Streptococcus, Enterococcus, and Similar Organisms CHAPTER 15 249
TABLE 15-1 Epidemiology
Organism Habitat (reservoir) Mode of Transmission
Streptococcus pyogenes Normal flora: Not considered normal flora Direct contact: person to person (group A) Inhabits skin and upper respiratory tract of humans, Indirect contact: aerosolized droplets from coughs carried on nasal, pharyngeal, and, sometimes, or sneezes anal mucosa; presence in specimens is almost always considered clinically significant Streptococcus agalactiae Normal flora: female genital tract and lower Endogenous strain: gaining access to sterile (group B) gastrointestinal tract site(s) probable Occasional colonizer of upper respiratory tract Direct contact: person to person from mother in utero or during delivery; or nosocomial transmission by unwashed hands of mother or health care personnel Groups C, F, and G beta- Normal flora: Endogenous strain: gain access to sterile site hemolytic streptococci Skin Direct contact: person to person Nasopharynx Gastrointestinal tract Genital tract Streptococcus pneumoniae Colonizer of nasopharynx Direct contact: person to person with contaminated respiratory secretions Viridans streptococci Normal flora: Endogenous strain: gain access to sterile site; Oral cavity most notably results from dental manipulations Gastrointestinal tract Female genital tract Enterococcus spp. Normal flora: Endogenous strain: gain access to sterile sites Humans, animals, and birds Direct contact: person to person E. faecalis and E. faecium) are normal flora of the Contaminated medical human gastrointestinal tract and female equipment; immunocompromised patients are at genitourinary tract risk of developing infections with antibiotic Colonizers resistant strains Abiotrophia spp. (nutritionally Normal flora: Endogenous strains: gain access to normally variant streptococci) Oral cavity sterile sites Leuconostoc spp. Plants, vegetables, dairy products Mode of transmission for the miscellaneous gram-positive cocci listed is unknown; most are likely to transiently colonize the gastrointestinal tract after ingestion; from that site they gain access to sterile sites, usually in compromised patients; all are rarely associated with human infections Lactococcus spp. (group N) Foods and vegetation Globicatella sp. Uncertain Pediococcus spp. Foods and vegetation Aerococcus spp. Environmental; occasionally found on skin Gemella spp. Normal flora of human oral cavity and upper respiratory tract Helcococcus sp. Uncertain Alloiococcus otitidis Occasionally isolated from human sources, but Uncertain; rarely implicated in infections natural habitat is unknown