Pathogen Safety Data Sheets: Infectious Substances – Streptococcus salivarius

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 4Footnote 5Footnote 9Footnote 10Footnote 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 18Footnote 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 Recommendations

Risk Group Classification

Risk Group 1. This bacteria is not regulated under the Human Pathogens and Toxins Act, or the Health of Animals Act.

Containment

Containment Level 1 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 where there is a known or potential risk of exposure to splashes ^{Footnote 22}.

Other Precautions

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 Recommendations

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.

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

February 2018

Prepared by:

Centre for Biosecurity, 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, 2018
Canada