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Term 4: Infectious Diseases > Streptococci > Flashcards

Flashcards in Streptococci Deck (101)
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1

What is the most pathogenic group of streptococcus?

Group A (Streptococcus pyogenes)

2

What is the microscopic morphology of streptococci?

-Spherical cells, tend to form pairs or chains of cocci -Gram positive (blurple)

3

What are the various hemolysis patterns of streptococci types on 5% sheep blood agar?

-alpha = green (some intact red cells) -beta = clear (no intact red cells) -gamma = no hemolysis (intact red cells)

4

Which hemolysis type does Group A strep have?

-Beta (clear)

5

What hemolysis type does strep pneumoniae have?

-alpha (Green)

6

What does the bacitracin susceptibility test reveal about a strep culture, and which hemolytic pattern is it used on?

-used on beta-hemolysis (clear) -Strep pyrogenes is susceptible (group A), the other groups are resistant

7

What is the important Group D strep species?

-S. gallolyticus [bovis]

8

What is Lancefield classification?

-developed for strep -immunologic classification based on differences of cell wall carbs -used for beta-hemolytic and non-hemolytic streptococci

9

How are Group D streptococci identified?

-either alpha or gamma hemolytic -can grow in presence of 40% bile -can hydrolyze esculin (turns black on bile esculin agar) **very sensitive to penicillin

10

What is the antigenic structure of streptococci?

-capsule (non-antigenic, antiphagocytic) -M-proteins (antiphagocytic) -C-carbohydrate (lancefield groupings) -Peptidoglycan -lipoteichoic acid

11

How is the capsule of strep non-antigenic?

-probably because it is chemically indistinguishable from hyaluronate in ground substance of connective tissue

12

How are M-proteins of strep antiphagocytic?

-prevents interaction of organism with complement **antibody to M-protein is protective and imparts long-lasting immunity

13

What are the extracellular products of Group A strep?

-Pyrogenic exotoxins A -streptolysin O (hemolysin) -Streptokinase -Hyaluronidase -DNAse

14

Which extracellular product of Group A strep is responsible for a number of the clinical manifestations of toxic strep syndrome?

-Pyrogenic exotoxins

15

What do pyrogenic exotoxins of strep do?

-superantigens bind directly with class II MHC, leads to clinical manifestations of toxic strep syndrome (releases a bunch of cytokines) -Pyrogenic exotoxin B degrades ECM proteins such as fibronectin & vitronectin (facilitate spread of infection)

16

What does streptokinase do?

-activates plasminogen to disrupt blood clots -can be used to lyse coronary occlusions *Hypersensitivity reactions occur in patients previously exposed to this antigen.

17

Why are anti-DNAse titers more useful than Antistreptolysin O (ASO) titer in diagnosing strep A/Rheumatic fever?

-DNAse is not neutralized by cholesterol during skin infections

18

How does Group A strep cause disease?

-direct damage due to infection itself (acute suppurative disease) -toxin production -immune response (post-streptococcal sequelae)

19

What is the pathogenesis of acute suppurative diseases caused by Group A strep?

-adherence to skin/mucous membrane by lipoteichoic acid -tendency for local spread, due to enzymes -other enzymes = "thin dishwater pus"

20

What are common examples of acute suppurative diseases caused by Group A strep?

-Pharyngitis/tonsillitis (strep throat) -Pyoderma (impetigo) -cellulitis/Lymphangitis -erysipelas

21

What is pyoderma?

-impetigo -discrete skin lesions with a papule-vesicle-pustule crusting sequence

22

What is erysipelas?

-form of cellulitis -diffuse lymphangitis of skin, infection spreads along lymphatics -well demarcated

23

What are some common examples of toxin-associated disease caused by Group A strep?

-scarlet fever -Toxic strep syndrome

24

What is toxic strep/shock syndrome?

-"flesh-eating bacteria" Group A strep (pyrogenic exotoxins) -severe infections, soft tissue, with bacteremia -high mortality -hypotension with multiple organ impairment

25

What is scarlet fever?

-caused by group A strep -Streptococcal pharyngitis/tonsillitis accompanied by a diffuse, bright scarlet erythema of skin and mucous membranes -rash begins on trunk and neck, then spreads to extremities, sparing the face -due to production of erythrogenic (scarlatiniform) toxin

26

What are some common post-streptococcal sequelae caused by group A strep?

-acute rheumatic fever, from cross-reactivity between strep M-proteins & cardiac sarcolemmal proteins -acute glomerulonephritis, from deposition of immune complexes in glomeruli -guttate psoriasis, from superantigenic stimulation of T-cells by pyrogenic exotoxin C

27

What are the first line treatments for Group A strep infections?

-penicillins & cephalosporins *resistance to these has not yet been described *macrolide can be used in pts with penicillin allergy

28

How should patients with a history of rheumatic fever be managed long-term? Why?

-long-term penicillin prophylaxis -because they are at an increased risk to develop repeated attacks

29

What are the two important Strep strains that do alpha-hemolysis?

-Viridans strept -strept pneumo

30

How do we differentiate viridans strep from strept pneumo?

-Viridans strept is not susceptible to Optochin, strep pneumo are -strep neumo is soluble in bile salts, viridans is not