration could be 6 weeks to 65 years.
Generally, it is given in three doses starting at the age of 2 months, second dose at the
age of 4 months and third at 6 months.
• The vaccine gives protection for 5 to 10 years.

PREPARED BY: MR. SHIVARAJ KUMBAR, ASSOCIATE PROFESSOR, GIMS GOVERNMENT COLLEGE OF NURSING, GADAG 8