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Streptococci
Gram-positive cocci in chains
• Gram positive cocci arranged in chains
Planes of division
Catalase Test

Catalase +ve

Catalase –ve

Staphylococci

Streptococci
• Growth requires enriched media containing
blood or serum.
Haemolysis on sheep blood agar can be used for
distinguishing between streptococci
Group Antigens
• Cell wall Carbohydrate antigens
• Lancefield group antigens
A – W (except I & J)
Streptococcus pyogenes
Group A Streptococci
Gram-positive cocci in chains

Beta hemolytic
Virulence Factors
Pharyngitis
• Sore Throat
• Tonsillitis
Scarlet Fever
Skin & Soft Tissue Infections
• Impetigo
– Lesions on
extremities
– Commonly on face
– Pustular and crusty
Skin & Soft Tissue Infections
Cellulitis & Erysipelas
Invasive streptococcal infections
•
•
•
•

Puerperal fever
Acute endocarditis
Necrotizing fasciitis
Toxic shock syndrome
Necrotizing Fasciitis
Laboratory Diagnosis
• Specimen:
– Throat swab
– Pus
– CSF
– Blood
• Direct detection
– Gram-stained smear

S. pyogenes

– Detection of group A streptococcal antigen
from throat swab.
• Culture:
Blood

Throat swab
Pus
CSF

Culture
on

Blood
culture
bottle

Culture on

Blood Agar

subculture
• Identification :
A. Colony morphology
B. Gram-stained smear
C. Catalase test

negative
D. Bacitracin sensitivity test
E. Agglutination by group A antibody .
Viridans streptococci
Diseases:
- Subacute Bacterial
Endocarditis (SBE)

- Dental Caries
Laboratory diagnosis of SBE
Blood culture technique
Streptococcus pneumoniae
Gram positive
capsulated diplococci.

Alpha haemolytic .
Quellung test :
Pneumococcal diseases
Three major diseases:
• Pneumonia
• Meningitis

• Otitis media
Laboratory diagnosis
A-Specimens:
– Sputum
– CSF
– Ear discharge
– Blood
B- Direct detection :

1- Gram-stained smear
2- Quellung test
3- Detection of capsular polysaccharide antigen
in CSF by slide agglutination test
• Culture:
Blood

Throat swab
Pus
CSF

Culture
on

Blood
culture
bottle

Culture on

Blood Agar

subculture
Identification :
1-Colony morphology
2-Gram-stained smear
3-Differentiation from viridans streptococci
A. Growth inhibition by optochin
B. Solubility of colonies in bile
C. Capsular polysaccharide antigen detection
D. Quellung reaction
E. DNA probe specific to S. pneumoniae
F. Virulence to mice
Populations at risk of being infected with
S. pneumoniae
• Asplenic individuals
• infants
• Immunosuppressed individuals

• Alcoholics
So, how to protect them?
• A vaccine is available.
– Capsular polysaccharide vaccine
– Antigens from 23 serotypes.

• Under age of TWO years:
– Pneumococcal conjugate vaccine
– Capsular polysaccharide + protein carrier
Enterococcus
•
•

Gram +ve cocci
singly / in pairs /short chains
Enterococcus
•
•
•

Catalase negative
Hydrolyze esculin in presence
of bile salts
Lancefield group D
Enterococcus Infections
•
•
•
•
•

UTI
Intra-abdominal & pelvic wound infections
Bacteraemia
Endocarditis
Abscesses, meningitis, peritonitis, osteomyelitis &
wound infection
Case 1
A 10-year-old girl presents to her
primary care physician with :

o severe sore throat,
o fever,
o headache, nausea, and abdominal
pain.
Case (cont.)

Examination shows:
The back of her throat is covered with a purulent
exudate with white pus-filled nodules.

How can you reach
a diagnosis?
A. Specimen
Specimen
Throat swabs
Direct detection:
- Gram-stained smear

Gram-positive cocci
arranged in chains
amongst pus cells
B. Direct detection
- Detection of group A streptococcal
antigen from throat swab.
Culture:
On blood agar: β- hemolysis
Identification from colonies:
1.Gram-stained smear

Gram positive cocci
in chains

2. Catalase test

catalase negative
3.Bacitracin sensitivity test
Bacitracin sensitive

Group A
(S. pyogenes)
What treatment would you offer her?

• Penicillin, or erythromycin if allergic to
penicillin.
This patient may present afterwards with one
of Post - Streptococcal sequelae.
What are they? And what is the underlying
mechanism?
1.
2.

Rheumatic Fever
Post-Streptococcal glomerulonephritis
Rheumatic Fever
Immune response against Strept. antigens
similar to heart antigens.
Post-streptococcal glomerulonephritis
Deposition of Ag-Ab complexes, activation
of complement.
Diagnosis of ARF
No single test is pathognomonic .

Diagnosis is based on modified Jones criteria:
a) Evidence of recent S .pyogenes infection
b) Two of the five major criteria ,or one major and
two minor criteria .
The evidence of recent streptococcal
infection
a-History of acute tonsillitis .
b-Elevation of ASO titre above 200 units .
N.B. In case of AGN:
Anti-DNAse
Review Questions
1. The simplest test to differentiate staphylococci
from streptococci is the:
a) Coagulase test
b) Bacitracin test
c) Gram stain
d) Catalase test
e) Optochin test
2. Group A streptococcus growing on a blood agar
plate, shows which of the following:
a) Alpha hemolysis, a clear zone surrounding the
colonies
b) Alpha hemolysis, a green zone surrounding the
colonies
c) Beta-hemolysis, a clear zone surrounding the
colonies
d) Beta-hemolysis, a green zone surrounding the
colonies
e) No haemolysis
3.Susceptibility to bacitracin is used to differentiate:
a) Streptococcus pneumoniae from Staphylococcus
aureus.
b) Streptococcus pyogenes from Streptococcus
pneumoniae.
c) Streptococcus pneumoniae from viridans streptococci.
d) Streptococcus pyogenes from non group A beta
haemolytic streptococci.
e) Streptococcus pyogenes from Staphylococc aureus
4. Streptococcus pyogenes can not be isolated
in case of:
a) Pharyngitis.
b) Puerperal fever.
c) Acute endocarditis.
d) Rheumatic fever.
e) Necrotizing fasciitis.
5. The inhibition of growth of alpha-hemolytic
colonies by optochin indicates:
a) Streptococcus pyogenes

b) Viridans streptococci
c) Streptococcus pneumoniae
d) Staphylococcus aureus
e) Enterococci
6. Blood culture is required for the diagnosis of:

a) Subacute bacterial endocarditis
b) Pharyngitis
c) Glomerulonephritis
d) Rheumatic fever
e) Scarlet fever
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