COURSE CODE: 318
Ms. Ammara Arshad
Microbiology - II
Spring_2025
REFERENCE TEXT BOOK:
Warren Levinson.
Lange: Review of Medical Microbiology and Immu
nology
: Thirteen edition
Streptococcus D
&
Streptococci
pneumonia
Group D streptococci
Group D streptococci include:
• Enterococci (e.g., E. faecalis and Enterococcus
faecium)
• Nonenterococci (e.g., S. bovis).
Hemolytic reaction of group D
streptococci is variable:
Most are α-hemolytic,
but some are β-hemolytic,
and others are nonhemolytic
Diseases
• Enterococcus faecalis is an important cause of
hospital-acquired urinary tract infections and
endocarditis.
• Predisposing factors are: catheterization and
gut or bladder surgery or instrumentation
• Streptococcus bovis also causes endocarditis.
Enterococcus
• Enterococci are members of the normal flora
of the colon and are noted for their ability to
cause urinary, biliary, and cardiovascular
infections.
Differences between
Enterococcus and Non-
Enterococcus
GROUP D STREPTOCOCCI
Enterococcus Non- Enterococcus
• Cause of UTI and • Cause of UTI and
endocarditis endocarditis
• very hardy organisms • much less hardy organisms
• they can grow in hypertonic • they are inhibited by 6.5%
(6.5%) saline or in bile NaCl
• are not killed by penicillin G • Killed by Penicillin G
DIAGNOSIS
• Group D streptococci hydrolyze esculin in the
presence of bile (i.e., they produce a black
pigment on bile-esculin agar).
• The group D organisms are further subdivided:
the enterococci grow in hypertonic (6.5%)
NaCl, whereas the nonenterococci do not
Identification Scheme
Schema to differentiate Enterococcus and Group D
streptococci from other nonhemolytic streptococci
Treatment
Enterococcus
• synergistic combination of penicillin & an
aminoglycoside
• Vancomycin is another drug to treat
• linezolid (Zyvox) and daptomycin (Cubicin) for
VRE (vasomycin resistant enterococci)
Non-Enterococcus
penicillin G
VRE HAVE EMERGED. (MORE STRAINS OF E. FAECIUM ARE VANCOMYCIN RESISTANT
THAN ARE STRAINS OF E. FAECALIS)
Streptococcus
pneumoniae
Introduction
– Streptococcus pneumoniae causes pneumonia,
bacteremia, meningitis, and infections of the upper
respiratory tract such as otitis media, mastoiditis, and
sinusitis.
• Pneumococci are the most common cause of
community-acquired pneumonia.
• They are a common cause of conjunctivitis,
especially in children.
• Morphology
• Gram-positive lancet-shaped cocci arranged in pairs
(diplococci) or short chains.
– (The term lancet-shaped means that the diplococci are oval with
somewhat pointed ends rather than being round.)
• Reservoir and Transmission
– Humans are the natural hosts for pneumococci;
there is no animal reservoir. Because a proportion
(5%–50%) of the healthy population harbors
virulent organisms in the oropharynx.
• Biochemical Properties
– Bile soluble
• Virulence factors
– Capsular Polysaccharide
– IgA protease
– Lipoteichoic Acid
– Pneumolysin (Binds to cholesterol in host cell
membranes). But the actual effect is unknown
• Pathogenesis
– Capsular polysaccharide is important factor in pathogenesis.
– Lipoteichoic acid, contributes to the inflammatory response and
to the septic shock syndrome
– Pneumolysin, the hemolysin that causes α-hemolysis, may also
contribute to pathogenesis.
– Pneumococci produce IgA protease that enhances the
organism’s ability to colonize the mucosa of the upper
respiratory tract.
– Pneumococci multiply in tissues and cause inflammation.
When they reach alveoli, there is outpouring of fluid and red
and white blood cells, resulting in consolidation of the lung.
• Factors that lower resistance and predispose
persons to pneumococcal infection:
– Alcohol or drug intoxication
– Abnormality of the respiratory tract (e.g., viral infections)
– Abnormal circulatory dynamics (e.g., pulmonary congestion
and heart failure)
– Splenectomy
– Certain chronic diseases such as sickle cell anemia and
nephrosis.
– Trauma to the head that causes leakage of spinal fluid
through the nose predisposes to pneumococcal meningitis.
• Clinical Features
– Pneumonia often begins with a sudden chill, fever,
cough, and pleuritic pain. Sputum is a red or
brown “rusty” color.
– Pneumococci are a prominent cause of otitis
media, sinusitis, mastoiditis, conjunctivitis,
purulent bronchitis, pericarditis, bacterial
meningitis, and sepsis.
• Lab Diagnosis
– Lancet-shaped gram-positive diplococci in Gram-stained
smears
– Quelling reaction with multitype antiserum.
– On blood agar, pneumococci form small α-hemolytic
colonies.
– The colonies are bile-soluble (i.e., are lysed by bile), and
growth is inhibited by optochin
– Blood cultures are positive in 15% to 25% of pneumococcal
infections.
– Detecting of capsular polysaccharide in CSF
IDENTIFICATION
Not optochin sensitive
Not Pneumococci
optochin sensitive
Pneumococci
• Treatment
– Penicillin G is the drug of choice
– Ceftriaxone or levofloxacin can be used
– Prevention
• Pneumococcal conjugate vaccine
