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Streptococci M@™Characters of Streptococci - Gram positive cocci - lum in diameter - Chains or pairs Usually capsulated Non motile - Non spore forming Facultative anaerobes Fastidious Catalase negative (Staphylococci are catalase positive)

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Classification of Streptococci Streptococci can be classified according to: - Oxygen requirements #Anaerobic (Peptostreptococcus) #Aerobic or facultative anaerobic (Streptococcus) - Serology (Lanciefield Classification) - Hemolysis on Blood Agar (BA)

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رک رت 00 ‎Crassitcation‏ Se 12 ‏لحل‎ اک لي ل ل ا | One or more species per group Classification based on C- carbohydrate antigen of cell ‏لونلا‎ ‎- Groupable streptococci WB and D (more frequent) WIC, Gand F (Less frequent) - Non-groupable streptococci 0 | 0001-0 0

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‘TABLE 13-1 Medically Important Streptococei Type species serogroup ‏ی‎ 0 8 ‘Catle, humans "Necneta meningtis anc sepsis and intectors in souls 5 0 We ram aed aia Uoparrestrtry econ Hernan, axils Suteutancais or oman abscesses, endocanits ia Seats Homans Encocaie cari ‏نو‎ Swine ‘Siutens 7 sited Huan aes, onde و ‎Nona ior We human ae ard‏ سم موه موومووو نومه ‎[isin and pulraray‏ اه Sonewnonse ‏ام مود‎ Humans ea presmonse ano cers Shovis ave denied youpartigenssh ruttoratyvarentsteptecoos mayer

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۶۱۱۱۹۱۱2 ‏المت ره كر‎ Based on Hemolysis on Blood ی ۱ ۱۲۱۵۲۱۵۱۷56 ۵0 ۸۵ a-hemolysis ‏رزیت ریت۱۱‎ Green discoloration around the colonies ‘e.g. non-groupable streptococci (S. pneumoniae & S. viridans) p-hemolysis ‏توت یات تا ا‎ “Clear zone of hemolysis around the ‏لب‎ ‘e.g. Group A & B (S. pyogenes & S. agalai y-hemolysis ENo lysis ‘e.g. Group D (Enterococcus. r

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Hemolysis on Blood agar ل رزیت یو a-hemolysis. 7m مروت زرم ۲

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Group A streptococci ۲۳ Include only S. pyogenes ™@Group A streptococcal infections affect all ages peak incidence at 5-15 years of age 1 90% of cases of pharyngitis

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Pathogenesis and Virulence Factors @ Structural components - M protein M, which interferes with opsonization and lysis ‏ات۱۹۵۰‎ - Lipoteichoic acid & F protein> adhesion - Hyaluronic acid capsule, which acts to camouflage the bacteria @ Enzymes - Streptokinases sac the spread of streptococci through tissue: - Deoxynucleases - C5a peptidase lM Pyrogenic toxins that stimulate macrophages and helper T cells to release cytokines M@Streptolysins ~ 5 op.5)5 © lyse red blood cells, white blood cells, and platelets - Streptolysin S

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Disease caused by. S. pyogenes | ‏ل‎ ‎- Non-Invasive Pharyngitis (“strep throat”)-inflammation of the pharynx Miskin infection, Impetigo - Invasive 1662۲۱6۲ ۲6۷۵۲-۲۵6 2۲ ‏۲عع(» ۲6 ۵ کطنوع‎ 200 5۵۲6۵05 across the body ‘™iPyoderma-confined, pus-producing lesion that usually ‏,عع13 عط مه 5أناءع0‎ 36205, 06 605 M@iNecrotizing fasciitis-toxin production destroys tissues and eventually muscle and fat tissue Non Suppurative - Rheumatic fever: Life ‏نار لل‎ inflammatory disease that leads to damage of heart valves muscle - Glomerulonephritits ۳ ‏رت تا ار رای‎ ‘inflammation of the 9 and nephrons which obstruct blood flow through the kidneys |

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Differentiation between f- hemolytic streptococci The following tests can be used to differentiate between p-hemolytic streptococci - Lanciefield Classification - Bacitracin susceptibility Test aSpecific for S. pyogenes (Group A) - CAMP test aSpecific for S. agalactiae (Group B)

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Bacitracin sensitivity @ Principle: - Bacitracin test is used for presumptive identification of group A - To ‏رکه‎ between S. pyogenes| (susceptible to B) & non group A sucl] as S. agalactiae (Resistant to B) - ‏م‎ will inhibit the growth ae ‏م‎ A Strep. pyogenes giving zone ot Thiet around the disk W@ Procedure: - Inoculate BAP with heavy suspension of tested organism - Bacitracin disk (0.04 U) is applied to inoculated BAP - After incubation, any zone of inhibition around the disk is considered as susceptible

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3 CAMP test lieve elo - Group B streptococci produce extracellular protein (CAMP factor) - CAMP act synergistically with staph. B-lysin to cause lysis of 85865 Mi Procedure: - Single streak of Streptococcus to be tested and a Staph. aureus are made perpendicular to each other - 3-5 mm distance was left between two streaks: - After incubation, a positive result appear as an arrowhead shaped zone of complete hemolysis - S. agalactiae is CAMP test positive while non gp B streptococci are negative

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Positive Control: Negative Control: Group A or Group D Strep.

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Differentiation between a- hemolytic streptococci ithe following definitive tests used to differentiate between S. pneumoniae & viridans ‏تت‎ - Optochin Test - Bile Solubility Test - ‏مهمع ممعع ملتاناما‎

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Optochin Susceptibility Test Mi Principle: - Optochin (OP) test is presumptive test that is used to identify S. pneumoniae - S. pneumoniae is inhibited by Optochin reagent (<5 ug/ml) giving a inhibition zone =14 mm in diameter. (۱۱ ۱ - BAP inoculated with organism to be tested - OP disk is placed on the center of inoculated BAP - After incubation at 370C for 18 hrs, accurately measure the diameter of the inhibition zone by the ill - 214 mm zone of inhibition around the disk is considered as positive and <13 mm is considered negative lS. pneumoniae is positive (S) while S. viridans is negative (R)

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متت زور نت راز رهز ۱9۰۹۰ 4 لك 0 Optochin susceptible S. pneumoniae

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Bile Solubility test ۱ - S. pneumoniae produce a self-lysing enzyme to inhibit the growth - The presence of bile salt accelerate this process Procedure: Add ten parts (10 ml) of the broth culture of the organism to be tested to one part (1 ml) of 2% Na deoxycholate (bile) into the test tube - Negative control is made by adding saline instead of bile to the culture - Incubate at 370C for 15 min - ‏ملم 15 مع366 غاناوعء عط لرمععم‎

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لمك علد

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۱۱ رز کر ار زره کرت 15۳۲۲۲ لبم زج ‎rs be‏ —! CAMP test Bacitracin Hemolysis ‏لاع ألا و۳‎ Negative Susceptible B S. pyogenes Positive Resistant 1 S: agalactiae , Differentiation between a-hemotytic ۳30001 Inulin Bile Optochi | Hemolysi Fermentatio | solubilit 0 5 n y ‏يت‎ ‎۷ ‎Not ferment | Soluble | Sensitive a 5: 9 pneumoniae mm) poe! (pet | ‏سكب‎ oe ee

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