Gram--Positive Cocci

Gram

Prof Dr
Prof. Dr. Asem Shehabi
Faculty of Medicine
University of Jordan
 Gram--psitive cocci
Gram
ƒ Micrococcaceae
Mi f il F
family.. Facultative
lt ti AAnaerobic
bi
Gram--positive cocci .. includes the following
Gram
Genera/Groups:
ƒ Staphylococcus
Staphylococcus.. .. Arranged in Irregular Clusters
..Catalase+ve
Catalase+ve
ƒ Streptococci
Streptococci..
.. Arranged in Diplococci or Chain
of Cocci..
Cocci Catalase
Catalase--ve
ƒ Enterococci
Enterococci..
.. Arranged in Diplococci & Short
Chain Catalase-
Chain.. Catalase-ve e
ƒ The Two Common Staphylococcus species
are: S.
S aureus.. S.
S epidermidis
id idi are common iin
skin, nose, oral cavity. other body sites.
Stapylococci--Streptococci
Stapylococci
 Pathogenicity of S.
S aureus
ƒ More invasive & pathogenic than other Staph. species
ƒ Contains capsule
capsule,, cell wall antigenic structure
Polysaccharides.. Protein A A..
.. Production Specific
Enzymes
y & Exo-
Exo- & Enterotoxins
Enterotoxins.... Food Poisoning g
Coagulase & Clumping factor +ve +ve.. .. Both converted
prothrombin into fibrin & fibrinogen .. Deposit fibrin
during infection.. Hyaluronidase
Hyaluronidase.. .. Spreading factor,
Leukocidin..
Leukocidin .. destroy WBCs.. formation of pus and
acne
ƒ A common cause of skin abscess ..wounds, sepsis/
bacteremia sinusitis
bacteremia, sinusitis, conjunctivitis pneumonia
pneumonia,
meningitis, osteomyelitis, any body sites.
 S.
S epidermidis
ƒ Less pathogenic.. part body normal flora.. coagulase -
ve.. opportunistic pathogen.. Bacteremia.. Skin
abscess.
ƒ Diagnosis: Collect specimens ..Culture & identification
of isolates by gram-
gram-stain, catalase & coagulase test,
susceptibility test..
ƒ Most S. aureus strains.. Less S. epidermidis are
resistant to all B-
B-lactams.. Increase rate of isolation
Methicillin/Oxacillin--resistant S. aureus (MRSA).. All
Methicillin/Oxacillin
still
till susceptible
tibl tto vancomycin
vancomycin.i .
ƒ Micrococcus species: common on skin.. coagulase -
ve.. opportunistic
t i ti pathogen..
th IImmuno-
Immuno-compromised
i d
patients.. mostly susceptible to B B--Lactams.
 Streptococci--1
Streptococci
ƒ Viridans Streptococci Group:
Group: Alpha
Alpha--hemolytic/ Non
Non--
Hemolytic..
y Normal respiratory
p y flora.. Oral cavity..
y
opportunistic pathogen, Dental caries, Sepsis,
Localized oral abscesses.. Common Endocarditis
ƒ Beta
B t -hemolytic
Beta- h l ti Streptococci
St t i Group:
Group
G : Serogroups
S A
A,
B, C, D, F, G.. Cell wall specific carbohydrates..
Respiratory flora
flora.. Healthy Carries
Carries..Population
Population
ƒ Group A Hemolytic Streptococci ( S. pyogens):
pyogens):
Most invasive & Pathogenic
Pathogenic.. Virulence Factors
Factors.. Cell
Wall antigens/ M Proteins.. Many Extracellular
Enzymes..
y Hemolysins,
y , 80 Specific
p yp ,
subtypes
Pyrogenic /Erythrogenic Toxin.. Superficial skin
infection.. Scarlet fever.. Children
Beta-Hemolytic
Beta- y Streptococcis-
Streptococcis
p -
Susceptible for Bacitracin
 Streptococci--2
Streptococci

ƒ Group A streptococcal infections affect all

ages
g with p peak incidence at 5-15 y years of age..
g
Acute Sore throat/ Pharyngitis, Skin infection,
Sepsis, Otitis media, Sinusitis, Meningitis.. Less
Ad lt
Adults
ƒ Complications: A) Rheumatic Fever..
i fl
inflammatory di
disease affecting
ff i primarily
i il the
h
heart and joints. B) Glomerulonephritis..
imm ne comple
immune complex disease of the kidne
kidney
ƒ Group B Streptococci: Common in vaginal
t t Purperal
tract.. P l Sepsis,
S i Neonatal
N t lM
Meningitis,
i iti
Fatal ..Urinary Tract Infection.
 Streptococci--3
Streptococci
ƒ Streptococci pneumonia: Capsule..
Capsule polysacharides
85 Serotypes.. Healthy Carriers
ƒ Common cause of bacterial p pneumonia.. more
common in the very young and the very old persons.
ƒ Common cause of meningitis, Sinusitis, Otitis Media,
B t
Bacteremia..
i Young
Y children..
hild IImunocompromisedi d
persons.. up 50
50%
% S. pneumonia R- R-Penicillin.
ƒ S.
S pneumoniae can be differentiated from S.viridans
S viridans,
which is also alpha hemolytic, using an Optochin test,
ƒ Enterococcus: E. fecalis, E. faecium.. Common
Intestine Human-
Human-Animal.. opportunistic pathogen..
Urinary Tract Infect., Wound, Rare Sepsis,
E d
Endocarditis..
diti
S. p
pneumoniae - Susceptible
p to
Optochin in Lab test
 Enterococcus species

ƒ Gram-
Gram-positive diplococci..short strept. Chains.
Common intestinal tract human
human, animals
animals..
resistance to environmental conditions.. and
many antibiotics ..cephalosporines and
gy
aminoglycosides
ƒ Common cause of urinary tract infections.
Sepsis nosocomial infections in associated
Sepsis..nosocomial
with underlying diseases.
ƒ Treatment: combination of antibiotics