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Questions and Answers
Group A Streptococcus is responsible for causing rheumatic fever.
Group A Streptococcus is responsible for causing rheumatic fever.
True
Streptococcus pneumoniae is a major cause of urinary tract infections.
Streptococcus pneumoniae is a major cause of urinary tract infections.
False
Streptococcus agalactiae is commonly found in gastrointestinal and genital tracts.
Streptococcus agalactiae is commonly found in gastrointestinal and genital tracts.
True
Streptococcus pyogenes is characterized by alpha-hemolysis.
Streptococcus pyogenes is characterized by alpha-hemolysis.
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Viridans Group Streptococci is a well-studied genus that contributes to insights into bacterial immunity.
Viridans Group Streptococci is a well-studied genus that contributes to insights into bacterial immunity.
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Pepto-streptococci are part of the normal flora of the mouth and upper respiratory tract.
Pepto-streptococci are part of the normal flora of the mouth and upper respiratory tract.
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Beta-haemolytic streptococci cause incomplete lysis of red blood cells.
Beta-haemolytic streptococci cause incomplete lysis of red blood cells.
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Streptococcus pyogenes is a Gram-negative cocci.
Streptococcus pyogenes is a Gram-negative cocci.
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Streptococcus isolates can be differentiated based on their Lancefield groups.
Streptococcus isolates can be differentiated based on their Lancefield groups.
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Streptococcus pyogenes does not grow on blood agar.
Streptococcus pyogenes does not grow on blood agar.
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Streptococcus infections can only affect the respiratory tract.
Streptococcus infections can only affect the respiratory tract.
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Streptococcal pharyngitis is commonly known as strep throat.
Streptococcal pharyngitis is commonly known as strep throat.
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Rheumatic fever is an autoimmune condition that can result from untreated strep throat.
Rheumatic fever is an autoimmune condition that can result from untreated strep throat.
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Streptococcus infections can lead to long-term complications if untreated.
Streptococcus infections can lead to long-term complications if untreated.
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Streptolysin is a type of antibiotic used to treat Streptococcus infections.
Streptolysin is a type of antibiotic used to treat Streptococcus infections.
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Which of the following is primarily associated with Group B Streptococcus infections?
Which of the following is primarily associated with Group B Streptococcus infections?
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What is the hemolysis characteristic of Streptococcus pneumoniae?
What is the hemolysis characteristic of Streptococcus pneumoniae?
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Which clinical condition is a consequence of Group A Streptococcus infection?
Which clinical condition is a consequence of Group A Streptococcus infection?
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What distinguishes Streptococcus agalactiae in terms of hemolytic activity?
What distinguishes Streptococcus agalactiae in terms of hemolytic activity?
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Which of the following is a characteristic of Streptococcus pyogenes?
Which of the following is a characteristic of Streptococcus pyogenes?
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What is the infectious disease commonly associated with Viridans Group Streptococci?
What is the infectious disease commonly associated with Viridans Group Streptococci?
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What is the hemolysis pattern of Viridans Streptococci?
What is the hemolysis pattern of Viridans Streptococci?
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Which media is optimal for cultivating Streptococcus species?
Which media is optimal for cultivating Streptococcus species?
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Which characteristic feature distinguishes Streptococcus bacteria in terms of arrangement?
Which characteristic feature distinguishes Streptococcus bacteria in terms of arrangement?
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What are the typical size dimensions of Streptococcus cells?
What are the typical size dimensions of Streptococcus cells?
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What are common clinical presentations of skin infections caused by Streptococcus?
What are common clinical presentations of skin infections caused by Streptococcus?
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What is a potential life-threatening condition resulting from infections with S.pyogenes?
What is a potential life-threatening condition resulting from infections with S.pyogenes?
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Which autoimmune condition can be triggered by untreated streptococcal pharyngitis?
Which autoimmune condition can be triggered by untreated streptococcal pharyngitis?
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What diagnostic method is used to detect the presence of S.pyogenes in a patient with a sore throat?
What diagnostic method is used to detect the presence of S.pyogenes in a patient with a sore throat?
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What symptoms typically present in streptococcal pharyngitis?
What symptoms typically present in streptococcal pharyngitis?
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What are the key clinical infections associated with Group B Streptococcus (Streptococcus agalactiae)?
What are the key clinical infections associated with Group B Streptococcus (Streptococcus agalactiae)?
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How do you identify Streptococcus pneumoniae based on its hemolytic property?
How do you identify Streptococcus pneumoniae based on its hemolytic property?
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What culture characteristics distinguish Group A Streptococcus (Streptococcus pyogenes) from other streptococci?
What culture characteristics distinguish Group A Streptococcus (Streptococcus pyogenes) from other streptococci?
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List two virulence factors commonly associated with Streptococcus pyogenes.
List two virulence factors commonly associated with Streptococcus pyogenes.
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What laboratory test is used to differentiate Streptococcus agalactiae from other streptococci?
What laboratory test is used to differentiate Streptococcus agalactiae from other streptococci?
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Viridans Group Streptococci is commonly associated with __________.
Viridans Group Streptococci is commonly associated with __________.
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Streptococcus species thrive at __________ degrees Celsius.
Streptococcus species thrive at __________ degrees Celsius.
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Most Streptococcus are facultative __________, meaning they can grow in both aerobic and anaerobic conditions.
Most Streptococcus are facultative __________, meaning they can grow in both aerobic and anaerobic conditions.
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Streptococcus bacteria are typically arranged in __________ or chains.
Streptococcus bacteria are typically arranged in __________ or chains.
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The cell wall of Streptococcus is composed of __________ and teichoic acid.
The cell wall of Streptococcus is composed of __________ and teichoic acid.
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Study Notes
Streptococcus Species: Key Facts
- Streptococcus is a genus of Gram-positive, spherical bacteria often seen in chains.
-
Clinical Importance: Many Streptococcus species cause infections, including:
- Group A Streptococcus (Streptococcus pyogenes): Pharyngitis (strep throat), Scarlet fever, Impetigo, Erysipelas, Cellulitis, Necrotizing fasciitis, Rheumatic fever, Post-streptococcal glomerulonephritis
- Group B Streptococcus (Streptococcus agalactiae): Neonatal sepsis, Neonatal pneumonia, Meningitis, Infections in adults with weakened immune systems, UTIs
- Streptococcus pneumoniae: Pneumonia, Meningitis, Otitis media (middle ear infections), Sinusitis, Bacteremia
- Viridans Group Streptococci: Can cause opportunistic infections, especially in people with weakened immune systems.
Streptococcus pyogenes (Group A Streptococcus)
- Hemolysis: Beta-hemolysis (clear zone on blood agar)
- Colony Appearance: Small, translucent, white colonies
- Catalase: Negative
- Bacitracin Susceptibility: Sensitive
Streptococcus agalactiae (Group B Streptococcus)
- Hemolysis: Beta-hemolysis (narrow clear zone on blood agar)
- Colony Appearance: Larger than S. pyogenes, grayish white colonies
- CAMP Test: Positive (Indicates production of CAMP factor)
Streptococcus pneumoniae
- Hemolysis: Alpha-hemolysis (greenish zone on blood agar)
- Colony Appearance: Mucoid or flattened colonies due to capsule production
- Capsule: Important virulence factor
- Clinical Importance: Most common cause of bacterial pneumonia, particularly community-acquired pneumonia (CAP).
Laboratory Identification of Streptococcus Species
- Gram Staining: Gram-positive cocci, often in chains
-
Hemolysis: Used to differentiate between species on blood agar
- Beta-hemolytic: Complete lysis of red blood cells
- Alpha-hemolytic: Incomplete lysis, greenish discoloration
- Non-hemolytic: No hemolysis
- Catalase Test: Used to differentiate from Staphylococcus (catalase positive)
- Bacitracin Sensitivity: Differentiates S. pyogenes from other beta-hemolytic streptococci
- CAMP Test: Differentiates S. agalactiae from other beta-hemolytic streptococci
- Quellung Reaction: Used to identify and type Streptococcus pneumoniae
- Serological Grouping: Used to classify Streptococcus species into groups based on cell wall carbohydrate antigens (Lancefield groups)
Streptococcus Infections: Diagnosis
- Sample Collection: Appropriate sample type (throat, skin, blood) collected using sterile technique
- Transport Medium: Samples are transported in Stuart's or Amies medium to maintain viability
- Preliminary Tests: Gram staining, Catalase, and other rapid identification tests are performed
- Culture Identification: Using selective/differential media and biochemical tests
- Serological Assays: Antibody detection to differentiate acute from convalescent phases of infection
Streptococcus Infections: Clinical Manifestations
-
Skin and Soft Tissue Infections:
- Impetigo
- Cellulitis
- Necrotizing fasciitis
- Erysipelas
-
Respiratory Tract Infections:
- Pharyngitis (strep throat)
- Pneumonia
- Empyema
-
Invasive Infections:
- Bacteremia
- Meningitis
- Endocarditis
- Toxic shock syndrome
-
Post-Infectious Sequelae:
- Rheumatic fever
- Glomerulonephritis
Introduction to Streptococcus
- Streptococcus is a genus of Gram-positive, spherical bacteria
- Streptococcus species often appear in chains
- Many are important human pathogens, causing a wide range of infections
- Streptococcus is a well-studied genus providing insights into bacterial pathogenesis and immunity
Main Species of Clinical Importance
- Group A Streptococcus (Streptococcus pyogenes)
- Group B Streptococcus (Streptococcus agalactiae)
- Streptococcus pneumoniae
- Viridans Group Streptococci
Group A Streptococcus (Streptococcus pyogenes)
- Responsible for a wide range of infections, including:
- Pharyngitis (strep throat)
- Scarlet fever
- Impetigo
- Erysipelas
- Cellulitis
- Necrotizing fasciitis
- Rheumatic fever
- Post-streptococcal glomerulonephritis
- Beta-hemolysis (clear zone)
- Small, translucent, white colonies
- Catalase: Negative
- Bacitracin: Sensitive
Group B Streptococcus (Streptococcus agalactiae)
- Commonly found in gastrointestinal and genital tracts
- Can cause:
- Neonatal sepsis
- Neonatal pneumonia
- Meningitis
- Infections in immunocompromised adults
- Urinary tract infections (UTIs)
- Beta-hemolysis (narrow clear zone)
- Larger than S. pyogenes, grayish white colonies
- CAMP test: Positive
Streptococcus pneumoniae
- Major cause of
- Pneumonia
- Meningitis
- Otitis media (middle ear infections)
- Sinusitis
- Bacteremia
- Alpha-hemolysis (greenish zone)
- Mucoid or flattened colonies due to capsule production
- Optochin: Sensitive
- Bile solubility: Positive
Viridans Group Streptococci
- Includes species such as Streptococcus mutans, S.mitis, S.sanguinis and others
- Commonly associated with dental caries (tooth decay)
- Can cause subacute bacterial endocarditis (especially in individuals with damaged heart valves)
- Alpha or gamma hemolysis
- Small, rough, or smooth, non-capsulated colonies
- Optochin: Resistant
- Bile solubility: Negative
Streptococcus Taxonomy and Classification
- Several classifications apply to Streptococcus
- Taxonomic Diversity: Includes both commensal and pathogenic species
- Cell Morphology: Spherical or ovoid bacteria that typically arrange in chains
- Lancefield Grouping: Groups are based on specific carbohydrate antigens found on the cell surface
Cell Structure and Morphology
- Gram-positive cocci, typically arranged in pairs or chains
- Thick, rigid cell wall composed of peptidoglycan and teichoic acid
- Cell surface features pili and other surface proteins important for adherence and virulence
- Streptococcal cells range in size from 0.5-1.0 μm in diameter and lack flagella, instead relying on Brownian motion for movement
- The internal structure includes a cytoplasmic membrane, cytoplasm, and genetic material in the form of a single, circular chromosome
Growth Requirements
- Nutrient-Rich Media: Streptococcus species require nutrient-rich media like blood agar or Todd-Hewitt broth for optimal growth and cultivation in the laboratory
- Oxygen Needs: Most Streptococcus are facultative anaerobes, able to grow in both aerobic and anaerobic conditions, although some are strictly aerobic or anaerobic
- Temperature Preferences: Streptococcus thrive at 35-37°C, the typical human body temperature, making them well-adapted to infect and colonize human hosts
- pH Range: Streptococcus prefer a neutral to slightly acidic pH range of 6.5-7.5, although some species can tolerate a wider pH variation
Classification of Streptococci
- According to oxygen requirement for growth, Streptococci are classified into:
- Obligate (strict) anaerobes
Streptococcus Infections: Clinical Manifestations
- Skin and Soft Tissue Infections: Examples include impetigo, cellulitis, necrotizing fasciitis, and erysipelas
- Respiratory Tract Infections: Example include Streptococcal pharyngitis (strep throat), pneumonia and empyema
- Invasive Infections: Examples include bacteremia, meningitis, endocarditis, and toxic shock syndrome (TSS), leading to high fever, organ dysfunction, and rapid progression
- Post-Infectious Sequelae: Examples include rheumatic fever and glomerulonephritis. These occur weeks after the initial infection and can cause long-term complications
Clinical Manifestations of S. pyogenes
- Throat Infections: S. pyogenes is a leading cause of strep throat, resulting in severe sore throat, fever, and swollen lymph nodes
- Skin Infections: It can cause skin infections like impetigo, cellulitis, and necrotizing fasciitis, leading to painful, red, and swollen skin lesions
- Rheumatic Fever: Untreated strep throat can lead to an autoimmune reaction causing rheumatic fever, damaging the heart, joints, and central nervous system
- Toxic Shock Syndrome: S. pyogenes can also produce toxins that lead to a life-threatening condition called toxic shock syndrome, causing high fever, rash, and organ failure
Diagnosis of S. pyogenes Infections
- Clinical Presentation: Evaluate the patient's symptoms, such as sore throat, fever, and skin lesions to identify potential S. pyogenes infections
- Throat Culture: Perform a throat swab and culture the sample to detect the presence of S. pyogenes bacteria
- Rapid Antigen Test: Use a rapid antigen detection test to quickly identify the presence of S. pyogenes Group A Streptococcus
- PCR Assays: Molecular methods like PCR can rapidly detect the presence of S. pyogenes genetic material in patient samples
Streptococcus pneumoniae (Pneumococcus)
- Gram-positive bacterium
- A leading cause of pneumonia, meningitis, and other severe infections
- Common colonizer of the upper respiratory tract, particularly in young children
- Can cause a range of clinical presentations, from mild upper respiratory tract infections to life-threatening invasive disease
- It is normal inhabitants of the upper respiratory tract of humans.
- Gram-positive, ovoid arranged in pairs (diplococci), lancet shaped
- They are capsulated.
- Capsules may appear as unstained halos around the organism.
Cultural Characters of Streptococcus Pneumoniae
- Grows on blood agar
- Produces alpha haemolysis or greenish discolouration
- This does not easily differentiate S. pneumoniae from commensal Strept. viridans on blood agar
Virulence Factors of Streptococcus Pneumoniae
- The capsule is the most important virulence factor
- Pneumococci is the most common type of bacterial pneumonia, accounting for most cases of community-acquired pneumonia (CAP)
Laboratory Identification of Strept. pneumoniae
- Direct gram stained film showing gram positive diplococci capsulated among pus cells
- Capsules appear as unstained halos around the organism
- Culture on Blood agar: alpha hemolysis
- Colonies identified by Gram stained lm shows Gram positive diplococci capsulated
- Biochemical identification
- Catalase negative
- Quellung test is positive
- Tests for differentiation from Strept. viridans
Capsule swelling test (Quellung reaction)
- This test is used for identification and typing of pneumococci
- Method:
- The test is done by mixing of sputum specimen or suspension of pneumococcal culture with specific antiserum on a microscopic slide and examined by oil immersion lens.
- Prompt and reliable diagnosis is key to guiding appropriate treatment.
Susceptibility Testing:
- Important for Guiding Appropriate Antimicrobial Therapy for Streptococcus Infections
- Sample Preparation: Obtain pure Streptococcus isolate, prepare standardized inoculum
- Disk Diffusion: Apply standardized inoculum, place antibiotic disks, incubate
- Interpretation: Measure zone of inhibition, compare to breakpoints
- Reporting: Report susceptible, intermediate, or resistant for each antibiotic
Conclusion: The Importance of Streptococcus Diagnostics
- Accurate and timely diagnosis of Streptococcus infections is crucial for effective patient management and public health surveillance
- Proper laboratory identification allows clinicians to initiate appropriate antimicrobial therapy, track emerging resistance patterns, and monitor disease outbreaks
Streptococcus
- Streptococcus is a genus of Gram-positive, spherical bacteria commonly found in chains.
- They are important human pathogens causing a wide range of infections.
- Many species of Streptococcus are well-studied, providing insights into bacterial pathogenesis and immunity.
Main Species of Clinical Importance
- Group A Streptococcus (Streptococcus pyogenes): Responsible for infections like strep throat, scarlet fever, impetigo, and necrotizing fasciitis.
- Group B Streptococcus (Streptococcus agalactiae): Commonly found in the gastrointestinal and genital tracts, causing neonatal sepsis, pneumonia, and infections in immunocompromised adults.
- Streptococcus pneumoniae: A major cause of pneumonia, meningitis, otitis media, and bacteremia.
- Viridans Group Streptococci: Normal inhabitants of the human oral cavity, upper respiratory tract, and gastrointestinal tract. Can cause opportunistic infections in immunocompromised individuals.
Streptococcus pyogenes (Group A Streptococcus)
- Beta-hemolysis (clear zone) on blood agar
- Small, translucent, white colonies.
- Catalase negative
- Sensitive to Bacitracin
Streptococcus agalactiae (Group B Streptococcus):
- Beta-hemolysis (narrow clear zone) on blood agar
- Larger than S. pyogenes, grayish white colonies.
- CAMP test positive
Streptococcus pneumoniae
- Alpha-hemolysis (greenish zone) on blood agar
- Mucoid or flattened colonies due to capsule production
- Gram-positive, ovoid, arranged in pairs (diplococci), lancet shaped.
- They are capsulated
- Capsules appear as unstained halos around the organism.
- The capsule is the most important virulence factor.
Laboratory Identification of Streptococcus
- Gram staining: Gram-positive cocci.
- Catalase test: Catalase negative (Differentiates from staphylococci).
- Hemolysis: Beta-hemolytic (complete lysis of red blood cells), alpha-hemolytic (incomplete lysis with green pigments), or non-hemolytic.
- Culture: Blood agar is used for growth.
- Biochemical tests: Various biochemical tests like bacitracin susceptibility test, CAMP test, and optochin susceptibility test are used to further differentiate between Streptococcus species.
- Serological assays: Used for serological grouping and identification of Streptococcus.
Sample Collection and Transport
- Collect samples from appropriate sites (throat, skin lesions, blood) using sterile technique.
- Transport in appropriate media (Stuart's or Amies medium) to maintain viability during transit to the lab.
- Deliver the sample to the laboratory as soon as possible (typically within 2 hours).
Infections: Diagnosis
- Specimen Collection: Select appropriate samples based on the infection site.
- Preliminary Tests: Gram staining, catalase, and other rapid identification tests.
- Culture Identification: Selective/differential media and biochemical tests for culture identification.
- Serological Assays: Antibody detection (acute vs. convalescent) to confirm diagnosis.
Susceptibility Testing
- Sample Preparation: Obtain a pure Streptococcus isolate and prepare a standardized inoculum.
- Disk Diffusion Method: Apply standardized inoculum, place antibiotic disks, incubate, and measure zone of inhibition.
- Interpretation: Compare zone of inhibition to breakpoints to determine susceptible, intermediate, or resistant for each antibiotic.
Viridans Group Streptococci
- Associated with dental caries (tooth decay)
- Can lead to subacute bacterial endocarditis, especially in people with damaged heart valves
Streptococcus Taxonomy and Classification
- Gram-positive cocci, typically arranged in chains
- Thick, rigid cell wall composed of peptidoglycan and teichoic acid
- Lack flagella, rely on Brownian motion for movement
- Cell size: 0.5-1.0 μm in diameter
- Require nutrient-rich media like blood agar or Todd-Hewitt broth
- Facultative anaerobes, can grow in both aerobic and anaerobic conditions
- Optimal growth temperature: 35-37°C
- Prefer a neutral to slightly acidic pH range of 6.5-7.5
Streptococcus Classification by Oxygen Requirements
- Obligate (strict) anaerobes: pepto-streptococcus, part of the normal flora of the mouth and upper respiratory tract.
- Aerobic and facultative anaerobic streptococci: classified according to hemolysis on blood agar
Streptococcus Classification by Hemolysis on Blood Agar
- Beta-haemolytic streptococci: produce complete lysis of red blood cells due to production of streptolysin S.
- Alpha-haemolytic streptococci: cause incomplete lysis of red blood cell with formation of green pigments.
- Nonhaemolytic streptococci: do not cause lysis of red blood cells
Serological Grouping of Streptococcus
- Based on the antigenic properties of their cell wall carbohydrates, known as Lancefield groups.
- The most clinically relevant groups are A, B, C, D, F, and G, each associated with distinct disease patterns.
- Important for identification and differentiation of Streptococcus isolates in the clinical microbiology laboratory.
Streptococcus pyogenes (Group A beta haemolytic)
- Gram-positive cocci, non-motile, non-spore forming, arranged in chains
- Requires enriched medium (blood agar) for growth, produces β-haemolysis
- Catalase negative
Streptococcus Infections: Clinical Manifestations
- Skin and Soft Tissue Infections: impetigo, cellulitis, necrotizing fasciitis, erysipelas
- Respiratory Tract Infections: pharyngitis (strep throat), pneumonia, empyema
- Invasive Infections: bacteremia, meningitis, endocarditis, toxic shock syndrome
- Post-Infectious Sequelae: rheumatic fever, glomerulonephritis
Clinical Manifestations of S.pyogenes
- Throat Infections: strep throat (severe sore throat, fever, swollen lymph nodes)
- Skin Infections: impetigo, cellulitis, necrotizing fasciitis
- Rheumatic Fever: autoimmune reaction damaging the heart, joints, and central nervous system
- Toxic Shock Syndrome: life-threatening condition caused by toxins produced by S.pyogenes
Diagnosis of S.pyogenes Infections
- Clinical Presentation: evaluate patient symptoms, such as sore throat, fever, and skin lesions
- Throat Culture: perform a throat swab and culture the sample
- Rapid Antigen Test: identify the presence of S.pyogenes Group A Streptococcus
- Molecular Diagnostics: use PCR to detect and identify S.pyogenes genetic material
Streptococcus agalactiae (Group B Streptococcus)
- Leading cause of invasive infections in newborns and pregnant women
- Can cause sepsis, meningitis, and pneumonia in neonates
- Common colonizer of the human gastrointestinal and genitourinary tracts
- Transmission occurs during childbirth from a colonized mother to her infant
- Specimen: CSF and sputum
- Culture on Blood agar: β- (complete) hemolysis = clear zone.
- Gram stained film shows Gram positive cocci arranged in chains
Biochemical Identification of Streptococcus agalactiae
- Catalase negative
- Bacitracin sensitivity: resistant to bacitracin
- CAMP test: positive
CAMP test
- Differentiates between Streptococcus agalactiae and other beta haemolytic streptococci
- Procedure: Strept.agalactia produce CAMP factor that synergistically acts with beta lysin of Staph aureus and enhances the lysis of red blood cells, while S.pyogenes does not produce CAMP factor.
Clinical Manifestations of S.agalactiae
- Neonatal Infections: sepsis, pneumonia, meningitis
- Maternal Infections: urinary tract infections, colonization of the birth canal
- Adult Infections: skin and soft tissue infections, bacteremia, endocarditis, pneumonia
Diagnosis of S.agalactiae Infections
- Culture: identify S.agalactiae from clinical specimens such as urine, blood, or cerebrospinal fluid
- Antigen Detection: rapid antigen tests identify S.agalactiae surface proteins
Susceptibility Testing
- Sample Preparation: obtain pure Streptococcus isolate, prepare standardized inoculum
- Disk Diffusion: apply standardized inoculum, place antibiotic disks, incubate
- Interpretation: measure zone of inhibition, compare to breakpoints
- Reporting: report susceptible, intermediate, or resistant for each antibiotic
Conclusion: Importance of Streptococcus Diagnostics
- Accurate and timely diagnosis is crucial for effective patient management and public health surveillance
- Allows clinicians to initiate appropriate antimicrobial therapy, track emerging resistance patterns, and monitor disease outbreaks.
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Explore the key facts about Streptococcus species, focusing on their clinical importance and implications for human health. This quiz covers various strains, including Group A, Group B, and Streptococcus pneumoniae, alongside their related infections. Test your knowledge on the characteristics and effects of these bacteria.
