Streptococcus

Streptococcus
Description

and Morphology
Classification of Streptococci
Laboratory diagnosis
Epidemiology
Clinical infections
Treatment

Description & Morphology

Gram

Positive Cocci arranged in chains

except S.pneumoniae Diplococci
All are Catalase Negative

May be capsulated eg. S.pneumoniae

Classification of Streptococci

Type of Haemolysis:
1-- hemolytic
{S.pneumoniae & Viridans}
2--hemolytic
{ Streptococcus group A, B, C, G, D
& F}
3- ( ) non- hemolytic
{ Enterococcus}

Type of Haemolysis

Group
A,B,C,D,F,G

S.Pneumo
Viridans

Enterococci

Latex agglut

Optochin

Biochemical
tests

Bacitracin (S )
GAS

Latex agglutination

Optochin

Streptococci of importance in human

infection
Species

S. Pyogenes
S. Agalactiae
S. equisimilis
S.Milleri
S. bovis
S. viridans
S. pneumoniae

Type of
hemolysis

Lancefield group

A
B
C
F
D
-

Streptococcus Pyogenes

Group A Streptococci (GAS) = S. pyogenes

Gram-positive cocci, -hemolytic, catalase

negative, arranged in chains, bacitracine sensitive

Carriers:
Throat ( 10% 0f children) & Nasal carrier
Infected skin lesions

Streptococcus Pyogenes Clinical Infections

Upper Respiratory tract Infections
A- Tonsillitis / Pharyngitis
The commonest bacterial cause of tonsillitis

B- Scarlet fever
Streptococcal sore throat (Children < 10 years)
Incubation period is 2-3 days
Generalized erythema & Strawberry tongue
C- Acute Otitis media & Sinusitis

Otitis medi

tonsillitis

Scarlet fever

Streptococcus Pyogenes Clinical

Infections
Skin and Soft tissue infections
A- Cellulitis
Streptococcal cellulitis is a spreading
infection bacteraemia
B- Erysipelas
Acute spreading skin lesion
Marked oedema & erythema of skin
C-Impetigo
Primary bullous skin lesion
Children

Streptococcus Pyogenes Clinical

Infections
D-Necrotizing Fasciitis
Infection progress rapidly
Destroy fascia
Systemic shock
Young healthy & immunocompromised

D-Myositis

Rare & mimic necrotizing fasciitis

Throat blood Muscle

erysipellas
impetigo

cellulitis

Necrotizing fascitis

Streptococcus Pyogenes Clinical

Infections
Streptococcal toxic shock syndrome
Acute fulminating disease
Bacteraemia with toxaemia
Shock with multi-organ failure
Mortality 20-30%
Streptococcal pyrogenic exotoxins

Question
List

infections can be caused by GAS

and S. aureus
Cellulitis
Erysipelas
Impetigo
Wound

infection
Toxic shock syndrome

Streptococcus Pyogenes
Non- Suppurative Complications
A- Acute Rheumatic Fever (ARF)
Throat infection 1-5 weeks earlier, children 6-15yrs
Autoimmune phenomenon (streptococcal antigens
to a variety of human tissue antigens)
Pathology involve primarily heart,
Joints & Central nervous system

are similar

Streptococcus Pyogenes

Non- Suppurative Complications

B- Acute Glomerulonephritis ( AGN)
Post GAS throat & skin infections
Children & young adult
Oedema, Hypertension, Haematuria & Proteinuria

Streptococcus Pyogenes

Treatment
All GAS are sensitive to penicillin

Chemoprophylaxis
Penicillin prophylaxis after primary attack of ARF
No prophylaxis in case of AGN

Case
A 3 year old child with a heart murmur comes to your
office and you suspect that he might have rheumatic
fever. His parents stated that 3 weeks ago he had
sore throat. To see if the child had a GAS infection
the best action would be to:
do a throat swab and Gram stain it
do a throat swab and streak on blood agar
do a skin test with M protein
look for antibodies to streptolysin O (ASO)
Look for toxic shock toxin

Streptococcus agalactiae
Group B streptococci ( GBS)
Common cause of neonatal
infections
( Meningitis & Septicemia)
15-20 % of women are vaginal
carriers
Prevention of GBS
neonatal infection
Intrapartum prophylaxis
with ampicillin

Other Streptococci
Group C Streptococci
Sore throat/ tonsillitis
Group D Streptococci (S. bovis )
Bacteraemia & Endocarditis in
patients with bowel carcinoma
Group F streptococci
Abscesses (brain, abdominal)

Viridans streptococci
Clinical infections
Oral streptococci
A-Dental caries
B-Infective Endocarditis
the most common cause of infective
endocarditis
Treatment:
Penicillin + gentamicin for 4-6 wks