Streptococcus

• The Streptococcaceae consist of a large family of

medically important species in the genus Streptococcus.

• Streptococcus are generally catalase-negative,

gram-positive cocci with 0.5 to 1.2 µm in diameter and
arranged predominantly in pairs or chains, with some
forming irregular clusters

• The word STREP means "Chains" while the word COCCUS

means "Spherical" so basically the word streptococcus
comes from its morphological characteristics "String of
Pearls"

• These organisms can be differentiated based on cell

wall structure, hemolytic patterns on sheep blood agar
(beta, alpha, or gamma), reaction of antibodies to
specific bacterial antigen, the Lancefield Classification
scheme, and biochemical identification relating to
physiologic characteristics.

• Most commonly encountered streptococci infections in

Enterococcus
humans include S. pyogenes, S. agalactiae, S.
pneumoniae, and the viridans streptococci group. • Like the streptococci, organisms within this genus
produce hemolysis on sheep blood agar (beta, alpha, or
gamma); however, the hemolytic patterns vary within a
NOTE: In some cases with the molecular analysis of the single species and are therefore not as useful in the
16S ribosomal ribonucleic acid (rRNA) sequences. identification of specific species.

Bile solubility Test • E. faecalis and E. faecium are the most common
-Viridans insoluble species encountered in human infections.
- S.pneumoniae a soluble
• The genus Enterococcus includes organisms that were
Classification previously included in the Streptococcaceae family.
However, due to the introduction of molecular methods,
● Group A-Streptococcus pyogenes
these organisms have been placed in a separate family,
● Group B-Streptococcus agalactiae the Enterococcaceae.
● Group C-Streptococcus equisimis, Streptococcus equi,
Streptococcus zooepidemicus, Streptococcus
• The members of this genus microscopically produce
dysgalactiae
cocci arranged in pairs, short chains, or as small irregular
● Group D-Enterococci, Streptococcus bovis clusters and are commensal organisms of the human
● Group E-Streptococcus milleri and mutans gastrointestinal (GI) tract that cause a variety of
● Group F-Streptococcus anginosus opportunistic infections

● Group G-Streptococcus canis and Streptococcus

dysgalactae Habitat
● Group H-Streptococcus sanguis Many of these organisms are commonly found as part of
● Group L-Streptococcus dysgalactiae the normal human microbiome of the pharynx, mouth,
lower GI tract, and vagina
● Group N-Lactococcus lactis
Group A = Skin and Oropharynx
● Group R&S-Streptococcus suis other Streptococcus
species are classified as 'non-Lancefield Streptococci Group B Female genital tract, colon
Group D = Colon
Viridans Oropharynx, colon
Streptococcus pnuemoniae = Nasopharynx
Enterococcus Gastrointestinal

Mode of transmission
Methods of transmission are spread person to person by
various means and, subsequently, establish a state of
colonization or carriage, infections may then develop
when colonizing strains gain entrance to normally sterile
sites. In some instances, this may involve trauma
(medically or nonmedically induced) to skin or mucosal
surfaces or, as in the case of S. pneumoniae pneumonia, Age: infants and elderly
may result from aspiration into the lungs of organisms Others: HIV, Diabetes, Malignancy, alcohol, smoking
colonizing the upper respiratory tract.

Pathogenesis
Alpha Hemolytic Streptococcus
1. Polysaccharide capsule
Streptococcus pneumoniae
2. Biofilms
Viridans strep
3. Pnuemococcal surface protein A
Streptococcus pneumoniae
4. Toxins Capsule
• In addition, this organism accesses the bloodstream
and the meninges to cause acute, purulent, and often • Protects bacteria from phagocytosis
life-threatening infections. • Principal virulence factor of Streptococcus
pneumoniae bacteria
•S. pneumoniae is capable of mobilizing inflammatory • Due to this it can cause death in asplenic
cells mediated by its cell wall structure, including individuals.
peptidoglycan, teichoic acids, and a pneumolysin. The • OPSI (Overwhelming Post splenectomy
pneumolysin activates the The pneumolysin mediates Infection)
suppression of classic complement pathway. the
oxidative burst in phagocytes, providing for effective
evasion of immune clearance. Biofilms

• S. pneumoniae is still one of the leading causes of 1. Bacteria enter the body
morbidity and mortality. 2. Attach to mucosal surfaces
• The organism is the primary cause of 3. Forms biofilm
community-associated bacterial pneumonia, meningitis,
and otitis media.
Pneumococcal surface protein A
• The organism may harmlessly inhabit the upper
• It inhibits complement activation
respiratory tract, with a 5% to 75% carriage rate in humans.
S. pneumoniae is capable of spreading to the lungs,
paranasal sinuses, and middle ear. Toxins
1. IgA protease
Morphology - Cleaves mucosal IgA causing mucosal infection
• Shape -Lancet shaped diplococci in chains - Meningits Otitis media
• Arrangement -It comes it pairs and short chains, - Pnuemonia
sometimes irregular clusters • Diameter -0.5 to 1.2 um - Sinusitis
• Color - When stained it depicts purple colorization, and 2. . Autolysin
when cultured in a blood agar media a white colony is
- Destruction of bacteria and release of internal
seen surrounded by a green zone
components
• Structurally
- Local inflammation Destruction of Host tissue
No flagella 3. Pneumolysin
Non motile bacteria - The pneumolysin activates the classic complement
pathway.
Capsule made out of polysaccharide
- Binds to cholesterol in cell membrane and form a spore
-Helps in the antiphagocytic ability of the bacteria
causing a cell lysis resulting to destruction of
Cell wall pneumocytes and alveolar capillaries
-Teichoic acid is present - The pneumolysin mediates suppression of the oxidative
burst in phagocytes, providing for effective evasion of
Cell membrane immune clearance
-Energy generation

Pathogenesis
Transmission • Pneumonia
- Being a part of normal flora not much • Rhinosinusitits
communicable
• Otitis media
• Mastoditis
- Depends on the type of disease
• Meningitis
● P'nuemonia → through respiratory droplet →
coughing and sneezing - In severe cases once S.pneumonia infects the blood
it can now cause: Pneumococcal endocarditis, purulent
● Sinusitis → aerosols endocarditis, meningitis, septic arthritis, peritonitis and
● Otitis media → if surrounded by many sepsis from patient with no spleen.
infected individual airborne

Clinical Findings
- Can easily infect individuals with weaker immune • Lobar pnemonia
system and defenses o
 1. Chill S salivary
2. Fever = S. salivarius group organisms are isolated primarily from
the oropharynx and blood.
3. Cough
= S. salivarius has been reported in bacteremia,
4. Chest pain endocarditis, and meningitis.
5. Rusty sputum Lab Diagnosis
S bovis
= S. bovis group may be isolated in cases of bacteremia,
Samples: septicemia, and endocarditis. S. anginosus
• Sputum, pus, CSF, peritoneal fluid •
Microscopy S. anginosus
= are normal microbiota in the oropharynx, urogenital,
• Gram stain = purple
and Gl tract. Small-colony (<0.5 mm) beta-hemolytic
• Shape lancet shape or Diplococci in chains group A, C, F, and G (or no group) organisms are
• Size in diameter: 0.5 to 1.2um considered normal microbiota of the throat and typically
Culture: not reported when screening for beta hemolytic
streptococcus of the throat. However, they can cause
1. Blood agar plate
bacteremia and disseminated deep-seated infections,
→check for hemolysis especially in immunocompromised patients.
→check for characteristics (mucoids colony with
flattened and depressed centers "umblicate) S mitis
= are also commensals of the oropharynx, urogenital, and
Gl tract They may also be transient colonizers of the skin
Catalase test and identified as contaminants in blood cultures. These
→ no bubble formation organisms may be isolated in cases of endocarditis.
→ positive for Streptococcus Immunocompromised patients may develop septicemia
or pneumonia. Infections with organisms in the S. mitis
→ CATALASE NRGATIVE - no bubble formation
group may be difficult to treat due to the presence of
penicillin resistance
Optochin disc test/Taxo P disc test
Viridans strep→ Resistant
S. pneumoniae → Susceptible

Bile solubility Test

-Viridans insoluble
- S.pneumoniae a soluble

Prevention
• Infection with S. pneumoniae can be prevented
through a series of vaccinations. There are two vaccines
currently available, a 13-valent conjugate vaccine and a
23-valent capsular polysaccharide vaccine. Vaccine use
reduced nasopharyngeal carrier rate and the number of
invasive infections associated with the organism.

Viridans strep
The viridans group includes a large and complex group of
human streptococci that are not groupable by
Lancefield serology. The viridans group of streptococci
includes five groups, each containing several species.
The groups include:
the mutans group,
salivarius group,
bovis group,
anginosus group (previously S. milleri group), the only
beta hemolytic viridans strep
and mitis group.

S. MUTANS
= S. mutans group have been isolated from the human
oropharynx Including S. criceti, S. ratti, and S. downei. S.
mutans and S. sobrinus are the most commonly isolated
species associated with dental carries.