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. 1991 Apr;4(2):184–190. doi: 10.1128/cmr.4.2.184

Nutritionally variant streptococci.

K L Ruoff 1
PMCID: PMC358190  PMID: 2070344

Abstract

Streptococci requiring either pyridoxal or L-cysteine for growth were first observed 30 years ago as organisms forming satellite colonies adjacent to colonies of "helper" bacteria. Although they were previously considered nutritional mutants of viridans streptococcal species, the nutritionally variant streptococci (NVS) are currently thought to belong to distinct species of the genus Streptococcus. NVS strains may display pleomorphic cellular morphologies, depending on their growth conditions, and are distinguished from most other streptococci by enzymatic and serological characteristics and the presence of a cell wall chromophore. NVS are found as normal inhabitants of the oral cavity, and in addition to their participation in endocarditis, they have been isolated from a wide range of clinical specimens. Endocarditis caused by NVS is often difficult to eradicate; combinations of penicillin and an aminoglycoside are recommended for treatment. The unique physiological features of the NVS contribute to the difficulties encountered in their recovery from clinical specimens and may play a role in the problems associated with successful treatment of NVS endocarditis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barrios H., Bump C. M. Conjunctivitis caused by a nutritionally variant streptococcus. J Clin Microbiol. 1986 Feb;23(2):379–380. doi: 10.1128/jcm.23.2.379-380.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bouvet A., Cremieux A. C., Contrepois A., Vallois J. M., Lamesch C., Carbon C. Comparison of penicillin and vancomycin, individually and in combination with gentamicin and amikacin, in the treatment of experimental endocarditis induced by nutritionally variant streptococci. Antimicrob Agents Chemother. 1985 Nov;28(5):607–611. doi: 10.1128/aac.28.5.607. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bouvet A., Ryter A., Fréhel C., Acar J. F. Nutritionally deficient streptococci: electron microscopic study of 14 strains isolated in bacterial endocarditis. Ann Microbiol (Paris) 1980 Sep-Oct;131B(2):101–120. [PubMed] [Google Scholar]
  4. Bouvet A., Villeroy F., Cheng F., Lamesch C., Williamson R., Gutmann L. Characterization of nutritionally variant streptococci by biochemical tests and penicillin-binding proteins. J Clin Microbiol. 1985 Dec;22(6):1030–1034. doi: 10.1128/jcm.22.6.1030-1034.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Bouvet A., van de Rijn I., McCarty M. Nutritionally variant streptococci from patients with endocarditis: growth parameters in a semisynthetic medium and demonstration of a chromophore. J Bacteriol. 1981 Jun;146(3):1075–1082. doi: 10.1128/jb.146.3.1075-1082.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Carey R. B., Brause B. D., Roberts R. B. Antimicrobial therapy of vitamin B6-dependent streptococcal endocarditis. Ann Intern Med. 1977 Aug;87(2):150–154. doi: 10.7326/0003-4819-87-2-150. [DOI] [PubMed] [Google Scholar]
  7. Carey R. B., Gross K. C., Roberts R. B. Vitamin B6-dependent Streptococcus mitior (mitis) isolated from patients with systemic infections. J Infect Dis. 1975 Jun;131(6):722–726. doi: 10.1093/infdis/131.6.722. [DOI] [PubMed] [Google Scholar]
  8. Carlier J. P., Bouvet A. Fermentation products of nutritionally variant streptococci: additional evidence for their classification in the genus Streptococcus. Res Microbiol. 1989 Feb;140(2):119–123. doi: 10.1016/0923-2508(89)90045-4. [DOI] [PubMed] [Google Scholar]
  9. Cayeux P., Acar J. F., Chabbert Y. A. Bacterial persistence in streptococcal endocarditis due to thiol-requiring mutants. J Infect Dis. 1971 Sep;124(3):247–254. doi: 10.1093/infdis/124.3.247. [DOI] [PubMed] [Google Scholar]
  10. Chengappa M. M., Bailie W. E., Stowe E. C. Isolation and characterization of nutritionally variant streptococci from animal sources. Am J Vet Res. 1984 Nov;45(11):2445–2447. [PubMed] [Google Scholar]
  11. Clark R. B., Gordon R. E., Bottone E. J., Reitano M. Morphological aberrations of nutritionally deficient streptococci: association with pyridoxal (vitamin B6) concentration and potential role in antibiotic resistance. Infect Immun. 1983 Oct;42(1):414–417. doi: 10.1128/iai.42.1.414-417.1983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Cooksey R. C., Swenson J. M. In vitro antimicrobial inhibition patterns of nutritionally variant streptococci. Antimicrob Agents Chemother. 1979 Oct;16(4):514–518. doi: 10.1128/aac.16.4.514. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Cooksey R. C., Thompson F. S., Facklam R. R. Physiological characterization of nutritionally variant streptococci. J Clin Microbiol. 1979 Sep;10(3):326–330. doi: 10.1128/jcm.10.3.326-330.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Coto H., Berk S. L. Endocarditis caused by Streptococcus morbillorum. Am J Med Sci. 1984 May-Jun;287(3):54–58. doi: 10.1097/00000441-198405000-00019. [DOI] [PubMed] [Google Scholar]
  15. Dykstra M. A., Polly S. M., Sanders C. C., Chastain D. E., Sanders W. E., Jr Vitamin B6-dependent Streptococcus mimicking fungi in a patient with endocarditis. Am J Clin Pathol. 1983 Jul;80(1):107–110. doi: 10.1093/ajcp/80.1.107. [DOI] [PubMed] [Google Scholar]
  16. Eisenberg F. P., Lorber B., Suh B., McDonough M. T. Case report: prosthetic valve endocarditis due to a nutritionally variant streptococcus. Am J Med Sci. 1985 Jun;289(6):249–250. doi: 10.1097/00000441-198506000-00008. [DOI] [PubMed] [Google Scholar]
  17. FRENKEL A., HIRSCH W. Spontaneous development of L forms of streptococci requiring secretions of other bacteria or sulphydryl compounds for normal growth. Nature. 1961 Aug 12;191:728–730. doi: 10.1038/191728a0. [DOI] [PubMed] [Google Scholar]
  18. Facklam R. R., Thacker L. G., Fox B., Eriquez L. Presumptive identification of streptococci with a new test system. J Clin Microbiol. 1982 Jun;15(6):987–990. doi: 10.1128/jcm.15.6.987-990.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Feder H. M., Jr, Olsen N., McLaughlin J. C., Bartlett R. C., Chameides L. Bacterial endocarditis caused by vitamin B6-dependent viridans group Streptococcus. Pediatrics. 1980 Aug;66(2):309–312. [PubMed] [Google Scholar]
  20. Frehel C., Hellio R., Cremieux A. C., Contrepois A., Bouvet A. Nutritionally variant streptococci develop ultrastructural abnormalities during experimental endocarditis. Microb Pathog. 1988 Apr;4(4):247–255. doi: 10.1016/0882-4010(88)90085-x. [DOI] [PubMed] [Google Scholar]
  21. George M., van de Rijn I. Nutritionally variant streptococcal serotype I antigen. Characterization as a lipid-substituted poly(ribitol phosphate). J Immunol. 1988 Mar 15;140(6):2008–2015. [PubMed] [Google Scholar]
  22. George M., van de Rijn I. Purification of serotype I antigen from nutritionally variant streptococci. Infect Immun. 1988 May;56(5):1222–1231. doi: 10.1128/iai.56.5.1222-1231.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. George R. H. The isolation of symbiotic streptococci. J Med Microbiol. 1974 Feb;7(1):77–83. doi: 10.1099/00222615-7-1-77. [DOI] [PubMed] [Google Scholar]
  24. Gephart J. F., Washington J. A., 2nd Antimicrobial susceptibilities of nutritionally variant streptococci. J Infect Dis. 1982 Oct;146(4):536–539. doi: 10.1093/infdis/146.4.536. [DOI] [PubMed] [Google Scholar]
  25. Gill V. J., Williams D. Usefulness of pyridoxal-containing blood agar as a primary plating medium to enhance recovery of nutritionally deficient streptococci. Diagn Microbiol Infect Dis. 1988 Feb;9(2):119–121. doi: 10.1016/0732-8893(88)90105-8. [DOI] [PubMed] [Google Scholar]
  26. Gross K. C., Houghton M. P., Roberts R. B. Evaluation of blood culture media for isolation of pyridoxal-dependent Streptococcus mitior (mitis). J Clin Microbiol. 1981 Sep;14(3):266–272. doi: 10.1128/jcm.14.3.266-272.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Henry N. K., Wilson W. R., Roberts R. B., Acar J. F., Geraci J. E. Antimicrobial therapy of experimental endocarditis caused by nutritionally variant viridans group streptococci. Antimicrob Agents Chemother. 1986 Sep;30(3):465–467. doi: 10.1128/aac.30.3.465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Higgins R., Biberstein E. L., Jang S. S. Nutritionally variant streptococci from corneal ulcers in horses. J Clin Microbiol. 1984 Dec;20(6):1130–1134. doi: 10.1128/jcm.20.6.1130-1134.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Holloway Y., Dankert J. Penicillin tolerance in nutritionally variant streptococci. Antimicrob Agents Chemother. 1982 Dec;22(6):1073–1075. doi: 10.1128/aac.22.6.1073. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Kocka F. E., Chittom A. L., Sanders L., Hernandez L., Soriano E., Jacobs N., Carey R. B. Nutritionally variant Streptococcus pyogenes from a periorbital abscess. J Clin Microbiol. 1987 Apr;25(4):736–737. doi: 10.1128/jcm.25.4.736-737.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Koshi G., Lalitha M. K. Satelliting streptococci causing infective endocarditis--a short communication. Indian J Med Res. 1978 Apr;67:538–541. [PubMed] [Google Scholar]
  32. Levine J. F., Hanna B. A., Pollock A. A., Simberkoff M. S., Rahal J. J., Jr Penicillin sensitive nutritionally variant streptococcal endocarditis: relapse after penicillin therapy. Am J Med Sci. 1983 Jul-Aug;286(1):31–36. doi: 10.1097/00000441-198307000-00005. [DOI] [PubMed] [Google Scholar]
  33. McCarthy L. R., Bottone E. J. Bacteremia and endocarditis caused by satelliting streptococci. Am J Clin Pathol. 1974 May;61(5):585–591. doi: 10.1093/ajcp/61.5.585. [DOI] [PubMed] [Google Scholar]
  34. Narasimhan S. L., Weinstein A. J. Infective endocarditis due to a nutritionally deficient streptococcus. J Pediatr. 1980 Jan;96(1):61–62. doi: 10.1016/s0022-3476(80)80327-1. [DOI] [PubMed] [Google Scholar]
  35. Peterson C. E., Cook J. L., Burke J. P. Media-dependent subculture of nutritionally variant streptococci. Am J Clin Pathol. 1981 Apr;75(4):634–636. doi: 10.1093/ajcp/75.4.634. [DOI] [PubMed] [Google Scholar]
  36. Pompei R., Caredda E., Piras V., Serra C., Pintus L. Production of bacteriolytic activity in the oral cavity by nutritionally variant streptococci. J Clin Microbiol. 1990 Jul;28(7):1623–1627. doi: 10.1128/jcm.28.7.1623-1627.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Pulvirenti J., Dorigan F., Chittom A. L., Kallick C., Kocka F. E. Vaginitis caused by nutritionally variant Streptococcus pyogenes. Eur J Clin Microbiol Infect Dis. 1988 Feb;7(1):56–57. doi: 10.1007/BF01962175. [DOI] [PubMed] [Google Scholar]
  38. Reimer L. G. Measurement of serum bactericidal activity and use of vancomycin for treatment of nutritionally variant streptococcal bacteremia. Diagn Microbiol Infect Dis. 1987 Apr;6(4):319–322. doi: 10.1016/0732-8893(87)90182-9. [DOI] [PubMed] [Google Scholar]
  39. Reimer L. G., Reller L. B. Effect of pyridoxal on growth of nutritionally variant streptococci and other bacteria on sheep blood agar. Diagn Microbiol Infect Dis. 1983 Dec;1(4):273–275. doi: 10.1016/0732-8893(83)90002-0. [DOI] [PubMed] [Google Scholar]
  40. Reimer L. G., Reller L. B. Growth of nutritionally variant streptococci on common laboratory and 10 commercial blood culture media. J Clin Microbiol. 1981 Sep;14(3):329–332. doi: 10.1128/jcm.14.3.329-332.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Roberts K. B., Sidlak M. J. Satellite streptococci. A major cause of "negative" blood cultures in bacterial endocarditis? JAMA. 1979 May 25;241(21):2293–2294. doi: 10.1001/jama.241.21.2293. [DOI] [PubMed] [Google Scholar]
  42. Roberts R. B., Krieger A. G., Schiller N. L., Gross K. C. Viridans streptococcal endocarditis: the role of various species, including pyridoxal-dependent streptococci. Rev Infect Dis. 1979 Nov-Dec;1(6):955–966. doi: 10.1093/clinids/1.6.955. [DOI] [PubMed] [Google Scholar]
  43. Sherman S. P., Washington J. A., 2nd Pyridoxine inhibition of a symbiotic streptococcus. Am J Clin Pathol. 1978 Oct;70(4):689–690. doi: 10.1093/ajcp/70.4.689. [DOI] [PubMed] [Google Scholar]
  44. Stein D. S., Libertin C. R. A double-blinded comparative evaluation of three media for chromophore testing with viridans and nutritionally variant (deficient) streptococci. Am J Clin Pathol. 1989 May;91(5):589–593. doi: 10.1093/ajcp/91.5.589. [DOI] [PubMed] [Google Scholar]
  45. Stein D. S., Libertin C. R. Enzymatic extraction and spectral analysis of the chromophore from cell walls of nutritionally deficient streptococci. J Clin Microbiol. 1989 Jan;27(1):207–209. doi: 10.1128/jcm.27.1.207-209.1989. [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Stein D. S., Libertin C. R. Molecular analysis of viridans and nutritionally deficient (variant) streptococci causing sequential episodes of endocarditis in a patient. Am J Clin Pathol. 1989 May;91(5):620–624. doi: 10.1093/ajcp/91.5.620. [DOI] [PubMed] [Google Scholar]
  47. Stein D. S., Libertin C. R. Time kill curve analysis of vancomycin and rifampin alone and in combination against nine strains of nutritionally deficient streptococci. Diagn Microbiol Infect Dis. 1988 Jul;10(3):139–144. doi: 10.1016/0732-8893(88)90032-6. [DOI] [PubMed] [Google Scholar]
  48. Stein D. S., Nelson K. E. Endocarditis due to nutritionally deficient streptococci: therapeutic dilemma. Rev Infect Dis. 1987 Sep-Oct;9(5):908–916. doi: 10.1093/clinids/9.5.908. [DOI] [PubMed] [Google Scholar]
  49. Thornsberry C., Swenson J. M., Baker C. N., McDougal L. K., Stocker S. A., Hill B. C. Methods for determining susceptibility of fastidious and unusual pathogens to selected antimicrobial agents. Diagn Microbiol Infect Dis. 1988 Mar;9(3):139–153. doi: 10.1016/0732-8893(88)90024-7. [DOI] [PubMed] [Google Scholar]
  50. Tillotson G. S. Evaluation of ten commercial blood culture systems to isolate a pyridoxal-dependent streptococcus. J Clin Pathol. 1981 Aug;34(8):930–934. doi: 10.1136/jcp.34.8.930. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Weinberg M. S., Ellis C. A., Levy S. B. Nutritionally deficient Streptococcus: investigation of the hidden culprit in culture-negative endocarditis. South Med J. 1980 Dec;73(12):1647–1649. [PubMed] [Google Scholar]
  52. Wofsy D. Culture-negative septic arthritis and bacterial endocarditis. Diagnosis by synovial biopsy. Arthritis Rheum. 1980 May;23(5):605–607. doi: 10.1002/art.1780230513. [DOI] [PubMed] [Google Scholar]
  53. van de Rijn I. Analysis of cross-protection between serotypes and passively transferred immune globulin in experimental nutritionally variant streptococcal endocarditis. Infect Immun. 1988 Jan;56(1):117–121. doi: 10.1128/iai.56.1.117-121.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. van de Rijn I., Bouvet A. Characterization of a pH-dependent chromophore from nutritionally variant streptococci. Infect Immun. 1984 Jan;43(1):28–31. doi: 10.1128/iai.43.1.28-31.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. van de Rijn I., George M., Bouvet A., Roberts R. B. Enzyme-linked immunosorbent assay for the detection of antibodies to nutritionally variant streptococci in patients with endocarditis. J Infect Dis. 1986 Jan;153(1):116–121. doi: 10.1093/infdis/153.1.116. [DOI] [PubMed] [Google Scholar]
  56. van de Rijn I., George M. Immunochemical study of nutritionally variant streptococci. J Immunol. 1984 Oct;133(4):2220–2225. [PubMed] [Google Scholar]
  57. van de Rijn I. Quantitative analysis of cell walls of nutritionally variant streptococci grown under various growth conditions. Infect Immun. 1985 Sep;49(3):518–522. doi: 10.1128/iai.49.3.518-522.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. van de Rijn I. Role of culture conditions and immunization in experimental nutritionally variant streptococcal endocarditis. Infect Immun. 1985 Dec;50(3):641–646. doi: 10.1128/iai.50.3.641-646.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]

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