Strep2.pdf university of health sciences

Strep2.pdf university of health science

1. AIM Sothea, MD, MHPEd
012-209069
[email protected]
Streptococcus spp

2. Classification of staph
3
Gram+
+
Cocci
Staph
+
+
+
+
S. Areus
Strept
+ + + +
S. Epidermidis S. Saprophyticus
+
Bacili
Staph
Gram +
Catalase +
In cluster
Catalase + -

3. Classification of strep
4
Gram+
+
Cocci
Strept
+ + + +
Staph
+
+
+
+
S. Pneumonia S. Pyogenes
+
Bacili
Strep
Gram +
Catalase –
In chain or pairs
S. Viridans Enterococcus S. Bovis S. Agalactiae
- Catalase +

4. Classification of strep
5
Gram+
+
Cocci
Strept
+ + + +
Staph
+
+
+
+
S. Pneumonia S. Pyogenes
+
Bacili
S. Viridans Enterococcus S. Bovis S. Agalactiae
Bactracin Optochin
- + - +
- +
- Catalase +
Grow
6.5% NaCl
β α γ

5. Lancefield group
6
Pathogen Hemolysis Lancefield
S. pyogenes β A Bacitracin +
S. Agalactiae β B Bacitracin –
S. pneumoniae α
NA Optochin +
S. Viridans α
NA Optochin -
Enterococcus
γ (α)
D 6.5% Nacl +
S. bovis
γ (α)
D 6.5% Nacl -

6. β- hemolysis strep
7
Pathogen Hemolysis Lancefield
S. pyogenes β A Bacitracin +
S. Agalactiae β B Bacitracin –
S. pneumoniae α
NA Optochin +
S. Viridans α
NA Optochin -
Enterococcus
γ (α)
D 6.5% Nacl +
S. bovis
γ (α)
D 6.5% Nacl -

7. Objectives
8
List characteristics of respective pathogen
Explain virulence factors
List diseases caused by respective pathogen
Discuss treatment

8. S. pyogenes
9

9. Classification of strep
10
Gram+
+
Cocci
Strept
+ + + +
Staph
+
+
+
+
S. Pneumonia S. Pyogenes
+
Bacili
S. Viridans Enterococcus S. Bovis S. Agalactiae
- + - +
- +
- Catalase +
Bactracin Optochin
Grow
6.5% NaCl
β α γ

10. S. pyogenes
GAS
GABHS
flesh-eating bacterium
11

11. S. pyogenes
12
Hemolysis Lancefield
S. pyogenes β A Bacitracin +
Description
Gram +
Catalase –
β-hemolytic
Group A (GAS)
Bacitracin +
PYR +

Habitat (not flora)
oNasopharynx
oGenital mucosa

12. S. pyogenes
13
Hemolysis Lancefield
S. pyogenes β A Bacitracin +
Virulence factors
(1) adherence
oM protein,
ofibronectin-binding protein (Protein F) and
olipoteichoic acid (LTA)
(2) inhibiting phagocytosis
oM-protein
oCapsule hyaluronic acid

13. S. pyogenes
14
Hemolysis Lancefield
S. pyogenes β A Bacitracin +
Virulence factors
(3) invasins
oHyaluronidase ("spreading factor")
‒can digest host connective tissue
oC5a peptidase
oStreptokinase
‒fibrin lysis
oStreptodornase (DNase B)
‒limit immune response (killing Neutrophils)

oStreptolysins (SLO, SLS) [Leucocidin]

14. S. pyogenes
15
Hemolysis Lancefield
S. pyogenes β A Bacitracin +
Virulence factors
pyrogenic (erythrogenic) toxin as superantigen
(SAg)
ocauses the rash of scarlet fever and
otoxic shock syndrome
‒through massive release of cytokines.

15. Virulence factors of s. pygenes
16
http://textbookofbacteriology.net/streptococcus.html

16. S. pyogenes
17
Hemolysis Lancefield
S. pyogenes β A Bacitracin +
Disease
Pharyngitis

17. S. pyogenes
18
Hemolysis Lancefield
S. pyogenes β A Bacitracin +
Disease
Rheumatic fever
o2-4 after infection


https://medical-junction.com/rheumatic-fever-diagnostic-criteria-mnemonics/

18. S. pyogenes
19
Hemolysis Lancefield
S. pyogenes β A Bacitracin +
Disease
M protein
oinhibiting phagocytosis through inactivation of opsonization


orheumatic fever :
‒through molecular mimicry to myocardial tissue

+
http://textbookofbacteriology.net/streptococcus_2.html

19. S. pyogenes
20
Hemolysis Lancefield
S. pyogenes β A Bacitracin +
Disease
PostStreptococcal Glumeronephritis
otype III hypersensitivity reaction
Necrotizing fasciitis (flesh-eating disease)
oby Hyaluronidase (the "spreading factor")

20. S. pyogenes
21
Hemolysis Lancefield
S. pyogenes β A Bacitracin +
Disease
Impetigo



Erysipelas

21. S. pyogenes
22
Hemolysis Lancefield
S. pyogenes β A Bacitracin +
Disease
Scarlet fever
oPyrogenic Toxin

22. S. pyogenes
23
Hemolysis Lancefield
S. pyogenes β A Bacitracin +
Treatment
Penicillin,
Macrolides or 1st cephalosporins

23. 24
S. pyogenes…
Appearance •Cocci in chain
Description •Gram +
•Catalase –
•β-hemolytic
•Group A (GAS)
•Bacitracin +
•PYR +
Pathogenesis/Virulence •M protein
•Fibronectin-binding protein (Protein F)
•Capsule hyaluronic acid
•Hyaluronidase (the "spreading factor")
•Streptokinase
•Streptodornase (DNase B)
•Streptolysins (SLO, SLS) [Leucocidin]
•Pyrogenic (erythrogenic) toxin
Diseases

•Pharyngitis
•Acute rheumatic fever
•Impetigo
•PSGN
•Necrotizing fasciitis
•Scarlet fever
Treatment •Penicillin
•Macrolides or 1st cephalosporins

24. Q1.SPyo
25
A 6-year-old boy presents to his pediatrician for sore
throat and a headache. His symptoms began
approximately 2 days ago and have not improved.
The mother reports that the patient appears
uncomfortable and feels warm. Physical examination
is notable for perioral crusted lesions with tonsillar
swelling with exudates.
Which of the following is most likely cause the problem?
A.Strep pyones
B.Strep viridans
C.Strep agalatiae
D.Strep bovis

25. Q2.SPyo
26
Part of the success of the Streptococcus pyogenes
bacterium lies in its ability to evade phagocytosis.
Which of the following helps in this evasion?
A.M protein
B.Streptolysin O
C.Streptolysin S
D.Pyrogenic toxin
E.Streptokinase

26. Q3.SPyo
27
A 10-year-old male is taken to his physician by his
parents due to a sore throat. The bacteria from
throat specimen are gram-positive and bacitracin
inhibits their growth. The child is given treatment of
Penicillin G and sent home.
Which of the following is most likely cause the problem?
A.Strep pyones
B.Strep viridans
C.Strep agalatiae
D.Strep bovis

27. Q4.SPyo
28
A 10-year-old male is taken to his physician by his
parents due to a sore throat. The bacteria from
throat specimen are gram-positive and bacitracin
inhibits their growth. The child is given treatment of
Penicillin G and sent home. 20 years later, the
patient presents to the emergency department with
dyspnea on exertion and CXR showed an enlarged
cardiac silhouette and pulmonary edema.
The patient's current symptomatology most likely occurred
secondary to which of the following?
A.Molecular mimicry of M protein
B.Streptolysin O antibodies
C.Pyrogenic toxin superantigent
D.Streptokinase invasion

28. Q5.SPyo
29
A 14-year-old male is brought to the Emergency
Department by his mother. She is worried because
his face has become puffy and his urine has turned a
tea-color. Patient history reveals the child recently
suffered from a sore throat.
The physician suspects a bacterial infection. Which of the
following describes the likely bacteria responsible?
A.Coagulase positive
B.Catalase positive
C.Beta-hemolytic
D.Bacitracin insensitive
E.Gram negative
https://step1.medbullets.com/microbiology/104030/streptococcus-pyogenes-group-a-streptococci

29. S. agalactiae
GBS
(Group B streptococcus)
30

30. Classification of strep
31
Gram+
+
Cocci
Strept
+ + + +
Staph
+
+
+
+
S. Pneumonia S. Pyogenes
+
Bacili
S. Viridans Enterococcus S. Bovis S. Agalactiae
Bactracin Optochin
- + - +
- +
- Catalase +
Grow
6.5% NaCl
β α γ

31. S. agalactiae
32
Gram+
+
Cocci
Strept
+ + + +
Catalase -
S. agalactiae
β
-
Description
Gram +
Catalase –
β-hemolytic
Bacitracin –
Arranged in short chain
Group B
Hipurate +
PYR –
Facultative anaerobe

Habitat
ofemale genital tract (up 37%)
Bactracin

32. S. agalactiae
33
Gram+
+
Cocci
Catalase
Strept
+ + + +
-
S. agalactiae
β
-
Virulence factors
Lipoteichoic acid
oParticipate in facilitating adherence as the first step in
infection.
Polysaccharide capsular antigens
oInhibits activation of the alternative complement cascade and
prevents phagocytosis
C5a peptidase
C antigen
oProtect organisms from intracellular killing following
phagocytosis
Hyaluronic acid lyase
oSpread infection by the breakdown of hyaluronic acid in the
extracellular matrix



Bactracin

33. S. agalactiae
34
Gram+
+
Cocci
Catalase
S. agalactiae
β
-
Disease
Neonate infection
oPneumonia
oMeningitis
oSepsis
To screen at 35-37 of pregnancy

Treatment
Intrapartum penicillin

Bactracin
Strept
+ + + +
-

34. 35
S. agalactiae…
Appearance •Cocci in chain
Description •Gram +
•Catalase –
•β-hemolytic
•Group B (GBS)
•Bacitracin -
•PYR –
•Hipurrate +
Pathogenesis/Virulence •Lipoteichoic acid
•Capsule
•Hyaluronic acid lyase
Diseases •Neonate infection (SPM)
Treatment •Intrapartum Penicillin

35. Q1.Sagat
36
A 2-day-old premature baby boy born to a 22-year-old
woman developed pneumonia. The mother showed the
symptoms of urinary tract infection after the delivery. A
blood specimen from the baby shows Beta-hemolytic
colonies.
Which of the following could be the possible pathogen
that can be easily spread from the mother to the baby
and cause pneumonia?
oa) Streptococcus pyogenes
ob) Streptococcus agalactiae
oc) Enterococcus faecalis
od) Streptococcus bovis

36. Q1.Sagat
37
A 2-day-old premature baby boy born to a 22-year-old
woman developed pneumonia. The mother showed the
symptoms of urinary tract infection after the delivery. A
culture of blood specimen from the baby shows
Streptococcus agalactiae colonies.
Which of the following is true about the pathogen?
A.Group B and Bacitracin resistant
B.Group A and Bacitracin resistant
C.Group B and Bacitracin sensitive
D.Group A and Bacitracin sensitive

37. 38

38. α- hemolysis strep
39
Pathogen Hemolysis Lancefield
S. pyogenes β A Bacitracin +
S. Agalactiae β B Bacitracin –
S. pneumoniae α
NA Optochin +
S. Viridans α
NA Optochin -
Enterococcus
γ (α)
D 6.5% Nacl +
S. bovis
γ (α)
D 6.5% Nacl -

39. S. Pneumoniae
Pneumococci
40

40. Classification of strep
41
Gram+
+
Cocci
Staph
+
+
+
+
S. Pneumonia S. Pyogenes
+
Bacili
S. Viridans Enterococcus S. Bovis S. Agalactiae
Bactracin Optochin
6.5% NaCl
- + - +
- +
Catalase +
Strept
+ + + +
-
β α γ

41. S. pneumoniae (pneumococcus)
42
Gram+
+
Cocci
S. Pneumonia
+
Bacili
α
Optochin
+
Catalase
Description
Commensal organism
Gram +
Catalase -
α-hemolytic
Optochin +
Lancet-shape diplococci in chain

Pyrrolidonyl arylamidase +
Fastidious (enriched media)
oBlood or chocolate agar
o5-10 % CO2
Glucose fermenter can’t survive in high
glucose
Facultative anaerobe
oFound in nasopharynx
Strept
+ + + +
-

42. 43
Diplococci

43. 44
Diseases caused by S. pneumoniae
Hemolysis Lancefield
S. pneumoniae α
NA Optochin +

44. S. pneumoniae (pneumococcus)
45
Virulence factors
Capsular polysaccharide
oThe major factor
oAntiphagocytic
oOPSI (Overwhelming Postsplenectomy Infection
‒Asplenia (Anatomic or functional)




IgA Protease
oCleves IgA in mucus infection

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939560/#:~:text=For%20S.,factors%20of%20host%20protein%20targets.
Hemolysis Lancefield
S. pneumoniae α
NA Optochin +

45. S. pneumoniae (pneumococcus)
46
Virulence factors

Pneumolysin
oMembrane damaging toxin
Choline Binding Proteins (CBP)
oPspA (protective antigen),
oLytA, B, and C (three autolysins), and
oCbpA (an adhesin).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939560/#:~:text=For%20S.,factors%20of%20host%20protein%20targets.
Hemolysis Lancefield
S. pneumoniae α
NA Optochin +

46. S. pneumoniae (pneumococcus)
47
Treatment

Penicillin
3
rd
cephalosporines
Macrolide

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939560/#:~:text=For%20S.,factors%20of%20host%20protein%20targets.
Hemolysis Lancefield
S. pneumoniae α
NA Optochin +

47. 48
S. pneumoniae…
Appearance •DiploCocci
•Lancet shape
Description •Gram +
•Catalase –
•α-hemolytic
•Optocin +
Pathogenesis/Virulence •Capsular polysaccharide
•IgA Protease
•Pneumonlysin
Diseases •Pneumonia
•Otitis media
•Meningitis
•Sinusitis
Treatment •Penicillin
•3rd cephalosporines
•Macrolide

48. Q1.Spneu
49
A 65-old man transferred to ER having sudden nausea
vomiting & confusion. Physical exam: high fever 38.8C,
Brudzinski positive and altered mental status . CSF
Gramm stain reveals gramm+ lancet-shape diplococci.
Which of the following is true about the pathogen?
A.Group B and Bacitracin resistant
B.Group A and Bacitracin resistant
C.Group B and Bacitracin sensitive
D.Group A and Bacitracin sensitive

49. Q2.Spneu
50
A 65-old man transferred to ER having sudden nausea
vomiting & confusion. Physical exam: high fever 38.8C,
Brudzinski positive and altered mental status . CSF
Gramm stain reveals gramm+ lancet-shape diplococci.
What pathogen is most likely pathogen responsible
for the patient problem ?
a) Streptococcus pneumoniae
b) Streptococcus agalactiae
c) Streptococcus pyogenes
d) Streptococcus intermedius

50. Q3.Spneu
51
10. What is major virulence factor for Streptococcus
pneumoniae uses to evade the host’s immune
response?
a) Capsular polysaccharide
b) Pneumolysin
c) PspA (protective antigen),
d) LytA, B, and C autolysins

51. S. pneumoniae
52
Q4. Which of the following bacteria is the common
pathogen found in otitis media?
a) Streptococcus pneumoniae
b) Streptococcus agalactiae
c) Streptococcus pyogenes
d) Streptococcus intermedius

Q5. What is the most common type of infection
caused by Streptococcus pneumoniae?
a) Pneumonia
b) Meningitis
c) Otitis media
d) Sinusitis

52. S. Viridans
S. mutans,
S. mitis
S. sanguinis
53

53. Classification of strep
54
Gram+
+
Cocci
Staph
+
+
+
+
S. Pneumonia S. Pyogenes
+
Bacili
S. Viridans Enterococcus S. Bovis S. Agalactiae
Bactracin Optochin
6.5% NaCl
- + - +
- +
Catalase +
Strept
+ + + +
-
β α γ

54. S. viridans
55
Gram+
+
Cocci
S. viridans
+
Bacili
α
Optochin
-
Catalase
Description
Gram +
Catalase -
α-hemolytic
Optochin -
in chain

Facultative anaerobe
oFound in oropharynx
Strept
+ + + +
-

55. S. viridans
56
Gram+
+
Cocci
S. viridans
+
Bacili
α
Optochin
-
Catalase
Strept
+ + + +
-
Virulence factors
Biofilm
oPromote oral adhesion gingivitis (S. mutans & s. mitis)
Dextrans
oBind to fibrin platelet aggregate on demaged heart valves

Desease
Carries
Subacute bacterial endocarditis

56. S. viridans
57
Gram+
+
Cocci
S. viridans
+
Bacili
α
Optochin
-
Catalase
Strept
+ + + +
-
Treatment
oAmpicicillin prophylaxix

57. 58
S. viridans…
Appearance •DiploCocci
•Lancet shape
Description •Gram +
•Catalase –
•α-hemolytic
•Optocin +
Pathogenesis/Virulence •Capsular polysaccharide
•IgA Protease
•Pneumonlysin
Diseases •Pneumonia
•Otitis media
•Meningitis
•Sinusitis
Treatment •Penicillin
•3rd cephalosporines
•Macrolide

58. S. Viridans q1
59
Which of the following cocci is found in the mouth as
normal flora?
A.Streptococcus agalactiae
B.Staphylococcus saprophyticus
C.Staphylococcus epidermidis
D.Streptococcus mutans

59. S. Viridans q2
60
The bacteria involved in the production of dental caries
is
A.Streptococcus agalactiae
B.Streptococcus pneumoniae
C.Enterococus
D.Streptococcus mutans

60. S. Viridans q3
61
Streptococcus viridans can be differentiated from
other haemolytic Streptococci on the basis of its
resistance to
A.Bacitracin
B.Optochin
C.Novobiocin
D.Penicillin

61. S. Viridans q5
62
Before dental procedure Ampicillin is given to
bacterial sub-acute endocarditis.
What is most likely pathogen for this condition?
A.Streptococcus agalactiae
B.Streptococcus pneumoniae
C.Streptococcus spp.
D.Streptococcus sanguinis

62. γ - hemolysis strep
63
Pathogen Hemolysis Lancefield
S. pyogenes β A Bacitracin +
S. Agalactiae β B Bacitracin –
S. pneumoniae α
NA Optochin +
S. Viridans α
NA Optochin -
Enterococcus
γ (α)
D 6.5% Nacl +
S. bovis
γ (α)
D 6.5% Nacl -

63. Enterococci
E. Faecalis
E. faecium
64

64. Classification of strep
65
Gram+
+
Cocci
Strept
+ + + +
S. Pneumonia S. Pyogenes
+
Bacili
S. Viridans Enterococcus S. Bovis S. Agalactiae
β α γ
Bactracin Optochin
Grow
6.5% NaCl
- + - +
- +
Catalase
Staph
+
+
+
+
+ -

65. Enterococcus
66
Gram+
+
Cocci
Strept
+ + + +
Enterococcus
γ
Grow
NaCl 6.5%
+
Catalase -
Description
Gram +
Catalase –
γ (α-)hemolytic
NaCl 6.5% +
Arranged in pair or short chain
Group D
Facultative anaerobe
oFound in GI tract

66. 67
Enterococcus
Hemolysis Lancefield
Enterococcus γ (α)
D 6.5% Nacl +
Pathogenesis
Biofilm
Intrinsic resistance to penicillin-G or Cephalosporin
Acquired Van Gene causing Vancomycin-resistant
enterococci (VRE)

67. 68
Enterococcus
Hemolysis Lancefield
Enterococcus γ (α)
D 6.5% Nacl +
Diseases
UTI
oCystitis
Peritonitis
Endocarditis
Risks
Hospitalization
Immuno-compromised
Prolong use of antibiotics

68. 69
Enterococcus
Appearance •Cocci
•in pair or short chain
Description •Gram +
•Catalase –
•γ (α-)hemolytic
•NaCl 6.5% +
•Group D
Pathogenesis/Virulence •Resistance to penicillin-G or Cephalosporin
•Vancomycin-resistant enterococci (VRE)
Diseases

•Cystitis
•Peritonitis
•Risks:
•Hospitalization; Immuno-compromised
Treatment •Ampicillin/Vancomycin
•Linezolid for VRE

69. Enterococcus q1
70
60-man is hospilized for pneumonia and urine
catheter is placed. Patient feels better after 2 days,
however he has dysuria and urgency. A urine culture
reveals gramm+ in pairs and chain. Antibiogram is
resistant to vancomycin.
What is most likely pathogen for this condition?
A.Enterococcus
B.Streptococcus pneumoniae
C.Streptococcus spp.
D.Streptococcus sanguinis

70. Enterococcus q2
71
60-man is hospitalized for pneumonia and urine
catheter is placed. Patient feels better after 2 days,
however he has dysuria and urgency. A urine culture
reveals gramm+ in pairs and chain. Antibiogram is
resistant to vancomycin.
What is true about the pathogen?
A.Grow in 6.5% NaCl
B.Show β-hemolysis in blood agar
C.Not grow in 6.5% NaCl
D.Is catalase positive

71. Enterococcus q3
72
Which of the following bacteria is also called the
gamma or nonhemolytic streptococci?
A.Enterococcus
B.Streptococcus pneumoniae
C.Streptococcus spp.
D.Streptococcus sanguinis

72. Enterococcus q4
73
Which of the following bacteria have been found to
be most resistant to the drug vancomycin?
A.Enterococcus faecium
B.Streptococcus pyogenes
C.Staphylococcus aureus
D.Lactobacillus acidophilus

73. Non-Enterococci
E. Bovis (E. gallolyticus)
74

74. Classification of strep
75
Gram+
+
Cocci
Strept
+ + + +
S. Pneumonia S. Pyogenes
+
Bacili
S. Viridans Enterococcus S. Bovis S. Agalactiae
β α γ
Bactracin Optochin
Grow
6.5% NaCl
- + - +
- +
Catalase
Staph
+
+
+
+
+ -

75. Non-Enterococcus
76
Gram+
+
Cocci
Strept
+ + + +
Enterococcus
γ
Grow
NaCl 6.5%
-
Catalase -
Description
Gram +
Catalase –
γ (α-)hemolytic
NaCl 6.5% -
Arranged in pair or short chain
Group D
Facultative anaerobe
oFound in GI tract

76. 77
Enterococcus
Hemolysis Lancefield
Enterococcus γ (α)
D 6.5% Nacl +
Pathogenesis
Capsule
Pilli (pil1, Pil2, pil3)

Disease
Colon cancer (80%)
Infective endocarditis

Treatment
Penicillin/3
rd
cephalosporins + Gentamycin

77. 78
Enterococcus
Appearance •Cocci
•in pair or short chain
Description •Gram +
•Catalase –
•γ (α-)hemolytic
•NaCl 6.5% -
•Group D
Pathogenesis/Virulence •Capsule
•Pilli (pil1, Pil2, pil3)
Diseases

•Colon cancer (80%)
•Infective endocarditis
Treatment •Penicillin/3rd cephalosporins + Gentamycin

78. Non-Enterococcus q1
79
Which is an example of Non-enterococcus
A.Sytreptoccus bovis
B.Streptococcus pyogenes
C.Staphylococcus aureus
D.Lactobacillus acidophilus

79. Non-Enterococcus q2
80
Which pathogen is causing colon cancer?
A.Sytreptoccus bovis
B.Streptococcus pyogenes
C.Staphylococcus aureus
D.Lactobacillus acidophilus