1. STREPTOCOCCI

2. Streptococci • facultative anaerobe • Gram-positive • chains or pairs • catalase negative • (staphylococci are catalase positive)

3. Streptococcus in chains

4. Streptococcus pneumoniae (diplococcus). Fluorescent stain

5. Streptococci • Lancefield groups • Satu atau lebih spesies per group • antigen permukaan

6. groupablestreptococci • A, B and D • most important • C, G, F • rare

7. Non-groupable • S. pneumoniae • pneumonia • viridans streptococci • e.g. S. mutans • dental caries

8. hemolysis reaction - sheep blood agar • α (alpha) • partial hemolysis • green color • β (beta) • complete clearing • A and B • γ (gamma) • no lysis

9. Hemolysis • Groups A an B • β • Group D • α or γ • S. pneumoniae and viridans • γ

10. hemolysis reaction + one characteristic • presumptive identification

11. Group A streptococcus(S. pyogenes)

12. Group A streptococcal menginfeksi semua umur • Insiden tertinggi pd usia 5-15 thn

13. S. pyogenes -suppurative • non-invasive • pharyngitis • Infeksikulit, impetigo • invasive bacteremia • toxic shock-like syndrome • "flesh eating" bacteria • pyrogenic toxin

14. Pyrogenic toxin • superantigen • T cell mitogen • Mengaktifkan sistem imun

15. Scarlet fever • rash • erythrogenic toxin

16. non-suppurative • rheumatic fever • inflammatory disease • life threatening • Sekuel kronik • demam • jantung • sendi • rheumatic tidak sama dengan rheumatoid arthritis

17. Rheumatic fever -etiology • M protein • cross-reacts heart myosin • autoimun • Antigen dinding sel • sedikit dicerna in vivo • bertahan lama

18. Rheumatic fever • penicillin • menyembuhkan pharyngitis • Menurunkan resiko carditis

19. Acute glomerulonephritis • immune complex disease of kidney

20. Major pathogenesis factors • lipoteichoic acid/F protein • fimbriae • binds to epithelial cells • M protein • anti-phagocytic

21. M protein • major target • Imunitas alami • strain variation • antigenicity • re-infection • Terjadi dengan strain yg berbeda

22. Capsules • Anti-phagocytic • mucoid strains

23. Isolation and identification • β hemolytic colonies • bacitracin menghambat pertumbuhan • β hemolytic colonies • group A antigen

24. β hemolysis • hemolysin O • Sensitif oksigen • hemolysin S • Non sensitive oksigen

25. Post-infectious diagnosis (serology) • Antibodi thd streptolysin O • Penting! Bila menetap sekuel kronik terjadi

26. Serotyping • M • T • R

27. Group B streptococcus • neonatal meningitis • septicemia • transmission • vaginal flora

28. Group B streptococcus - identification • β hemolysis • hippurate hydrolysis • CAMP reaction • meningkatkan βhemolisis S. aureus

29. Group D streptococcus • Tumbuhpada bile esculin agar • precipitasihitam 6.5% salin • Tumbuh • enterococci • Tidaktumbuh • non-enterococci

30. Enterococci • Hubungannya agak jauh dr streptococci lain • genus Enterococcus • Flora usus • urinary tract infection • Kontaminasi dr anus • opportunistic infections • khususnya endocarditis • Paling sering E. (S.) faecalis

31. Enterococci • resisten thd banyak antibiotik • termasuk vancomycin • ujung D-ala diganti dengan D-lactat

32. Minute colony streptococci • Various groups (e.g. group A) • berbeda scr genetik • koloni yg besar (e.g. S. pyogenes) • tdk ada demam rheuma Koloni besar Koloni kecil

33. Viridans streptococci • diverse species • oral • Karies gigi • α hemolytic dan negatif thd tes lain • non-groupable. • termasuk S. mutans • endocarditis • cabut gigi