Produces poisonous
H2S gas and necrotizing infections

Food sources of infection include ice cream, eggs, steamed lobster, ground ham, potato salad, egg salad,
custard, rice pudding, and shrimp salad,  sausage, evaporated milk, cheese, meat croquettes, meat pie,
pudding, raw milk, and pasteurized milk. Proper cooking (temperatures at or above 70º C

In regard to antigenic structure, the cell walls of streptococci are complex structures containing many
different antigenic substances. The major virulence factor of GAS is M protein. The strains containing an
abundance of M protein resist phagocytosis, multiply rapidly in human tissues, and initiate disease. M
protein is a macromolecule present on the cell membrane; it traverses and penetrates the bacterial cell
Most strains of GAS produce 2 hemolytic toxins: streptolysin O and streptolysin S. Streptolysin is toxic to a
variety of cells, including polymorphonuclear leukocytes, platelets, and tissue culture cells. GAS produce 3
different types of exotoxins (ie, A, B, C). These toxins are responsible for causing fever and scarlet fever
rash. Additionally, these exotoxins increase susceptibility to endotoxic shock, cause dysfunction of the
reticuloendothelial system, produce cardiac and hepatic necrosis in animals, and depress antibody

Horse bite leads to meningitis
Posted on October 10, 2010 by Scott Weese

You never want to be the subject of a medical case report. A 37-yr-old British woman was featured in a recent edition of
Lancet (Brouwer et al 2010), in a paper entitled A horse bite to remember.

The woman was admitted to hospital with a fever, headache, neck stiffness, confusion, difficulty speaking and nausea.
These signs were suggestive of meningitis and a spinal tap was supportive of that presumptive diagnosis. Blood
samples were also taken, and the same bacterium, Streptococcus zooepidemicus was isolated from both blood and
spinal fluid, confirming a diagnostic of S. zooepidemicus meningitis. She was treated and improved, but did not fully

Streptococcus zooepidemicus is primarily associated with horses, although it can occasionally be found in other species
such as dogs. After the diagnosis, the woman's family was questioned about her hobbies and it was revealed that she
was an avid horsewoman. Further, she had been bitten by her horse the previous week. That was the presumed source
of infection, but it doesn't appear that any further investigation was taken.

EID Journal Home > Volume 13, Number 8–August 2007

Volume 13, Number 8–August 2007
Streptococcus sinensis Endocarditis outside Hong Kong
Ilker Uçkay,*  Peter Rohner,* Ignacio Bolivar,† Béatrice Ninet,* Marina Djordjevic,* Vandack Nobre,* Christian Garzoni,*
and Jacques Schrenzel*
*University Hospitals of Geneva, Geneva, Switzerland; and †Institut für Angewandte Immunologie, Zuchwil, Switzerland

Suggested citation for this article

Streptococcus sinensis has been described as a causative organism for infective endocarditis in 3 Chinese patients
from Hong Kong. We describe a closely related strain in an Italian patient with chronic rheumatic heart disease. The
case illustrates that S. sinensis is a worldwide emerging pathogen.

Among the hundreds of bacteria that are pathogenic for humans, some are reposted only once and remain a rarity,
while others are considered as emerging pathogens after several cases have been published. In 2002, Woo et al. from
Hong Kong Special Administrative Region, People's Republic of China, reported a new pathogen isolated from a 42-
year-old Chinese woman with mitral regurgitation due to chronic rheumatic heart disease and infective endocarditis
(HKU4) (1). Its 16S rRNA sequence (2) showed a new streptococcal species, subsequently named Streptococcus
sinensis in honor of China; the sequencing showed that it was closely related to Streptococcus gordonii (96.4%
homology) and to Streptococcus intermedius (96.3%) (1). Phenotypically, the species most closely resembled S.
intermedius; some evidence suggests that S. sinensis could be the common ancestor of S. anginosus and S. mitis (3).
In 2004, the same group published a retrospective analysis of 302 bacteremia cases caused by S. viridans in Hong
Kong, including 2 other cases of endocarditis caused by S. sinensis with Lancefield group F (4). We describe another
case of an infective endocarditis (or infection in general) due to S. sinensis outside Hong Kong.

Streptococcus genus:

Group A Streptococcus (2006)

Skin and soft tissue infections are most commonly caused by bacteria and account for ~7 to 10% of hospitalizations in
North America.1 Substantial portions are caused by Streptococcus pyogenes (group A streptococci; GAS). A major
human pathogen, GAS is associated with millions of skin and throat infections each year.2 Serious complications after
infection, namely rheumatic fever, glomerulonephritis, and reactive arthritis, can follow even relatively mild GAS
infections and cause significant morbidity worldwide.3,4 Some GAS infections rapidly progress to life-threatening
invasive diseases such as
septicemia, streptococcal toxic shock syndrome, and necrotizing fasciitis, requiring
life-saving interventions in the form of aggressive fluid replacement, general supportive measures, and/or emergent
surgical debridement.2–4 Nearly 15,000 cases of invasive GAS disease and an estimated 1300 deaths occur annually
in the United States.5 Epidemiological data also suggest increased incidence and severity of GAS infections in recent
years.2,6,7 Because progression to systemic toxicity and shock can occur throughout a span of hours, early recognition
and initiation of aggressive therapies are essential.
In addition to strep throat, members of this genus are responsible for many cases of meningitis, bacterial pneumonia,
endocarditis, erysipelas and even necrotizing fasciitis (so-called 'flesh-eating' bacterial infections). It should be noted,
however, that many streptococcal species are non-pathogenic.

S. pneumoniae, a leading cause of bacterial pneumonia, otitis media and meningitis.

S. mutans, a contributor to dental caries.

S. viridans, a cause of endocarditis and dental abscesses.

Group A Streptococci
S. pyogenes (also known as GAS) is the causative agent in Group A streptococcal infections, (GAS) including strep
throat, acute rheumatic fever, scarlet fever, and acute glomerulonephritis. If strep throat is not treated, it can develop
into rheumatic fever, a disease that affects the joints and heart valves. Other Streptococcus species may also possess
the Group A antigen, but human infections by non-S. pyogenes GAS strains (some S. dysgalactiae subsp. equisimilis
and S. anginosus Group strains) appear to be uncommon.

Group B Streptococci
S. agalactiae, or GBS, causes meningitis in neonates and the elderly, with occasional systemic bacteremia. They can
also colonize the female reproductive tract, increasing the risk for premature rupture of membranes and transmission to
the child. The CDC recommends women who are pregnant should be tested for Group B Strep and given antibiotics
during labor in order to reduce the risk of transmission to the baby. In the UK, as the prevalence in the female genital
tract is around 15%, antibiotics are not recommended as the side effects of giving antibiotics to the sheer number of
women who would test positive and not pass it to their babies outweighs the very few it would benefit.

Group C Streptococci
Includes S. equi which causes strangles in horses, and S. zooepidemicus which causes infections in several species of
mammals including cattle and horses.
Group D Streptococci (Enterococci)

Many former Group D streptococci have been reclassified and placed in the genus Enterococcus (includes S. faecalis,
S. faciem, S. durans, and S. avium).[4] For example, Streptococcus faecalis is now Enterococcus faecalis.

S. pyogenes is responsable for about 90% of all cases of pharyngitis. "Strep throat" which is
characterized by inflamation and swelling of the throat, as well as development of pus-filled regions on the tonsils.
infection spreading from the upper respiratory system into the lungs. Once in the lungs, the infection could give rise to
pneumonia. Some cases also develop into rheumatic fever if left untreated. Other diseases linked to S. pyogenes are
skin infections such as impetigo, cellulitis, and erysipelas.

S. agalactiae. For years this bacterium has been the causative agent in mastitis in cows. Currently, it has been found
to be a cause of sexually transmitted urogenital infections in females. Although infection is easily treated with penicillin,
proper diagnosis is necessary for women nearing labor because the infection can easily spread to the child via the birth

Type D Streptococcus The Enterococci include E. faecalis, a cause of urinary tract infections, and E. faecium, a
bacterium resistant to many common antibiotics. Diseases such as septicemia, endocarrditis, and appendicitis have also
been attributed to group D Strep.

Streptococcus pneumoniae causes pneumonia, meningitis, and otitis media.
S. mutans and S. mitis, are alpha-hemolytic bacteria. These bacteria inhabit the mouth. In fact, a large percentage of
tooth decay can be attributed to S. mutans.

Am J Surg. 1977 Jul ;134 (1):52-7 327844 [Cited: 4]   
Bacteriology of necrotizing fasciitis.  
[My paper] A Giuliano , F Lewis Jr , K Hadley , F W Blaisdell  
Sixteen patients with necrotizing fasciitis were observed under clinical and laboratory conditions for collection,
preservation, and culture that permitted optimal retrieval of anaerobes. The clinical observations of necrosis of fascia,
subcutaneous fat and skin with thrombosis of the microvasculature, and absence of myonecrosis were clearly apparent
in these patients. Two clear-cut groups of culture and gram stain results were found, suggesting that the clinical entity
necrotizing fasciitis can occur after infection by different infecting organisms. The cultivation of Streptococcus
pyogenes (group A), either alone or in combination with staphylococcus, in three patients conforms to the culture
results found by Meleney [1] in his original description.