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STREPTOCOCCUS B,C,D,VIRIDANS



                 DEEPA BABIN
                  ASST PROF
       Travancore Medical College, Kollam
Hemolyic patterns on blood agar
Streptococus deepa
Group B: Streptococcus agalactiae
• Regularly resides in human
  vagina, pharynx, and large intestine
• Can be transferred to infant during
  delivery and cause severe infection


  – Pregnant women should be screened and
    treated
• Wound and skin infections and
  endocarditis in debilitated people
Deepa Babin   5


   LAB DIAGNOSIS
 Cultivation  and diagnosis
  ensure proper treatment
  to prevent possible
  complications
 Rapid diagnostic tests
  based on monoclonal
  antibodies that react with
  C-carbohydrates
 Culture using bacitracin
  disc test, CAMP
  test, Hippurate hydrolysis
Deepa Babin                 6

               CAMP Test- S.agalactiae
• By Christie, Atkins, and Munch-Peterson
• In the CAMP test, group B streptococci release a soluble factor
    (CAMP factor) that acts synergistically with the -hemolysin of
    Staphylococcus aureus.
•   A strain of -hemolysin producing Staphylococcus aureus is
    inoculated down the center of a sheep blood agar plate.
•     A single streak of an isolate to be identified is inoculated
    perpendicular to the S. aureus streak to within 3-4 mm of the S.
    aureus streak.
•   The blood agar plate is then incubated overnight in an 35-37oC air
    incubator
•   If a large arrowhead zone of enhanced -hemolysis develops
    between the unknown isolate and S. aureus the unknown isolate
    is group B Streptococcus.
Streptococus deepa
• Groups C –Strep equisimilis species
  – Common animal flora, frequently isolated from upper
    respiratory;
    pharyngitis,osteomylitis,glomerulonephritis, bactere
    mia,brain abscess,puerperal sepsis
  – Strep equisimilis- source of streptokinase
 Group G,H,K O,R:
 Group G- commensals of throat of man monkey
 dogs
 Occationaly-tonsilitis,endocarditis,UTI
 Group H and K- Endocarditis
 Group O- tonsilitis,endocarditis
 Group R- Pigs(Septicemia,meningitis)
Treatment
• Groups A and B are treated with
  Penicillin
• Long-term penicillin prophylaxis for
  people with a history of rheumatic
  fever or recurrent strep throat
Deepa Babin   10




        Group D (Enterococci)
• Two groups-
  Enterococcal gp and
  Non Enterococcal
  gp
  – Enterococcus
    faecalis, E.
    faecium, E. durans
  – Strep bovis,Strep
    equinus- Non
   Enterococcal gp
Deepa Babin         11




             Group D (Enterococci)
• -Normal colonists of human large intestine,Genital
  tract and saliva
   – Cause opportunistic urinary, wound, and skin
     infections, particularly in debilitated persons

  – Intra abdominal abscess complicating
    diverticulitis and peritonitis
Lab diagnosis
• Bile Esculin hydrolysis
  – Ability to grow in 40% bile and hydrolyze Esculin
    are features of Enterococci that possess Group D
    antigen
• Growth in 6.5% NaCl broth
  – Differentiates Group D streptococci from
    enterococci
Treatment
•   Treatment-Penicillin- Resistance(enterococci)
•   P –R ,CHOICE IS VANCOMYCIN
•   VRE- Vancomycin resitant Enterococci
•   Enterococcal treatment usually requires
    combined therap
• Cephalosporin's are inherently resistant
  for Enterococci
Deepa Babin            14

                     Viridans Group
• Bacteremia, meningitis, abdominal infection, tooth
  abscesses
• Most serious infection – Sub Acute Endocarditis – Blood-
  borne bacteria settle and grow on heart lining or valves
• S. mutans produce slime layers that adhere to teeth, basis
  for plaque
• Involved in dental caries
• Persons with pre existing heart conditions should receive
  prophylactic antibiotics before surgery or dental
  procedures
• Persons with pre existing heart disease are at high risk
• Colonization of heart by forming biofilms
Deepa Babin   15

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Streptococus deepa

  • 1. STREPTOCOCCUS B,C,D,VIRIDANS DEEPA BABIN ASST PROF Travancore Medical College, Kollam
  • 2. Hemolyic patterns on blood agar
  • 4. Group B: Streptococcus agalactiae • Regularly resides in human vagina, pharynx, and large intestine • Can be transferred to infant during delivery and cause severe infection – Pregnant women should be screened and treated • Wound and skin infections and endocarditis in debilitated people
  • 5. Deepa Babin 5 LAB DIAGNOSIS  Cultivation and diagnosis ensure proper treatment to prevent possible complications  Rapid diagnostic tests based on monoclonal antibodies that react with C-carbohydrates  Culture using bacitracin disc test, CAMP test, Hippurate hydrolysis
  • 6. Deepa Babin 6 CAMP Test- S.agalactiae • By Christie, Atkins, and Munch-Peterson • In the CAMP test, group B streptococci release a soluble factor (CAMP factor) that acts synergistically with the -hemolysin of Staphylococcus aureus. • A strain of -hemolysin producing Staphylococcus aureus is inoculated down the center of a sheep blood agar plate. • A single streak of an isolate to be identified is inoculated perpendicular to the S. aureus streak to within 3-4 mm of the S. aureus streak. • The blood agar plate is then incubated overnight in an 35-37oC air incubator • If a large arrowhead zone of enhanced -hemolysis develops between the unknown isolate and S. aureus the unknown isolate is group B Streptococcus.
  • 8. • Groups C –Strep equisimilis species – Common animal flora, frequently isolated from upper respiratory; pharyngitis,osteomylitis,glomerulonephritis, bactere mia,brain abscess,puerperal sepsis – Strep equisimilis- source of streptokinase Group G,H,K O,R: Group G- commensals of throat of man monkey dogs Occationaly-tonsilitis,endocarditis,UTI Group H and K- Endocarditis Group O- tonsilitis,endocarditis Group R- Pigs(Septicemia,meningitis)
  • 9. Treatment • Groups A and B are treated with Penicillin • Long-term penicillin prophylaxis for people with a history of rheumatic fever or recurrent strep throat
  • 10. Deepa Babin 10 Group D (Enterococci) • Two groups- Enterococcal gp and Non Enterococcal gp – Enterococcus faecalis, E. faecium, E. durans – Strep bovis,Strep equinus- Non Enterococcal gp
  • 11. Deepa Babin 11 Group D (Enterococci) • -Normal colonists of human large intestine,Genital tract and saliva – Cause opportunistic urinary, wound, and skin infections, particularly in debilitated persons – Intra abdominal abscess complicating diverticulitis and peritonitis
  • 12. Lab diagnosis • Bile Esculin hydrolysis – Ability to grow in 40% bile and hydrolyze Esculin are features of Enterococci that possess Group D antigen • Growth in 6.5% NaCl broth – Differentiates Group D streptococci from enterococci
  • 13. Treatment • Treatment-Penicillin- Resistance(enterococci) • P –R ,CHOICE IS VANCOMYCIN • VRE- Vancomycin resitant Enterococci • Enterococcal treatment usually requires combined therap • Cephalosporin's are inherently resistant for Enterococci
  • 14. Deepa Babin 14 Viridans Group • Bacteremia, meningitis, abdominal infection, tooth abscesses • Most serious infection – Sub Acute Endocarditis – Blood- borne bacteria settle and grow on heart lining or valves • S. mutans produce slime layers that adhere to teeth, basis for plaque • Involved in dental caries • Persons with pre existing heart conditions should receive prophylactic antibiotics before surgery or dental procedures • Persons with pre existing heart disease are at high risk • Colonization of heart by forming biofilms