Streptococcus anginosus group (formerly known as Streptococcus milleri) refers to a group of streptococcal species that commonly cause abscesses and infections. They were initially discovered in oral infections and named after a microbiologist. While usually considered harmless oral commensals, they can cause serious infections, especially in immunocompromised individuals or those with underlying conditions. Identification and treatment of infections involves bacterial culture and antibiotic therapy along with drainage of abscesses.

1. Streptococcus anginosus group ( Streptococcus milleri )

2. Streptococcus milleri was first used to describe a nonhemolytic Streptococcus species found in oral infections in 1956. “ Milleri” was given to the species in honor of W. D. Miller , a famous oral microbiologist and graduate of the dental school at the University of Pennsylvania. Streptococcus anginosus Group: Clinical Significance of an Important Group of Pathogens. Clinical Microbiology Newsletter 2005. Toby Gray, M.D., Department of Pathology, Virginia Commonwealth University, Medical College of Virginia Campus,Richmond, Virginia

3. In 1989, it was proposed in the United States to rename under one species name, Streptococcus anginosus. In Great Britain the designation S. milleri was preferred . Streptococcus anginosus Group: Clinical Significance of an Important Group of Pathogens. Clinical Microbiology Newsletter 2005. Toby Gray, M.D., Department of Pathology, Virginia Commonwealth University, Medical College of Virginia Campus,Richmond, Virginia

4. may be β-hemolytic, α-hemolytic, or γ-hemolytic on sheep blood agar S. anginosus group bacteria are considered to belong to Lancefield group F. Studies have reported S. anginosus group strains presenting with Lancefield group antigens A, C, and G, or even no Lancefield antigen at all. Streptococcus anginosus Group: Clinical Significance of an Important Group of Pathogens. Clinical Microbiology Newsletter 2005. Toby Gray, M.D., Department of Pathology, Virginia Commonwealth University, Medical College of Virginia Campus,Richmond, Virginia

5. Streptococcus anginosus Group Streptococcus intermedius Streptococcus constellatus S. constellatu s subsp. constellatus S. constellatus subsp. pharyngis Streptococcus anginosus CATHY A. PETTI,CHARLES W. STRATTON IV. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases,7th ed.

6. Streptococcus anginosus Group commensals of the oropharyngeal ( S. intermedius) commensals of respiratory tract ( S. intermedius) gastrointestinal microbiota ( S. anginosus) commensals of urogenital( S. anginosus) CATHY A. PETTI,CHARLES W. STRATTON IV. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases,7th ed.

7. Streptococcus anginosus Group microaerophilic or anaerobic growth environment minute colonies presence of a characteristic caramel-like odor ( production of a diacetyl metabolite) differentiated from other streptococci by a combination of three rapid test a positive Voges-Proskauer test for acetoin production hydrolysis of arginine failure to ferment sorbitol CATHY A. PETTI,CHARLES W. STRATTON IV. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases,7th ed.

8. gram positive group - C, β haemolytic microaerophyllic www.jortho . org

9. Pediatr Infect Dis J, 2002;21:715–26

10. CATHY A. PETTI,CHARLES W. STRATTON IV. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases,7th ed.

11. Streptococcus anginosus Group: Clinical Significance of an Important Group of Pathogens. Clinical Microbiology Newsletter 2005. Toby Gray, M.D., Department of Pathology, Virginia Commonwealth University, Medical College of Virginia Campus,Richmond, Virginia

12. Voges - Proskauer reaction is positive in the presence of acetoin, Which is produced by S. anginosus group bacteria and not by other beta-hemolytic streptococcal species

13. Rapid Anginosus Kit

14. Identification of S.anginosus group PCR assays : ribosomal RNA to identify S. anginosus species Genes for D-ala:D-ala ligases to identify viridans streptococci as belonging to the S. anginosus group Streptococcus anginosus Group: Clinical Significance of an Important Group of Pathogens. Clinical Microbiology Newsletter 2005. Toby Gray, M.D., Department of Pathology, Virginia Commonwealth University, Medical College of Virginia Campus,Richmond, Virginia

15. Clinically significant infections with organism of the Streptococcus milleri group JOHN BELKO, MD, DONALD A. GOLDMANN, MD, ANN MACONE, BS AND ANITA K. M. ZAIDI, MBBS, MS Division of Infectious Diseases, Department of Medicine(JB, AKMZ, DAG), and the Department of Laboratory Medicine (AM), Children’s Hospital, Boston, MA. JB is a fellow in pediatric infectious diseases; DAG is a professor of pediatrics; AM is a microbiology lab manager; AKMZ is an instructor in pediatric infectious diseases. Pediatr Infect Dis J, 2002;21:715–26

16. Previous surgery or trauma History of diabetes Immunodeficiency are at a higher risk for infections involving these organisms Streptococcus anginosus Group: Clinical Significance of an Important Group of Pathogens. Clinical Microbiology Newsletter 2005. Toby Gray, M.D., Department of Pathology, Virginia Commonwealth University, Medical College of Virginia Campus,Richmond, Virginia

17. S. constellatus is associated with pleuropulmonary and soft tissue abscesses, more likely to cause odontogenic and intra-abdominal abscesses. Streptococcus anginosus Group: Clinical Significance of an Important Group of Pathogens. Clinical Microbiology Newsletter 2005. Toby Gray, M.D., Department of Pathology, Virginia Commonwealth University, Medical College of Virginia Campus,Richmond, Virginia uncommon uncommon

18. S. intermedius is associated with pleuropulmonary infections, CNS abscesses, and deep soft tissue abscesse. Streptococcus anginosus Group: Clinical Significance of an Important Group of Pathogens. Clinical Microbiology Newsletter 2005. Toby Gray, M.D., Department of Pathology, Virginia Commonwealth University, Medical College of Virginia Campus,Richmond, Virginia uncommon uncommon

19. S. anginosus is more commonly isolated from blood, urine, and soft tissue infections , less often cause abscess Streptococcus anginosus Group: Clinical Significance of an Important Group of Pathogens. Clinical Microbiology Newsletter 2005. Toby Gray, M.D., Department of Pathology, Virginia Commonwealth University, Medical College of Virginia Campus,Richmond, Virginia uncommon uncommon

20. Pathophysiology of Infection All members of the S. anginosus group are able to bind fibronectin via a cell surface protein— promote attachment to tissue S. anginosus is able to bind to platelets, fibrin, fibrin clots, and fibrinogen , factor in the ability of these pathogens to cause endocarditis. 1. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases,7th ed. 2.Clinical Microbiology Newsletter 2005.

21. Pathophysiology of Infection A bility of S. intermedius to form a polysaccharide capsule that aids in prevention of phagocytosis P roduction of pyrogeni c exotoxins , intermedilysin , is essential for the invasion of human hepatic cells--- cause liver abscess ( S. intermedius) 1. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases,7th ed. 2.Clinical Microbiology Newsletter 2005.

22. Pathophysiology of Infection Produc tion of h ydrolytic enzymes : hyaluronidase,deoxyribonuclease, chondroitin sulfatase, role in microbial nutrition, and assist in liquefaction of pus Production of an acidic environment in abscesses by other bacteria enhances growth of S. anginosus group bacteria in mixed culture . S. anginosus group bacteria have the means to inhibit their lysis within neutrophils . 1. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases,7th ed. 2.Clinical Microbiology Newsletter 2005.

23. CID 2001:32 ;1511-1515

24. CID 2001:32 ;1511-1515

25. CID 2001:32 ;1511-1515

26. CID 2001:32 ;1511-1515

27. Indian J Med Res 2004 : 119 (Suppl) ; 164-167 species identity confirmed by Rapid ID32 Strep test (BioMerieux, Marcy L’Etoile, France), Lancefield grouped by latex agglutination test

28. 1989-2000 Indian J Med Res 2004 : 119 (Suppl) ; 164-167

29. Indian J Med Res 2004 : 119 (Suppl) ; 164-167

30. Indian J Med Res 2004 : 119 (Suppl) ; 164-167 E test

31. Clinically significant infections with organisms of the Streptococcus milleri group JOHN BELKO, MD, DONALD A. GOLDMANN, MD, ANN MACONE, BS AND ANITA K. M. ZAIDI, MBBS, MS Pediatr Infect Dis J, 2002;21:715–26 Children’s Hospital, Boston, from April 1, 1992, to December 31, 1998

32. Treatment Surgical drainage as the mainstay of management for abscesses Antibiotics as adjunct therapy High rate of susceptibility to penicillin, Clindamycin,erythromycin, and cephalosporins are considered acceptable alternatives Streptococcus anginosus Group: Clinical Significance of an Important Group of Pathogens. Clinical Microbiology Newsletter 2005. Toby Gray, M.D., Department of Pathology, Virginia Commonwealth University, Medical College of Virginia Campus,Richmond, Virginia

33. thank you.

34. Streptococcus constellatus