Copy of streptococcus. By mma seeMabp ptx

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1. streptococcus Seemab Hassan Respiratory Therapist Subect: Microbiology

2. Streptoccous identification Streptococci are spherical gram-positive cocci arranged in chains or pairs One of the most important characteristics for identification of streptococci is the type of hemolysis. α-Hemolytic β-Hemolytic γ-hemolysis

3. β-hemolytic streptococci There are two important antigens of β-hemolytic streptococci: (1) C carbohydrate: determines the group of β-hemolytic streptococci. It is located in the cell wall, and its specificity is determined by an amino sugar. (2) M protein: is the most important virulence factor and determines the type of group A β-hemolytic streptococci. It protrudes from the outer surface of the cell and interferes with ingestion by phagocytes (i.e., it is antiphagocytic). There are approximately 80 serotypes based on the M protein.

4. Classification of streptococci β-Hemolytic Streptococci These are arranged into groups A–U (known as Lancefield groups) on the basis of antigenic differences in C carbohydrate. Group A streptococci (S. pyogenes) Group B streptococci (S. agalactiae) Group D streptococci include enterococci (e.g., E. faecalis and Enterococcus faecium) and nonenterococci (e.g., S. bovis) Groups C, E, F, G, H, and K–U streptococci infrequently cause human disease

5. Classification of streptococci Non Hemolytic Streptococci Some streptococci produce no hemolysis; others produce α-hemolysis. The principal α-hemolytic organisms are S. pneumoniae (pneumococci) and the viridans group of streptococci.

6. Transmission Most streptococci are part of the normal flora of the human throat, skin, and intestines but produce disease when they gain access to tissues or blood. Viridans streptococci and S. pneumoniae are found chiefly in the oropharynx; S. pyogenes is found on the skin and in the oropharynx in small numbers; S. agalactiae occurs in the vagina and colon; and both the enterococci and anaerobic streptococci are located in the colon.

7. Pathogenesis Group A streptococci (S. pyogenes) cause disease by three mechanisms: pyogenic inflammation-induced locally at the site of organism in tissue exotoxin production- cause widespread systematic symptoms immunologic-which occurs when antibody against a component of the organism cross-reacts with normal tissue or forms immune complexes that damage normal tissue

8. Pathogensis

9. Pathogenesis Group A streptococci produce three important inflammation-related enzymes: Hyaluronidase- degrades hyaluronic acid, which is the ground substance of subcutaneous tissue. Hyaluronidase is known as spreading factor because it facilitates the rapid spread of S. pyogenes in skin infections (cellulitis). Streptokinase- (fibrinolysin) activates plasminogen to form plasmin, which dissolves fibrin in clots, thrombi, and emboli. It can be used to lyse thrombi in the coronary arteries of heart attack patients DNase- (streptodornase) degrades DNA in exudates or necrotic tissue

10. Pathogenesis group A streptococci produce five important toxins and hemolysins: Erythrogenic toxin- cause rash of scarlet fever Streptolysin O- cause beta hemolysis, oxygen labile Streptolysin S- oxygen stable Pyrogenic exotoxin A -cause toxic shock syndrome Exotoxin B- cause necrotising fasciitis

11. clinical findings S. pyogenes causes three types of diseases: (1) pyogenic diseases such as pharyngitis and cellulitis, (2) toxigenic diseases such as scarlet fever and toxic shock syndrome, and (3) immunologic diseases such as rheumatic fever and acute glomerulonephritis (AGN).

12. clinical findings of Group A streptococci S. pyogenes (Group A Streptococcus) Pyogenic Diseases: Pharyngitis (strep throat): Symptoms: Throat pain, fever, inflamed throat and tonsils, yellowish exudate, tender cervical lymph nodes. Cellulitis: Symptoms: Red, swollen, and painful skin; warmth in the affected area; fever. Erysipelas: Symptoms: Well-demarcated, raised, red area of skin; fever; chills.

13. clinical findings of Group A streptococci Necrotizing fasciitis: Symptoms: Severe pain, swelling, fever, rapid progression of skin changes. Impetigo: Symptoms: Honey-colored crusted lesions, itching, and redness.

14. clinical findings of Group A streptococci Toxigenic Diseases: Scarlet fever: Symptoms: Red rash, "strawberry" tongue, fever, sore throat. Streptococcal toxic shock syndrome: Symptoms: Fever, rash, multi-organ failure, hypotension, and a recognizable site of infection.

15. clinical findings of Group A streptococci Immunologic Diseases: Rheumatic fever: Symptoms: Fever, joint pain, carditis, rash (erythema marginatum), chorea. Acute glomerulonephritis (AGN): Symptoms: Hematuria (blood in urine), proteinuria, edema, hypertension.

16. clinical findings of Group B Streptococcus Neonatal sepsis: Symptoms: Fever, lethargy, irritability, feeding difficulties, respiratory distress. Neonatal meningitis: Symptoms: Fever, irritability, poor feeding, bulging fontanelle, seizures. Neonatal pneumonia : Symptoms: Respiratory distress, cough, fever, difficulty feeding.

17. clinical findings of Group B Streptococcus Endometritis (puerperal fever ): Symptoms: Fever, abdominal pain, foul-smelling vaginal discharge. Sepsis in adults: Symptoms: Fever, chills, rapid heartbeat, confusion. Pneumonia in adults: Symptoms: Cough, fever, difficulty breathing, chest pain.

18. clinical findings of Group B Streptococcus Arthritis in adults: Symptoms: Joint pain, swelling, redness, fever. Cellulitis in adults: Symptoms: Redness, swelling, warmth, pain in the affected area. Osteomyelitis in adults : Symptoms: Bone pain, fever, swelling, redness over the affected area.

19. clinical findings of viridans streptococci Viridans Streptococci Diseases: Infective endocarditis: Symptoms: Fever, heart murmur, fatigue, anemia, embolic events (e.g., splinter hemorrhages). Brain abscesses: Symptoms: Headache, fever, neurological deficits, altered mental status. Lung abscesses: Symptoms: Cough, fever, chest pain, difficulty breathing. Abdominal abscesses: Symptoms: Abdominal pain, fever, nausea, vomiting.

20. clinical findings of Group D Streptococcus Enterococci Diseases: Urinary tract infections: Symptoms: Dysuria (painful urination), frequency, urgency, lower abdominal pain. Endocarditis: Symptoms: Fever, heart murmur, fatigue, embolic events. Intra-abdominal infections: Symptoms: Abdominal pain, fever, nausea, vomiting. Pelvic infections: Symptoms: Pelvic pain, fever, abnormal discharge.

21. Lab diagnosis Gram Staining Streptococcal Pharyngitis: 1. Gram Staining Streptococcal Pharyngitis: Gram stains are ineffective due to viridans streptococci being part of normal flora and indistinguishable from S. pyogenes. Stained smears from skin lesions are diagnostic.

22. Lab diagnosis 2. Culture Blood Agar Cultures: Pharyngeal or skin swabs show small, translucent β-hemolytic colonies in 18-48 hours. Bacitracin Sensitivity: Inhibition indicates Group A streptococci (S. pyogenes). Group B Streptococci: Identified by hippurate hydrolysis. Group D Streptococci: Hydrolyze esculin in bile, producing a black pigment.

23. Lab diagnosis 3. Rapid Test s Throat Swab Antigen Detection: Results in ~10 minutes; detects Group A streptococcal antigens via agglutination with latex particles. High specificity but low sensitivity; negative results warrant culture. Group B Detection: Rapid DNA test from vaginal/rectal samples provides results in ~1 hour.

24. Lab diagnosis Viridans Group Streptococci Characteristics: Form α-hemolytic colonies; resistant to bile and grow in optochin presence. Classification: Identified through biochemical tests.

25. Lab diagnosis Serologic Testing ASO Titers : Elevated in Group A infections; used for diagnosing rheumatic fever. Anti-DNase B Titers: Indicative of past Group A skin infections and acute glomerulonephritis (AGN).

26. Treatment Group A Streptococcal Infections: Treated with Penicillin G, Amoxicillin, or Oral Penicillin V for mild cases. For penicillin-allergic patients, use Erythromycin, Azithromycin, or Clindamycin. Viridans Streptococci: Curable with prolonged Penicillin treatment. Enterococcal Endocarditis: Requires Penicillin or Vancomycin combined with an Aminoglycoside.

27. Treatment Vancomycin-Resistant Enterococci (VRE): Treated with Linezolid (Zyvox) or Daptomycin (Cubicin) due to multi-drug resistance. Nonenterococcal Group D Streptococci (e.g., S. bovis): Generally treated with Penicillin G. Group B Streptococcal Infections: Treated with Penicillin G or Ampicillin, with some strains requiring higher doses or combination therapy.

28. STREPTOCOCCUS PNEUMONIAE Diseases Caused: Pneumonia: Most common cause of community-acquired pneumonia, characterized by sudden chills, fever, cough, and "rusty" sputum. Bacteremia : Occurs in 15-25% of pneumonia cases, leading to sepsis. Meningitis : A significant cause of bacterial meningitis, especially in children and immunocompromised individuals. Upper Respiratory Infections: Causes otitis media, mastoiditis, and sinusitis. Conjunctivitis: Commonly seen in children.

29. STREPTOCOCCUS PNEUMONIAE Characteristics: Morphology : Gram-positive, lancet-shaped cocci arranged in pairs (diplococci) or short chains. Hemolysis : Produces α-hemolysis on blood agar. Biochemical Properties : Lysed by bile and growth inhibited by optochin. Capsule : Contains over 85 antigenically distinct polysaccharide types, which are important virulence factors that interfere with phagocytosis.

30. Transmission and Pathogenesis: Natural Host: Humans are the only natural hosts; no animal reservoir. Colonization : A significant proportion (5%-50%) of healthy individuals carry pneumococci in the oropharynx without symptoms. Virulence Factors: The capsular polysaccharide is the primary virulence factor, promoting invasiveness and evasion of the immune response. Other factors include lipoteichoic acid and pneumolysin, which contribute to inflammation and tissue damage.

31. Clinical Findings: Pneumonia Symptoms : Sudden onset of chills, fever, cough, pleuritic chest pain, and "rusty" sputum. Bacteremia: Can lead to sepsis, particularly in patients without a functional spleen (e.g., asplenic patients). Other Infections: Pneumococci are also responsible for otitis media, sinusitis, mastoiditis, purulent bronchitis, pericarditis, and bacterial meningitis.

32. Laboratory Diagnosis: Microscopy: Gram-stained sputum shows lancet-shaped gram-positive diplococci. Culture: Grows as small α-hemolytic colonies on blood agar; bile-soluble and optochin-sensitive. Blood Cultures: Positive in 15-25% of cases; cerebrospinal fluid culture is positive in meningitis. Rapid Tests: Latex agglutination tests for capsular polysaccharide in spinal fluid; urinary antigen tests for pneumococcal pneumonia.

33. Treatment: Antibiotic Susceptibility: Most strains are susceptible to penicillins and erythromycin, but resistance is increasing. Severe Infections: Penicillin G is the drug of choice; for mild infections, oral penicillin V or levofloxacin can be used. Penicillin-Resistant Strains: Vancomycin is preferred for severe cases; ceftriaxone or levofloxacin for less severe cases. Resistance: Approximately 25% of isolates show low-level resistance to penicillin, with 15%-35% exhibiting high-level resistance due to changes in penicillin-binding proteins.