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STREPTOCOCCUS SALIVARIUS

PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES

SECTION I - INFECTIOUS AGENT

NAME: Streptococcus salivarius.

SYNONYM OR CROSS REFERENCE: Part of the Salivarius group of streptococci Footnote 1-Footnote 7.

CHARACTERISTICS: A member of the Salivarius group of viridans streptococci Footnote 7, Footnote 8. S. salivarius is an α-haemolytic streptococci Footnote 9, existing as a commensal of the oral cavity Footnote 1, Footnote 3, Footnote 5, Footnote 8, Footnote 10-Footnote 12, skin Footnote 4, Footnote 5, Footnote 9, Footnote 10, Footnote 12, gastrointestinal Footnote 3, Footnote 5, Footnote 10-Footnote 12, oropharynx Footnote 4, Footnote 13, and genitourinary tracts Footnote 3, Footnote 8, Footnote 10, Footnote 12. Streptococci, in general, are spherical or ovoid in shape and typically exist in chains or pairs Footnote 11. They are gram positive, non-motile, non-sporing, catalase negative, and facultatively anaerobic.

SECTION II - HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: S. salivarius has been associated with a variety of infections Footnote 14. The most common reports refer to meningitis Footnote 3-Footnote 5, Footnote 9, Footnote 12, Footnote 13, and bacteraemia Footnote 6, Footnote 15. Other cases include pericarditis, spontaneous bacterial peritonitis, acute jejunitis, pancreatic abscess, multimicrobial endocarditis, early neonatal sepsis, sinusitis, endophthalmitits, bullous impetigo and femoral osteitis Footnote 14. It must be noted, however, that although S. salivarius frequently enter the bloodstream, infections with S. salivarius are rare due to their low virulence Footnote 1, Footnote 3, Footnote 5, Footnote 16. Many patients with S. salivarius bacteraemia have predisposing local factors such as mucosal disruption and/or serious underlying diseases, such as malignancy or liver cirrhosis Footnote 16.

EPIDEMIOLOGY: Worldwide, all streptococcus species are obligate parasites of the mucosal membranes of humans Footnote 4, Footnote 11.

HOST RANGE: Humans Footnote 1, Footnote 3-Footnote 5, Footnote 9-Footnote 13, Footnote 16.

INFECTIOUS DOSE: Unknown.

MODE OF TRANSMISSION: S. salivarius is part of the normal human flora. It can be transmitted by direct contamination of sterile body fluid, for example, contamination of cerebrospinal fluid following epidural anaesthesia or lumbar puncture Footnote 4, Footnote 5, Footnote 9, Footnote 10, Footnote 14, due to contaminated equipment, by migration of the organism from the patient’s skin along the outer surface of the catheter Footnote 4, Footnote 5, Footnote 9, or via air droplets originating from the oropharynx Footnote 10. S. salivarius in the oral cavity can also enter the bloodstream (bacteraemia) following endoscopy and associated therapeutic interventions Footnote 5, Footnote 14-Footnote 16. Once the organism is in the bloodstream it can seed various anatomical sites (including the meninges and the cerebrospinal fluid) Footnote 14.

INCUBATION PERIOD: Unknown.

COMMUNICABILITY: Many suspected cases of human-to-human transmission have been recorded Footnote 4, Footnote 5, Footnote 9, Footnote 10, Footnote 12; however, very few cases have been confirmed. So far, only one report was able to unambiguously identify the source of infection, which was from the throat of a doctor to a patient during a lumbar puncture procedure Footnote 13.

SECTION III - DISSEMINATION

RESERVOIR: Humans Footnote 1, Footnote 3-Footnote 5, Footnote 9, Footnote 11, Footnote 12, Footnote 14, Footnote 16.

ZOONOSIS: None.

VECTORS: None.

SECTION IV - STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY: Sensitive to various antibiotics, including ciprofloxacin, levofloxacin, metronidazole Footnote 8, penicillin Footnote 2, Footnote 10, Footnote 13, amoxicillin Footnote 2, Footnote 5, Footnote 12, Footnote 16, ceftriaxone Footnote 2-Footnote 5, Footnote 14, clindamycin, rifampicin Footnote 2, gentamycin Footnote 5, cefuroxime, moxifloxacin Footnote 16, ceftoxime Footnote 1, and vancomycin Footnote 1, Footnote 2, Footnote 4, Footnote 12, Footnote 14. Certain strains of S. salivarius have shown partial resistance to penicillin Footnote 1, Footnote 4, Footnote 16, ceftriaxone Footnote 4, erythromycin Footnote 1, Footnote 2, Footnote 16, and meropenem Footnote 1.

SUSCEPTIBILITY TO DISINFECTANTS: Susceptible to 5.25% sodium hypochlorite, and cresophene (30% paramonochlorophenol, 5% thymol, 0.1% dexamethasone), 21% alcohol, and 2.0% chlorohexidine Footnote 17.

PHYSICAL INACTIVATION: Streptococcal species are inactivated at low pH Footnote 15.

SURVIVAL OUTSIDE HOST: Unknown. Studies in the 1930s and 1940s suggest that S. salivarius can survive on drinking glass rims and utensils for at least a couple of days Footnote 18, Footnote 19; however, genetic identification was not available at this time, and it is unknown whether species-specific identification was possible.

SECTION V – FIRST AID / MEDICAL

SURVEILLANCE: Monitor for symptoms. Confirm infection using gram-stain Footnote 4, Footnote 5, Footnote 10, followed by isolation of the organism from blood Footnote 3, Footnote 5, Footnote 6, Footnote 8, Footnote 16, Footnote 17 or cerebrospinal fluid culture Footnote 3-Footnote 5, Footnote 9, Footnote 10, Footnote 12, Footnote 13. PCR has also been used to identify S. salivarius in clinical samples Footnote 13.

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: Antibiotic therapy Footnote 3-Footnote 5, Footnote 8-Footnote 10, Footnote 12, Footnote 14, Footnote 16, typically with ceftriaxone Footnote 4, Footnote 5, Footnote 12, Footnote 14, Footnote 16, amoxicillin Footnote 12, Footnote 16, and/or vancomycin Footnote 4, Footnote 5, Footnote 14, Footnote 16. Treatment is delivered depending on the manifestation of the infection, for example patients suffering from meningitis due to S. salivarius may require mechanical ventilation Footnote 4.

IMMUNIZATION: None currently available.

PROPHYLAXIS: None.

SECTION VI - LABORATORY HAZARDS

LABORATORY-ACQUIRED INFECTIONS: No specific laboratory-acquired infections with S. salivarius have been reported; however, there were 78 recorded cases of streptococcal infection (species not specified), with 4 deaths up to 1976 Footnote 20.

SOURCES/SPECIMENS: Blood Footnote 6, Footnote 8, Footnote 14, Footnote 16, Footnote 17, peritoneal fluid Footnote 8, cerebrospinal fluid Footnote 3-Footnote 5, Footnote 10, Footnote 12, Footnote 14, and oropharyngeal secretions Footnote 4, Footnote 10.

PRIMARY HAZARDS: Accidental parenteral inoculation Footnote 9, Footnote 12.

SPECIAL HAZARDS: None.

SECTION VII – EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 2 Footnote 21.

CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures Footnote 22.

PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes Footnote 22.

OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities Footnote 22.

SECTION VIII – HANDLING AND STORAGE

SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up Footnote 22.

DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism before disposing by autoclave, chemical disinfection, gamma irradiation, or incineration Footnote 22.

STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled Footnote 22.

SECTION IX - REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: December 2011

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada.

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright ©
Public Health Agency of Canada, 2011
Canada

REFERENCES:

Footnote 1
Ahmed, R., Hassall, T., Morland, B., & Gray, J. (2003). Viridans streptococcus bacteremia in children on chemotherapy for cancer: an underestimated problem. Pediatric Hematology & Oncology, 20(6), 439-444.
Footnote 2
Smith, A., Jackson, M. S., & Kennedy, H. (2004). Antimicrobial susceptibility of viridans group streptococcal blood isolates to eight antimicrobial agents. Scandinavian Journal of Infectious Diseases, 36(4), 259-263.
Footnote 3
Conte, A., Chinello, P., Civljak, R., Bellussi, A., Noto, P., & Petrosillo, N. (2006). Streptococcus salivarius meningitis and sphenoid sinus mucocele. Case report and literature review. Journal of Infection, 52(1), e27-30.
Footnote 4
Yaniv, L. G., & Potasman, I. (2000). Iatrogenic meningitis: an increasing role for resistant viridans streptococci? Case report and review of the last 20 years. Scandinavian Journal of Infectious Diseases, 32(6), 693-696.
Footnote 5
Megarbane, B., Casetta, A., Esvant, H., Marchal, P., Axler, O., & Brivet, F. G. (2000). Streptococcus salivarius acute meningitis with latent petromastoiditis. Scandinavian Journal of Infectious Diseases, 32(3), 322-323.
Footnote 6
Wisplinghoff, H., Reinert, R. R., Cornely, O., & Seifert, H. (1999). Molecular relationships and antimicrobial susceptibilities of viridans group streptococci isolated from blood of neutropenic cancer patients. Journal of Clinical Microbiology, 37(6), 1876-1880.
Footnote 7
Facklam, R. (2002). What happened to the streptococci: overview of taxonomic and nomenclature changes. Clinical Microbiology Reviews, 15(4), 613-630.
Footnote 8
Peterson, M. C. (2002). Spontaneous bacterial peritonitis from Streptococcus salivarius in a compromised host. Journal of Infection, 45(3), 197-198.
Footnote 9
Trautmann, M., Lepper, P. M., & Schmitz, F. J. (2002). Three cases of bacterial meningitis after spinal and epidural anesthesia. European Journal of Clinical Microbiology & Infectious Diseases, 21(1), 43-45.
Footnote 10
Couzigou, C., Vuong, T. K., Botherel, A. H., Aggoune, M., & Astagneau, P. (2003). Iatrogenic Streptococcus salivarius meningitis after spinal anaesthesia: need for strict application of standard precautions. Journal of Hospital Infection, 53(4), 313-314.
Footnote 11
Kilian, M. (1998). Streptococcus and Lactobacillus. In A. Balows, & B. I. Duerden (Eds.), Topley & Wilson's microbiology and microbial infections (9th ed., pp. 633-668). London: Arnold.
Footnote 12
Bouhemad, B., Dounas, M., Mercier, F. J., & Benhamou, D. (1998). Bacterial meningitis following combined spinal-epidural analgesia for labour. Anaesthesia, 53(3), 292-295.
Footnote 13
Veringa, E., van Belkum, A., & Schellekens, H. (1995). Iatrogenic meningitis by Streptococcus salivarius following lumbar puncture. Journal of Hospital Infection, 29(4), 316-318.
Footnote 14
Rafailidis, P. I., Prapas, S. N., Kasiakou, S. K., Costeas, X. F., & Falagas, M. E. (2005). Effusive-constrictive calcific pericarditis associated with Streptococcus salivarius. Case report and review of the literature. Cardiology in Review, 13(3), 113-117.
Footnote 15
Lee, T. H., Hsueh, P. R., Yeh, W. C., Wang, H. P., Wang, T. H., & Lin, J. T. (2000). Low frequency of bacteremia after endoscopic mucosal resection. Gastrointestinal Endoscopy, 52(2), 223-225.
Footnote 16
Corredoira, J. C., Alonso, M. P., Garcia, J. F., Casariego, E., Coira, A., Rodriguez, A., Pita, J., Louzao, C., Pombo, B., Lopez, M. J., & Varela, J. (2005). Clinical characteristics and significance of Streptococcus salivarius bacteremia and Streptococcus bovis bacteremia: a prospective 16-year study. European Journal of Clinical Microbiology & Infectious Diseases, 24(4), 250-255.
Footnote 17
Ayhan, H., Sultan, N., Cirak, M., Ruhi, M. Z., & Bodur, H. (1999). Antimicrobial effects of various endodontic irrigants on selected microorganisms. International Endodontic Journal, 32(2), 99-102.
Footnote 18
Dick, L. A. (1938). Contamination of Drinking Glasses by Streptococci. Proceedings of the Branches of the Society of American Bacteriologists, , 224-225.
Footnote 19
Walter, W. G. (1941). Sanitization of Beverage Glasses. Proceedings of the Branches of the Society of American Bacteriologists, , 114-115.
Footnote 20
Pike, R. M. (1976). Laboratory associated infections: summary and analysis of 3921 cases. Health Laboratory Science, 13(2), 105-114.
Footnote 21
Human Pathogens and Toxins Act. S.C. 2009, c. 24. Government of Canada, Second Session, Fortieth Parliament, 57-58 Elizabeth II, 2009, (2009).
Footnote 22
Public Health Agency of Canada. (2004). In Best M., Graham M. L., Leitner R., Ouellette M. and Ugwu K. (Eds.), Laboratory Biosafety Guidelines (3rd ed.). Canada: Public Health Agency of Canada.