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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

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