Streptococcal] Infections INTRODUCTION tre genus Streptococcus comprises a I: and biologically diverse group of gram. pesitive cocei that grow in pairs and chains\Figures 13.1. and 13.2). Streptococci were first described by Billroth in 1874 in exudates from erysipelas and wound infections. ‘@ Chain of coccus: (perpendicular to ong exis of chain) Figure 13.2 ¢ [ Roveabach 1884) j a them § (1884) aed eoIt is a facultative anaerobe with fermentative metabolism, Thi ium is ta ‘ sm. This bacterium is peste and oxidase-negativey) ous strategies are adopted to classify streptococcus. The Strep i lad complex fhe first eition of Bergey's Manual of Syaemate Baceringy decribes es species clustered into four groups namely pyogenic streptococci (S. pyngenes), oral treptococci (S. oralis), anaerobic streptococci (lactococci) and other streptococci (6, bis). Box 13.1 shows the recent classification of streptococcus. Box 13.1. Classification of str Enubacteria Firmicutes Bacilli Lactobacillales Streptocaccaccac ‘Streptococcus (Rosenbach, 1884)Streptococe! i Apna haemolysis cara tear (Haemolytic group) group classified into 49-Lancefield groups GHK.LMN,O,P.A.RS,T &U a Gritfith typing MEDICALLY IMPORTANT STREPTOCOCCI Various medically important streptococci are given in Table 13.1. Table 13.1 Classification and grouping of streptococci th Group Haemolysis Example On Ta a5 Bei __ 5. pyogenesyIRULENCE FACTORS “phe following virulent factors of strejtococcus are involved in pathogenesis, srulence factors Effect Vir Hyaluronic acid (capsule) Prevents opsonization peptidoglycan Induces fever, cardiac necrosis © M Protein Prevents phagocytosis “sa peptidase Destroys chemotactic signals | Lipoteichoie acid Improves colonization Haemolytic haemolysin Lyses RBC Cytolytic haemolysin Lyses RBC and epithelial cells Pyogenic exotoxin Induces pus formatign _ Esterases Induces pus formation Streptokinase Induces pus formation Phosphatase Induces pus formation Proteinase Induces pus formation _DNase Cleaves DNA ATPase Cleaves ATP ~ Nuclease Lyses nucleus Cardiohepatic toxin Kills or affects heart and liver cells © Streptolysin O : heat , haemolysin The organism enters i Nechanisms, They include: ® Scratching of skin & Wound Droplets ® Aerosols ® Blood _ Fromee by k ‘Ee js is and killing by leucocytes can prolife; | es are abl 5 ee Deh aryngeal or cutaneous infection may ae oa iva, cos a adjacent tissues or distant tissues via bloodstream, Onte ani i? may uced, organisms may be readily engulfed and killed by phagocye iq) ne a luc a ea IgG ina non-immune manner. Cell wall antigens als hel a ) wall reacts alternative complement pathway. are bs capability (© activate During infection, Streptococcus produces various types of ne may induce both suppurative (tonsillar abscess, otitis, septicaemia, cae Wid Iris a pons acute sheumatic fever, glomerulonephrits) infections! itis 2°" and non-suppurative <4 9-3 W _ DISEASES CAUSED BY STREPTOCOCCI | ve a Planets ® Acute glomerulonephritis | profonged u® Scarlet fever Puerperal sepsis used for treat (LS Septicaemia _® Meningitis | Glomerulo ® Ensipelas Endocarditis 2 Ampetign _® Urinary tract infections i ae ®@ Rheumatic fever | hypertension, « Pharyngitis | Group B ‘Sepsis, mening: Streptococcus attaches to the cel epitheli ipoteichoi oe pithelial cells through lipoteichoic add See sre aridly killed after ingestion. Some virulent strains resisttheina= Group C ponse and induce inflamma : : aod i cael as Testonse- Peptidoglycan also activates comps" Group Ep fever, chills, headac Hon may be symptomatic or may be associated with strep i cryenatous or beefy ab nausea and vomiting. Pharynx may be 8 from the throat, Shreptocoe ey ae gates and there may Petjulitis—an inflammation of the skin and i See, poets. it may avo eacl manera underlying connective tissue in Puerperal sepsis or child bed fever—a common cause of maternal death, It ~~following child birth. ) = ‘ te Rheumatic Fever a non-suppurative inflammatory response. It is manifested as arthritis, iis, chorea, erythema marginatam or subcutaneaus nodules. Symptoms occur in 2-3 weeks. Pathogencsis is poorly understood. Antigenic cross-reactivity en streptococcal antigens and heart tissue, direct toxicity due to exotoxins, al invasion of heart by Streptococcus are the reasons for rheumatic fever. longed bed rest is needed for recovery. Salicylates and corticosteroids are for treatment. is merulonephritis ally follows cutaneous infections. Kidney damage was originally believed to be condary to the deposition of immune complexes. Symptoms are oedema, oliguria, sion, congestive heart failure and proteinuria. Group B Streptococcus (Streptococcus agalactiae) causes bacteraemia, is, meningitis and urinary tract infection. Group C Streptococcus causes pharyngitis. neonatal d endocarditis.ee aa 7 ecalture ' anaerobically. Temperature range fo.» | feos anetcoe grow ariel agar and incubated at 37°C. EN is 2 han 1 mm in diameter, they appear greyish white or ¢ clo that Se usually irregular, 5. pyogenes produces beta haemolytic ct) ke ‘blood agar is recommended for group B Streptococcus. When ' eae agar S, agalactiae produces an orange pigment. Isolates are iden Z making use of biochemical parameters (Table 13.2 and Box 13.2). io st _ Serology / ASO test Antistreptolysin O test is used to detect streptolysin O in blood,/ Dick test_ Erythrogenic toxin produces erythematous reaction in suscepij, individuals)For the detection of S. pyogenes, 0.1 ml of toxin is injected into human) intradermal injection, which produces an erythematous reaction. This is called Dis test described by Dick in 1924, Table 13.2 Biochemical characterization of different Streptococci Bile solubility Growth at 6.5% NaC] OptochinSITeprococcal ImecuurD 177 Di Ripcham& Ear clo ai tale Rial Lee Lm IN) ede ae positive cocci, B-haemolytic colonies, non-motile, optochin-resistant, catalase- and oxidase. vancomycin-Sensitve, bacitracin-sensitive, SX'T-resistant, CAMP-negative, hippurite- negative, PYR- positive, esculin-hydrolysis-positive, bile-solubilization-negative. Gram F negative, hydrolysis: ATMENT Fntibiotics like erythromycin, clindamycin, cephalexin, penicillin, vancomycin, Streptomycin, etc, are used for treatment. J _ Describe the virulence factors of streptococci. What are the major groups of streptococci? How can you classify streptococci based on haemolysis? . Write short notes on i. Lancefield serogrouping ii, Griffith typing ‘a iii, ASO test iv. Dick test