gram positive cocci medicine 2 year 06 7

8/14/2019 Gram Positive Cocci Medicine 2 Year 06 7

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Gram-Positive CocciGram-Positive Cocci

Prof. Dr. Asem ShehabiProf. Dr. Asem Shehabi

Faculty of MedicineFaculty of MedicineUniversity of JordanUniversity of Jordan


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Gram-psitiveGram-psitive coccicocci

MicrococcaceaeMicrococcaceae family.. Facultative Anaerobicfamily.. Facultative AnaerobicGram-positive cocci .. includes the followingGram-positive cocci .. includes the followingGenera/Groups:Genera/Groups:

StaphylococcusSta

phylococcus.. Arranged in Irregular Clusters.. Arranged in Irregular Clusters..Catalase+ve..Catalase+ve StreptococciStre

ptococci.. Arranged in Diplococci or Chain.. Arranged in Diplococci or Chainof Cocci.. Catalase-veof Cocci.. Catalase-ve

EnterococciEnterococci.. Arranged in Diplococci & Short.. Arranged in Diplococci & ShortChain.. Catalase-veChain.. Catalase-ve

The Two CommonThe Two Common StaphylococcusStaphylococcus speciesspeciesare:are: S. aureusS. aureus.... S. epidermidisS. epidermidis are common inare common inskin, nose, oral cavity. other body sites.skin, nose, oral cavity. other body sites.


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Stapylococci-StreptococciStapylococci-Streptococci


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PathogenicityPathogenicityofofS. aureusS. aureus

More invasive & pathogenic than other Staph. speciesMore invasive & pathogenic than other Staph. species

ContainsContains capsuleca

psule, cell wall antigenic structure, cell wall antigenic structurePolysaccharides..Polysaccharides.. Protein AProtein A.. Production.. Production SpecificS

pecific

EnzymesE

nzymes && Exo- & EnterotoxinsExo- & Enterotoxins.... Food PoisoningFood Poisoni

ngCoagulaseC

oagulase && Clumping factor +veClum

ping factor +ve.. Both converted.. Both convertedprothrombin into fibrin & fibrinogen .. Deposit fibrinprothrombin into fibrin & fibrinogen .. Deposit fibrinduring infection..during infection.. Hyaluronidase

Hyaluronidase.. Spreading factor,.. Spreading factor,

LeukocidinLeukocidin.. destroy WBCs.. formation of pus and.. destroy WBCs.. formation of pus andacneacne

A common cause of skin abscess ..wounds, sepsis/A common cause of skin abscess ..wounds, sepsis/bacteremia, sinusitis, conjunctivitis pneumonia,bacteremia, sinusitis, conjunctivitis pneumonia,

meningitis, osteomyelitis, any body sites.meningitis, osteomyelitis, any body sites.


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S. epidermidisS. epidermidis

Less pathogenic.. part body normal flora.. coagulaseLess pathogenic.. part body normal flora.. coagulase-ve.. opportunistic pathogen.. Bacteremia.. Skin-ve.. opportunistic pathogen.. Bacteremia.. Skinabscess.abscess.

Diagnosis:Di

agnosis: Collect specimens ..Culture & identificationCollect specimens ..Culture & identification

of isolates by gram-stain, catalase & coagulase test,of isolates by gram-stain, catalase & coagulase test,susceptibility test..susceptibility test..

Most S. aureus strains.. LessMost S. aureus strains.. Less S. epidermidisS. epidermidis areareresistant to all B-lactams.. Increase rate of isolationresistant to all B-lactams.. Increase rate of isolation

Methicillin/Oxacillin-resistantMethicillin/Oxacillin-resistant S. aureusS. aureus (MRSA).. All(MRSA).. Allstill susceptible tostill susceptible to vancomycinvancom

ycin.. Micrococcus species: commonMicrococcus species: common on skin.. coagulaseon skin.. coagulase

-ve.. opportunistic pathogen.. Immuno-compromised-ve.. opportunistic pathogen.. Immuno-compromised

patients.. mostly susceptible to B-Lactams.patients.. mostly susceptible to B-Lactams.


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Streptococci-1Streptococci-1

Viridans Streptococci GroupViridans Stre

ptococci Group:: Alpha-hemolytic/ Non-Alpha-hemolytic/ Non-Hemolytic.. Normal respiratory flora.. Oral cavity..Hemolytic.. Normal respiratory flora.. Oral cavity..opportunistic pathogen, Dental caries, Sepsis,opportunistic pathogen, Dental caries, Sepsis,

Localized oral abscesses.. Common EndocarditisLocalized oral abscesses.. Common Endocarditis Beta-hemolytic Streptococci GroupBeta-hem

olytic Streptococci Group:: Serogroups A,Serogroups A,B, C, D, F, G.. Cell wall specific carbohydrates..B, C, D, F, G.. Cell wall specific carbohydrates..Respiratory flora.. Healthy Carries..PopulationRespiratory flora.. Healthy Carries..Population

Group A Hemolytic Streptococci ( S. pyogens)Grou

p A Hemolytic Streptococci ( S. pyogens)::Most invasive & Pathogenic.. Virulence Factors.. CellMost invasive & Pathogenic.. Virulence Factors.. CellWall antigens/ M Proteins.. Many ExtracellularWall antigens/ M Proteins.. Many Extracellular

Enzymes.. Hemolysins, 80 Specific subtypesEnzymes.. Hemolysins, 80 Specific subtypes,,

Pyrogenic /Erythrogenic Toxin.. Superficial skinPyrogenic /Erythrogenic Toxin.. Superficial skininfection.. Scarlet fever..infection.. Scarlet fever..ChildrenChildren


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Beta-Hemolytic Streptococcis-Beta-Hemolytic Streptococcis-

Susceptible for BacitracinSusceptible for Bacitracin


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Group A streptococcalGroup A streptococcal infections affect allinfections affect allages with peak incidence at 5-15 years of age..ages with peak incidence at 5-15 years of age..Acute Sore throat/ Pharyngitis, Skin infection,Acute Sore throat/ Pharyngitis, Skin infection,

Sepsis, Otitis media, Sinusitis, Meningitis.. LessSepsis, Otitis media, Sinusitis, Meningitis.. LessAdultsAdults

Complications: A) Rheumatic Fever..Complications: A) Rheumatic Fever..inflammatory disease affecting primarily theinflammatory disease affecting primarily the

heart and joints. B) Glomerulonephritis..heart and joints. B) Glomerulonephritis..immune complex disease of the kidneyimmune complex disease of the kidney

Group BGroup BStreptococci:Streptococci:Common in vaginalCommon in vaginaltract.. Purperal Sepsis, Neonatal Meningitis,tract.. Purperal Sepsis, Neonatal Meningitis,Fatal ..Urinary Tract Infection.Fatal ..Urinary Tract Infection.


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Streptococci pneumonia:Streptococci pneumonia:Capsule.. polysacharidesCapsule.. polysacharides85 Serotypes.. Healthy Carriers85 Serotypes.. Healthy Carriers

Common cause of bacterial pneumonia.. moreCommon cause of bacterial pneumonia.. morecommon in the very young and the very old persons.common in the very young and the very old persons.

Common cause of meningitis, Sinusitis,Common cause of meningitis, Sinusitis, Otitis Media,Otitis Media,Bacteremia.. Young children..Bacteremia.. Young children.. ImunocompromisedImunocompromisedpersons.. up 50% S. pneumonia R-Penicillin.persons.. up 50% S. pneumonia R-Penicillin.

S. pneumoniaeS. pneumoniae can be differentiated fromcan be differentiated from S.viridansS.viridans,,

which is also alpha hemolytic, using an Optochin test,which is also alpha hemolytic, using an Optochin test, Enterococcus:Enterococcus:E. fecalisE. fecalis,, E. faeciumE. faecium.. Common.. CommonIntestine Human-Animal.. opportunistic pathogen..Intestine Human-Animal.. opportunistic pathogen..Urinary Tract Infect., Wound, Rare Sepsis,Urinary Tract Infect., Wound, Rare Sepsis,Endocarditis..Endocarditis..


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S. pneumoniae -S. pneumoniae -Susceptible toSusceptible to

Optochin in Lab testOptochin in Lab test


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Enterococcus speciesEnterococcus species

Gram-positive diplococci..short strept. Chains.Gram-positive diplococci..short strept. Chains.

Common intestinal tract human, animals..Common intestinal tract human, animals..

resistance to environmental conditions.. andresistance to environmental conditions.. andmany antibiotics ..cephalosporines andmany antibiotics ..cephalosporines and

aminoglycosidesaminoglycosides

Common cause of urinary tract infections.Common cause of urinary tract infections.Sepsis..nosocomial infections in associatedSepsis..nosocomial infections in associated

with underlying diseases.with underlying diseases.

Treatment: combination of antibioticsTreatment: combination of antibiotics

gram positive cocci medicine 2 year 06 7

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