Chapter 4: Gram-positive Bacteria: Streptococcus Flashcards
0
Q
Streptococcus - morphology?
A
chains (strips) of cocci
1
Q
Streptococci - Gram stain?
A
Gram-positive
2
Q
Streptococcus - catalase?
A
catalase-negative
3
Q
Group A streptococci - taxonomic name?
A
Streptococcus pyogenes
4
Q
S. pyogenes - Lancefield antigen?
A
Group A streptococcus
5
Q
Group A strep (S. pyogenes) displays what kind of hemolysis on blood agar?
A
beta (complete) hemolysis
6
Q
Group A strep (S. pyogenes) can be differentiated from Group B strep (S. agalactiae) based on sensitivity to what?
A
bacitracin
7
Q
Group A strep (S. pyogenes) is (sensitive, resistant) to bacitracin.
A
sensitive
“B-BRAS”
8
Q
Group A strep (S. pyogenes) causes what 3 categories of diseases?
A
1) pyogenic
2) toxigenic
3) immunologic
9
Q
Group A strep (S. pyogenes) causes what pyogenic diseases? (2)
A
1) pharyngitis
2) skin infections - cellulitis, impetigo, folliculitis, erysipelas, pyoderma
10
Q
Group A strep (S. pyogenes) causes what toxigenic diseases? (3)
A
1) scarlet fever
2) toxic shock-like syndrome
3) necrotizing fasciitis
11
Q
Group A strep causes what immunologic (antibody-mediated) diseases? (2)
A
1) rheumatic fever
2) acute glomerulonephritis
12
Q
What is the major virulence factor for Group A streptococci (S. pyogenes)?
A
Protein M
13
Q
What is M protein and which microbe expresses it?
A
M protein is a major virulence factor for Group A streptococci (S. pyogenes).
It inhibits the activation of complement and protects the organism from phagocytosis.
14
Q
What test can be used to detect recent Group A strep (S. pyogenes) infection? How does it work?
A
ASO titer. Following infection, anti-streptolysin O antibodies develop.
15
Q
ASO titer is used to detect infection by what microbe?
A
Group A streptococci (S. pyogenes)
16
Q
What is streptolysin O?
A
an enzyme that destroys red and white blood cells, and is the reason for the beta-hemolytic ability of Group A streptococci (S. pyogenes). It is oxygen labile (inactivated by oxygen). It is antigenic (ASO antibodies)
17
Q
What is streptolysin S?
A
an enzyme that destroys red and white blood cells, and is responsible (with streptolysin O) for the beta-hemolytic ability of Group A streptococci (S. pyogenes). It is oxygen stable. It is not antigenic.
18
Q
A throat swab rapid antigen detection test (RADT) can be used to specifically diagnose infection with what microbe?
A
Group A streptococcus (S. pyogenes)
19
Q
What specific test can be used to quickly diagnose Group A streptococcus (S. pyogenes) infection?
A
throat swab rapid antigen detection test (RADT), immunologically detects group A Lancefield carbohydrate antigen
20
Q
What toxins are produced by Group A streptococcus (S. pyogenes), and what diseases do they cause? (2)
A
1) pyrogenic toxin –> Scarlet fever
2) Exotoxin A (toxic shock syndrome toxin) (different from staphylococcus toxin TSST-1) –> Toxic shock-like syndrome
21
Q
Pyrogenic toxin produced by Group A streptococcus (S. pyogenes) leads to what disease?
A
Scarlet fever
22
Q
Exotoxin A is produced by what microbe?
A
Streptococcus pyogenes (Group A Strep)
23
Q
Exotoxin A produces what disease?
A
Toxic shock-like syndrome (S. pyogenes)
24
How does streptococcus pyrogenic toxin released by Group A strep (S. pyogenes) lead to scarlet fever?
activates the endogenous mediators of sepsis, such as the cytokine IL-1
25
Scarlet fever results from what bacterial toxin?
Streptococcus pyrogenic toxin by Group A streptococcus (S. pyogenes)
26
How do strains of Group A streptococci (S. pyogenes) obtain streptococcus pyrogenic toxin leading to scarlet fever?
obtain exotoxin from a temperate bacteriophage by lysogenic conversion
27
streptokinase - function
activates plasminogen to plasmin to lyse fibrin clots. expressed by Group A strep (S. pyogenes)
28
What enzyme activates plasminogen to plasmin to lyse fibrin clots, and is expressed by Group A strep (S. pyogenes)?
streptokinase
29
What virulence factors does Group A streptococcus (S. pyogenes) express? (6)
1) M protein
2) Streptolysin O, streptolysin S
3) streptokinase
4) hyaluronidase
5) DNAse
6) anti-C5a peptidase
30
What enzyme breaks down proteoglycans of extracellular matrix, and is expressed by Group A strep (S. pyogenes) and S. aureus?
hyaluronidase
31
hyaluronidase - function
breaks down proteoglycans of extracellular matrix. Expressed by Group A strep (S. pyogenes) and S. aureus
32
What enzymes are responsible for the beta-hemolytic ability of Group A streptococcus (S. pyogenes)? Which are antigenic?
streptolysin O, streptolysin S
| Streptolysin O is antigenic (ASO titer)
33
What microbe causes pharyngitis, skin infections, scarlet fever, toxic shock-like syndrome, necrotizing fasciitis, rheumatic fever, and acute glomerulonephritis?
Group A streptococcus (S. pyogenes)
34
The pyogenic diseases of pharyngitis and skin infection are caused by what microbe?
Group A streptococcus (S. pyogenes)
35
The toxigenic diseases of scarlet fever, toxic shock like syndrome, and necrotizing fasciitis are caused by what microbe?
Group A streptococcus (S. pyogenes)
36
The immunologic diseases of rheumatic fever and acute glomerulonephritis are caused by what microbe?
Group A streptococcus (S. pyogenes)
37
What skin infections can result from Group A streptococci (S. pyogenes)? (5) Define them.
1) Folliculitis - infection of hair follicle
2) Impetigo - vesicular blistered eruption that becomes crusty and flaky, frequently found around the mouth
3) Cellulitis - deep infection of the skin cells, producing red, swollen skin which is hot to the touch
4) Erysipelas - superficial infection of skin cells (dermis). Specific appearance of raised (erythematous) bright red rash with a sharp border
5) Pyoderma - pustule, usually on the extremity of the face, that breaks down after 4-6 days to form a thick crust, healing slowly to leave a depigmented area
38
Erysipelas are more common caused by (S. pyogenes; S. aureus)
```
Streptococcus pyogenes (Group A strep)
Rarely caused by staphylococcus aureus
```
39
Define folliculitis.
infection of hair follicle
40
What is infection of the hair follicle called?
folliculitis
41
Define impetigo.
vesicular blistered eruption that becomes crusty and flaky, frequently found around the mouth
42
What is the term for vesicular blistered eruption that becomes crusty and flaky, frequently found around the mouth?
impetigo
43
Define cellulitis.
deep infection of the skin cells, producing red, swollen skin which is hot to the touch
44
What is the term for deep infection of the skin cells, producing red, swollen skin which is hot to the touch?
cellulitis
45
Define erysipelas.
superficial infection of skin cells (dermis). Specific appearance of raised (erythematous) bright red rash with a sharp border
46
What is the term for a superficial infection of skin cells (dermis), with a specific appearance of raised (erythematous) bright red rash with a sharp border?
erysipelas
47
Define pyoderma.
pustule, usually on the extremity of the face, that breaks down after 4-6 days to form a thick crust, healing slowly to leave a depigmented area
48
What is the term for a pustule, usually on the extremity of the face, that breaks down after 4-6 days to form a thick crust, healing slowly to leave a depigmented area?
pyoderma
49
Streptococcal pharyngitis - characteristics (4)
1) red, swollen tons and pharynx
2) purulent exudate on tonsils
3) fever
4) swollen lymph nodes
50
What is the clinical syndrome described by the following:
1) red, swollen tons and pharynx
2) purulent exudate on tonsils
3) fever
4) swollen lymph nodes
pharyngitis
51
scarlet fever - characteristics? (4)
1) fever
2) scarlet red rash: confluent erythematous sandpaper-like (fine, blanching) rash
3) circumoral pallor
4) strawberry tongue
52
What syndrome has these features?
1) fever
2) scarlet red rash: confluent erythematous sandpaper-like (fine, blanching) rash
3) circumoral pallor
4) strawberry tongue
scarlet fever
53
Describe the red rash caused by scarlet fever (texture, location, timing of onset and fading)
1) sand-paper like red rash (fine and rough-textured)
2) blanches upon pressure
3) appears 12–72 hours after the fever starts
4) generally begins on the chest and armpits and behind the ears. It may also appear in the groin
5) on the face, often shows as red cheeks with a characteristic pale area around the mouth (circumoral pallor)
6) is worse in the skin folds (so-called Pastia lines, where the rash runs together in the armpits and groin, appear and can persist after the rash is gone)
7) begins to fade three to four days after onset and desquamation (peeling) begins. "This phase begins with flakes peeling from the face. Peeling from the palms and around the fingers occurs about a week later." Peeling also occurs in the axilla, the groin, and the tips of fingers and toes.
54
How do strains of streptococcus pyogenes (Group A strep) lead to necrotizing fasciitis?
Certain strains express M proteins that block phagocytosis, allowing the bacteria to move rapidly through tissue. S. pyogenes enter a break in the skin and follow a path along the fascia (between the subcutaneous tissue and muscle).
55
How is S. pyogenes (Group A strep) transmitted? (3)
- respiratory droplets
- food
- direct inoculation to the skin
56
Rheumatic fever is caused by what bacterium? What mechanism?
S. pyogenes (Group A strep)
| antibody-mediated
57
What are the major manifestations of rheumatic fever (other than fever)? (5)
JONES
1) Joints - migratory polyarthritis
2) Carditis (O for heart) - endocarditis, myocarditis, or pericarditis
3) Nodules - subcutaneous (rubbery nodules just under the skin) on extensor surfaces (wrist, elbow, knee)
4) Erythema marginatum rash - rash with a red margin that spreads out from its center
5) Sydenham's chorea - uncontrolled dance-like movements of the extremities, usually begins 2-3 weeks after pharyngitis
58
What syndrome is characterized by these major criteria?
1) migratory polyarthritis
2) carditis
3) subcutaneous nodules on extensor surfaces
4) Erythema marginatum rash
5) chorea 2-3 weeks after pharyngitis
Rheumatic Fever
JONES criteria:
1) Joints - migratory polyarthritis
2) Carditis (O for heart) - endocarditis, myocarditis, or pericarditis
3) Nodules - subcutaneous (rubbery nodules just under the skin) on extensor surfaces (wrist, elbow, knee)
4) Erythema marginatum rash - rash with a red margin that spreads out from its center
5) Sydenham's chorea - uncontrolled dance-like movements of the extremities, usually begins 2-3 weeks after pharyngitis
59
What is the cause of carditis in rheumatic fever?
There are antigens in the heart that are similar to the antigens of Group A strep (S. pyogenes). The antibodies that form to fight S. pyogenes infection cross-react with self-antigens in the heart.
60
After 10-20 years of recurrent infections with Group A strep (S. pyogenes), what can happen to the heart? specific site?
Initial myocarditis, followed by valvular heart disease (most frequently the mitral valve, followed by the aortic valve)
61
How does Group A strep (S. pyogenes) cause acute glomerulonephritis?
A few strains of S. pyogenes are nephritogenic: Antigens from these bacteria induce an antibody response. The resulting antigen-antibody complexes travel to and are deposited in the glomerular basement membrane, where they activate the complement cascade, leading to local glomerular destruction in the kidney.
62
How does acute post-streptococcal glomerulonephritis typically present? (4)
1) puffy face, caused by retention of fluid from damaged kidney
2) tea or coca-cola colored urine, due to hematuria
3) high blood pressure, from hypervolemia secondary to fluid retention
4) sore throat or skin infection ~1 week prior (impetigo more commonly precedes glomerulonephritis than pharyngitis)
63
What is the differential diagnosis for a child presenting with:
1) puffy face
2) tea or coca-cola colored urine
3) high blood pressure
4) sore throat or skin infection ~1 week prior
acute glomerulonephritis caused by Group A strep (S. pyogenes) infection
64
What are treatment options for Group A streptococcus (S. pyogenes) infection? (3+2)
1) Penicillin G - inhibits transpeptidase
2) Penicillin V (oral form - covers all organisms that penicillin G does)
3) erythromycin - macrolide, binds to 50S ribosomal subunit to inhibit protein synthesis
4) penicillinase-resistant penicillin for skin infections where staphylococcus could be the responsible organism
5) add clindamycin for invasive S. pyogenes infections such as necrotizing fasciitis or toxic shock like syndrome (lincomycin derivative, binds to 50S ribosomal subunit to inhibit protein synthesis)
65
What is the treatment for Group A strep (S. pyogenes) skin infection where stapylococcus could also be the responsible organism?
penicillinase-resistant penicillin
66
What is the treatment for invasive S. pyogenes infection (such as necrotizing fasciitis or toxic shock like syndrome)?
penicillin G (or V), plus clindamycin
67
Group B streptococci - taxonomic name?
Streptococcus agalactiae
68
S. agalactiae - Lancefield antigen?
Group B streptococcus
69
Group B strep (S. agalactiae) displays what kind of hemolysis on blood agar?
beta (complete) hemolysis
70
Group B strep (S. agalactiae) can be differentiated from Group A strep (S. pyogenes) based on resistance to what?
bacitracin
71
Group B strep (S. agalactiae) is (sensitive, resistant) to bacitracin.
resistant
| "B-BRAS"
72
Where is Group B streptococci (S. agalactiae) commonly found?
25% of women carry these bugs vaginally, and a baby can acquire these bacteria during delivery
73
What microbe is commonly carried vaginally and transmitted to the baby upon delivery, causing neonatal (<3 mos) meningitis, pneumonia, and sepsis?
Group B streptococcus (S. agalactiae)
74
What diseases does Group B strep (S. agalactiae) cause? (3)
1) neonatal meningitis
2) neonatal pharyngitis
3) neonatal sepsis
75
What factor produced by Group B streptococcus enlarges the area of beta hemolysis by Staph aureus on blood agar?
CAMP factor
| formation of arrowhead when GBS streak meets S. aureus streak
76
What microbe can the CAMP test identify? How?
Group B strep (S. agalactiae).
GBS is not strongly beta hemolytic on its own, but it produces CAMP, which enlarges the area of beta-hemolysis formed by Staph aureus, forming an arrowhead when streaked on blood agar.
77
A positive hippurate test indicates the presence of which bacterium?
Group B streptococcus (S. agalactiae)
78
How is the hippurate test used to detect Group B strep (S. agalactiae)?
Group B strep can hydrolyze hippurate to produce glycine and benzoate. Upon addition of the oxidizing agent ninhydrin, the glycine gets deaminated, and the ninhydrin gets reduced, forming a precipitate and becoming purple/brown (if no glycine is present, the solution stays clear)
79
What is the treatment for Group B streptococcus (S. agalactiae) infection?
Penicillin G
80
A pregnant woman is screened at 35-37 weeks, and is positive for Group B streptococcus (S. agalactiae) colonization. Should she be treated?
Yes - with intrapartum ampicillin prophylaxis
(Group B strep in pregnant women can cause bacteremia and sepsis, and secondary infection of the fetus resulting in stillbirth or spontaneous abortion in 30% of cases)
81
What bacteria can cause neonatal meningitis (<3 mos)? (3)
1) Group B streptococcus (S. agalactiae)
2) E. coli
3) Listeria monocytogenes
82
Group B strep, E. coli, and Listeria monocytogenes are the common causes of what disease?
neonatal meningitis
83
What bacteria cause meningitis in older children (<5yo, after maternal antibodies wane but before new antibodies develop)? (2)
1) Neisseria meningitides
| 2) Haemophilus influenzae
84
Neisseria meningitides and Haemophilus influenzae are the common causes of what disease?
Meningitis in older children (<5 yo)
85
Enterococci and Non-enterococci - Lancefield antigen?
Group D
86
Group D streptococci can be divided into 2 subcategories:
Enterococci and Non-enterics
87
E. faecalis and E. faecium are species in what category of bacteria?
Group D streptococci - enterococci
88
Group D streptococci (enterococci and non-enterococci) exhibit what type of hemolysis when grown on blood agar?
gamma (non) hemolytic
89
E. faecalis exhibits what pattern of hemolysis when grown on blood agar?
Gamma (non) hemolytic
| E. faecalis is Group D streptococcus / Enterococci
90
E. faecium displays what pattern of hemolysis when grown on blood agar?
Gamma (non) hemolytic
| E. faecium is Group D streptococcus / Enterococci
91
S. bovis displays what pattern of hemolysis when grown on blood agar?
Gamma (non) hemolytic
| S. bovis is Group D streptococcus, non-enterococci
92
Major example species of Enterococci (2)
E. faecalis
| E. faecium
93
Major examples of non-enterococci Group D strep (2)
Streptococcus bovus
| Streptococcus equinus
94
Group D streptococci are commonly found in the gut. Are all Group D streptococci part of normal gut flora?
No: Enterococci (E. faecalis and E. faecum) are part of normal gut flora. Non-enterococci (S. bovis) is not part of normal gut flora.
95
Where can Group D streptococcus (enterococci and non-enterococci) be found?
in the gut
| Enterococci are part of normal gut flora, but S. bovis is not part of normal gut flora
96
What diseases do Group D strep (enterococci such as E. faecalis and E. faecium; non-enterococci such as S. bovis and S. equinus) commonly cause? (3)
1) UTI
2) biliary tract infection
3) subacute bacterial endocarditis (SBE) (following GI/GU procedures)
(4) bacteremia and sepsis
97
What special lab media conditions can enterococcus grow in?
40% bile
| 6.5% NaCl
98
What special lab media can S. bovis grow in?
40% bile (but not 6.5% NaCl, unlike enterococci; not as hardy)
99
These bacteria can grow in 40% bile or in 6.5% NaCl
Enterococci (group D strep): E. faecalis and E. faecium
100
These bacteria can grown in 40% bile, but not in 6.5% NaCl
Non-enterococci (group D strep): S. bovis, S. equinus
101
How can enterococci and non-enterococci Group D streptococci be differentiated based on growth in special media?
Enterococci can grow in both 40% bile and 6.5% NaCl.
| Non-enterococci (S. bovis) can grow in 40% bile, but not in 6.5% NaCl.
102
What are treatment options for non-resistant strains of enterococci? (2)
1) ampicillin with aminoglycoside (synergistic)
2) vancomycin with aminoglycoside (synergistic)
* Note, Group D strep are resistant to penicillin G
103
Which streptococcus group is resistant to penicillin G?
Enterococci: E. faecalis, E. faecium
104
What are treatment options for vancomycin-resistant enterococci (VRE)? (3)
1) linezolid - kills Gram+ bugs by blocking the 50S ribosomal subunit
2) daptomycin - a cyclic lipopeptide that kills Gram+ bugs by altering the microbe cell membrane electrical charge and transport
3) nitrofurantoin
105
S. bovis infection is strongly correlated with what disease?
colon cancer (colorectal neoplasms)
"Bovis in the Blood: Cancer in the Colon"
106
Infection with which microbe is strongly correlated with colon cancer (colorectal neoplasms)?
Stretococcus bovis
"Bovis in the Blood, Cancer in the Colon"
107
What microbe commonly causes the following diseases:
1) UTI
2) biliary tract infection
3) subacute bacterial endocarditis (SBE) (following GI/GU procedures)
Group D streptococci:
Enterococci: E. faecalis, E. faecium
Non-enterococci: S. bovis, S. equinus
108
S. viridans displays what pattern of hemolysis when grown on blood agar?
alpha (partial, green) hemolysis
109
Which streptococci species are alpha hemolytic?
S. viridans
| S. pneumoniae
110
How can the alpha hemolytic streptococci species be differentiated? (3)
1) capsule - S.pneumoniae has a capsule; S. viridans does not
2) optochin - S.pneumoniae is susceptible; S. viridans is resistant (OVRPS)
3) bile - S. pneumoniae is bile soluble; S. viridans is bile insoluble
111
Where are S. viridans found?
normal GI flora, frequently found in the nasopharynx and gingival crevices
(Viridans group strep live in the mouth because they are not afraid of-the-chin (op-to-chin resistant))
112
Viridans group streptococci can cause which 3 main types of infections?
1) dental caries (S. mutans)
2) subacute bacterial endocarditis at damaged heart valve (such as from old rheumatic fever from S. pyogenes, congenital heart defect, or mitral valve prolapse) (S. sanguinis)
3) abscesses in brain or liver (S. intermedius)
113
Which species of streptococcus bacterium is responsible for causing dental caries?
S. mutans of the viridans group streptococci
114
S. mutans of the viridans group streptococci causes what disease? Mechanism?
dental caries. S. mutans can bind to teeth and ferment sugar, which produces acid and dental caries.
115
Which species of viridans group streptococci causes subacute bacterial endocarditis?
S. sanguinis
116
Which streptococcal species can cause subacute endocarditis? (2)
enterococcus (Group D strep)
| S. sanguinis of viridans group streptococci
117
Enterococci (Group D strep) and the viridans group of streptococci (S. sanguinis) can both cause what disease?
subacute (slow onset) endocarditis
118
Enterococci (Group D strep) and S. viridans (S. sanguinis) express what molecule to cause subacute bacterial endocarditis (SBE)?
extracellular dextran helps them bind to fibrin-platelet aggregates on damaged heart valves
119
Dextran is expressed by which bacterial species?
Enterococci (Group D. strep) and S. viridans (S. sanguinis)
120
Extracellular expression of dextran by enterococci (Group D strep) and S. viridans (S. sanguinis) causes what disease?
subacute bacterial endocarditis. Extracellular dextran helps them bind to heart valves
121
Which streptococcal species can cause brain and liver abscesses?
S. intermedius (anginosis)
"Streptococcus InterMeDius an AnginoSus - IMmeDiately Assess for ABSCESS"
122
S. sanguinis of the viridans group of streptococci cause what disease?
subacute bacterial endocarditis (SBE)
123
S. intermedius / S. anginosus can cause what disease?
abscess in the brain or liver
If find in the blood "Streptococcus InterMeDius and AnginoSus, IMmeDiately ASSess for ABSCESS"
124
Abscesses in the brain or liver is associated with what streptococcal species?
S. intermedius / S. anginosus of the viridans group streptococci
125
What is the treatment for infection with viridans group streptococci (S. mutans, S. sanguinis, S. intermedius/anginosus)?
penicillin G
126
Appearance of streptococcus pneumoniae? (3)
lancet-shaped
Gram-positive cocci
diplococci (arranged in pairs)
encapsulated
127
What Gram-positive cocci is lancet-shaped and arranged in pairs (diplococci)?
Streptococcus pneumoniae
128
S. pneumoniae displays what pattern of hemolysis when grown on blood agar?
alpha (partial, green) hemolysis
129
S. pneumoniae is optochin (sensitive, resistant)
sensitive
130
S. pneumoniae is bile (soluble, insoluble)
soluble (lysed by bile)
131
What is the major virulence factor of pneumococcus (S. pneumo)?
polysaccharide capsule, which protects the organism from phagocytosis
-no virulence without capsule
(also IgA protease)
132
Other than its polysaccharide capsule, what is another major virulence factor of S. pneumoniae?
IgA protease
133
Is the S. pneumoniae polysaccharide capsule antigenic?
Yes, but there are 84 different capsule serotypes, so surviving an infection with one strain only provides immunity to 1 out of 83 possible capsule types
134
What is the most common cause of pneumonia in adults?
Streptococcus pneumoniae
135
S. pneumoniae is the most common cause of what diseases? (4)
1) meningitis
2) otitis media (in childreN)
3) pneumonia
4) sinusitis
MOPS are Most Optochin Sensitive (and remember OVRPS)
136
What is the most common cause of bacterial meningitis in adults?
Streptococcus pneumoniae
137
What is the most common cause of otitis media (middle ear infection) in children?
Streptococcus pneumoniae
138
How does pneumococcal (S.pneumoniae) pneumonia present on physical exam? (5)
1) sudden onset
2) shaking chills (rigors)
3) fever
4) chest pain with respirations
5) shortness of breath
-Get a CXR and sputum culture
139
How does pneumococcal (S.pneumoniae) pneumonia appear on chest X-ray?
white consolidated lobe: the alveoli of one or more lung lobes fill up with white blood cels (pus), bacteria, and exudatae
140
How does pneumococcal (S.pneumoniae) pneumonia present on sputum culture?
the patient will cough up yellow-green phlegm ("rusty sputum" from hemoptysis caused by coughing) that on Grm stain reveals gram-positive lancet-shaped diplococci
141
How does meningitis in neonates (Group B strep) differ from meningitis in adults (S. pneumoniae)?
```
Nuchal rigidity (stiff neck), the classic sign of meningitis, is usually present in an adult with meningitis.
Nenoates with meningitis don't usually present with stiff neck, but display nonspecific signs such as fever, vomiting, poor feeding, and irritability.
```
142
What bacterium is commonly associated with the following diseases?
1) meningitis (in adults)
2) otitis media (in children)
3) pneumonia (in adults)
4) sinusitis
Streptococcus pneumoniae
143
S. pneumoniae is associated with sepsis in what patient populations?
asplenecis/splenectomy
| sickle cell anemia (functionally asplenic)
144
Is there a vaccine for pneumoniae? What is it made of and who is it given to?
- Pneumovax has 23 of the most common capsular polysaccharide antigens against Streptococcus pneumoniae.
- Given to asplenics, or with HIV disease who are unable to defend themselves against encapsulated bacteria.
- Prevnar (13 valent conjugated vaccine) can also reduce cases of otitis media in children
145
S. pneumoniae is (positive, negative) for the Quellung test.
positive - it has a polysaccharide capsule that swells when tested against antiserum containing anti-capsular antibodies
146
How is S. pneumoniae transmitted?
respiratory droplets
147
What are Pneumovax and Prevnar? Who are the target populations?
Both are S. pneumococcus vaccines.
Pneumovax contains 23 of the most common capsular polysaccharide antigens. Given to asplenic, immunocompromised, elderly.
Prevnar is a 13-valent conjugte vaccine. Given to children <5 to prevent pneumonia and otitis media.
148
What is the treatment for S. pneumoniae infection? (3)
1) penicillin (high-dose intramuscular (IM))
2) erythromycin
3) ceftriaxone (third generation cephalosporin)
149
Enterococci - morphology?
Gram-positive cocci in pairs
