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Streptococcus Pyogenes

Streptococcus pyogenes -classification, morphology, cultural characteristics,lab diagnosis ( microbiology )

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nshree155
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74 views

Streptococcus Pyogenes

Streptococcus pyogenes -classification, morphology, cultural characteristics,lab diagnosis ( microbiology )

Uploaded by

nshree155
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Streptococcus pyogenes

Classification
Introduction
• Streptococci (streptos, twisted or coiled)

• Normal flora of humans upper respiratory tract and animals

• Some of them may be pathogens e.g. Streptococcus pyogenes


causing pyogenic infections with a tendency to spread
unlike staphylococcal infections

• It produces non-suppurative lesions, acute rheumatic fever


and glomerulonephritis which occur as sequelae to infection
Morphology

• Ovoid to spherical in shape


• Gram-positive cocci arranged in chains or pairs
• Chain formation is due to the cocci dividing in one
plane only and the daughter cells failing to separate
completely
• Chains are longer in liquid than in solid media
• Non motile and non-sporing
• Capsulated (hyaluronic acid)
• Group A b-hemolytic streptococci
Gram staining of
Streptococcus pyogenes
Cultural characteristics

• Aerobes and facultative anaerobes


• Optimum temperature: 37C
• Growth occurs only in media containing
fermentable carbohydrates or enriched with blood
or serum
i. Blood agar:
• Small (0.5-1mm), circular, semi-
transparent colonies
• Produce wide zone of β- hemolysis
• Growth and hemolysis are promoted by 5-
10% CO2
• Virulent strains, on fresh isolation form lesions, produce a
‘matt’ (finely granular) colony while avirulent strains form
‘glossy’ colonies
• Mucoid colonies are formed by strains that produce large
capsules

ii. Liquid media:


• Glucose or serum broth
• Growth occurs as a granular turbidity with a powdery deposit
• No pellicle is formed
Biochemical reactions
• Catalase negative

• Bile insoluble

• Ferments sugars producing acid but no gas

• PYR test positive

• Hydrolyse pyrrolidonyl-beta-napthylamide (PYR) due to presence

of peptidase, the resulting napthylamide produces a red colour


upon the addition of 0.01% cinnamaldehyde reagent
• Faliure to ferment ribose
Overview of reactions sensitive to
S. pyogenes
Antigenic structure
Proteins
Toxins and enzymes

1. Hemolysins (Streptolysins)
2. Erythrogenic toxin
3. Streptokinase (Fibrinolysin)
4. Deoxyribonucleases (Streptodornase, DNAase)
5. Hyaluronidase
Pathogenicity
 Produces pyrogenic infection with a tendency to
spread locally, along lymphatics and through blood
stream

 Disease caused can be:

 Suppurative or

 Non suppurative
Pathogenicity
Pathogenicity
Suppurative complications

1. Respiratory infections
 Primary site of invasion is throat causing sore throat
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
 Otitis media
 Meningitis(rare)
2. Skin and soft tissue infection

• Include infections of wounds or burns, with a predilection


to produce lymphangitis and cellulitis
• Infection of minor abrasions may lead to fatal septicemia
• S. pyogenes is also known as ‘flesh eating bacteria’ -
extensive necrosis of subcutaneous and muscular tissue
and adjacent fascia – causes Toxic shock like syndrome
a) Impetigo (Pyoderma)
 Pyo-purulent and derma-skin
 Caused by higher numbered M types S. pyrogen
 Superficial discrete crushed spot of less than one inch
in diameter seen in children
 Lasts for 1-2 weeks and heals spontaneously without
any scars
3. Genital infection
 Both aerobic and anaerobic Streptococci are normal habitat
of female genitalia
 Causes puerperal sepsis with exogenous infection
 Puerperal fever is caused due to endogenous infection
with anaerobic Streptococci

 Other suppurative infections: Abscesses in brain,


lungs, kidney and liver causing septicemia and pyemia
Non suppurative complications

 After a latent period of 1-4 weeks


 Followed by rheumatic fever and acute glomerulonephritis
a) Rheumatic fever

• Complication of S.pyogenes pharyngitis due to specific M


protein types
• Characterized by aschoff nodules (sub cutaneous nodule)
• Causes inflammatory myocardial lesion of connective
tissue degeneration of heart valves
• Results in chronic and progressive damage to heart
valves.
b) Glomerulonephritis
• Caused by specific nephritogenic strains of group A
streptococcus
• Characterized by acute inflammation of renal
glomeruli with edema, hypertension, hematuria and
proteinuria
• Progressive, irreversible loss of renal function in
young is
common
Laboratory Diagnosis

a. Throat swab culture: Detection of group A antigen


b. Specific nucleic acid based test

1. Specimen:
 Throat swab, pus swab or exudates are collected.
2. Microscopy:
 Gram-staining of pus can be examined
 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 medium.

 The specimen should be plated on blood agar and


incubated at 37˚C anaerobically or under 5-10% CO2 ,as
hemolysis develops better.
4. Identification:

 Rapid diagnostic test kits are available for the detection


of streptococcal group A antigen from throat swab

 Bacitracin sensitivity:
 Based on Maxted’s observation that they are more sensitive
to bacitracin than other streptococci
 A filter paper disc of 0.04U is applied on the surface of an
inoculated blood agar
 After incubation, a wide zone of inhibition is seen with
S.pyrogenes but not with other streptococci
Treatment
Penicillin – Streptococcal pharyngitis
Oral Cephalosporin for penicillin sensitive patients

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