Streptococcal Diseases

Streptococcus pyogenes
Streptococcus pyogenes
Pyogenes means pus producing
One of the most important pathogens

Gram positive cocci in chains

Lancefield Serological Group A

Beta Hemolytic on blood agar
Gram Stain of S. pyogenes
Hemolysis on Blood Agar
Plates
Alpha hemolysis-organism excretes
hemolysins which partially break down rbc
(incomplete hemolysis) thus a greenish zone
appears around colony. S. pneumoniae
Beta hemolysis-organisms excretes potent
hemoysins which completely lyse rbc
(complete hemolysis) thus a clear zone
appears around colony. S. pyogenes
S.pyogenes
S. pneumonia
Beta
hemolysis
Alpha
hemolysis
Diseases caused by S. pyogenes
Strep throat
Impetigo
Erysipelas
Cellulitis
Invasive Strep A infections
Necrotizing fasciitis
Myositis
Toxic shock-like syndrome

Erysipelas
Acute infection and imflammation of the
dermal layer of skin.
Painful red patches which enlarge and
thicken
Treatment -penicillin or erythromycin
Erysipelas
Strep Throat
Most common of all Strep diseases
Spread by saliva or nasal secretions
Incubation period 2-4 days
Sore throat, slight fever (101)
Important to treat immediately to avoid
post strep diseases

Diagnosis and treatment of Strep Throat
Tell tale symptoms are slight fever
associated with sore throat and visual of
pus in back of throat
Quick diagnostic tests (Molecular)
available but must be confirmed by
throat swab and growth on blood agar
(beta hemolysis)
Diagnosis and treatment of Strep Throat
If the strain of S. pyogenes is lysogenic
for a particular phage which expresses
an erythrogenic toxin the result is
Scarlet fever
Rash appears and characteristic is the
strawberry colored tongue
Strawberry Tongue
Treatment of Strep
Penicillin G or Erythromycin are drugs
of choice
Although the disease is self-limiting it is
important to treat immediately to avoid
post strep complications
Poststreptococcal diseases
Rheumatic Fever-autoimmune disease
involving heart valves,joints, nervous
system. Follows a strep throat
Acute glomerulonehritis or Brights
Disease-inflamatory disease of renal
glomeruli and structures involved in
blood filter of kidney. Due to deposition
of Ag/Ab complexes
Rheumatic Fever
Most common cause of permanent
heart valve damage in children
Exact cause not yet known but there
appears to be some antibody cross
reactivity between the cell wall of S.
pyogenes and heart muscle
Rheumatic Fever
Diagnosis is based on symptoms and is
difficult
Occurs most frequently between ages
of 6 and 15
US it is about 0.05% of pop having strep
infections
100x more frequent in tropical countries
Rheumatic Fever
Treatment is via salicylates (aspirin
derivatives) and corticosteroids to
decrease inflammation and fever.
Glomerular Nephritis
Diagnosis based on history of Strep
throat and clinical findings.
Symptoms include fever,
malaise,edema, hypertension and blood
or protein in urine
Occurs in 0.5% of those having strep
throat.
Glomerular Nephritis
Treatment and Recovery
Penicillin or erythromycin to eradicate
and residual strep infection
80-90% of cases recover with bed rest
lasting for months
Kidney damage in the remainder is
often permanent resulting in chronic
glomerular nephritis
Streptococcus Pneumonia
Caused by infection with Streptococcus
pneumoniae
Gram positive, alpha hemolytic, not of
lancefield serotype A
Often part of normal flora of respiratory
track and becomes infective once hosts
resistance is lowered. Classified as an
endogenous infection.

Strep Pneumonia
Strep Pneumonia
S. pneumoniae
Alpha hemolysis
Strep pneumonia
Predisposing factors: upper respiratory
viral infection, diabetes, alcoholism

60-80% of all pneumonias

Strep Pneumonia
Cause of strep pneumonia
Primary virulence factor is the capsular
polysaccharide which protects the
organism against phagocytosis

Pathogenesis is due to rapid growth of
bacteria in alveolar spaces
Symptoms of Strep
Pneumonia
Onset abrupt

Chest pains

Chills

Labored breathing
Diagnosis of Strep pneumonia
Chest Xray

Culture and staining

Biochemical tests of isolated organism
Treatment of Strep
Pneumonia
Typically treated with Penicillin G
cefotaxime, oflaxacin or for those
allergic to penicillins can be treated with
erythromycin or tetracycline
Pneumococcal vaccine (Pneumovax 23
or Pnu-immune 23) is available for the
elderly
Staphylococcal infections
One of the most common of all
infections
Staphylococcus are divided into
pathogens and non pathogens based
on possession of the enzyme coagulase
Coagulase + are usually S. aureus and
pathogenic
Coagulase - are organisms like S.
epidermidis are less invasive
Diseases of Staphylococcus

Toxic Shock Syndrome
Most in women using superabsorbant
tampons
Staphylococcus aureus-Gram positive
cocci
Low blood pressure, fever, diarrhea,
skin rash can be fatal

Toxic Shock Syndrome
Symptoms mainly caused by toxic
shock syndrome toxin 1(TSST1)

Several other enterotoxins also involved
Staph skin infections
Most common cause of acne, boils,
furuncle and cabuncles

Treatment can be difficult because of
antibiotic resistance.Usually can be
treated with methicillin,
cephalosporins,or vancomycin
Methicillin resistant strains=MRSA
Staph skin infections
superficialfolliculitis
Deep folliculitis
Furuncle
(infected hair
follicle
Carbuncle
Multiple abcesses
Around many hair
follicles
Staph impetigo
Scalded skin
syndrome
Scalded Skin Syndrome
Due to strains of S. aureus containing a
special toxin-exfoliatin
Diagnosis
Culture and stain-gram positive in
grape-like clusters

Catalase and coagulase tests

DNA fingerprinting
S. aureus