S.

pneumoniae
 Streptococcus pneumoniae
• General characteristics
– Inhabits the nasopharyngeal areas of healthy individuals
– Typical opportunist
– Possess C substance
• Virulence factors
– Polysaccharide capsule
• Clinical infections
– Pneumonia (most common cause of bacterial pneumonia)
– Meningitis
– Bacteremia
– Sinusitis/otitis media (most common cause of otitis media in
children < 3 years)
– Vaccine should be given to elderly and those without spleens
 Laboratory Diagnosis:
Streptococcus pneumoniae
• Microscopic
morphology
– Gram-positive cocci
in pairs; lancet-
shaped (somewhat
oval in shape)
 Laboratory Diagnosis:
Streptococcus pneumoniae
• Colony
morphology
– Smooth,
glistening, wet-
looking, mucoid
 -Hemolytic
– CO2enhances
growth
– As colony ages,
autolytic
collapse causes
“checker shape”
 Laboratory Diagnosis:
Streptococcus pneumoniae
• Identification
– Catalase negative
– Optochin-
susceptibility-test–
susceptible
– Bile-solubility-test–
positive
 Identification Schema

Schema to differentiate S.
pneumoniae from other -
hemolytic streptococci
 S. pneumoniae
• leading cause of pneumonia
– particularly young and old
– after damage to upper respiratory tract
*e.g. following viral infection
• bacteremia
• meningitis
• middle ear infections (otitis media)
 S. pneumoniae
  hemolytic
• pneumolysin
– degrades red blood cells under aerobic
conditions
• grows well on sheep blood agar
• no group antigen
 Diagnosis - spinal fluid
• direct Gram staining
• detection of capsular antigen
 Autolysis - identification

autolysin Bile
teichoic acid
-choline

peptidoglycan

cell
membrane
lipoteichoic acid
 C polysaccharide
• Teichoic acid
– Precipitates in serum
– C-reactive protein
Identification

Not optochin sensitive

optochin sensitive
 Capsule
• prominent
– virulent strains
• anti-phagocytic
• carbohydrate antigens
– vary among strains
 Capsule

• immunity
– serotype specific
• vaccine contains multiple serotypes
• only for susceptible population
 Quellung reaction
• using antisera
• capsule "fixed"
• visible microscopically
 Pathogenesis
• Teichoic acid
– complement activation
– large numbers of inflammatory
cells at infection site
 Therapy
• S. pneumoniae
– most strains susceptible to
penicillin
– resistance is common
 Other Streptococcal Species
• Viridans group (Viridans means “green”)
– Members of the normal oral and nasopharyngeal
flora
– Includes those that lack the Lancefield group
antigen
– Most are  hemolytic but also includes
nonhemolytic species
– The most common cause of subacute bacterial
endocarditis (SBE)
• 5. Optochin Susceptibility
• Optochin (ethylhydroxycupreine hydrochloride), a quinine
derivative, selectively inhibits the growth of S.
pneumoniae in very low concentration. Optochin may
inhibit other alpha-hemolytic streptococci, but only at
higher concentrations.
• a. Place a disk impregnated with optochin (Taxo P)
on the thickly inoculated area of a blood agar plate
of suspected S. pneumoniae.
• b. A zone of inhibition of growth ≥ 14 mm is
considered a positive test for S. pneumoniae.
(See page 394 in text)
• c. Record results.
• 2. Bacitracin Sensitivity
• Group A Streptococcus may be differentiated
from other Streptococci by its sensitivity to low
concentrations of bacitracin. A paper disk
containing 0.04 U bacitracin (Taxo A) is placed
on the thick part of a freshly streaked plate of
suspected Group A strep. Any zone of inhibition
of growth around the disk after overnight
incubation is positive identification of Group A
Streptococcus (S. pyogenes). Indicate the
results for this organism on the chart. (See page
390 in text)