Streptococci (Gram

positive cocci)
Lecture 37
Faculty: Dr. Alvin Fox

1
 Key Words
• Lancefield groups • Group B streptococcus (S.agalactiae)
• Hemolysis (alpha, beta, gamma) - Neonatal septicemia/meningitis
• Group A streptococcus (S. pyogenes) - CAMP test
- Bacitracin susceptibility test - Hippurate hydrolysis test
- M, T, R proteins • Group D streptococcus
- Streptolysins O and S - Urinary tract infection
- F protein/lipoteichoic acid - Endocarditis
- Rheumatic fever/carditis/arthritis - Bile-esculin test
- Glomerulonephritis - Enterococci
- Scarlet fever - Non-enterococci
- Toxic shock-like syndrome • Large colony
- Bacteremia • Minute colony
- Flesh-eating bacteria • Viridans streptococci
- Pyrogenic toxin • Dental caries/endocarditis
- Erythrogenic toxin 2
• Streptococci
– facultative anaerobe
– Gram-positive
– usually chains (sometimes pairs)
– catalase negative
(staphylococci are catalase positive)

3
Streptococcus in chains (Gram stain)

4
Streptococcus pneumoniae (diplococcus). Fluorescent stain

5
Identification : Lancefield groups
- carbohydrate antigens

6
 groupable streptococci
• A, B and D
– frequent
• C, G, F
– less frequent

7
 Non-groupable

• S. pneumoniae
– pneumonia

• viridans streptococci
– e.g. S. mutans
*dental caries
8
 hemolysis reaction - sheep blood agar
• α (alpha)
– partial hemolysis
– green color
• β (beta)
– complete clearing
White colonies
• γ (gamma)
- no lysis
9
 Hemolysis
• Groups A an B
–β
• Group D
– α or γ
• S. pneumoniae and viridans
–α
10
Identification:
hemolysis reaction
+ one biochemical characteristic

11
Group A streptococcus (S. pyogenes)

12
Group A streptococcal infections affect all ages
peak incidence at 5-15 years of age

13
 S. pyogenes -suppurative
• non-invasive
– pharyngitis
– skin infection, impetigo

• invasive bacteremia
– toxic shock-like syndrome
– "flesh eating" bacteria
– pyrogenic toxin
14
 Pyrogenic toxin
• Superantigen
• Non-specific activation of T cells
− Cross-link antigen presenting
cells (MHC) and T cell receptor
− Cytokine production

15
 Scarlet fever
• rash
• “erythrogenic toxin”

16
 non-suppurative
• rheumatic fever
– inflammatory disease
– life threatening
– chronic sequalae
• fever
• heart
• joints
• rheumatic NOT rheumatoid arthritis

17
 Rheumatic fever -etiology
• M protein
– cross-reacts heart myosin
– autoimmunity

• Cell wall antigens

– poorly digested in vivo
– persist indefinitely

18
 Rheumatic fever
• penicillin
- terminates pharyngitis
- decreases carditis

19
Acute glomerulonephritis

• immune complex disease of kidney

20
 Major pathogenesis factors
• lipoteichoic acid/F protein
– fimbriae
– binds to epithelial cells

• M protein
– anti-phagocytic

21
S. pyogenes
lipoteichoic acid
F-protein

fibronectin

epithelial cells
22
 M protein
Complement IMMUNE

IgG

r
r r
M protein
peptidoglycan NON-IMMUNE
fibrinogen

r 23
r r
 M protein
• major target
– natural immunity
• strain variation
– antigenicity
• re-infection
– occurs with different strain

24
 Capsules
• Anti-phagocytic
– mucoid strains

25
 Isolation and identification

• β hemolytic colonies
– bacitracin inhibits growth

• β hemolytic colonies
– group A antigen

26
 β hemolysis
• Hemolysin/streptolysin O
– sensitive oxygen
• Hemolysin/streplysin S
– insensitive oxygen

27
 Modern Rapid “Strep” Test
Throat swab extract
(+/- streptococcal antigen)
-

+
Antibody
Liposome
28
Streptococcal antigen
 Post-infectious diagnosis
(serology)
• antibodies to streptolysin O
• important if delayed clinical
sequelae occur

29
 Typing

Traditional serotyping of
proteins:
-M
-T
-R
Current:
- Sequencing of M protein gene

30
 Group B streptococcus
• neonatal meningitis
• septicemia
• transmission
– vaginal flora

31
 Group B streptococcus
- identification
• β hemolysis
• hippurate hydrolysis
• CAMP reaction
– increases β hemolysis of S. aureus

32
 Group D streptococcus
• Growth on bile esculin agar
– black precipitate

• 6.5% saline
• grow
– enterococci
• no growth
– non-enterococci

33
 Enterococci

• distantly related to other streptococci

• genus Enterococcus
• gut flora
– urinary tract infection
• fecal contamination
– opportunistic infections
• particularly endocarditis
• most common E. (S.) faecalis

34
 Enterococci
• resistant to many antibiotics
– including vancomycin
• terminal D-ala replaced by D-lactate

35
Minute colony streptococci
Various groups/hemolysis (e.g. group A)
– genetically distinct
from large colony (e.g. S. pyogenes)
– no rheumatic fever

Large colony Minute colony 36

 Viridans streptococci
• diverse species
• oral
• dental caries
• α hemolytic and negative for other tests
• non-groupable.
• includes S. mutans
– occassional endocarditis after tooth extraction

37