Gram
positive cocci
By
Dr.Ra nda Hes ha m
ILOs
by the end of this lecture you will be able to:
1. Identify classification of Gram-positive cocci.
2. Differentiate the outlines of laboratory diagnosis of
Staphylococcus aureus & Streptococcus pyogenes.
3. Differentiate between Viridans streptococci &
Streptococcus pneumoniae.
Gram Positive Cocci
Staphylococci Streptococci
Aerobic/AFA O2 Anaerobic
Growth on blood agar Peptostreptococci
β hemolysis hemolysis ɣ hemolysis
Strept. pyogenes Viridans strept
Strept. pneumoniae
•STREPTOCOCCI
The importantproperties of genus Streptococci
1. These are Gram-positive cocci arranged in chains
2. non-motile, and nonspore forming, sometimes capsulated.
3. All Streptococci are catalase negative.
Classification of STREPTOCOCCI acc. to
hemolysis on blood agar
β hemolysis
S. pyogenes (GAS) ɣ hemolysis
hemolysis
S.pneumoniae
Viridans Streptococci
Beta- hemolysis on blood agar:
Grayish colonies with CLEAR
zone around the colony caused
by complete hemolysis of the red
blood cells in the agar.
Alpha hemolysis on blood agar:
Grayish colonies with GREENISH
zone around the colony caused by
incomplete hemolysis of the red
blood cells in the agar.
Gamma hemolysis on blood agar:
Grayish colonies show no
hemolysis or discoloration.
Beta heamolytic
streptococci
Streptococcus pyogenes
S. Pyogenes characters
o Gram +ve cocci in chain
o Beta heamolysis on blood agar
o Sensitive to bacitracin
o Pathogenic organism as it produces variety of extracellular enzymes
and toxins
o Causes local, invasive and toxic diseases
Streptococcus pyogenes
Diseases Tonsillitis, cellulitis, skin infections e.g. impetigo.
Specimen Throat swab ,blood, skin swab.
Smear
S: Gram (+)
S: Cocci
S: non
M: non
A: in chains
C: non
Culture
Colony morphology
on blood agar
(can not grow on
ordinary media)
Film (morphology)
Biochemical
reactions
Catalase test (-)
Bacitracin S
sensitivity
Biochemical reaction
• Catalase negative (differ it from Staphylococci).
Alpha heamolytic streptococci Viridans Streptococci
S. Viridans characters
• These are alpha haemolytic Streptococci
• They are members of the resident flora of the oral cavity (including S. mutans & S. mitis)
• Gram +ve cocci in chains (non capsulated)
• Grow on ordinary media and blood (Alpha heamolytic)
• Ctalase –ve (no inuline fermintation – not bile soluble)
• Resistant to bacitracin (differentiate it from strept. Pyogen) and optochin (differntiate it from
pneumococci) both are types of antibacterial agents.
Viridans Streptococcus
Diseases 1. Dental caries.
2. Gingival infections, periodontal disease
3. Subacute bacterial endocarditis( SBE).
Specimen Dental surface or Blood.
Smear
S: Gram (+)
S:Cocci
S: non
M: non
A: In short
chains
C: non
S. Viridans
o Dental lesions:
✓ Important component of plaque
✓ They are involved in dental caries
(decay/cavitation)
✓ Gingival infections,periodontal
disease and abscess
o Systemic disease:
✓ Sub acute bacterial endocarditis
(SBE)
S. Viridans dental caries
Strept. Mutans is the most cariogenic bacteria as it has a number of properties :
o Regular component of the normal oral flora in large numbers.
o Colonizes tooth surfaces by attaching to salivary mucins forming enamel pellicle.
o Contains a cell-bound protein, glycosyl transferase serve as:
✓ An adhesion for attachment to the tooth,
✓ An enzyme that polymerizes dietary sugars into glucans that leads to formation of plaque.
o Produces lactic acid from the utilization of dietary carbohydrate which demineralizes tooth enamel,
creating the risk for cavities.
S. Viridans SBE
o Caused by: Streptococcus mutans and others.
o The normal commensals in the upper respiratory tract and buccal cavity may enter the blood (e.g. after
tonsillectomy or tooth extraction).
o In healthy individuals, such bacteria are cleared from the circulation within one hour
o If heart valves are abnormal rheumatic affection or ( congenital abnormalities), bacteria will
settle and multiply on heart valves causing endocarditis.
o Clinical presentation: fever, cardiac manifestations and history of cardiac affection.
o Laboratory diagnosis: Blood culture
o Prophylaxis: History + Penicillin must be administrated to patients before any dental manipulation.
o Treatment: Prolonged course of penicillin must be given.
S. Viridans (SBE) diagnosis
o Specimen: – blood sample (5-10 ml)
o Subculture on blood agar
o Gram stain: Grm +ve cocci in chains (non capsulated)
o Culture on blood agar: gryish colonies with Alpha heamolysis
o Biochemical R.: Ctalase –ve
Culture Viridans Streptococci
Colony morphology
on blood agar
Film (morphology)
Biochemical Viridans Streptococcus
reactions
Catalase teat (-)
Optochin R
sensitivity
Pyogenes vs viridans
Pyogenes Viridans
• Pathogenic o Commensal
• Do not grow on ordinary media o Can grow on ordinary media
• Beta heamolysis on blood agar o Alpha heamolysis on blood agar
• Sensitive to bacitracin o Resistant to bacitracin
pneumococci
❑ Pneumococci are Gram positive cocci arranged in pairs they are capsulated
❑ The capsule is Polysaccharide in nature
❑ Pneumococci can be classified into 90 serotypes according to the capsular
polysaccharide.
❑ 5%–50% of the healthy population harbours virulent organisms in the oropharynx,
so pneumococcal infections are not considered to be communicable.
Streptococcus pneumonia
Pneumonia (inhalation)
• For diagnosis we need sputum which may
be contaminated by oral commensals
including Streptococcus viridans.
• Both organisms produce alpha
heamolysis on blood agar.
S. pneumoniae S. viridans
Gram positive cocci in
Gram +ve cocci
Morphology pairs, capsulated)
in chains, non
capsulated
S. pneumoniae S. viridans
Clear
Bile Turbid
solubility (soluble) (non soluble)
Inulin
fermentation
+ve -ve
Optochin sensitivity
Difference between Pneumococci & viridians Streptococci.
Viridans
Pneumococci
Streptococcus
Inulin fermentation + -
Bile solubility Soluble Not soluble
Sensitivity to optochin Sensitive Not sensitive
Capsule Present Absent
Quellung reaction + -
Bile solubility test
Quellung test (capsular swelling test)
Anaerobic streptococci
Peptostreptococci
Peptostreptococci
The same as Streptococcus pyogenes
but ………?
Anaerobic
Obligatory Anaerobe: • Commensal in mouth,skin, GIT, UT
• One of the cuases of dental caries, periodontal diseases,..
Peptostrept.
• Oppourtunistic pathogen: CNS, head, neck, chest,
abdomen, pelvis, skin, bone, joint, and soft tissues.
• Gram +ve cocci in chains
• Anaerobic
• Slowly growing (5-7 days)
• Incresing resistence to antibiotics
Gram-Positive Cocci
Staphylococci
Streptococci
(+) Coagulase (-)
enzyme
Staph. aureus CoNS
Sensitive Resistant
Novobiocin
Staph. epidermidis Staph. saprophyticus
Staphylococci genus properties
They are Gram-positive cocci arranged in grape-like irregular clusters non-motile, and non-spore
forming. Some may be capsulated.
All are catalase positive.
Classification:
• Staphylococci are classified according to coagulase production
into:
1. Coagulase positive Staphylococci : Staphylococcus aureus (S.
aureus)
2. Coagulase negative Staphylococci (CoNS): Staphylococcus
epidermidis & Staphylococcus saprophyticus.
Staph aureus:
• Gram-positive Cocci
• Arranged in grape like clusters
• Coagulase positive
• Some are members of the normal flora of the Nasal mucosa
(25%) and Skin and others cause pyogenic infections
• Pathogenesis of Staphylococcus aureus
(S. aureus) infection:
• It is the most important pathogen of the Staphylococci
• S. aureus is carried by 20-50% of humans in the anterior
nares.
• It is also present in the environment e.g. clothing, bed
linens, and fomites.
• Acquisition of infection may be either exogenous or
endogenous.
Staphylococcus aureus
Diseases Abscess , skin infections e.g. impetigo.
Specimen Pus or skin swab.
Smear
S: Gram (+)
S: Cocci
S: non
M: non
A: in
groups/clusters
C: non
Culture
Colony
morphology
Golden yellow colonies on nutrient agar B hemolysis on blood agar
Yellow colonies
(mannitol fermenter)
on mannitol salt agar
Biochemical
reactions
Catalase test
Coagulase test
+
Staph. aureus Strept. pyogens
Arrangement In groups In chains
Catalase test
(+) (-)
Coagulase test (+) (-)
