Gram-Positive BacilliGram-Positive Bacilli

Prof. Dr. Asem ShehabiProf. Dr. Asem Shehabi

Faculty of MedicineFaculty of Medicine

University of JordanUniversity of Jordan

Corynebacteria Corynebacteria GroupGroup Gram-positive Pleomorphic Bacilli.. Diphteroides.. Gram-positive Pleomorphic Bacilli.. Diphteroides..

Aerobic, Normal Flora, Respiratory-Urinary tract, Aerobic, Normal Flora, Respiratory-Urinary tract, Skin.. Mostly Nonpathogenic.Skin.. Mostly Nonpathogenic.

Corynebacterium diphtheriaeCorynebacterium diphtheriae: : Highly infectious & Highly infectious & Human Pathogenic.. Spread by Droplets Carriers/ Human Pathogenic.. Spread by Droplets Carriers/ Clinical cases.. Inflammation.. Necrosis.. Throat-Clinical cases.. Inflammation.. Necrosis.. Throat-Pharynx-Larynx.. Diphtheria Toxin.. Lysogenic Pharynx-Larynx.. Diphtheria Toxin.. Lysogenic Strains.. High Fatality.. Antibiotics. Strains.. High Fatality.. Antibiotics.

Diphteria Antitoxin Serum, Diphteria Toxoid (Diphteria Antitoxin Serum, Diphteria Toxoid (Triple Triple Vaccine, DTPVaccine, DTP) 2-4-6 Months Children . ) 2-4-6 Months Children .

Lab DiagnosisLab Diagnosis: Albert's stain Direct Smear & Throat : Albert's stain Direct Smear & Throat culture.. Tellurite Blood Medium.. Toxin test of culture.. Tellurite Blood Medium.. Toxin test of C.diphtheria C.diphtheria isolates.isolates.

Corynebacteria-Bacillus speciesCorynebacteria-Bacillus species

Spore Forming BacilliSpore Forming Bacilli Gram+ve Spore-forming small/Large Bacilli .. Gram+ve Spore-forming small/Large Bacilli ..

Aerobic/AnaerobicAerobic/Anaerobic.. Survive Long Period in Dryness.. .. Survive Long Period in Dryness.. Resist boiling temperature..Common in Nature.. Soil, Resist boiling temperature..Common in Nature.. Soil, Dust, Vegetations, Human /Animal Intestines, Feces & Dust, Vegetations, Human /Animal Intestines, Feces & Water.. Mostly Saprophytes..Putrefaction of organic Water.. Mostly Saprophytes..Putrefaction of organic compounds.. Few Pathogenic for humans/Animals.. compounds.. Few Pathogenic for humans/Animals.. Rapid growth 24-48h Rapid growth 24-48h

Aerobic Bacilli Group:Aerobic Bacilli Group: Bacillus cereusBacillus cereus: Contamination Food ( Rice, Meat, : Contamination Food ( Rice, Meat,

Fish, Dairy products).. Heat-stable Enterotoxin.. Food-Fish, Dairy products).. Heat-stable Enterotoxin.. Food-poisoning: Incubation Period.. 1-24 Hrs, Vomiting & poisoning: Incubation Period.. 1-24 Hrs, Vomiting & Diarrhea, No Fever..No Need for Antibiotic..Very rare Diarrhea, No Fever..No Need for Antibiotic..Very rare invasive infections.invasive infections.

Aerobic BacilliAerobic Bacilli

B. subtilisB. subtilis: Opportunistic Pathogen.. Wound : Opportunistic Pathogen.. Wound infect ..Sepsis.. Infant.. Immunocompromid Patients.infect ..Sepsis.. Infant.. Immunocompromid Patients.

B. anthracisB. anthracis: : Polypeptide Capsule.. Potent virulence Polypeptide Capsule.. Potent virulence factors.. Common cause of intestinal FATAL disease factors.. Common cause of intestinal FATAL disease in animals.. Human Cutaneous Anthrax- Lesions.. in animals.. Human Cutaneous Anthrax- Lesions.. Inhalation Inhalation B. anthracis B. anthracis spores causes spores causes hemorrhagic hemorrhagic Pneumonia & SepticemiaPneumonia & Septicemia, High mortality..Biological , High mortality..Biological War Agent.War Agent.

Lab DiagnosisLab Diagnosis: Culture Specimens.. Skin Ulcer.. : Culture Specimens.. Skin Ulcer.. Rare Blood / SputumRare Blood / Sputum .. Culture on Blood & Chocolate .. Culture on Blood & Chocolate Agar.. Agar..

Clostridia-1Clostridia-1

2- Anaerobic Clostridia Group2- Anaerobic Clostridia Group:: Spore forming bacilli.. Exo- Spore forming bacilli.. Exo- Enterotoxins.. Heat-Stable /Labile .. Exo-& Endogenous Enterotoxins.. Heat-Stable /Labile .. Exo-& Endogenous Infection.. High Fatality without Treatment.Infection.. High Fatality without Treatment.

Clostridium tetaniClostridium tetani:: Tetanus highly fatal disease .. Without Tetanus highly fatal disease .. Without treatment .. Localized infection/-Surface -Deep Tissue treatment .. Localized infection/-Surface -Deep Tissue injurey ..Release potent neurotoxin (injurey ..Release potent neurotoxin (Tetanus toxinTetanus toxin / / tetanospasmintetanospasmin) produced when spores germinate and ) produced when spores germinate and vegetative cells grow in necrotic tissues. The organism vegetative cells grow in necrotic tissues. The organism multiplies locally and symptoms appear remote from the multiplies locally and symptoms appear remote from the infection site.infection site.

Treatment:Treatment: Surgical Debridement.. Antibiotics.. Tetanus Surgical Debridement.. Antibiotics.. Tetanus Vaccine. Vaccine.

Lab Diagnosis:Lab Diagnosis: Specimens from damaged Tissues.. Direct Specimens from damaged Tissues.. Direct Gram-stain.. Culture on blood & chocolate agarGram-stain.. Culture on blood & chocolate agar

Clostridium tetani- Clostridium tetani- Cl.perfingensCl.perfingens

Clostridia-2Clostridia-2

Clostridium perfringensClostridium perfringens & Others& Others SpeciesSpecies:: Toxigenic & Invasive .. Toxigenic & Invasive .. Endo-Exo Infections.. Enzymes (Collagenese, Hyaluronidase,Toxins). Contamination Deep Wounds.. Bacteremia.. Gasgangrene- Myonecrosis- Cellulitis..

Treatment: Surgical Debridement/ Amputation & Antibiotics.. No Preventative Vaccine

A common cause of Food-Poisoning.. Enterotoxin.. Incub 6-24 Hrs.. Intense Watery Diarrhea.. No Fever Lab Diagnosis: Culture Specimens: Aspirated Fluid

Wound/Blood

Wound Infection with MixedWound Infection with Mixed Clostridia & Other Bacteria Clostridia & Other Bacteria

Clostridia-3Clostridia-3

C .botulinum : Food-borne botulism is intoxication .. Ingestion of foods contain preformed toxin.. Heat-Stable Exotoxins..20min /100C.

Contamination Canned Food.. Meat, Fish, Beans. Botulism:Botulism: Clinical symptoms begin 8-36 hours after Clinical symptoms begin 8-36 hours after

toxin ingestion with weakness, dizziness, dryness toxin ingestion with weakness, dizziness, dryness mouth, Nausea, Neurologic features.. blurred vision, mouth, Nausea, Neurologic features.. blurred vision, inability to swallow, difficulty in speech, weakness of inability to swallow, difficulty in speech, weakness of skeletal muscles and Respiratory Paralysis.. Inhibition skeletal muscles and Respiratory Paralysis.. Inhibition the release of the neurotransmitter acetylcholine.. the release of the neurotransmitter acetylcholine.. No Fever. .

Diagnosis & treatmentDiagnosis & treatment: Clinical Features.. Difficult to : Clinical Features.. Difficult to detect toxin..antitoxin serum..support therapy. detect toxin..antitoxin serum..support therapy.

Clostridia-4Clostridia-4 Clostridium difficileClostridium difficile: Human intestines..Healthy : Human intestines..Healthy

Carriers .. Endo.. Common Nosocomial Carriers .. Endo.. Common Nosocomial Infection..Antibiotic usageInfection..Antibiotic usage

Produces two toxins: Toxin A is enterotoxin .. causes Produces two toxins: Toxin A is enterotoxin .. causes fluid accumulation in the Intestinesl. Toxin B is an fluid accumulation in the Intestinesl. Toxin B is an extremely lethal (cytopathic) toxin. extremely lethal (cytopathic) toxin.

Pseudomembranous ColitisPseudomembranous Colitis.. .. Bloody Diarrhea.. Bloody Diarrhea.. AntibioticAssociated diarrhea (Amoxicillin, AntibioticAssociated diarrhea (Amoxicillin, Lincomycin-Lincomycin-Clindymicin, Cephalosporines) .. Long Treatment.. Clindymicin, Cephalosporines) .. Long Treatment.. Fatal.. Fatal.. Treatment: Treatment: Stop used Antibiotics..replace by Stop used Antibiotics..replace by Metronidazole or vancomycinMetronidazole or vancomycin

Lab DiagnosisLab Diagnosis: Identification of Toxins in Stool : Identification of Toxins in Stool Specimen by immunological test.. Less Culture Specimen by immunological test.. Less Culture