Streptococcus pneumoniae

Staphylococci
Faculty: Dr. Alvin Fox

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 KEYWORDS
• S. pneumoniae • Staphylococcus aureus
• • opportunistic diseases
diplococci
• food poisoning/enterotoxins
• Pneumococcus
• toxic shock syndrome
• autolysin
• toxic shock toxin
• bile solubility test • exfoliative toxin/scalded skin
• optochin susceptibility syndrome
• capsule • α, β, γ and δ cytotoxins
• Quellung reaction • leucocidin
• lipase
• hyaluronidase
• protein A
• coagulase (+) or coagulase (–)
• Staphylococcus epidermidis
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S. pneumoniae

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 S. pneumoniae
• leading cause of pneumonia
– particularly young and old
– after damage to upper respiratory tract
*e.g. following viral infection
• bacteremia
• meningitis
• middle ear infections (otitis media)

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 S. pneumoniae
• α hemolytic
• pneumolysin
– degrades red blood cells under aerobic conditions
• grows well on sheep blood agar
• no group antigen

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 Diagnosis - spinal fluid
• direct Gram staining
• detection of capsular antigen

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 Autolysis – identification after
growth
lipoteichoic acid
autolysin

Bile
teichoic acid
-choline

peptidoglycan
autolysin
Cell membrane

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 C polysaccharide
• Teichoic acid
– Precipitates in serum
– C-reactive protein

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Identification

Not optochin sensitive

optochin sensitive

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 Capsule
• prominent
– virulent strains
• anti-phagocytic
• carbohydrate antigens
– vary among strains

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 Capsule
• immunity
– serotype specific
• vaccine contains multiple serotypes
• only for susceptible population

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 Quellung reaction
• using antisera
• capsule "fixed"
• visible microscopically

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 Pathogenesis
• Teichoic acid
– complement activation
– large numbers of inflammatory
cells at infection site

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 Therapy
• S. pneumoniae
– most strains susceptible to
penicillin
– resistance is common

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 STAPHYLOCOCCI

• Gram positive
• Facultative anaerobes
• Grape like-clusters
• Catalase positive
• Major components
of normal flora
- skin
- nose

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Staphylococcus aureus

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One of commonest opportunistic
infections - hospital and community:
community
• pneumonia
• osteomyelitis
• septic arthritis
• bacteremia
• endocarditis
• abscesses/boils
• other skin infections
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 Food poisoning
• not an infection
• food contaminated by humans
– growth of bacteria
– production of enterotoxin
• onset and recovery both occur within few
hours

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 Food poisoning
• Vomiting
• nausea
• diarrhea
• abdominal pain

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 Associated with outbreak
of toxic shock syndrome.

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 Toxic shock syndrome
• fever
• rash
• desquamation
• vomiting
• diarrhea

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 Toxic shock syndrome
• Toxic shock toxin
- Dissemination

• Organism
– no dissemination

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 S. aureus
• babies
– scalded skin syndrome
* exfoliatin

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 Lytic exotoxins:
• α toxin
• β toxin (sphingomyelinase C)
• γ toxin
• δ toxins
– detergent-like
• leucocidins
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 Protein A inhibits phagocytosis

PHAGOCYTE
Fc receptor

immunoglobulin Protein A
BACTERIUM

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 Spread
• tissue-degrading enzymes
– lipase
– hyaluronidase

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 Identification
• Sheep blood agar
– β hemolytic
– yellow pigmented (aureus)

• mannitol fermentation
• coagulase-positive

• reference laboratories
– phage-typing 27
 Staphylococcus epidermidis
• major member, skin flora

• opportunistic infection
- less common than S.aureus

• nosomial infections
- shunts, catheters

• artificial heart valves/joints

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 Identification
• Sheep blood agar
– non-hemolytic
– Non-pigmented

• Does not ferment mannitol

• Coagulase negative

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Staphylococcus saprophyticus

• urinary tract infections

• coagulase-negative
– not usually differentiated from S. epidermidis

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 Antibiotic therapy
• Resistance to penicillin
– penicillinase
• β lactam antibiotics (including methicillin for MRSA)
– often ineffective
– modified penicillin binding proteins
• Vancomycin
• current drug of choice
• resistance has been observed

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 Summary Figure (Identification Scheme)
Note: S. viridans is
GRAM POSITIVE COCCI ALPHA hemolytic and
negative for all the tests
Catalase below

+
Staphylococcus (Clusters)
-
Streptococcus (pairs & chains)

Coagulase
Hemolysis/Test

+
S. aureus
-
S. epidermidis
BETA: Bacitracin
+ S. pyogenes (group A)

Beta hemolytic Non-hemolytic

CAMP/ Hippurate + S. agalactiae (group B)
mannitol mannitol ALPHA: Optochin /Bile Solubility + S.pneumoniae
yellow white
GAMMA OR ALPHA: Bile Esculin + 6.5% NaCl + Group D
Enterococcus

Bile Esculin + 6.5% NaCl

- Group D
Non-Enterococcus

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