A child had pustular lesion on leg. On gram staining gram positive cocci are seen. To establish the diagnosis of Group A beta streptococcal pyoderma, the test used is:
**Core Concept**
Group A beta streptococci (GABHS) are gram-positive cocci that can cause pyoderma, a type of skin infection characterized by pustules and pus-filled lesions. To differentiate GABHS from other streptococcal species, a specific test is employed.
**Why the Correct Answer is Right**
Bacitracin sensitivity testing is the preferred method for identifying Group A beta streptococci. This test exploits the unique susceptibility of GABHS to bacitracin, a polypeptide antibiotic. When a GABHS isolate is streaked onto a bacitracin-containing agar plate, growth inhibition occurs due to the bacteriocidal effect of bacitracin. This characteristic reaction is diagnostic for GABHS. The mechanism involves the inhibition of cell wall synthesis, leading to the death of the bacteria.
**Why Each Wrong Option is Incorrect**
**Option A:** Bile solubility test is used to differentiate pneumococci (Streptococcus pneumoniae) from other streptococci, as pneumococci are bile soluble. This test is not applicable to GABHS.
**Option B:** Catalase test is used to differentiate streptococci (catalase-negative) from staphylococci (catalase-positive). While this test can help identify streptococci, it does not specifically differentiate between different species of streptococci, including GABHS.
**Option C:** Optochin sensitivity is used to differentiate pneumococci (optochin-sensitive) from other streptococci. GABHS is optochin-resistant, making this test unsuitable for identifying GABHS.
**Clinical Pearl / High-Yield Fact**
When suspecting Group A beta streptococcal pyoderma, remember that a positive bacitracin sensitivity test is diagnostic, but a negative test does not rule out the diagnosis, as some GABHS isolates may be bacitracin-resistant.
**✓ Correct Answer:** D. Bacitracin sensitivity