WEEK 5: STREPTOCOCCI Flashcards
- Complete lysis of RBC’s around colony
- **Clear area **around colony
BETA
- Partial lysis of RBC’s around colony
- Greenish discoloration of area around colony
ALPHA
- No lysis of RBC’s around colony
- No change in agar
GAMMA
Small area of intact RBC around colony surrounded by a wider zone of complete hemolysis
ALPHA PRIME
i. Gram (+) cocci arranged in pairs or chains
ii. Facultative anaerobe but some are aerotolerant anaerobes
iii. Some are capnophilic
iv. Non-motile; (-) catalase, oxidase and gas production
Streptococci
Negative in Catalase test
Streptococci
test the ability of the organism to
breakdown of H2O2 into oxygen and water
Catalase Test
organisms that are positive in catalase test
Staphylococcus & Micrococcus
in catalase test, copious bubble form if the organism is?
Positive
No or few bubbles
Negative in Catalase test
What is being extracted in Lancefield Classification?
C Carbohydrate
Group A strep
S. pyogenes
Group B strep
S. agalactiae
Group C strep
S. dysgalactiae, S. equisimilis
Group D Non enterococcus
S. bovis group / S. gallolyticus
Group D Enterococcus
E. faecalis, E. faecium
Pneumococcus
S. pneumoniae
Which of the species under Streptococci group does not have a Lancefield Classification?
S. pneumoniae
Viridans strep (A, C, F, G, N)
S. anginosus, mutans, mitis
What is the hemolytic pattern of Group A strep? (S. pyogenes)
β (beta)
What is the hemolytic pattern of Group B strep? (S. agalactiae)
β (beta)
What is the hemolytic pattern of Group C strep? (S. dysaglactiae, S. equisimilis)
β (beta)
What is the hemolytic pattern of Group D Non enterococcus? (S. bovis group)
α,γ (alpha, gamma)
What is the hemolytic pattern of Group D Enterococcus? (E. faecalis, E. faecium)
α,β,γ (alpha, beta, gamma)
What is the hemolytic pattern of Pneumococcus? (S. pneumoniae)
α (alpha)
What is the hemolytic pattern of Viridans strep? (Anginosus, mutans, mitis)
β, α, γ (beta, alpha, gamma)
- Grows at 37C
- Mostly has β-hemolytic reactions
- S. pyogenes, group C and G streptococci
Pyogenic group
- Grows at 37C and 45C
- indigenous microbiota in the URT
- S. mutans, S. mitis and S. salivarius
Viridans group
- Grows at 10C and 37C
- found on dairy products
- S. lactis
Lactic group
- Grows at 10C, 37C and 45C
- part of the indigenous microbiota of the human intestine
- E. faecalis
Enterococcus group
Attached to the peptidoglycan
Antiphagocytic
For adherence to mucosal cells
Primary
M Protein
Mediates adherence to host epithelial cells
Protein F (Fibronectin-binding protein)
Mediates attachment to mucosal cells
Lipoteichoic acid
Prevents opsonized phagocytosis
Mask bacterial antigens
Hyaluronic acid Capsule
Group of four enzymes with nuclease activity
Degrade host DNA (DNase) and RNA
Streptodornase (DNases)
Subsurface hemolysin (Oxygen labile)
Toxic to RBC’s, WBC’s and platelets
Induces antibody response - anti-streptolysin O
Streptolysin O
Surface hemolysin (Oxygen stable)
Lysis WBC’s and is non immunogenic
Streptolysin S
Causes lysis of fibrin clots
Streptokinase (Fibrinolysin)
Solubilizes hyaluronic acid in connective tissues
Hyaluronidase
Exotoxins are associated with Scarlet Fever and Streptococcal Toxic shock-like syndrome
Streptococcal pyrogenic exotoxins A, B, C (SPE)
Spreading-factor enzyme
Hyaluronidase
Suppurative fasciitis, hospital
gangrene, necrotizing erysipelas
Invasive infection characterized by
inflammation and necrosis of skin,
subcutaneous fat and fascia
Necrotizing Fasciitis
superficial and localized
Impetigo
involves deeper tissue invasion
Cellulitis
acute spreading erythematous lesion
Erysipelas
Two types of Post-Streptococcal Sequelae
Rheumatic Heart Fever and Acute glomerulonephrits (AGN)
diffuse red rashes (chest to extremities)
Scarlet Fever
Condition wherein organ system
shuts down leading to death
Streptococcal Toxic Shock Syndrome
what organism causes these clinical Infections?
- Bacterial Pharyngitis and Tonsilitis
- Pyodermal Infections
- Necrotizing Fascitis
- Streptococcal Toxic Shock Syndrome
- Post-Streptococcal Sequelae
Streptococcus pyogenes
i. Virulence Factor
Capsular material interferes with phagocytic activity and complement cascade activation
normal flora usually found in vagina or GIT
Streptococcus agalactiae
Deposition of ab-ag complexes in glomeruli
Acute glomerulonephrits (AGN)
Cross reactive antibodies against streptococcal antigens and human heart tissue
Fever and inflammation of heart and blood vessels
Rheumatic Heart Fever
Transmission occurs vertically or during delivery (associated with obstetric complications)
In newborn it causes pneumonia, sepsis and meningitis
In adult, causes endometritis and wound infections
Streptococcus agalactiae
Small-colony forming β-hemolytic isolates
Resembles S. pyogenes infections
S. anginosus group
Large-colony forming β-hemolytic isolates
Resembles S. pyogenes infections
S. dysgalactiae subsp. equisimilis
i. Virulence Factor
Capsular polysaccharide
Antigenic polysaccharide resulting to 80-100 serogroup
Antiphagocytic
Streptococcus pneumoniae
ii. Associated Disease
1. Pneumonia (lobar and community acquired) – leads to edema of lungs and drowning in own fluids
2. Sinusitis, Otitis Media, Bacteremia, Meningitis
Streptococcus pneumoniae
- Gram-positive diplococci (lancet or bullet shape)
- Capnophilic
Streptococcus pneumoniae
Products produced by S. agalactiae
- Hemolysin
- DNases
- Hyaluronidase
- Protease
- CAMP factor (Christie-Atkins-Munch-Peterson)
leads to edema of lungs and drowning in own fluids
Pneumonia
Polysaccharide capsule, extracellular dextran and cell surface-associated proteins (adhesins)
Enhance attachment to host cell surfaces
Viridans Streptococci
- Subacute bacterial endocarditis from patients with damaged heart valves.
- Bacteremia, septicemia and cavities
Viridans Streptococci
In Neufeld- Quellung reaction, it’s positive if the capsule ______.
Swell
What are the five groups under Viridans Streptococci
- S. mitis
- S. mutans
- S. salivarius
- S. bovis
- S. anginosus
i. Virulence Factor
Extracellular surface protein, serine protease and gelatinase for adhesion
Cytolysins and resistance to antimicrobial agents
Enterococcus
ii. Associated Disease
- Nosocomial infection
- UTI (catheterization), bacteremia (hemodialysis, surgery), endocarditis (prosthetic heart valves)
Enterococcus
Disease Associations: Pyogenic infections, endocarditis, dental caries
S. anginosus, S. mutans, S. mitis
Disease Associations: Pharyngitis, Pyodermal infections, NF, STSS, PSS (Rheumatic fever, AGN)
S. pyogenes
Disease Associations: Neonatal sepsis (pneumonia, meningitis) puerperal
fever, pyogenic infections
S. agalactiae
Disease Associations: Pharyngitis, impetigo, pyogenic infections
S. dysgalactiae, S. equi
Disease Associations: UTI, endocarditis, pyogenic infections, bacteremia
E. faecalis, E. faecium
Selective medium for Beta-hemolytic
Streptococci
Blood Agar with trimethoprim and sulfamethoxazole
Nonhemolytic organism with lancefield
group N, often found in dairy products
Lactococci
Disease Associations: Pneumonia, meningitis, pyogenic infections
S. pneumoniae
Disease Associations: UTI, endocarditis, pyogenic infections,
S. bovis group
Small, round, glistening, dome-shaped, mucoid colonies. Colonies tend umbilicated as they age; α hemolytic
Pneumococci
Minute to small, gray, domed, smooth; α, β,γ hemolytic
Viridans
Grayish white (pinpoint), transparent to translucent, matte or glossy; large zone of β hemolysis
Group A (S. pyogenes)
Small, cream or white, smooth; α, β,γ hemolytic
Group D
Larger that Group A streptococci; translucent to opaque; flat glossy; narrow zone of β hemolysis
Group B (S. agalactiae)
Test for susceptibility to 0.04U Bacitracin
Bacitracin Susceptibility test (Taxo A)
Produce pus, mostly β-hemolytic
Pyogenic
Normal biota of the human intestine
Enterococci
Found as normal biota in the upper
respiratory tract of humans
Viridans
Enriched isolation of Streptococci
Blood Agar
In Taxo A test, what is the indication that the organism tested positive?
any zone of inhibition
Causes pseudo catalase
E. faecalis and E. faecium
What group tests positive in Taxo A test?
Group A
Meaning of SXT?
Sulfamethoxazole-Trimethoprim
Taxo A resistant and SXT resistant
Group B
Taxo A susceptible and SXT Resistant
Group A
Test for the synergistic hemolysis between group B Streptococcus
and β-hemolytic S. aureus.
CAMP Reaction
What organisms test positive in SXT?
Group C and G
What tests positive in CAMP reaction?
Group B
In this test, it’s positive if ther is an enhanced hemolysis in arrowhead pattern and no Zone of enhanced
hemolysis in arrowhead pattern if it’s negative.
CAMP Reaction
Taxo A resistant and SXT
susceptible
Group C, F, G
is a diffusible, protein like compound produced by Group B
CAMP factor
- Test for the ability to hydrolyze hippuric acid (Sodium hippurate ) to benzoic acid and glycine
- Glycine can be detected with Ninhydrin reagent
Hippurate Hydrolysis
if positive in this test, after addition of color developer, it will turn into pink to cherry-red color within 5 minutes and no color change or an orange color if negative.
PYR Test
In Hippurate Hydrolysis, what is the indication that it’s positive and what is the organism that tested positive?
Deep blue (purple) color, S. agalactiae (group B)
Organisms that are positive in PYR test
Group A, Enterococcus
Negative: No color change or development of slight yellow color
(Aerococcus and Leuconostoc)
LAP Test
Detects for the ability of the bacteria to grow in the presence of 40% bile and hydrolyze esculin
Bile Esculin Hydrolysis
Test for the ability of the organism to hydrolyze the substrate L-pyrrolidonyl-β-naphthylamide
PYR Test
Indication that the organism is positive for Salt Tolerance Test
Visible turbidity in broth and color change
Used to differentiate Streptococcus pneumoniae from other α-hemolytic streptococci
* Ethylhydrocupreine hydrochloride
Optochin (Taxo P) Susceptibility
What is the indication if the organism is positive for Bile Esculin Hydrolysis test?
Blackening of the agar
In LAP test, the result is positive if after adding cinnamaldehyde, there is a development of what color within 1 minute?
Red
Test for the solubility to bile salt (2% sodium desoxycholate or sodium taurocholate)
Bile Solubility Test
Is it negative or positive if in Bile Solubility test, the colony disintegrated?
Positive
Identification of α Hemolytic
Streptococci
Optochin: R
Bile Esculin: +
6.5% Broth: -
PYR: -
Group D Non-Enterococcus
Identification of α Hemolytic
Streptococci
Optochin: R
Bile Esculin: -
6.5% Broth: -
PYR: -
S. viridans
Detects for the ability of the bacteria to hydrolyze Leucine-β-naphthylamide by enzyme leucine aminopeptidase to β-naphthylamide
LAP Test
Identification of α Hemolytic
Streptococci
Optochin: S
Bile Esculin: -
6.5% Broth: -
PYR: -
S. pneumoniae
Identification of β Hemolytic
Streptococci
Bacitracin: S
SXT: R
CAMP: -
Bile Esculin: -
6.5% NaCl: -
PYR: +
Group A
Test the ability of the organism to grow in 6.5% NaCl
Salt Tolerance Test (6.5% NaCl)
Identification of β Hemolytic
Streptococci
Bacitracin: R
SXT: S
CAMP: -
Bile Esculin: -
6.5% NaCl: -
PYR: -
Group C,F,G, Viridans
Identification of β Hemolytic
Streptococci
Bacitracin: R
SXT: R
CAMP: +
Bile Esculin: -
6.5% NaCl: -
PYR: -
Group B
Identification of α Hemolytic
Streptococci
Optochin: R
Bile Esculin: +
6.5% Broth: +
PYR: +
Group D Enterococcus
Identification of β Hemolytic
Streptococci
Bacitracin: R
SXT: R
CAMP: -
Bile Esculin: +
6.5% NaCl: -
PYR: -
Group D Streptococcus
Identification of β Hemolytic
Streptococci
Bacitracin: R
SXT: R
CAMP: -
Bile Esculin: +
6.5% NaCl: +
PYR: +
D Enterococcus
Identification of γ Hemolytic
Streptococci
Bile Esculin: -
6.5% Salt Broth: -
PYR: -
Viridans
Identification of γ Hemolytic
Streptococci
Bile Esculin: +
6.5% Salt Broth: +
PYR: +
Group D Enterococcus
Identification of γ Hemolytic
Streptococci
Bile Esculin: +
6.5% Salt Broth: -
PYR: -
Group D Non-enterococcus