Gram-Positive Cocci in Medicine

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Questions and Answers

What is the most significant virulence factor of Streptococcus pneumoniae?

Capsule

Besides pneumonia, what are two other common infections caused by Streptococcus pneumoniae?

Acute otitis media, meningitis

What is the primary habitat of Enterococci in humans?

Gastrointestinal tract

What is the leading cause of neonatal sepsis and meningitis?

<p><em>Streptococcus agalactiae</em> (GBS)</p> Signup and view all the answers

Name two infections, other than UTIs, that are commonly caused by enterococci.

<p>Septicemia, infective endocarditis</p> Signup and view all the answers

Besides secondary infections, what is another potential complication of S.aureus?

<p>Bacteraemia</p> Signup and view all the answers

What specific medical product was significantly linked to the rise of menstrual toxic shock syndrome in the early 1980s?

<p>Super-absorbent tampons</p> Signup and view all the answers

Besides menstruation, what other situation or procedure can be a source of non-menstrual toxic shock syndrome?

<p>Localized infections or surgery</p> Signup and view all the answers

What is the appearance of the rash associated with toxic shock syndrome?

<p>Sunburn-like or erythematous</p> Signup and view all the answers

What is the process that skin goes through after the rash appears in toxic shock syndrome?

<p>Desquamation</p> Signup and view all the answers

What is the name of the toxins produced by S. aureus that function as superantigens?

<p>Enterotoxins, epidermolytic toxins and TSST-1</p> Signup and view all the answers

What type of immune cell is directly stimulated by superantigens, leading to a large cytokine release?

<p>T cells</p> Signup and view all the answers

What is the first step in the laboratory investigation of an S. aureus infection?

<p>Collecting specimens</p> Signup and view all the answers

What is the primary site of colonization for Staphylococcus aureus?

<p>Anterior nares</p> Signup and view all the answers

Name one condition associated with a higher risk of S. aureus carriage.

<p>Type 1 diabetes, IV drug use, hemodialysis, skin diseases, or working in healthcare.</p> Signup and view all the answers

What is the second most common cause of urinary tract infections in young females?

<p>Staphylococcus saprophyticus</p> Signup and view all the answers

What is the skin infection that is characterized by an infection of the hair follicle?

<p>Folliculitis</p> Signup and view all the answers

What is a deeper infection in and around the hair follicle that may develop from untreated folliculitis?

<p>Furuncle (boil)</p> Signup and view all the answers

Name two arrangements of Streptococcus bacteria.

<p>Pairs and chains</p> Signup and view all the answers

Name one specific infection categorized as an invasive infection caused by S. aureus.

<p>Folliculitis, furunculosis, carbuncle, impetigo, wound infection, cellulitis, abscess, osteomyelitis, septic arthritis, pneumonia</p> Signup and view all the answers

What is a key feature that differentiates streptococci from staphylococci based on a lab test?

<p>Streptococci are catalase negative</p> Signup and view all the answers

What toxin produced by S. aureus is responsible for staphylococcal scalded skin syndrome?

<p>Epidermolytic toxin (exfoliatin)</p> Signup and view all the answers

Name two virulence factors of Streptococcus pyogenes.

<p>M protein, Streptolysin O</p> Signup and view all the answers

Name one skin infection caused by Streptococcus pyogenes.

<p>Impetigo</p> Signup and view all the answers

What is the common source of contamination in staphylococcal food poisoning?

<p>Contaminated food by colonized or infected food handlers.</p> Signup and view all the answers

What is the typical time frame in which symptoms of staphylococcal food poisoning occur after ingestion of contaminated food?

<p>1-6 hours</p> Signup and view all the answers

Besides pharyngitis, what is another disease caused by S. pyogenes characterized by a rash and circumoral pallor?

<p>Scarlet fever</p> Signup and view all the answers

What is the characteristic feature of erysipelas' margins?

<p>Sharply demarcated</p> Signup and view all the answers

What is the typical habitat of viridans streptococci?

<p>Oral cavity and upper respiratory tract</p> Signup and view all the answers

What is the literal Greek origin of the name Staphylococcus?

<p>&quot;bunch of grapes&quot; and &quot;grain or berry&quot;</p> Signup and view all the answers

What is the appearance of Staphylococcus bacteria when gram stained?

<p>gram-positive cocci in grape-like clusters</p> Signup and view all the answers

What are the two major categories of Staphylococcus species based on the coagulase test?

<p>Coagulase-positive and Coagulase-negative</p> Signup and view all the answers

Name the most clinically significant coagulase-positive Staphylococcus species.

<p><em>Staphylococcus aureus</em></p> Signup and view all the answers

What are two common coagulase-negative Staphylococcus species?

<p><em>Staphylococcus epidermidis</em> and <em>Staphylococcus saprophyticus</em></p> Signup and view all the answers

Describe the typical colony morphology of S. aureus on blood agar.

<p>sharply defined, round, convex, smooth, 1-4 mm diameter, pale yellow to dark orange, complete haemolysis</p> Signup and view all the answers

What is the optimal growth temperature for S. aureus?

<p>37°C</p> Signup and view all the answers

What is the typical colony appearance of Staphylococcus aureus on blood agar, and what type of hemolysis does it exhibit?

<p>White colonies with no complete hemolysis</p> Signup and view all the answers

What is the name of the carotenoid pigment produced by S. aureus that gives it a golden color?

<p>staphyloxanthin</p> Signup and view all the answers

What is a primary habitat for Staphylococcus epidermidis in humans?

<p>Skin and mucous membranes</p> Signup and view all the answers

In what type of patient is Staphylococcus epidermidis a major cause of infection?

<p>Hospitalized, immunocompromised, and those with indwelling foreign bodies</p> Signup and view all the answers

What is a major factor in the pathogenesis of Staphylococcus epidermidis polymer-associated infections?

<p>Biofilm formation</p> Signup and view all the answers

Name two types of infections associated with intravascular catheters that can be caused by Staphylococcus epidermidis.

<p>Bacteremia and peritonitis</p> Signup and view all the answers

Besides intravascular catheters, name two other types of prosthetic devices that Staphylococcus epidermidis can infect.

<p>Prosthetic heart valves and pacemakers</p> Signup and view all the answers

What is the most common type of endocarditis caused by Staphylococcus epidermidis?

<p>Early prosthetic valve endocarditis</p> Signup and view all the answers

How does the clinical presentation of S. epidermidis infections typically differ from S. aureus infections?

<p>Subtle, non-specific and subacute, with a long latent period</p> Signup and view all the answers

Flashcards

Folliculitis

An infection localized to the hair follicle.

Boil (Furuncle)

A deep, inflamed infection around a hair follicle, often starting as folliculitis.

Carbuncle

A larger, deeper collection of boils connected by inflamed tissue.

Impetigo

A contagious skin infection causing blisters and peeling skin, often in children.

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Toxic Shock Syndrome (TSS)

A serious bacterial infection caused by toxins produced by S. aureus.

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Staphylococcal Food Poisoning

A type of food poisoning caused by the enterotoxin of S. aureus.

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Staphylococcal Scalded Skin Syndrome (SSSS)

Caused by exfoliative toxins produced by S. aureus, leading to widespread skin peeling.

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Enterotoxin

A type of toxin that causes inflammation and tissue damage, often associated with food poisoning or other staph infections.

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What is Staphylococcus?

Staphylococcus is a genus of gram-positive bacteria that are commonly found on human skin and mucous membranes. They can cause a range of infections, from mild skin infections to serious systemic infections, such as pneumonia and sepsis.

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What is coagulase?

Coagulase is an enzyme produced by some Staphylococcus. It's a key factor in classifying Staphylococcus as coagulase-positive or coagulase-negative. Coagulase is important in the bacteria's pathogenesis (ability to cause disease).

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What is Staphylococcus aureus?

Staphylococcus aureus (S. aureus) is a type of Staphylococcus that is coagulase-positive. This means it produces coagulase, an enzyme that can cause blood to clot. S. Aureus is common on human skin but also a significant human pathogen.

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What are Coagulase-negative staphylococci (CoNS)?

Coagulase-negative staphylococci (CoNS) are Staphylococcus that don't produce coagulase. They are commonly found on the skin, in the environment and are frequently isolated from human blood cultures. They can cause infections in people with weakened immune systems.

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What is Staphylococcus epidermidis?

Staphylococcus epidermidis is a type of CoNS. It is usually harmless but can cause infections, particularly in people with weakened immune systems. It's commonly found on human skin.

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What is Staphylococcus saprophyticus?

Staphylococcus saprophyticus is a type of CoNS. It is usually harmless but can cause urinary tract infections, particularly in young women.

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Staphylococcus saprophyticus

A type of bacteria that often causes urinary tract infections (UTIs) in young women, especially those who are sexually active.

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Streptococcus

Gram-positive bacteria that are typically found in pairs or chains and appear round or oval under a microscope.

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Viridans Streptococci

A group of Streptococcus bacteria that are commonly found in the mouth and throat.

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Streptococcus pyogenes (GAS)

A type of Streptococcus that is known for causing strep throat, scarlet fever, and skin infections.

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Necrotizing fasciitis

A serious condition caused by Streptococcus pyogenes, characterized by intense pain, swelling, and tissue damage.

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Streptococcus agalactiae (GBS)

A type of Streptococcus that is found in the vagina and can cause infections in newborns.

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Circumoral pallor

A common symptom of scarlet fever, characterized by a pale ring around the mouth.

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Streptococcus pneumoniae

A type of Streptococcus that is responsible for causing pneumonia, a lung infection.

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Superantigens

Substances secreted by Staphylococcus aureus that cause Toxic Shock Syndrome. They trigger a massive immune response by activating a large number of T cells, leading to cytokine release and organ damage.

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Epidermolytic toxins

A type of Superantigen produced by Staphylococcus aureus that causes redness, swelling, and blistering of the skin in Staphylococcal Scalded Skin Syndrome (SSSS).

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Staphylococcus epidermidis

A common type of Staphylococcus that is generally harmless but can cause infections, particularly in people with weakened immune systems or those who have medical devices implanted.

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Agglutination Test

A test used to detect the presence of Staphylococcus aureus in a sample. It uses antibodies that specifically bind to antigens present on the bacteria.

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Antibiotic Sensitivity Test

A test that aims to determine the effectiveness of different antibiotics against the specific bacteria present. This helps doctors choose the right treatment for a bacterial infection.

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Bacteremia

An invasive bacterial infection involving the presence of bacteria in the bloodstream.

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Streptococcus pneumoniae (Pneumococcus)

A Gram-positive bacterium that often occurs in pairs (diplococci) and is known for its capsule, a major factor in its virulence. It's a common cause of pneumonia and other infections.

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Enterococci

A group of bacteria that were previously classified with group D streptococci. They are commonly found in the gastrointestinal tract of humans and animals, and are important causes of nosocomial infections (hospital-acquired infections).

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S. pneumoniae infections

A common bacterial cause of pneumonia, particularly in older adults and those with weakened immune systems. Other infections caused by this bacteria include acute exacerbations of COPD, otitis media (ear infections), sinusitis, meningitis, and bacteraemia.

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Enterococci (Nosocomial infections)

A bacterium that is a significant cause of nosocomial infections, particularly urinary tract infections, sepsis, infective endocarditis, and wound infections.

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S. epidermidis: Epidemiology

S. epidermidis is a major cause of infections, especially in hospital settings, particularly in patients with indwelling devices like catheters and those with weakened immune systems. These infections are often resistant to multiple antibiotics.

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S. epidermidis: Pathogenicity

S. epidermidis infections are often associated with foreign bodies, such as catheters and implants. The bacteria can adhere to these devices and form a biofilm. This biofilm protects the bacteria from the host's defense mechanisms and antibiotics.

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Biofilm

A complex structure formed by bacteria, consisting of cells embedded in an extracellular matrix that provides protection and allows for communication. They can be found on medical implants, making infections hard to treat.

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S. epidermidis: Polymer-associated infections

S. epidermidis commonly infects various indwelling devices and leads to specific types of infections depending on the location. For example, infections in catheters can cause bacteraemia (bacteria in the blood) or peritonitis (inflammation of the lining of the abdomen).

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S. epidermidis: Infections of other prosthetic devices

S. epidermidis can also infect various other prosthetic devices, leading to infections in different parts of the body. These infections can occur in joints, eyes, breasts, and the urinary system.

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S. epidermidis: Endocarditis

S. epidermidis can cause infective endocarditis, a serious condition affecting the heart's inner lining. It's more common in prosthetic valves than native valves.

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S. epidermidis: Infection Characteristics

S. epidermidis infections differ from S. aureus infections in several ways. They have a longer incubation period, a more subtle presentation, and often involve prosthetic devices. They also tend to be resistant to multiple antibiotics.

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Study Notes

Gram-Positive Cocci of Medical Importance

  • Gram-positive cocci are spherical bacteria that are important for medical reasons
  • Key genera include Staphylococcus, Streptococcus, and Enterococcus
  • These bacteria cause a variety of infections

Staphylococcus

  • Discovered in 1881 by Sir Alexander Ogston
  • Greek meaning: staphyle = bunch of grapes, kokkos = grain or berry
  • Microscopic appearance: Gram stain reveals grape-like clusters of gram-positive cocci
  • Different species classified as coagulase-positive and coagulase-negative
    • Coagulase-positive: Staphylococcus aureus
      • Causes various diseases in humans, even in healthy hosts
      • Produces many virulence factors, including cell surface proteins and toxins
      • Examples of diseases caused by Staphylococcus aureus: toxic shock syndrome and Staphylococcal Scalded Skin Syndrome
    • Coagulase-negative: Staphylococcus epidermidis and Staphylococcus saprophyticus
      • Staphylococcus epidermidis: Common cause of infection in hospitalised patients with indwelling devices
      • More common cause of nosocomial infections and resistant to many antibiotics
      • Staphylococcus saprophyticus: Common cause of urinary tract infections (UTIs) in young, sexually active women

Streptococcus

  • Gram-positive oval or spherical cocci occurring in pairs or chains
  • Catalase-negative
  • Important species for human infection include Streptococcus pyogenes (GAS), Viridans streptococci, Streptococcus pneumoniae, and Streptococcus agalactiae (GBS)

Streptococcus pyogenes (GAS)

  • Colonises the nasopharynx and skin
  • Produces several virulence factors like M protein, Streptolysins O and S, Streptococcal pyrogenic exotoxins (SPEs), and spreading factors (hyaluronidase, deoxyribonuclease, streptokinase)
  • Causes various infections, including acute pharyngitis/tonsillitis, scarlet fever, impetigo, erysipelas, cellulitis, sepsis, necrotizing fasciitis, toxic shock syndrome, puerperal sepsis, endocarditis, pneumonia (post-viral), and non-suppurative sequelae like acute rheumatic fever and acute glomerulonephritis.

Viridans streptococci

  • Heterogeneous group
  • Important species include S. sanguinis, S. mitis, S. mutans, S. anginosus
  • Normal habitat: oral cavity and upper respiratory tract
  • Cause dental caries, plaques, periodontal diseases, infective endocarditis, bacteraemia, and deep-seated abscesses

Streptococcus pneumoniae

  • Also known as pneumococcus
  • Gram-positive cocci in pairs (diplococci)
  • Important virulence factor: capsule
  • Causes pneumonia, acute exacerbations of COPD, acute otitis media, sinusitis, meningitis, and bacteraemia (in splenectomised patients)

Enterococci

  • Previously grouped with group D streptococci
  • Enterococcus faecalis and Enterococcus faecium are the most commonly associated with human diseases
  • Inhabit the gastrointestinal tract of humans and animals
  • Important cause of nosocomial infections: urinary tract, septicaemia, infective endocarditis, wound, intra-abdominal, and pelvic infections

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