Gram Positive Cocci

1. Staphylococci
• Staphylococci: Staphylococci are Gram-positive
cocci that tend to be arranged in grape-like
clusters.
• They are non-flagellate, non-motile, and non-
spore-forming.
• Staphylococci grow best aerobically but are
facultatively anaerobic.
• In contrast to streptococci, staphylococci
produce catalase.
 Cont…
• Many species of staphylococci colonize
humans; of these, three are of major medical
importance:
– Staphylococcus aureus (S. aureus,)
– Staphylococcus epidermidis (S. epidermidis,) and
– Staphylococcus saprophyticus (S. saprophyticus)
 Cont…
• S. aureus is
- Catalase and coagulase positive
- Gram positive cocci
- Coagulase is plasma clotting protein produced
by pathogenic S. aureus.
• S. aureus colonizes the nasal passage and axillae.
• Transmission
– Is person to person through direct contact
– Exposure to contaminated fomite
 Cont…

• Pathogenesis
• S. aureus expresses many potential virulence factors;
– Surface proteins that promote colonization of host tissues
– Toxins that damage host tissues and cause disease
symptoms.
• S. aureus causes
– Superficial (skin) infection that includes impetigo,
abscess, boils.
-- Gastrointestinal tract disease –food poisoning.
Enterotoxins secreted by some strains
-- Deep infection eg. Osteomyelitis (inflammation of bone)
septicemia
--causes bacterial endocarditis, usually acute,
 Cont…
• Exfoliatins produced by phage group II
S. aureus cause surface cell layers of the skin to
separate; leading to desquamation.
• Protein A (a surface protein) is anti-phagocytic
(binding to the Fc portion of antibody, making
it unavailable to attach to phagocytes).
• Lab. Dx – Specimen:- pus from lesions
• Gram staining :- which show pus cells and
Gram positive cocci in cluster.
• Culture:- grow on b/d agar chocolate (heated
blood) agar. Grow on mannitol salt agar.
 Cont…
• Staphylocuccus epidermidis
S. epidemidis :- It is catalase positive
- coagulase negative cocci
• Infection caused by S .epidermidis is hospital acquired
urinary tract infection(UTI).
• Bacterial endocarditis
• sensitive to novobiocin
• S. saprophyticus:- Catalase positive
• - coagulase negative cocci
• It is a pathogen causing acute urinary tract infection.
• The most common cause of cystitis (inflammation of
bladder)
 2. Streptococci

• Streptococci are catalase negative, Gram

positive, non-sporing cocci
• The streptococci will be considered as follows:
1. pyogenic streptococci (Lancefield groups);
2. pneumococci;
3. viridans and other streptococci
 1. Pyogenic streptococci (Lancefield
groups);
• Pyogenic streptococci usually are pathogens
and associated with pus formation (pyogenic
means pus producing).
• Most species produce Beta-hemolysis on
blood agar and form chains of cells.
• Of these, groups A (S. pyogenes) and B (S.
agalactiae) are the most frequent causes of
serious disease.
 Cont…

i) Streptococcus pyogens (S. pyogenes)

• - They are gram positive cocci
• - Occurring in chain of varying length.
• S. pyogenes produce several exotoxins and enzymes
which contribute to its pathogencity and identification.
• e.g hemolysins & hyaluronidase)
• S. pyogenes produces two types of Streptolysins (toxins
that haemolyze red cells): Streptolysin O (SLO) and
streptolysin S (SLS),
• Streptolysin 'O' hemolyzes RBC and stimulates the
production of anti streptolysin 'O' (ASO) antibody that
can be measured in pt's serum.
 Cont…
Pathogenecity
• Tonsillitis and pharyngitis:- the main site of streptococcal
infection is throat where purulent tonsillitis is the most
typical lesion.
• Impetigo highly contagious skin disease.
• There is considerable evidence that S. pyogenes is the cause
of acute rheumatic fever(ARF) involving the heart and joints
• Streptococcal cell wall antigens->antibodies; antibodies
cross-react with cardiomyocytes-> Arthritis, scarring of heart
valves, myocarditis
• Transmission is person to person from the large droplets
produced by infected persons during coughing, sneezing, or
even conversation.
 Cont…
• Lab. Dx
• Serology:- examination of serum for a rising
titer of ASO antibody.
• Specimen:- include a throat swab or swabs of
pus and serous fluid.
• Biochemical test
• Catalase negative and insoluble in bile salt
unlike S. pneumoniae.
 Cont…
• ii) Streptococci agalactae (S. agalactae)
• S. agalactae causes septic abortion and puerperal
sepsis.
• It forms part of the normal flora of the female
genital tract.
• Lab dx
• Culture:- It shows B-hemolytic reaction on blood
agar.
• CAMP (Christie, Atkins, and Munch, Peterson) test
 2. Pneumococci
• This category contains a single species, S.
pneumoniae, commonly called the
pneumococcus.
• Its distinctive feature is the presence of a
capsule composed of polysaccharide polymers
that vary in antigenic specificity.
• It is Gram positive cocci occur in pair (diplococcic) or
chains.
• It shows a lancet shape and is surrounded by a capsule.
It is alph-hemolytic
• Pathogenesis
• S. pneumoniae causes pneumonia, bronchitis,
meningitis, otitis media.
• Lab. Dx : Gram staining
• Specimen:- sputum, Exudates, blood depending on the
site of infection.
• Biochemical tests.
• Catalase negative
• Bile soluble test
 3. Viridans and Other Streptococci
• Viridans streptococci are alpha-hemolytic and lack both
the group carbohydrate antigens of the pyogenic
streptococci and the capsular polysaccharides of the
pneumococcus.
• The term encompasses several species, including S.
salivarius and S. mitis.
• Viridans streptococci comprise members of the normal
oral flora of humans.
• On access to the blood stream, these organisms are the
most frequent cause of subacute bacterial endocarditis
• Viridans streptococci are a major cause of dental
caries.
 Gram Positive rods

• 1. Bacillus
• The genus bacillus comprises more than 50
spp. But only 2 species are medically
important to cause human and animal disease
• These are B. anthrasis
B. cereus
• B. anthracis
• is large Gram-positive, catalase positive, non-
motile spore-forming bacilli.
• Used as Bioterrorism->Biological weapon.
 Cont…
• Pathogenicity
• B. antracis causes anthrax which is mainly a disease of
sheep, cattle, goats and other herbivores with humans
becoming infected after contact with infected animals or
their skins.
• Animals become infected by ingesting B.anthracis when
feeding.
• Depending on the source and site of infection,
B. antracis can cause:-
• Cutaneous anthrax:- bacillus enter damaged skin
producing blister.
• Pulmonarly anthrax :- caused by inhaling large no. of
B.anthracis spore.
• Enteric anthrax: - due to ingesting infected meat.
 Bacillus anthraces
Clinical findings
– Skin infection (malignant pustule)
– Mediastintis, sepsis, meningitis
– Hemorrhagic pulmonary edema
– Hemorrhagic pneumonia
 Cont…
• Lab dx
• Specimen: fluid aspirated from cutaneous
lesion, sputum
• Gram staining – Gram positive appearing
joined end to end in chains.
 Cont…
• Bacillus cereus
• Motile
• Beta-haemolysis on blood agar
• Pathogencity
• It causes food poisoning by producing
enterotoxins characterized by diarrhea,
abdominal clamp, vomiting
 Clostridium
• The genus clostridium is anaerobic
• Gram positive spore forming bacilli
• The main species of medical important are
– Clostridium perfrengens
– " tetani
– " botulinum
C. Perfrengens.
• Non- motile capsulated rod shape bacteria
• Pathogenicity
• Clostridium perfrengens type 'A' causes gas
gangrene, food poisoning.
 Cont…
• Gas gangrene – Under anaerobic condition C.
perfregens multiply and produces alpha toxin which
results in the rapid destruction of tissue carbohydrate
with the production of gas in decaying tissue.
• C. perfringens is the most common cause, and its
alpha -toxin produces the spreading tissue damage
and muscle death.
• Lab dx
• Specimen – material from wounds, necrotic tissue, to
investigate gas gangrene and faeces to investigate
food poisoning.
 Cont…
• Clostridium botulinum
• Pathogenicity
• C. botuIinum causes a rare and usually fatal food borne
disease called botulism in which a lethal performed
neurotoxin is ingested.
• The toxin causes paralysis
• Antitoxin needs to be administered to neutralize.
• Lab. Dx
– Suspected food and faeces.
– Gram reaction – Gram positive rod.
– Culture – Strict anaerobe
• - on b/d agar beta hemolytic colonies
 Cont…
Clostridium tetani (C. tetani)
• Gram positive, non-capsulate rod that forms spores
• Most strains are motile
Transmission
• The infection is initiated as a result of contamination of a
wound(skin) with C. tetani.
• The anaerobic tissue environment facilitates C. tetani
replication and secretion of exotoxins.
• Host defenses are essentially absent for clostridial
infection .
• There is little, if any, innate immunity and the disease
does not produce immunity in the patient.
• Active immunity follows vaccination with tetanus toxoid.
Pathogenicity
• C. tetani causes tetanus serious often fatal disease caused by the
neurotoxin (exotoxins)
• Tetanus results from trauma or a puncture wound leading to
tissue contamination.
• The toxin causes muscular rigidity and spasm difficult in opening
the jaw (lock jaw).
Prevention
• Injections of tetanus toxoid(TT) are prophylactic.
• Tetanus Anti Toxin(TAT) after exposure
• Lab dx.
• Most patients can be diagnosed clinically.
• Specimen – exudates from wounds.
• Gram staining: - Gram positive rod with round unstained spore
at one end.
 Corynebacterium

Corynebacterium
• Are gram – positive non-sporing rods.
• Non- motile, non-capsulated, grow best
aerobically
• Corynebacterium diphtheriae is the principal
human pathogen.
• C. diphtheriae is transmitted by droplet spread,
by direct contact with cutaneous infections, and,
to a lesser extent, by fomites.
 Cont..
• Pathogencity
• It causes nasal, nasopharyngeal and tonsillar
diphtheria.
• C. diphtheriae produces a powerful exotoxin
that is absorbed through the damaged
membranedifficulty in breathing
• Lab. Dx
• Specimen :-throat and nasopharyngeal swabs.
• Gram staining:- Gram positive rods.
 Gram negative cocci
(Neisseria)
• Neisseria are Gram-negative cocci that typically
appear in pairs.
• They are non-motile, non-spore forming.
• Important species include
– Neisseria meningitidis ( meningococci)
– Neisseria gonorrhoeae (Gonococci)
• The structural elements of N. meningitidis and N.
gonorrhoeae are the same, except that the
meningococcus has a polysaccharide capsule
external to the cell wall.
Neisseria meningitidis ( meningococci)

• It is gram –ve, non motile, non-sporing diplococci

• Occurs as a commensal in the nasopharynx.
• Pathogenicity
• N. menigitidis causes purulent meningitis often
has sudden onset with sever headache, vomiting
and stiff neck.
• N. meningitides a major cause of epidemic and
endemic meningitis.
• It also causes meningococcal septicaemia and
chronic meningococcal arthritis.
 Cont…
• EPIDEMIOLOGY
• Meningococci are found in the nasopharyngeal
flora of approximately 10% of healthy
individuals.
• Transmission occurs by inhalation of
aerosolized respiratory droplets.
• Close, prolonged contact such as occurs in
families and closed populations promotes
transmission.
 Cont…
• Lab. Dx.
• Specimen – cerebrospinal fluid (CSF), blood for
culture.
• Gram reaction – Gram negative intracellular
diplococci
• - Culture – aerobic primarily growing best in a
moist CO2 enriched atmosphere.
• N. meningitidis produces transparent, grey
colonies on CO2 enriched chocolate agar.
 Neisseria gonorrhoeae (gonococcus)

• N. gonorrhoeae is gram negative non-motile

diplococci
Pathogenicity
• N. gonorrhea causes gonorrhea.
• Infection is sexually acquired by direct genital
contact, and the primary manifestation is pain
and purulent discharge at the infected site.
• It can also cause conjunctivitis of new born.
• N. gonorrhea is exclusively a human pathogen
never found as commensal.
 Cont…
• Lab. Dx.
• Specimen
– Women – cervical discharge.
– Men – urethral discharge
– Infants – eye discharge.