1. Streptococcus

2.  Low G+C  Cocci pairs/chains  FA  Non motile, NSF  Capnophiles  Catalase (-)  Peroxidase  Hemolysins  Lancefield Groups 18 antigens Cell wall reactivity

3. Lancefield Groups  Membrane Ag  Groups A-H, K-V Group A  Strep. pyogenes Group B  Strep. agalactiae Group C, F, G  Strep equisimilis  Strep zooepidemicus  Strep anguinosus Group D  E. faecalis  Strep bovis  Strep equines Group K  Strep salivarius Viridans  Strep mutans  Strep mitis  Strep sanguis Pneumococci

4. Strep Virulence Factors

5. GAS: Strep pyogenes  Location Skin, mm Resp: pharynx  Pathogenicity Adhesins  Protein F and S (fibronectin)  Lipoteichoic acid (LTA) Immune evasion  Protein M Binds to fibrinogen Mimics CT/Muscle antigens  Capsule (hyaluronic acid) Proteins  Streptolysins (leukocidins) Function  Lyse formed elements  Beta hemolysis Types  S = O2 stable  O = O2 labile

6. Strep pyogenes  Enzymes Streptokinase  Break down clots DNase B  depolymerize Hyaluronidase Proteases C5a peptidase  Decrease chemotaxis  Toxins Exotoxins Pyrogenic (A, B, C)  Superantigens Increase immune cytokines Promote fever  TSS like syndrome Sepsis M1 and M3 strains

7. Strep pyogenes infections

8. Strep pyogenes diseases  Pharyngitis  Scarlet Fever (rash)  Skin Pyoderma Impetigo Erysipelas Cellulitis  Strep TSS  Necrotizing fasciitis  Myositis  Immune Mediated Rheumatic fever Glomerulonephritis

9. Necrotizing Fasciitis and Meningitis

10. GBS: Strep agalactiae  Epidemiology GI Uritogenital  Pathogenicity Capsule Enzymes  Proteases  Hemolysins Beta hemolysis  Hyaluronidase  Disease Puerperal fever Vaginitis UTI Endocarditis Osteomyelitis Newborn  Meningitis  Sepsis  Pneumonia CAMP test

12. Group C Strep  Strep equi strangles  Strep equisimilis pharyngitis  Strep anginosus abscess

13. Viridans Streptococcus  Alpha hemolysis  No Lancefield groups  Diseases Dental Caries Endocarditis Examples  Strep mitis  Strep mutans  Strep oralis  Strep sanguis  Strep salivarius (K)

14. Biofilms

15. Strep. pneumoniae

16. Strep pneumonia capsule

17. Strep pneumoniae  Epidemiology Mouth Upper respiratory Dz = lungs  Pathogenicity Capsule Protein A Phosphorylcholine Adhesins Proteases  Protects from IgA pneumolysins

18. Strep pneumonia diseases

19. Group D Strep  Examples E. faecalis E. faecium S. bovis S. equines  Location: GI  Tests Gamma hemolysis Salt tolerant Bile tolerant  Pathogenicity Bacterocins Nosocomial

20. Enterococcus Sequella

21. Rapid Strep Test

22. Vaccination

23. Questions?