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Streptococcus lecture 10 Flashcards

1
Q

Infectious disease is due to…

A

agents/toxins, multiplication, and host responses

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2
Q

Three principles one can contract infectious disease…

A

inoculum size, host defense, toxic agents.

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3
Q

Bacterial classifications

A

Shape: cocci, curved, spiral, bacilli (rod)

Gram Stain: Positive and negative

colony morphology

spore formation

serotyping

biochemical and genetic characteristics

growth (atmosphere): obligate aerobe, microaerophile, obligate anaerobe, facultative anaerobe, capnophile

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4
Q

obligate aerobe

A

requires oxygen

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5
Q

microaerophile

A

reduced oxygen

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6
Q

obligate anaerobe

A

no oxygen

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7
Q

facultative anaerobe

A

anaerobic or aerobic

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8
Q

capnophile

A

requires increased CO2

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9
Q

Streptococci

A

Heterogeneous group of bacteria, form a significant portion of the indigenous microflora of the oropharynx

causing many diseases in humans: strep throat, meningitis, pneumonia, bacteremia, brain abscess, endocarditis, and gangrene

the genus is classified on the basis of colony morphology hemolysis, biochemical reactions, and serologic specificity

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10
Q

General characteristics of streptococci

A

gram +

cocci arranged in pairs or chains

non motile

facultative anaerobic or capnophilic

Catalase negative

nutritional requirement: complex, need blood or serum enrich media for isolation.

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11
Q

Streptococcal species classification

A

Serological: Lancefield classification: Antigenic characteristics of carbohydrate (A, B, C, D, E through S.)

Biochemical and genetic: Physiological properties

Hemolytic patterns alpha hemolytics, Beta hemolytic, and gamma hemolytic

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12
Q

alpha hemolytic

A

partial hemolysis

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13
Q

beta hemolytic

A

complete hemolysis

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14
Q

gamma hemolytic

A

no hemolysis

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15
Q

Group of streptococci

A

Group A or streptococcus pygoenes

Group B or streptococcus agalactia

Group C and G streptococci

Group D streptococci (enterococci)

Viridans streptococci

streptococcus pneumoniae

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16
Q

Group A or streptococcal pyogenes

A

Gram + with cocci in chain

facultative anaerobe

capsule (hyaluronic acid)

beta hemolytic on blood agar

M proteins (80 Types)

F protein binds to fibronectin (helps establish infection)

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17
Q

Capsule (GAS)

A

nonimmunogeneic and antiphagocytic

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18
Q

M proteins (GAS)

A

Inhibits opsonization by interfering binding of C3b and degrades C3b via factor H; binding to Fc of antibodies; immunogenic

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19
Q

C5a peptidase (GAS)

A

Antichemotactic and reduces inflammation mediated by C5a

20
Q

DNase (Gas)

A

Aids in bacterial spread

Four immunologically distinct forms (A, B, C, D)

AntiDNAS B important marker of cutaneous group A streptococcal infections, particularly useful for those who do not failed ASO test

Depolymerizes cell free DNA in pus (reduction of viscosity); contribute to spread from local site

21
Q

Streptolysin O and S (gas)

A

lyse blood cells and plates, stimulate release of lysosomal enzymes

O: lyses leukocytes platelets, and erythrocytes; antigenically related to oxygen labile toxins produced by other gram positive bacteria such as S. Pneumonia, clostridium tetani, bacillus cereus and listeria monocytogenes; immunogenic, indicating a recent GAS infection (ASO)

S: the s indicated serum stable. Lyses leukocytes, platelets, and erythrocytes; stimulates release of lysosomal enzymes; Beta hemolysis; nonimmunogenic

22
Q

Hyaluronidase (gas)

A

promotes tissue destruction and bacterial spread

23
Q

streptokinase (GAS)

A

promotes bacterial spread into tissue by breaking down blood clots

catalyzes activation of plasmin to lyse blood clots

24
Q

Pyrogenic/erythrogenic exotoxins (gas)

A

some act as super antigens

25
Suppurative streptococcal disease (bacterial colonization)
pharyngitis scarlet fever skin infections: Impetigo (streptococcal pyoderma): purulent with crusting cellulitis (#1 causative agent) GAS cellulitis infects wounds (burns, trauma, IV drug abuser injection site) Erysipelas: acute infection of the skin. Mostly of the face "slapped cheek" rash
26
Suppurative streptococcal disease
pharyngitis: "strep throat" exudates on tonsils (children 5-15 years) scarlet fever: complication of strep pharyngitis that occurs when the infection strain is lysogenized by a bacteriophage that produces a pyrogenic exotoxin. Within 1-2 days, red maculopapular "sand paper" rash on trunk and then spreads to extremities. Intense at skin folds white and red "strawberry tongue". The rash disappears over 5-7 days and followed by desquamation of the superficial skin layer
27
Impetigo (streptococcal pyoderma): purulent with crusting
colonization is due to direct contact with an infected person or fomites. Entry of organism follwed by pathology development. Regional lymph node enlarged, but lack systemic signs. primarily seen in young children (2-5 yr.) or poor personal hygiene
28
Erysipelas
localized pain, inflammation, lymph node enlargement, system sign (chills, fever and leukocytosis) affect all age group fiery red, advancing erythema. Historically on face but now more common on the legs.
29
Necrotizing faciitis (suppurative streptoccoccal disease)
"flesh eating" rapidly spreading gangrene of skin and fascia stars with trivial skin infection but is rapidly fatal (due to multi-organ failure)
30
Nonsuppurative streptococcal disease-AGN (GAS)
no group A streptoccus present (autoimmune) AGN (acute glomerular nephritis) acute inflammation of the renal glomeruli with edema, hypertension, hematuria and proteinura post pharyngitis or post skin infection (after infection resolves) symptoms: facial edema, blood in urine (smoky urine)
31
AGN: acute inflammation of renal glomeruli (GAS)
occurs most commonly in children nephritogenic strain damage due to immune complex deposition on the glomerular basement membrane.
32
Acute rheumatic fever (GAS)
pancarditis (endo, peri, and myocarditis) no group A streptococcus present post pharyngitis only due to cross reactivty of anti M protein antibody with human cardiac tissue symptoms: migratory arthritis, subcutaneous nodules, carditis and erythema marginatum may proceed to rheumatic fever
33
Source of transmission: GAS
normal flora of skin and oropharynx cause infection upon penetration of tissue transmission: person to person
34
Diagnosis: GAS
microscopy antigen detection: throat swabs antibody detection: ASO test in rheumatic fever culture: blood agar or specialized selective agar TX: very sensitive to penicillin. Oxacillin or vancomycin (in mixed culture) Sensitive to bacitracin
35
Group B streptococcus (GBS) S agalactiae
Gram positive cocci in pair capsule CAMP test positive Beta hemolytic (1-2% non hemolytic) threat to infants infected perinatally also responsible for post partum endometritis (especially following C section)
36
Source and transmission: GBS
normal flora of GI tract and vagina vertical transmission: either at birth or via ascension in utero
37
Virulence factors: GBS
capsule: resist phagocytosis Sialic acid: capsular component, inhibit alternate pathway of complement
38
Group B streptococcal diseases
early onset neonatal disease begins with 7 days of birth acquired in utero or at delivery. Most common in premature infants. High mortality rate. Symptoms: Bacteremia, pneumonia, meningitis. Late onset neonatal disease begins 1 week to 3 months after birth. Acquired postpartum. Low mortality rate (<20%) Symptoms: bacteremia, meningitis
39
Postpartum sepsis (GBS)
usually acquired via wound inflected during parturition SX: post partum endometriosis fever, chills wound infection possible UTI
40
CAMP test GBS
CAMP factor produced by GBS that enhances beta hemolysis of S. Aureus
41
TX of GBS
penicillin G alone or in combination with an aminoglycosides passive immunization in serious caes
42
Streptococcus pneumoniae
gram positive cocci in pair or short chain capsule= Most important CAMP test negative bile solubility- positive Alpha hemolytic (aerobically) beta hemolytic (anaerobically) genome diversity: 20% of DNA sequences different, still the same species Catalase: negative: grow best in 5% CO2. Requires a source of catalase (blood) to grown on agar. Chronic granulomatous disease resistance to SP
43
Virulence factors of streptococcus pneumoniae
capsules: resist phagocytosis; >90 serotypes identified, the major protective antigen robust biofilm formation IgA proteases cleaves IgA into FAB and Fc fragments adhesins: mediates attachment of S. Pneumonia to epithelial cell lysis pneumolysis: destroys the ciliated epithelial cell
44
Streptococcus pneumoniae infections
lobar pneumonia (#1 causative organism in adults and in sickel cell disease) meningitis (1# causative agent in adult meningitis) Sinusitis (#1 causative organism) Otitis media (1# causative organism)
45
Diagnosis: Streptococcus Pneumoniae
Microscopic examination: Gram stain Quellung reaction: Polyvalent anticapsular antibodies are mixed with the bacteria: increase in refractive mass around the bacteria bile sensitive optochin sensitive
46
TX and prevetion of streptoccus pneumoniae
penicillin vancomycin combined with ceftriaxone in penicillin allergy two vaccines 13 and 23 valent polysaccharide vaccine

Exam 2 (23 decks)

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