COURSE CODE: 318

Ms. Ammara Arshad

Microbiology - II
Spring_2025

REFERENCE TEXT BOOK:

Warren Levinson.
Lange: Review of Medical Microbiology and Immu
nology
: Thirteen edition
Streptococci
 Classification of Streptococci
• According to:
– Oxygen requirement
• Anaerobic (Peptostreptococcus)
• Aerobic or facultative anaerobic
(Streptococci)
– Hemolysis on Blood Agar- α, β, Ƴ
– Lancefield classification- for β hemolytic
streptococci, based on C antigen
Identification on the basis
of Haemolysis
 Hemolysis on Blood Agar
– -hemolysis
Partial hemolysis
Green discoloration around colonies
e.g. S. pneumoniae & S. viridans
– -hemolysis
Complete hemolysis
Clear zone of hemolysis around colonies
e.g. Lancefield Group A & B (S. pyogenes &
S. agalactiae)
– -hemolysis
No hemolysis
e.g. Group D (Enterococcus sp.)
HEMOLYSIS ON BLOOD AGAR

-hemolysis

-hemolysis

-hemolysis
Identification : Lancefield groups
- carbohydrate antigens

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 Lancefield Classification- β hemolytic
B-haemolytic Streptococci

Lanciefield classification

Group A Group B Group C Group D Other groups

S. pyogenes S. agalactiae S. equisimitis Enterococcus (E-U)

• Classification based on C- carbohydrate antigen of cell wall

• 20 Lancefield groups from A-H & K-U
• One or more species per group
• Group A- Further subdivided based on M, T, R protein (Griffith
typing) into 80 serotypes
 streptococci

• A, B and D
– Frequently disease causing
• C, G, F
– less frequently disease causing

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STREPTOCOCCI:GRO
UP A, B AND
STREPT.VIRIDANS
 GAS
• S. pyogenes is found on the skin and in the

oropharynx in small numbers

• Cause skin infections &pharyngitis

• Group A streptococci (S. pyogenes) cause
disease by three mechanisms:
 Pyogenic inflammation (which is induced locally at the
site of the organisms in tissue)
 EXOTOXIN PRODUCTION (which can cause
widespread systemic symptoms in areas of the body where
there are no organisms)
 Immunologic (which occurs when antibody against a
component of the organism cross-reacts with normal
tissue or forms immune complexes that damage normal
tissue )
CLINICAL FEATURES
 S. pyogenes
1. PHARYNGITIS
– Most common bacterial cause of pharyngitis (sore
throat).
– Throat pain and fever. On examination, an inflamed
throat and tonsils, often with a yellowish exudate, are
found, accompanied by tender cervical lymph nodes.
– If untreated, spontaneous recovery often occurs in 10
days, but rheumatic fever may occur.
2. SCARLET FEVER
– A “strawberry” tongue is a characteristic lesion seen in
scarlet fever.
 S. pyogenes
3. SKIN AND SOFT TISSUE INFECTIONS –
cellulitis, necrotizing fasciitis (streptococcal
gangrene), and impetigo. Impetigo, a form of
pyoderma, is a superficial skin infection
characterized by “honey-colored” crusted
lesions.
4. ENDOMETRITIS – a serious infection of pregnant
women, and sepsis
 S. pyogenes
5. TOXIC SHOCK SYNDROME

– Has clinical findings similar to those of

staphylococcal toxic shock syndrome.
– However, streptococcal toxic shock syndrome
typically has a recognizable site of pyogenic
inflammation and blood cultures are often
positive.
 S. pyogenes
6. ACUTE GLOMERULONEPHRITIS (AGN)
– Occurs 2 to 3 weeks after skin infection by certain group A
streptococcal types in children
– AGN is more frequent after skin infections
– The most striking clinical features are hypertension,
edema of the face (especially periorbital edema) and
ankles, and “smoky” urine (due to red cells in the urine)
– The disease is initiated by antigen–antibody complexes on
the glomerular basement membrane, and soluble antigens
from streptococcal membranes may be the inciting antigen
 S. pyogenes
7. ACUTE RHEUMATIC FEVER
– Approximately 2 weeks after a group A streptococcal
infection—usually pharyngitis — rheumatic fever,
characterized by fever, migratory polyarthritis, and carditis,
may develop
– ASO titers are elevated
– Rheumatic fever is due to an immunologic reaction
between cross-reacting antibodies to certain streptococcal
M proteins and antigens of joint, heart, and brain tissue
– It is an autoimmune disease, greatly exacerbated by
recurrence of streptococcal infections
• Inflamation related enzymes:
1. Hyaluronidase (spreading factor)
2. Streptokinase (fibrinolysin)
3. DNAse (Streptodornase, degrades DNA in necrotic tissues)
• Toxins & hemolysins:
1. Erythrogenic toxin (Rash of Scarlet fever)
2. Streptolysin O (oxygen labile Hemolysin)
3. Streptolysin S (oxygen stable Hemolysin)
4. Pyrogenic exotoxin A (Toxic shock Syndrome)
5. Exotoxin B (a protease)
 Diagnosis
• The titer of ASO antibody can be important in
the diagnosis of rheumatic fever. In patients
suspected of having rheumatic fever, an
elevated ASO titer is typically used as
evidence of previous infection because throat
culture results are often negative at the time
the patient presents with rheumatic fever.
• Titers of anti-DNase B are high in group A
streptococcal skin infections and serve as an
indicator of previous streptococcal infection in
patients suspected of having AGN.
 Treatment
• Penicillin G or amoxicillin (but neither
rheumatic fever nor AGN patients benefit
from penicillin treatment after the onset of the
two diseases)
• oral penicillin V (for mild infections)
• Azithromycin or Clindamycin (for penicillin
allergic patients)
GROUP B STREPTOCOCCUS
 GBS Vs GAS

• No cytotoxic enzymes or exotoxins have been

described

• No immunologically induced disease

 GBS
• Group B streptococci (S. agalactiae) colonize
the genital tract of some women

• S. agalactiae occurs in the vagina and colon

• Transmitted to the neonate at the time of

birth
 Virulence Factors

• Polysaccharide capsule (antiphagocitic)

• Carbohydrate antigen

• Beta hemolysin
 Pathogenesis

• Pathogenesis by group B streptococci (S.

agalactiae) is based on the ability of the

organism to induce an inflammatory response

 Diseases

• Neonatal sepsis

• Neonatal meningitis

• Neonatal Pneumonia

• Postpartum endometritis
 Diagnosis
• They are usually bacitracin-resistant

• They hydrolyze (break down) hippurate, an

important diagnostic criterion

• CAMP test

• Agglutination test: It detects the DNA of the

organism
 Treatment
• The drug of choice for group B streptococcal
infections is either penicillin G or ampicillin

• Combination of penicillin G and an

aminoglycoside
 VIRIDANS STREPTOCOCCI
• are either α-hemolytic, producing a green coloration on blood agar
plates (hence the name "viridans", from Latin "vĭrĭdis", green), or
nonhemolytic
• Viridans streptococci (e.g., S. mutans, S. sanguinis, S. salivarius,
and S. mitis) are the most common cause of infective endocarditis.
• Also important cause of brain abscesses.
• They enter the bloodstream (bacteremia) from the oropharynx,
typically after dental surgery.
• Signs of endocarditis are fever, heart murmur,
anemia, and embolic events such as splinter
hemorrhages, and Janeway lesions
• The heart murmur is caused by vegetations on
the heart valve
• It is 100% fatal unless effectively treated with
antimicrobial agents