11 - PART Strep Staph.

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PART

Microbes of relevance to den stry


Dr.Zubaida N.M.Albarzanji
Streptococci comprise a diverse group of Gram-posi ve
cocci, which con nuously undergo taxonomic revision.
They are distributed widely in humans and animals,
mostly forming part of their normal flora. A few species
cause significant human morbidity.

The oral streptococci, which include the cariogenic


mutans group, are important members of the genus.

Another common group of cocci, the staphylococci, live


on the skin but are infrequently isolated from
the oral cavity and are significant agents of many
pyogenic (pus-producing) human infec ons
General proper es
1- Characteris cs :- They are ,
Gram-posi ve spherical or oval cocci in pairs and
chains; 0.7–0.9 µm in diameter. Chain forma on is
best seen in liquid cultures or pus.
2- Culture

These cocci grow well on blood agar, although enrichment of media with glucose
and serum may be necessary.
Typical haemoly c reac ons are produced on blood agar

• α-haemolysis: narrow zone of par al haemolysis and green (viridans) discoloura on


around the colony, e.g.viridans streptococci

• β-haemolysis: wide, clear, translucent zone of complete


haemolysis around the colony, e.g. Streptococcus pyogenes

• no haemolysis (γ-haemolysis), e.g. non-haemoly c streptococci.


Serology
The carbohydrate an gens found on the cell
walls of the organisms are related to their
virulence. Hence, serogrouping, termed
Lancefeld grouping, is useful in the
iden fca on of the more virulent β-
haemoly c species. Currently, 20 Lancefeld
groups are recognized (A–H and K–V) but not
all are equally important as human
pathogens.
Characteristics
Produces a large number of biologically ac ve substances,
such as:

• streptokinase: a protoly c enzyme that lyses fibrin

• hyaluronidase: a acks the material that binds the


connec ve ssue, thereby causing increasing
permeability (hence called the ‘spreading factor’)

• DNAases (streptodornases): destroy cellular DNA

• haemolysins (streptolysins, leukocidins): responsible for the


characteris c erythematous rash in scarlet fever.
.
wound infections:- leading to •
. Erysipelas
Impetigo (a skin infection) •
cellulitis scarlet fever

cellulitis •
Impe go
• post-streptococcal infection, manifesting as rheumatic fever, is
caused by immunological cross-reaction between bacterial antigen
and human heart tissue, and acute glomerulonephritis is caused by
immune complexes bound to glomeruli
Acute glomerulonephritis
 Cross reaction between streptococci and
kidney tissues

20
This species is increasingly recognized as a
human pathogen, especially as a cause of
neonatal meningitis and sepsis.
I
Viridans Group Streptococci
( No Lancefield antigen classification. Members
include Streptococcus salivarius, S. sanguis, S. mitis,
S. intermedius, S. mutans, and others.)
Habitat and transmission
Streptococci make up a large propor on of the resident oral
flora.
It is known that roughly one-quarter of the total cul vable
flora from supragingival and gingival plaque and half of the
isolates from the tongue and saliva are streptococci. They are
ver cally transmi ed from mother to child.
Infec ve endocardi s caused by these organisms (loosely
termed viridans streptococci) is generally a result of their
entry into the blood stream during intraoral surgical
procedures (e.g. tooth extrac on), and some mes even
during tooth-brushing
Culture and iden fica on
Gram-posi ve cocci in chains; α-haemoly c;
catalasenega ve. Growth not inhibited by bile
or optochin ,in contrast to pneumococci.
Commercially available kits are highly useful in
laboratory iden fica on of these organisms
Pathogenicity
• The mutans group of streptococci are the major agents of
dental caries (but in the absence of predisposing factors,
such as sucrose, they cannot cause caries).

• They have a characteris c ability to produce voluminous


amounts of s cky, extracellular polysaccharides in the
presence of dietary carbohydrates .

• These help tenacious binding of the organisms to enamel


and to each other.
• They are also important agents of infec ve endocardi s,
and some 60% of cases are due to this organism. Usually,
bacteria released during dental procedures se le on
damaged heart valves, causing infec ve endocardi s
Treatment and preven on
In pa ents at risk of infec ve endocardi s (e.g.
those with damaged or prosthe c heart valves),
prophylac c an bio c cover should always be
given before dental procedures
Streptococcus mutans gained notoriety in the
1960s when it was demonstrated that caries
could be experimentally induced and
transmitted in animals by oral inoculation with
the organism.
The name ‘mutans’ results from its frequent
transition from coccal phase to
coccobacillary phase.
Habitat and transmission

A normal commensal in the human upper


respiratory tract; up to 4% of the popula on
carry this bacteria in small numbers.
Transmission is via respiratory droplets
Culture and identifcation
Gram-positive cocci in chains;
α-haemolytic;
Catalase negative.
Growth not inhibited by bile or optochin in
contrast to pneumococci.
Pathogenicity
The mutans group of
streptococci are the major
agents of dental caries (but in
the absence of predisposing
factors, such as sucrose, they
cannot cause caries). They have
a characteristic ability to
produce voluminous amounts of
sticky, extracellular
polysaccharides in the presence
of dietary carbohydrates these
help tenacious binding of the
organisms to enamel and to
each other.
They are also important agents of infective
endocarditis, and some 60% of cases are due
to this organism.

Usually, bacteria released during dental


procedures settle on damaged heart valves,
causing infective endocarditis.
Treatment and prevention

In patients at risk of infective endocarditis (e.g.


those with damaged or prosthetic heart valves),
prophylactic antibiotic cover should always be
given before dental procedures
• Currently, seven distinct species of human
and animal mutans streptococci and eight
serotypes (a–h) are recognized, based on the
antigenic specifcity of cell wall
carbohydrates. The term Streptococcus
mutans is limited to human isolates
belonging to three serotypes (c, e and f)
• Forms α-haemolytic colonies. After incubation for 2
days,the colonies appear typically as ‘draughtsmen’
because of their central indentation (a result of
spontaneous autolysis of older bacteria in the centre
of the colony).
• The species is differentiated from other α-
haemolytic streptococci by its sensitivity to
optochin and solubility in bile.
• Observation for the capsular swelling with type-
specific antiserum (quellung reaction) confirms
the identity and is the standard reference
method.
• The latex agglutination test for capsular antigen
in spinal fluid can be diagnostic.
Pathogenicity

Although no exotoxins are known, this organism induces an


inflammatory response. The substantive polysaccharide
capsule retards phagocytosis. Vaccination with
antipolysaccharide vaccine helps provide type-specifc
immunity.

Viral respiratory infection predisposes to pneumococcal
pneumonia by damaging the mucociliary lining of the upper
respiratory tract (the mucociliary escalator).

• Other common diseases caused by pneumococci include


lobar pneumonia, acute exacerbation of chronic bronchitis,
otitis media, sinusitis, conjunctivitis, meningitis and, in
splenectomized patients, septicaemia
Treatment and prevention
Gram-posi ve anaerobic cocci
• Gram-posi ve anaerobic cocci (GPAC) all belonged to the genus
Peptostreptococcus un l recently. However, they now comprise
three genera, namely Peptostreptococcus, Micromonas and
Finegoldia.

• The representa ve species are Peptostreptococcus anaerobius,


Finegoldia magnus (previously Peptostreptococcus magnus) and
Micromonas micros (previously Peptostreptococcus micros).

• These GPAC can o en be isolated from dental plaque and the


female genital tract.

• They are also found in carious den ne, subgingival plaque,


dentoalveolar abscesses and in advanced periodontal disease,
usually in mixed culture. Their pathogenic role is s ll unclear
• Staphylococci cause a variety of both common
and uncommon infec ons, such as abscesses of
many organs, endocardi s, gastroenteri s (food-
poisoning) and toxic shock syndrome.
• They are not infrequent isolates from the oral
cavity. Higher propor ons of Staphylococcus
aureus are found in the saliva of healthy subjects
older than 70 years.
Coagulase test
Other tests
These methods are currently supplanted by
molecular typing techniques.

Antibiotic susceptibility patterns are also helpful in


tracing the source of outbreaks
Some of the diseases caused by
Staphylococcusaureus are
• food poisoning (vomiting and diarrhoea) caused by
enterotoxins phenomenon (multiresistance) is common,
particularly in strains isolated from hospitals; these cause
hospital (nosocomial) infection. Penicillin resistance is due to
the production of β-lactamase encoded by plasmids. The
enzyme destroys the effcacy of antibiotics with a β-lactam ring
(i.e.the penicillin group drugs).

Antibiotics active against Staphylococcus aureus include


penicillin for sensitive isolates, flucloxacillin (stable against
β-lactamase), erythromycin, fusidic acid (useful for skin
infections), cephalosporins and vancomycin.
Cleanliness, hand-washing and aseptic management of lesions
reduce the spread of staphylococci
Antibiotic resistance in
staphylococci
This is a global problem of much concern and falls into several classes.
• resistance to β-lactam drugs
• resistance to methicillin (and to nafcillin and oxacillin)
independent of β-
lactamase. The spread of methicillinresistant Staphylococcus aureus (MRSA)
worldwide is posing problems in many community and hospital
settings

• resistance to vancomycin, one of the last-line defences against


staphylococci and the emergence of vancomycin-resistant Staphylococcus
aureus (VRSA).
.
The mechanism of resistance here is due to alterations in the cell wall
• ’tolerance’, where the organism is inhibited but not killed by the antibiotic
(i.e. there is a large difference between minimum inhibitory concentration
and minimum bactericidal concentration), leading to prolonged course of
infections (e.g. staphylococcal infective endocarditis)
Staphylococcus epidermidis
Habitat and transmission

• This species is found on the skin surface and is


spread by contact

• Culture and identification


Grows as white colonies on blood agar, hence the
earlier name Staphylococcus albus; catalase-
positive; coagulase negative; biochemically
characterized by commercially available kits (e.g.
API Staph)
Pathogenicity

Being a normal commensal of the skin, this bacterium


causes infection only when an opportunity arises (it is
an opportunist pathogen). Common examples are
catheter related sepsis, infection of artifcial joints and
urinary tract infections.

Treatment
Staphylococcus epidermidis exhibits resistance to a
number of drugs (multiresistance), including penicillin
and methicillin. It is sensitive to vancomycin
Staphylococcus saprophyticus

This organism causes urinary tract infections in


women, an infection especially associated with
intercourse. It has the ability to colonize the
periurethral skin and the mucosa.

The organism can be differentiated from


Staphylococcus epidermidis (both grow as white
colonies on blood agar) by the mannitol fermentation
reaction and other biochemical tests .
Micrococci
Micrococci are catalase-positive organisms similar to
staphylococci. They are coagulase-negative and usually
grow as white colonies on blood agar, although some
species are brightly pigmented – pink, orange or yellow.

Stomatococcus mucilagenosus, formerly classifed in


the genus Micrococcus, is found in abundance on the
lingual surface.

This species has the ability to produce an extracellular


slime, which correlates with its predilection for the
lingual surface. Its role in disease, if any, is unknown

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