STREPTOCOCCI

Faculty: Dr. Alvin Fox

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

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Streptococcus in chains (Gram stain)

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Streptococcus pneumoniae (diplococcus). Fluorescent stain

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Identification : Lancefield groups
- carbohydrate antigens

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

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 Non-groupable
• S. pneumoniae
– pneumonia

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

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Group A streptococcus (S. pyogenes)

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

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

• invasive bacteremia
– toxic shock-like syndrome
– "flesh eating" bacteria
– pyrogenic toxin
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 Pyrogenic toxin
• superantigen
• T cell mitogen
• activates immune system

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 Scarlet fever
• rash
• erythrogenic toxin

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

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

• Cell wall antigens

– poorly digested in vivo
– persist indefinitely

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 Rheumatic fever
• penicillin
- terminates pharyngitis
- decreases carditis

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Acute glomerulonephritis

• immune complex disease of kidney

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

• M protein
– anti-phagocytic

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S. pyogenes
lipoteichoic acid
F-protein

fibronectin

epithelial cells
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 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

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 Capsules
• Anti-phagocytic
– mucoid strains

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 Isolation and identification
• β hemolytic colonies
– bacitracin inhibits growth

• β hemolytic colonies
– group A antigen

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 β hemolysis
• hemolysin O
– sensitive oxygen
• hemolysin S
– insensitive oxygen

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

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

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 Typing

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

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

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

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

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

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 Enterococci
• distantly related to other streptococci
• genus Enterococcus
• gut flora
– urinary tract infection
• fecal contamination
– opportunistic infections
• particularly endocarditis
• most common E. (S.) faecalis

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

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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

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