Streptococci ( gram positive cocci )

This presentation is about STREPTOCOCCI, GRAM POSITIVE STTREPTOCOCCI, BROWN’S CLASSIFICATION, ALPHA HEMOLYTIC STREP.,BETA HEMOLYTIC STREPTOCOCCI, LANCIFIED CLASSIFICATION, GROUP A ( S. PYOGENS) , GROUP – B ( S. AGLACTIA ), GROUP - D, DISEASES, PEPTOSTREPTOCOCCI
TRANSMISSION, PATHOGENESIS,STREPTOCOCCUS PNEUMONIAE, IMPORTANT PROPERTIES, C - SUBSTANCE, TRANSMISSION, CONSOLIDATION OF LUNGS, FACTORS THAT PREDISPOSE PERSON TO PNEOMCOCCAL INFECTIONS, CLINICAL FINDINGS, LABORATORY DIAGNOSIS, TREATMENT

1. Logo here TITLE Subtitle Date STREPTOCOCCI

2. GRAM POSITIVE STTREPTOCOCCI Arranged in pairs or chains Are catalase negative

3. BROWN’S CLASSIFICATION Based on hemolysis of blood by bacteria ALPHA - HEMOLYTIC BETA - HEMOLYTIC GAMMA - HEMOLYTIC

4. Incomplete hemolysis of blood hemoglobin biliverdin (red) (green) EXAMPLE 1 Strep. Pneumonia 2 Viridans S. part of normal flora of human pharynx intermittently reach blood stream INFECTIVE ENDOCARDITIS 3 Strep. Mutans found in dental plaque cause dental caries ALPHA HEMOLYTIC STREP. H 2 O 2 Produced by bacteria

5. Strep. Pneumonia OPTOCHIN inhibits growth Soluble in bile ( bile soluble) OPTOCHIN doesn’t inhibits growth Is not soluble in bile VIRIDANS S.

6. 1- C-CARBOHYDRATES Determine group of Beta Hemolytic Strep. LANCIFIED CLASSIFICATION Located in the cell wall Specificity is determined by amino sugars Divide Beta hemolytic Strep from group A-- U BETA HEMOLYTIC STREPTOCOCCI Complete hemolysis results in clear zone due to hemolysins STREPTOLYSIN O STREPTOLYSIN S 2 important antigens of BETA HEMOLYTIC Strep.

7. 2- M PROTEIN Most imp. Virulence factor of Strep. PYOGENS (group A) Produce from outer surface of cell Is ANTIPHAGOCYTIC inactivates C3b prior to phagocytosis Strains of S. pyogens that don’t produce it are non-pathogenic Classifies Group A of Beta Hemolytic Group some group A bacteria produce certain M protein NEPHRETOGENIC Some group A bacteria produce other M protein RHEUMATOGENIC BETA HEMOLYTIC STREPTOCOCCI Complete hemolysis results in clear zone due to hemolysins STREPTOLYSIN O STREPTOLYSIN S 2 important antigens of BETA HEMOLYTIC Strep.

8. LANCIFIED CLASSIFICATION Group determined by PRECIPITAN TEST with specific antisera or immunofluorescence GROUP- D GROUP- B GROUP- A GROUP C,E-U Strep. PYOGENS Strep. AGLACTIA ENTEROCOCCI E. faecalis E. faecium NON ENTEROCOCCI S. BOVIS

9. GROUP A ( S. PYOGENS) Most common bacterial cause of SKIN INFECTION PHARYNGITIS bacteria adhere to pharyngeal epithelium via pili composed of lipotechoic acid and M protein Many strains have HYALURONIC ACID capsule anti-phagocytic BACITRACIN sensitive

10. GROUP – B ( S. AGLACTIA ) Most common cause of NEONATAL PNEUMONIA Colonize in genital tract Cause NEONATAL MENINGITIS NEONATAL SEPSIS BACITRACIN resistant Diabetes is main predisposing factor of Group B Streptococcal infections in adults

11. GROUP - D ENTEROCOCCI member of normal flora of human colon cause URINARY infections BILIARY infections CARDIOVASCULAR infections can grow in harsh conditions hypertonic (6.5%) saline, bile not killed by penicillin G drug of choice VANCOMYCIN (for some) PENICILLIN + GENTAMYCIN NONENTEROCOCCAL i.e. S. BOVIS cause similar infections can’t grow in harsh conditions inhibited by 6.5% of NaCl and penicillin

12. DISEASES Strep. Cause wide variety of infections GROUP-A is a leading bacterial cause of PHARYNGITIS CELLULITIS IMPETIGO NECROTIZING FASCIITIS inciting factor of immunologic diseases RHEUMATIC FEVER & AGN GROUP-B NEONATAL SEPSIS NEONATAL MENINGITIS

13. GROUP – D E. Faecalis hospital acquired UTIs Endocarditis S. Bovis uncommon cause of Endocarditis

14. PEPTOSTREPTOCOCCI Grow under anaerobic/microaerophilic condition Produces variable hemolysis Member of normal flora of GUT MOUTH FEMALE GENITAL TRACT Participate in mixed anaerobic infections Found in brain abscesses after dental surgery Most common bacteria found in Abscess of BRAIN LUNGS ABDOMIN & PELVIS

15. TRANSMISSION Most strep. Are cause of human flora at SKIN THROAT INTESTINE Produce diseases when given access to blood stream and tissues VIRIDANS Strep. + S. PNEUMONIA found chiefly in OROPHARYNX S. PYOGENS found on SKIN + OROPHARYNX (in small no.) ENTEROCOCCI + ANAEROBIC Strep. Found in COLON

16. PATHOGENESIS

17. ALPHA – HEMOLYTIC STREP. STREP. PNEUMONIA produce no toxin produce no tissue destructive enzymes main virulent factor is ANTI PHAGOCYTIC POLYSACCHRIDE CAPSULE VIRIDANS produce no toxin produce no tissue destructive enzymes many strains produce GLYCOCYLAX enable bacteria to adhere to heart valve ENDOCARDITIS

18. BETA HEMOLYTIC GROUP – A (S. PYOGENS) Produce diseases by 3 mechanisms 1- PYOGENIC INFLAMMATION induce locally at the site of the bacteria in tissue i.e. PHARYNGITIS , CELLULITIS 2- EXOTOXIN PRODUCTION cause widespread systemic symptoms i.e. SCARLET FEVER , TSS by Strep. 3- IMMUNOLOGIC antibody against the component of bacteria cross react with normal tissue cause inflammation but there is no bacteria in lesion

19. 1- HYALURONIDASE Degrades HYALURONIC ACID which is ground substance of subcutaneous tissue Known as SPREADING FACTOR facilitates in rapid spread of S. pyogens in skin 2- STREPTOKINASE Activates plasminogen to form plasmin Dissolves fibrin present in clots thrombi emboli Use to lyse thrombi in coronary arteries of heart attack patient Produces 4 enzymes

20. 3 - DNase(STREPTODIANASE) Degrade DNA in exudate or necrotic tissue Antibody to it develops during pyoderma SREPTOKINASE + STREPTODIANASE applied as a skin test person with normal cell mediated immunity will give positive test 4- IgG DEGRADING ENZYME Is a protease Cleaves IgG heavy chains Prevent opsonization and compliment activation Enhance the virulence of bacteria

21. cause rash of scarlet fever same mechanism of action as that of TSS by S. AUREUS but there are recognizable site of pyogenic infection and blood culture are often positive produced by certain strains of S. PYOGENS that are lysogenized by bacteriophage carrying the gene for it injection of skin test dose of erythrogenic toxin person lacking antitoxin give positive test result Produce 5 toxins 1- ERYTHROGENIC TOXIN

22. is a hemolysin inactivated by oxidation ( oxygen labile) cause Beta Hemolysis in colonies produced under agar it’s antigen ASO develops after group A streptococcal infections titer of ASO is imp. In diagnosis of Rheumatic fever 2- STREPTOLYSIN-O

23. it is a hemolysin not activated by Oxygen (oxygen stable) not antigenic beta hemolysis in colonies produce on agar plate 3- STREPTOLYSIN-S

24. cause of most cases of Streptococcal TSS same mode of action as that of TSS by S. AUREUS 4- PYROGENIC EXOTOXIN A

25. is a protease it rapidly destroys tissue produce in large amount by S. Pyogens also called FLESH EATING strep. is a necrotizing factor 5- EXOTOXIN B

26. BETA HEMOLYTIC GROUP- B ( S. AGLACTIA) Based on ability to produce inflammatory response No cytotoxic enzyme/ toxin / immunological disease is produced Have polysaccharide capsule anti-phagocytic Anti capsular antibody are used for protection against it

27. STREPTOCOCCUS PNEUMONIAE

28. IMPORTANT PROPERTIES Lancet shaped cocci arranged in pairs ( diplococcus ) or short chains Have polysaccharide capsule that have 91 antigenically distinct types (serotype) Capsule are virulence factor that interfere with phagocytosis and favor invasiveness Capsular polysaccharide elicits B cell ( T cell independent ) response Specific antibodies to capsule opsonizes the bacteria facilitates phagocytosis promote resistence

29. C - SUBSTANCE S. Pneumoniae has a teichoic acid called C – Substance ( C-Polysaccharide ) in the cell wall C substance react with C Reactive Protein( CRP ) is normal serum protein made by liver acute phase protein elevated as much as 1000 times in acute inflammation it is a Beta globulin non specific indicator of inflammation elevated in response of many organisms measured in human serum in laboratory with carbohydrate of S. pneumonia Elevated CRP is better predicator of Heart attack than elevated cholesterol

30. TRANSMISSION Human are natural host for pneumococci There are no animal reservoirs

31. Have capsular polysaccharide Lipoteichoic acid activates complement induce cytokine production cause SEPTIC SHOCK SYNDROME in immunocompromised patients Pneumolysin hemolysin cause Alpha hemolysis Produce IgA protease enhances it’s ability to colonize the mucosa of upper respiratory tract by cleaving IgA PATHOGENESIS

32. CONSOLIDATION OF LUNGS PNEUMOCOCCI multiplies in tissue and cause inflammation When they reach alveoli out pouring of fluid and red and white cells occur consolidation of lung During recovery pneumococci are phagocytosed mononucleas cells ingest debris consolidation resolves

33. DISEASES Streptococcus pneumonia causes PNEUMONIAE BACTEREMIA MENINGITIS INFECTIONS of UPPER RESPIRATORY TRACT OTITIS MEDIA MASTOIDITIS SINUSITIS CONJUCTIVITIS (esp. in children) PURULENT BRONCHITIS PERICARDITIS

34. FACTORS THAT PREDISPOSE PERSON TO PNEOMOCOCCAL INFECTIONS Alcohol or drug intoxication Cerebral impairment depress cough reflex increase aspiration of secretions Abnormality of respiratory tract viral infections , pooling of mucus , bronchial obstruction, respiratory tract injury by irritants Abnormal circulatory dynamics pulmonary congestion , heart failure Splenectomy Chronic Sickle cell anemia patient auto-infarct their spleen asplenic pneumococcal disease nephrosis sepsis Trauma to head leakage if CSF through nose PNEMOCOCCAL MENINGITIS

35. CLINICAL FINDINGS Sudden chill Fever Cough Pleuritic pain Sputum of red or brown color Bacteremia in 15-25% of cases

36. LABORATORY DIAGNOSIS Gram stained smears lancet shaped gram positive diplococci Can be detected by QUELLUNG REACTION with multi type antiserum On blood agar pneumococci form small alpha hemolytic colonies bile soluble ( lysed by bile or deoxycholate ) Growth is inhibited by OPTOCHIN Diagnosis of pneumococcal meningitis is made by detecting capsular polysaccharide in spinal fluid using LATEX AGGULATINATIN TEST Diagnosis of bacteremia and pneumococcal pneumonia can also be done by detecting urinary antigen ( C- substance ) Antibiotic sensitivity test must be done on organisms isolated from serious infections.

37. TREATMENT Penicillin Eryhromycin Fluoroquinilone Severe pneumococcal infections PENICILLIN G Mild pneumococcal infections oral penicillin V Penicillin allergic patient erythromycin and it’s derivatives i.e. CAZITHROMYCIN Penicillin resistant pneumococci vancomysin

38. PREVENTION Persons esp. splenectomized and children under age of 5 years immunized with 13 valent pneumococcal conjugate vaccine (PREVNOR 13) immunogen is pneumococcal polysaccharide of 13 most prevalent serotypes conjugated to carrier protein ( diphtheria toxoid) Individuals of age 50 years or older immunized with unconjugated 23 – valent pneumococcal vaccine ( pneumovax 23)

39. THANK YOU SYEDA MARYAM

40. Hello there! My name is Syeda Maryam . I am here to assist you, whether you are a student or teacher . I can make educational presentations/slides for you based on the content you’ll give to me . I have 2 years of experience in this field of making slides on power point for students and teachers as well. so if you need any help then contact me through my freelancer account at Guru.com https ://www.guru.com/pro/dashboard.aspx you can view my portfolio at Slideshare.net and facebook page https ://www.slideshare.net/syedamaryam10 https ://www.facebook.com/Study-Slides-107976133868241 you can also contact me through my email [email protected] I’ll be glad to help you! See you soon!