Gram Positive Cocci of Medical Importance 

The most common gram-positive cocci of medical importance belong to Staphylococcus, Streptococcus, and Enterococcus genera. etc. Most organisms belonging to these genera are non-motile and do not form spores (exception; Sporosarcina ureae is spore-forming gram-positive cocci). Other gram-positive cocci are Micrococcus, Peptococcus, and Peptostreptococcus. Organisms belonging to these genera are part of the normal flora of the skin and are rare human pathogens.

Two main criteria distinguish staphylococci and streptococci

  1. Staphylococci appear in grapelike clusters, whereas streptococci are in chains
  2. Staphylococci produce catalase enzyme, whereas streptococci do not. 
Overview of Biochemical tests for differentiating Gram positive cocci
Overview of Biochemical tests for differentiating Gram positive cocci

Staphylococcus species 

Staphylococcus genus contains more than 30 species, two of which, Staphylococcus aureus and S. saprophyticus are commonly pathogenic in humans. S. epidermidis, primarily a normal skin flora of skin can also cause bloodstream infections in neonates and people with prosthetic implants and catheters. 

Gram positive cocci in clusters
Staphylococcus in Gram Stain

Staphylococcus aureus

Staphylooccus aureus is a normal flora of the nose and skin but also one of the notorious pathogens. It is catalase and coagulase positive gram-positive cocci. Major diseases caused by S. aureus are sepsis, pneumonia, wound infections, folliculitis, necrotizing fasciitis, scalded skin syndrome, surgical site infection, toxic shock syndrome, and food poisoning. This post discusses the properties of S. aureus, disease, and lab diagnosis

Major virulence factors of S. aureus are coagulase, collagenase, hyaluronidase, immunoglobulin proteases, protein A, toxic shock syndrome toxin (TSST-1), enterotoxin, exfoliatin, etc.  Find more about the Staphylococcus aureus virulence factors

Some strains of S. aureus, such as methicillin-resistant Staphylococcus aureus (MRSA), are highly resistant to multiple antibiotics. Bactericidal agent vancomycin is used for the effective treatment of MRSA infections. 

Staphylococcus saprophyticus 

Staphylococcus saprophyticus is found primarily on the mucosa of the genital tract in young women and causes urinary tract infections (UTI), especially cystitis in sexually active young women. In this group, it is second to E. coli as a cause of community-acquired UTIs. 

Read more about Staphylococcus saprophyticus characteristics and diagnosis. 

Staphylococcus epidermidis

Staphylococcus epidermidis are normal flora of the human skin and mucous membranes. They are opportunistic pathogens and can cause neonatal sepsis, prosthetic hip infection, intravascular catheter infection, and endocarditis on prosthetic heart values. 

These coagulase-negative staphylococci (CONS) do not produce exotoxins, but some strains may produce glycocalyx, which helps them to adhere to foreign bodies such as prosthetic implants and catheters. 

Streptococcus species

Streptococci are spherical gram-positive cocci arranged in pairs or chains. All streptococci are catalase-negative. Traditionally, streptococci are identified based on hemolysis type shown in blood agar cell wall structure and reaction of antibodies to the specific bacterial antigen.  S. pneumoniae and viridans streptococci are alpha-hemolytic, S. agalactiae and S. pyogenes are beta-hemolytic. 

C-carbohydrate antigen and M protein are two important antigens of beta-hemolytic streptococci. Based on antigenic differences in C carbohydrate, beta-hemolytic streptococci are arranged into groups A-U, also known as Lancefield grouping. Some other streptococci are non-hemolytic (gamma-hemolysis). Currently, the molecular analysis of the 16S ribosomal ribonucleic acid (rRNA) sequences is helpful to identify the isolates.  Streptococci cause various infections, such as pneumonia, sore throat, pyogenic skin infections, and meningitis. 

Streptococcus pyogenes

Group A Streptococcus (S.pyogenes), also known as “flesh-eating bacteria,” is the leading bacterial cause of pharyngitis (strep. throat) and cellulitis. It also causes impetigo, necrotizing fasciitis, scarlet fever, and streptococcal toxic shock syndrome. Rheumatic fever and acute post-streptococcal glomerulonephritis (PSGN) are the post-streptococcal sequelae of S. pyogenes infections. It is beta-hemolytic, bacitracin-sensitive, and pyrrolidonyl arylamidase (PYR) test positive.

Read more about characteristics, disease and tests for the identification of Streptococcus pyogenes

M proteins, hyaluronic acid capsule, adhesions, hemolysins, pyrogenic exotoxins, and spreading factors (deoxyribonucleases, streptokinase, and hyaluronidase) are the 

major virulence factors of S. pyogenes. Read more about virulence factors of S. pyogenes.

Streptococcus pneumoniae

Streptococcus pneumoniae (pneumococcus) is the normal upper respiratory tract flora and the most common cause of community-acquired pneumonia. It also causes bacteremia, meningitis, otitis media, sinusitis, and conjunctivitis. Pneumococci are gram-positive lancet-shaped diplococci. They produce alpha-hemolysis on blood agar, optochin-sensitive, and bile soluble.

gram positive cocci streptococcus
Gram positive diplocci: Streptococcus spp

Find more about properties, pathogenesis and diagnosis of S. pneumoniae

Autolysins, IgA1 proteases, pneumolysin, polysaccharide capsules, and teichoic acids are the major virulence factors of S. pneumoniae. There are >90 different capsular serotypes of S. pneumoniae. The capsular serotype of an individual pneumococcal isolate is determined by using quellung reaction. 

Streptococcus agalactiae

Group B Streptococcus (S. agalactiae) colonizes the genital tract of some women. It is the leading cause of neonatal sepsis, pneumonia, and meningitis. The infection is acquired before or during the birthing process. Because of this CDC recommends screening of all pregnant women for GBS carriage between 35 to 35 weeks of gestation.

S. agalactiae is beta-hemolytic streptococci that are resistant to bacitracin and hydrolyze hippurate. CAMP test positive results are the special diagnostic tests for identifying S. agalactiae. 

Find more about Streptococcus agalactiae properties, pathogenesis and lab diagnosis.

Viridans Streptococci 

Viridians group streptococci are also α-hemolytic streptococci, but unlike S. pneumoniae, they are optochin resistant and bile-insoluble. Viridans streptococci are normal flora of the human oral cavity and pharynx but are one of the major causes of bacterial endocarditis.

Streptococcus mutans, Streptococcus mitis, and Streptococcus sanguinis are the medically important species of viridans group of streptococci. S. mutans synthesizes polysaccharide dextran and is responsible for forming dental plaque leading to dental caries. Find more about viridans streptococci, their pathogensis and lab diagnosis.

Group D streptococci

These include enterococci (e.g., Enterococcus faecalis and Enterococcus faecium) and nonenterococci (e.g., S. bovis). Group D streptococci are mostly α-hemolytic, but some are β-hemolytic, and others are nonhemolytic. 

Enterococcus in gram-stain
Enterococcus faecalis in gram stain

Enterococci are members of the normal flora of the colon and are noted for their ability to cause urinary, biliary, and cardiovascular infections. Enterococcus faecalis is an important cause of hospital-acquired UTIs and endocarditis. Strains of E. faecium and E. faecalis are vancomycin-resistant (also known as vancomycin-resistant enterococci-VRE).

Find more about properties, pathogenesis, and lab diagnosis of Enterococcus faecalis

Micrococcus

Micrococci are gram-positive cocci usually arranged in tetrads or pairs and are part of the normal flora of the skin. Micrococci are usually considered contaminants of clinical specimens (blood) and are rarely implicated as a cause of human infections.

The two most common species of micrococci are Micrococcus luteus and Micrococcus roseus. Micrococcus gives non-hemolytic colonies with a wide variety of pigments (white, tan, yellow, orange, or pink) in blood agar. They can be differentiated from staphylococci using microdase test, micrococci are modified oxidase (microdase) positive and susceptible to bacitracin. 

Find more on the differentiation of staphylococci from micrococci.

Peptococcus

Peptococci are anaerobic gram-positive cocci, resembling staphylococci, found as members of the normal flora of the mouth and colon. They are also isolated from abscesses of various organs, usually from mixed anaerobic infections. Peptococcus niger is the only species of this genus. 

Peptostreptococcus

Peptostreptococci are anaerobic gram-positive cocci found as members of the normal flora of the mouth, gut, colon, and genital tract of women. Peptostreptococci are also isolated from abscesses of various organs, usually from mixed anaerobic infections.  

These organisms grow well under anaerobic or microaerophilic conditions and produce variable hemolysis. Peptostreptococcus magnus and Peptostreptococcus anaerobius are clinically important species. 

References 

Acharya Tankeshwar

Hello, thank you for visiting my blog. I am Tankeshwar Acharya. Blogging is my passion. As an asst. professor, I am teaching microbiology and immunology to medical and nursing students at PAHS, Nepal. I have been working as a microbiologist at Patan hospital for more than 10 years.

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