Chapter 15 STREPTOCOCCI

Clinical Significant Species: General Characteristics

 S. pyogenes (Grp A)  Aerotolerant anaerobes

 S. agalactiae (Grp B)  Some are capnophilic
 Group C & G Strep  Non motile
 S. pneumoniae  All Cocci are gram-positive
 Viridans streptococci
 Enterococcus
 Streptococcus Like Organism (SLO)

Grouping of Strep (Table 15-2 p.331)

Lancefield group – based on carbohydrate antigen, found on their cell wall.

Lancefield group – by Rebecca Lancefield
Hemolytic pathway – based on BAP

Streptococcus pyogenes
General properties
 Local/Systemic invasion and poststreptococcal immunologic disorder
 Penicillin-sensitive

- S. pyogenes: flesh eating bacteria

- Disease: Erysipelas, scarlet fever, tonsillitis
- Erysipeloid: Erysipelothrix rhusiopathiae
- Penicillin: acts on the cell wall of bacteria
- -lactams: targets transpeptidation of the cell wall
Virulence factors
1. Streptokines (fibrinolysin)
 Transforms plasminogen to plasmin
2. Hyaluronidase
 Spreading factor
 Prevents opsonized phagocytosis
3. Pyrogenic exotoxin A-C (Erythrogenic toxin)
 Scarlet Fever & Streptococcal TSS (Toxic Shock Syndrome)
4. M Protein
 Antiphagocytic
5. Protein F (Fibronectin-binding protein)
 Mediates adherence to host epithelial cells
6. SLO
 O2 labile
 Subsurface hemolysin
 immunogenic
7. SLS
 O2 stable
 Surface hemolysin
 non-immunogenic
8. Lipoteichoic acid
 Mediates attachment to mucosal cells
9. Streptodornase (DNases)
 Degrade host DNA (DNAse and RNA)

- Opsonization: enhance the phagocytosis

- Pyro: fire

Clinical infestations
 Bacterial Pharyngitis & Tonsilitis
 Necrotizing fasciitis
 TSS
 Post Streptococcal Sequelae
 Most Serious: Rheumatic Fever)
 Pyodermal infections
 Impetigo
 Superficial and localized skin infection
 Most common pyoderm disease
 Erysipelas
 Fiery red, advancing erythema on face & lower neck
 Puerperal fever
  Septicemia originating in the infected wound following childbirth
 Scarlet fever
 Pharyngitis & diffuse rash (chest, toe, extremities)

- Post Streptococcal Sequelae: can lead to heart disease, acute glomerulonephritis, rheumatic heart fever
- Enteric fever: Salmonella typhi

Lab diagnosis
 Taxo A/Bacitracin susceptible
 ASO (Anti- streptolysin O)
 Serologic test
 Principle: Latex agglutination
 (+) result: agglutination

Streptococcus agalactiae
 Often isolated from:
 Oral cavity
 Intestinal tract
 Vagina
 Newborns
 Significant cause of invasive disease in newborns

Virulence factors
 Capsular material interferes with phagocytic activity and complement cascade action
Stain (Capsule): India ink
Clinical infestations
 Vertical Transmission (mother-to-newborn)
 Neonatal sepsis & meningitis
Lab diagnosis
 CAMP (Christie, Atkins Munch-Peterson) test
 (+) result: arrowhead hemolysis
 Treatment:
Penicillin (DOC)
- S. aureus in CAMP: produce -lysin
Group C & G Strep
 S. dysaglactiae subsp, Equisimilis
 Large-colony forming β-hemolytic isolates
 S. anginosus grp
 Small colony forming β-hemolytic isolates
S. pneumoniae
 Nonmotile
 Encapsulated
 Capnophilic
 Fastidious cocci
 Normal inhabitants of URT
 Alpha-hemolytic, “crater-like” colony
 G (+) diploccoci, Cat (-)
 Lancet shaped
 Common name: Pneumococcus
- G (-) diploccoci: Neisseria gonorrhea
Virulence factors
 Polysaccharide capsule
 Anti-phagocytic property
 IgA protease
 Inactivates IgA abs.
 Autolysin
 Release of intracellular virulence factor
 Pneumolysin
 Ability to lyse mammalian cell membrane
Clinical infestations
 Bacterial pneumonia
 aka primary lobar pneumonia
 Community acquired pneumonia
 Meningitis
 Otitis Media (ear infection in children)
 Bacteremia
- Reiter's disease: staph. aureus
- Taxo N: novobiocin

Lab diagnosis
 Neufeld reaction/ Quellung test
 (+) Quellung: capsular swelling
 Taxo-P/ Optochin
 Reagent: ethyl hydrocupreine hydrochloric acid
 Media: BAP
 Incubation:
o 35C
o 18-24 hrs
o 5% CO2
  Susceptible: > 14 mm zone of inhibition
 Bile solubility
Treatment:
 Penicllin
 Vancomycin
Vaccine:
 PCV7
 PCV13 (routine vaccination)
 PS23 (23-valent vaccine)
- Disease of S. pneumoniae: primary lobar pneumonia

Viridans strepytococci/ Anginosus grp

 Normal flora of oral cavity
 Other -streptococcus
 SABE (Sub-acute Bacterial Endocarditis)
 flu-like symptoms, joint pain, salmon colored urine
Virulence factors
 Polysaccaharide capsule
 Dextran
 Adhesin
Associated disease
 Non-pathogenic, normal flora
 SABE
 Bacteremia & septicemia
 Gingivitis & dental caries
MR-VP Test (methyl red-Voges-Proskauer) Test
 Principle: detects acetoin production from glucose
 Reagents:
 5% alpha naphtol
 40% KOH
 (+) result: Red/pink color

Enterococcus
 Normal flora in GIT & oral cavity
 Causes nosocomial infection due to multiple antibiotic resistance
Virulence factors
 Adhesin
 Serine protease Colonization of species and adherence
 Gelatinase
- uncinariasis: Necator americanus
- oxyuriasis: Enterobius vermicularis
Associated disease
 Nosocomial infection
 UTI
 Bacteremia
 Endocarditis
Lab diagnosis
 Growth in 40% bile & 6.5% salt

Bile Esculin Test

 To isolate and identify bacteria able to hydrolyze esculin in the presence of bile
 Bile esculin azide agar uses Na+ azide to inhibit G (-)
 Indicator: Ferric citrate
 (+) color: black
 (+) org: Enterococcus faecalis
Treatment
 Synergistic response when treated with penicillin and an aminoglycoside
 Vancomycin and erythromycin

- Cystine tellurite blood agar: for Clostridium diphtheriae

Trimethoprim/sulfamethoxazole
 1.25 g
 (+): All (except Grp A or B and C, F, G)
 (-): Group A & B

Hippurate Hydrolysis
 Test for ability to hydrolyze hippuric acid (Sodium hippurate) to benzoic acid & glycine
 Glycine can be detected with Ninhydrin reagent
 (+):deep blue (purple) – group B [S. agalactiae]
 (-): colorless or very slight purple - group A [S. pyogenes]

PYR Test
 Tests for the ability of the organism to hydrolyze the substrate L-pyrrolidonyl-B-napththylamide
 (+): cherry red [S. pyogenes (group A) and Enterococcus]
 (-): Group D Non-enterococcus

Lap test
 Test for the ability to hydrolyze Leucine-β-napthylamide by enzyme leucine aminopeptidase to
β-napthylamide
  Reagent: Cinnamaldehyde reagent
 (+): Red Color (w/in 1 min); [S. pneumonia, S. pyogenes, Enterococcus, Pediococcus]
 (-): No color change/ Slightly yellow color [Aerococcus, Leuconostoc]

Salt Tolerance Test (6.5%)

 Test for ability to grow in 6.5% NaCl
 (+): Visible turbidity & color change [Grp D Enterococcus]
 (-): Lack of growth, no color change [Group D Non Enterococcus]

Bile Solubility Test

 Test for solubility to bile salt (2% Na+ desoxycholate or Na+ taurocholate)
 (+):Disintegrate [S. pneumonia]
 (-): Intact colonies [Other α-hemolytic strep.]