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Diverse group of gram-positive cocci which grow in chains in broth or individually, in pairs, or as short chains on solid media Some Streptococcus have capsules
Most species are facultative anaerobes but a few range from anaerobic to capnophilic (requires carbon dioxide)
G2
Energy is derived by carbohydrate fermentation with lactic acid production Unlike Staphylococci, this genus is catalase negative Preliminary laboratory identification is based on hemolytic reactions on 5% sheep blood agar plates
G3
Beta-Hemolytic Streptococci
G4
Rebecca Lancefield (1933) developed technique Based on immunoassay of group antigen in cell wall Within cell wall Group specific and Type-specific antigens Group antigen = N-acetylglucosamine-Rhamnose Group A Streptococci Group antigen = Glucosamine polysaccharide-Rhamnose Group B Streptococci Group antigen = N-acetylgalactosamine Rhamnose Group C Streptococci
G5
Rapid identification of pathogen Group antigen within the cell wall Immunoassay from a throat swab Quick way to identify Streptococcus pyogenes as the pathogen in pharyngitis Often used in physicians offices or the hospital to identify pathogen
G6
Group A, B, C, F, and G
G7
General Characteristics/Classification
Possesses a specific carbohydrate antigen in the cell wall called the C antigen. This antigen is used to separate the various species of Streptococcus into multiple groups: A, B, C, D, F, and G Serological Classification Group A Hemolytic Pattern Beta hemolytic
G8
S. pyogenes
S. pyogenes
Habitat lives on human skin and mucous membranes Transmission > Respiratory tract droplets from a carrier > Fomites (pens, paper, drinking glasses)
G10
Structural Components
Capsule
M Protein
The M protein on fimbriae serves as a major surface antigen and serves as the basis for the subdivision within Streptococcus pyogenes It is antiphagocytic and serves to degrade one of the components of complement
F Protein
May participate in tight binding of the pathogen to the epithelial cells of the throat and skin
G12
Antigenic Antibodies formed against this antigen helpful when testing for a recent infection by this pathogen
Antibodies against Streptolysin O (ASO) appear 3 to 4 weeks after initial infection and persist
G13
Streptokinase
Lyses blood clots Dissemination factor
G14
DNases A D
Lyses DNA Dissemination factor Pus, which contains DNA, is more fluid with Streptococcus infections in comparison to Staphylococcus infections
G15
Streptococcal Pyrogenic Exotoxins (previously called Erythrogenic Toxins) Four types (Toxin A, B, C, and F) Possibly responsible for clinical manifestations seen in severe reactions Rash in Scarlet fever Necrotizing fasciitis Streptococcal toxic shock syndrome Phage mediated Toxins are classified as a superantigen Bridge Macrophages to Helper T cells Hyper response of the immune system shock, organ failure, and death
G16
Streptococcus pyogenes-CDC
In 2005, CDC reports that 4700 cases of invasive disease in the U.S. Perhaps, 10 million cases of noninvasive disease, mostly pharyngitis and pyoderma Pharyngitis caused by Streptococcus pyogenes is most often seen in children, ages 5 to 15 years, but certainly not limited to this age range.
G17
Fever, sore throat, redness, and edema of the mucous membranes, purulent exudates, and enlargement of the cervical lymph nodes May extend to middle ear, mastoid, and meninges
Pyoderma (Impetigo) Vesicles Pustules (pus filled) Rupture Crust Puerperal Sepsis postpartum infection of uterus
G18
Cellulitis of skin
Involves deeper subcutaneous tissue with rapid spread Often the result of damage to skin (burn or wound)
Post-surgical Wound Infection Onset of symptoms of infection occur rapidly (6-12 hours), while 48 hours or longer with Staphylococcus aureus
G19
Scarlet Fever
Complications of pharyngitis Rash caused by pyrogenic exotoxins Within a couple of days after initial symptoms of pharyngitis, a red rash appears on upper chest and spreads to extremities
An infection that occurs in the deep subcutaneous tissue Very rapid movement Flesh eating bacteria that causes death to fascia and destruction to muscle and fat
G21
Typically occurs in association with necrotizing fasciitis or bacteremia Rapidly progresses to shock and death due to organ failure (kidneys, lungs, liver, heart) See Clinical Case 22-1 of Textbook-Page 231 (Note how rapidly this patient declined!!)
G22
Erysipelas
Necrotizing fasciitis
G23
G24
Acute Glomerulonephritis
Associated with untreated skin or respiratory tract infections caused by nephritogenic strains of S. pyogenes, Group A Onset of symptoms may be as short as one week after infection Evidence strongly support a Type III hypersensitivity reaction, where the antigen-antibody complex is trapped in the glomerular membranes Symptoms include hypertension, edema, BUN, serum creatinine, blood and protein in urine
G25
Greatly reduced incidence in U.S. (only 112 cases in 1994) Far more prevalent in developing countries Associated with untreated upper respiratory tract infections, usually pharyngitis Onset of symptoms 1 4 weeks post S. pyogenes infection M protein of the pathogen shares some common structural features with certain cardiac tissue. M protein serves as an antigen which induces antibody formation. A Type II hypersensitivity reaction may occur with the antibody binding to cardiac tissue, causing inflammation and cardiac damage
G26
S. pyogenes Diagnosis
Release the C antigen by enzymatic or chemical means Detection of the C antigen with ELISA or latex agglutination
If rheumatic fever is suspected, high ASO titers (Antibody to Streptolysis O) would confirm a recent Streptococcus pyogenes infection If acute glomerulonephritis is suspected, high anti-DNase B titers would confirm a recent Streptococcus pyogenes skin infection
G27
General Characteristics/Classification
Serological classification Group B Hemolytic pattern beta hemolytic, but narrow zone Growth pattern short chains long chains
Habitat GI and female genital tracts Transmission Can be transmitted to unborn, in utero, or to newborn during birth
G28
Early-Onset Neonatal
Late-Onset Neonatal
Birth 1st week of life Bacteremia, pneumonia, or meningitis Mortality rate-5% or so Meningitis survivalSignificant neurological effects (blindness, deafness, mental retardation)
One week 3 months Bacteremia with meningitis Neurological effects high with meningitis See Case 22-2-p 235
G29
S. agalactiae - Diseases
Adults
After deliver, the pathogen can cause endometritis . Pathogen may cause UTI Older adults with compromised immunity
Bacteremia, bone and joint, skin and soft-tissue, pneumonia Mortality rate fairly high
G30
S. agalactiae
Laboratory Diagnosis
G31