Alpha Hemolytic Streptococci
Viridans Group Streptococci & Pneumococci.
Department of Microbiology
College of Medicine
University of Baghdad
Lec3, 2014-2015
Dr.Sarmad M.H Zeiny
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Analyze the
diseases & pathogenicity
for viridans & pneumococci.
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Demons trate the
e pidemiology/ trans mission
for viridans &
pne umococci.
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Outline the
laboratory diagnosis
for viridans & pne umococci.
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State the
drug of choice and prophylaxis
where reg ularly use d.
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s by producing glycocalyx àplaque
formation.
Streptococcus intermedius are part of the normal G.I. tract
flora. àabscesses in the brain or abdominal organs.
Viridans Streptococcus is eating heart valves slowly,
while Staphylococcus aureus is eating fast .
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Why patient with abnormal heart valve
should take antibiotic prophylaxis before
tooth extraction?
S.pneumoniae
(Pneumococci, Diplococcus pneumoniae)
Di s t i n g u i s h i n g Fe a t u r e s :
—
α-hemolytic, capsulated G+ ve diplococci.
—
Lancet- shaped diplococci ( cat’
s eye).
—
Optochin sensitive.
—
Lysed by bile.
—
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Capsular polysaccharide
Gr am + VE diplococcus
Reservoir: human upper respiratory tract.
Transmission:
By respiratory droplets:
- Not considered highly communicable.
- Often colonizes the nasopharynx without
causing disease.
Predisposing Factors:
•Antecedent influenza or measles infection.
•Chronic obstructive pulmonary disease
(COPD).
•Congestive heart failure (CHF).
•Alcoholism.
•Asplenia.
Virulent factors & Pathogenesis:
—
Polysaccharide capsule
is the major
virulence factor à anti- phagocytosis
—
lgA protease
à Breakdown IgA
—
Teichoic acid. à
Rigid cell wall
—
Pneumolysin O
: hemolysin/ cytolysin
- Damages respiratory epithelium
- Inhibits leukocyte respiratory burst and
- Inhibits classical complement fixation
The "pneumococcal warrior." He is a mighty foe, with "capsule" armor, a lung emblem
on his shield, and a lancet-shaped diplococcus lance. The lung emblem on his shield shows
the severe lobar pneumonia caused by this organism.
-
-Pneumococci is part of the normal nasopharyngeal
and oropharyngeal flora of many healthy persons
(carrier rate 40-70%).
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Dise ases:
—
TYPICAL PNEUMONIA:
- Most common cause (especially adult & elderly)
-
Shaking chills, high fever, lobar consolidation, blood-tinged, "rusty"
sputum.
-
Pneumococcus is to Parents while group B streptococcus is to
Babies.
—
ADULT MENINGITIS:
- Common cause.
- CSF reveals high WBCs (neutrophils), low glucose and high protein.
—
OTITIS MEDIA AND SINUSITIS IN CHILDREN
:
- most common cause
Pre vention: by Vaccine
- Pe d i a t r i c ( PCV, pn e u m o c o c c a l
c a ps u l a r va c c i n e ):
—
Seven of the most common serotypes
—
Conjugated to diphtheria toxoid
- Ad u l t ( PPV, pn e u m o c o c c a l
po l y s a c c h a ri d e va c c i n e ):
—
23 of the most common capsular serotypes
—
Recommended for all
a d u l t s >65 y e a r s o f
a g e a n d a n y a t -r i s k i n d i vi d u a l s
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n
c
c
e
e
i
i
n
n
m
m
i
i
c
c
e
e
+
+
v
v
e
e
-
-
v
v
e
e
Differences between Viridans &
Pneumococci
Q: An s we r wi t h t ru e o r fals e
1)
Pneumococci is uncapsulated.
2)
Pneumococci is α
-hemolytic.
3)
No vaccine for pneumococci.
4)
Pneumococci is bile soluble.
5)
Pneumococci can’
t be differentiated
from viridans streptococci.
Anaerobic streptococcus:
Peptostreptococcus
—
Anaerobic or microaerophilic conditions and variably
produce hemolysins.
—
Normal flora of the mouth, upper respiratory tract,
bowel, and female genital tract.
—
Diseases:
mixed anaerobic infections. Such infections
may occur in wounds, in the breast, in postpartum
endometritis, following rupture of an abdominal viscus,
the brain, or in chronic suppuration of the lung.
L
L
a
a
b
b
D
D
x
x
1) Gram stain
2) Culture:
on Chocolate or blood Agarà α-
hemolysis small (pinpointed),
gray, colonies may be
m
m
u
u
c
c
o
o
i
i
d
d
.
3) Biochemical
tests:
•Optochin sensitivity disc
•Bile Solubility test
4) Serology
Quellung reaction test
Latex agglutination test
5) Virulence in
mice:
mice will die,
while when inject
Viridans the mice will
survive.
6) Antimicrobial
susceptibility
testing.
O
O
p
p
t
t
o
o
c
c
h
h
i
i
n
n
d
d
i
i
s
s
c
c
f
f
o
o
r
r
S
S
.
.
p
p
n
n
e
e
u
u
m
m
o
o
c
c
o
o
c
c
c
c
i
i
India ink slide, see the
Quelling reaction
Gram slide, see the diplococci
Q
Q
u
u
e
e
s
s
t
t
i
i
o
o
n
n
?
?
N
N
a
a
m
m
e
e
t
t
h
h
i
i
s
s
t
t
e
e
s
s
t
t
s u m m ary
•
Alpha hae molytics stre ptococci causing greenish discoloration
on chocolate agar.
•
Viridans causes SBE in suspected individuals. AB prophylaxis
ne ede d.
•
Pneumococci is caps ulate d and typ ed accordingly t o 84
se rot ype d.
•
Pneumococci is t he leading cause of adult pne umonia.
•
Pneumococci pre sent in carrie r st ate in 40-70% of he alt hy
humans.
•
Pneumococci & viridans can be differe ntiated by Optochin
se nsitiv it y, arrange ment, bile solubility, Capsular s welling t est
(Quelling re act ion) and se rologically .
•
Pneumococci can be prev ent ed b y a Vaccine
causing Ab
against caps ular Ag .
T
T
H
H
A
A
N
N
K
K
S
S