1. Streptococcus Tao Chuanmin

2. Widespread in nature Some strains as virulent pathogens
Other strains live harmoniously
Transient colonizers of skin
Resident colonizer of mucous membranes
Normal flora of alimentary, respiratory and genital tracts

3. Classification 40 species and subspecies Traditional rules
Hemolytic reactions
α hemolytic
β hemolytic
γ hemolytic
Lancefield serological tests
A、B、C、D、E…

4. Clinical significant Impressive human pathogen
Group A streptococci(S. pyogenes)
Impressive human pathogen
Acute pharyngitis,respiratory infection
Skin (impetigo and erysipelas) and soft tissue infection

5. Numerous virulence factors
Endoarditis, meningitis, scarlet fever and more serious toxic shock-like symptoms
Acute glomerulonephritis, rheumatic fever
Numerous virulence factors
M protein, Pyrogenic exotoxins, Hyaluronic acid capsule, Hemolysins etc.

6. Viridans Streptococci
Group B streptococci(S. agalactiae)
Neonatal infection
sepsis and meningitis
Group C and G streptococci
Similar to S. pyogenes
Viridans Streptococci
Normal flora
Subacte bacterial endocaditis(SBE)

7. Streptococcus pneumoniae
Community-acquired pneumonia, bacteremia
Otitis media, sinusitis, meningitis, and endocarditis

8. Microbial Characters
GPC
Arranged：single,pairs,chains
S. pneumoniae：

10. Facultatively anaerobe
Chemical reaction: active metabolism
Catalase：negative

11. Microbial diagnostics
procedure
　　　　　　 specimen
Smear and stain culture　direct examination
　　　　　　　 colony
Smear and stain biochemical serology　 antibiotic
identification　 identification susceptibility 返回

12. Microbial diagnostics
Specimen collection
Throat swab, sputum, pus and blood, et al
Specimen direct diagnostics
Smear and Gram stain
Direct antigen detection

13. Culture and identification
β hemolytic
PYR test：Group A
Bacitracin-susceptible：Group A
VP(Voges-Proskauer) test
CAMP test：Group B
The PYR test determines activity of pyrrolidonyl arylamindase, also called pyrrolidonyl aminopeptidase, an enzyme produced by S. pyogenes but not by other beta-hemolytic streptococci except for the rarely encountered animal-associated species S. porcinus and S, iniae.
CAMP factor(a diffusable extrceelular protien) acts synergistically with staphylococcal beta-lysin to cause lysis of red blood cells.

14. Non β hemolytic
Optochin test
Bile solubility test
Bile esculin test

15. Serologic tests：Streptolysin O Antibiotic susceptibilities：A、B、C group
Evaluation, interpretation and reporting of results
Beta-hemolytic streptococci and pneumococci are virulent pathogens, all reporting
PRSP(penicillin resistant Streptococcus pneumonia)

16. Enterococcus Common description Classification Widespread in nature
Gastrointestinal and genitourinary tract flora
Hospital-acquired infection pathogen
Classification
E. feacalis and E. faecium

17. Clinical significant
Urinary tract infections(UTIs)：underlying structural abnormalities and undergone urologic manipulations
Abdominal and pelvic
infections
sepsis

18. Microbial Characters GPC(single, pairs, short chains)
Facultative anaerobes
PYR test positive
Higher resistance to chemical and physical agents
Bile-esculin positive
Resistance to several antibiotics

19. Microbial diagnostics
procedure
Specimen collection
Direct detection
Culture and identification
Catalase negative
Grow in 6.5% NaCl broth
Bile-esculin positive

20. Antibiotic susceptibilities
A group Penicillin or ampicillin
B group Vancomycin
C group　Tetracycline, erythromycin, chlormphenicol, Rifampin
D group Ciprofloxacin, Norfloxin
high-level resistance(HLR) to aminoglycosides Enterococcus
500ug/ml gentamicin 　　2000ug/ml streptomycin
vancomycin resistant Enterococcus (VRE)
6ug/ml vancomycin

21. Neisseria and Branhamella
Neisseriaceae
Neisseria, Branhamella, Moraxella, Kingella and Acinetobacter
Mainly pathogens
N. gonorrhoeae
N. meningitidis
B. catarrhalis

22. Clinical significant N. gonorrhoeae
Common sexual transmitted diseases(STD)
Transmitted by direct, close, usually sexual
Transmission to neonates usually occurs during birth

23. virulence factor :pili

24. N. meningitidis B. catarrhalis Meningitis, meningococcemia
Usually transmitted by direct contact with contaminated respiratory secretions or air-borne droplets
School-age children, adolescents, and young adults
B. catarrhalis
Acute localized infections: otitis media, sinusitis, and bronchopneumonia
Life-threatening systemic diseases: endocarditis and meningitis

25. Microbial Characters Gram-negative diplococci
Adjacent sides flattened to give a characteristic kidney or coffee bean appearance
Nonmotile，no endospores，some species are encapsulated
Cell may autolyze in culture

26. Complex growth requirements
aerobe
The growth is enhanced by humidity and CO2
Oxidase positive
catalase positive

27. Microbial diagnostics
Procedure
Collection
Direct detection
Direct microscopy
Antigen and nucleate detection

28. Culture and identification
Selective media：MTM，ML，NYC（N. gonorrhoeae ）
Nonselective media：Chocolate agar or blood agar
5%CO2

29. Colonial appearance N. G：small,smooth N. M：small,smooth,flat,mucoid
B. C：small, friable

31. Presumptive identification Confirmatory identification
GNC，OX+
Confirmatory identification
G.M：acid production from glucose and maltose
G.N：acid production from glucose
B.C：DNase +，nitrate reduction +
(-)
(+)
氧化酶
DNA酶试验
硝酸盐还原试验阳性

32. Antibiotic Susceptibilities
Penicillin, cephalosporin、tetracycline、ciprofloxacin
Resistant strains
G.N：3rd cephalosporins、new fluoroquinolone
B.C：extended-spectrum penicillin＋penicillinase inhibitory

33. Evaluation, interpretation and reporting results
confirm：depend on culture and identification
Early and rapidly diagnosis

34. Summary Staphylococcus Streptococcus Enterococcus Neisseria and
Branhamella
Classification、Clinical Significance、Microbial Characters、Microbial diagnostics