10 Bacillus & Clostridium
10 Bacillus & Clostridium
10 Bacillus & Clostridium
Overview
Endospores
Formed when cells are unable to grow (when environmental conditions change or when nutrients are exhausted)
Made up of a complex multilayered coat surrounding a new bacterial cell
Presence of dipicolinic acid & high calcium content (confer extreme resistance to heat & chemicals)
Can remain viable in a dormant state for many years
SPORULATION: triggered by near depletion of nutrients (carbon, nitrogen, phosphorous)
Involves the production of many new structures, enzymes & metabolites along with the disappearance of many
vegetative cell components
Axial filament formation forespore septum formation engulfment of forespore cortex synthesis coat
deposition maturation lysis of mother cell
Properties of endospore:
1. Core
2. Spore Wall
3. Cortex
4. Coat
5. Exosporium
GERMINATION
1. ACTIVATION
2. INITIATION
3. OUTGROWTH
Important Diseases:
Anthrax (Bacillus anthracis)
Food poisoning (Bacillus cereus)
Tetanus (Clostridium tetani)
Gas gangrene (Clostridium perfringens)
Botulism (Clostridium botulinum)
Bacillus
Large, aerobic, Gram-positive rods occurring in chains
Most members are saprophytic organisms prevalent in soil, water & air and on vegetation ( Bacillus cereus, Bacillus subtilis)
Insect pathogens
Bacillus cereus grow in foods, produce enterotoxin or an emetic toxin food poisoning; produce disease in
immunocompromised humans (e.g. meningitis, endocarditis, endophthalmitis, conjunctivitis, acute gastroenteritis)
Bacillus anthracis causes anthrax
MORPHOLOGY & IDENTIFICATION
Typical cells: (1 x 3-4 mm) have SQUARE ENDS, arranged in long chains, spores located at the CENTER of a
nonmotile bacteria
Culture: round, “cut glass” /“ground-glass” appearance in transmitted light
Hemolysis Uncommon with B. anthracis
Gelatin is liquefied
Growth in gelatin stabs resembles an INVERTED FIR TREE
Growth Characteristics:
saprophytic bacilli utilize simple sources of nitrogen & carbon for energy & growth
spores are resistant to environmental changes, withstand dry heat, & certain chemical
disinfectants for moderate periods; persist for years in dry earth
Virulent strains are pathogenic for animals, encapsulated, with a capsule composed of poly-D-
glutamic acid
Aerobic anthrax bacteria grow well on blood agar media after overnight incubation at 35oC
without CO2
Characteristic colonies (2-5 mm) have a “ground-glass” appearance; nonhemolytic,
nonpigmented, edge-irregular with comma projections (“Medusa head”colonies)
On gelatin medium, inverted pine tree/ fir tree growth is seen
In PLET (Polymyxin Lysozome Ethylenediamine Tetraacetate, colonies stand-up like beaten
egg whites when pushed and lifted with an inoculating needle
or by inhalation of spores into the lung (inhalational anthrax) handling wools or animal hides
LETHAL TOXIN
Specific endopeptidase that cleaves the kinase family of proteins and interferes with intracellular
signaling
Targets the macrophages, causing hemorrhagic necrosis in the lymph nodes, resulting in the release of
large numbers of B anthracis
Treatment
Must be started early
Ciprofloxacin recommended
Two or more antimicrobial agents predicted to be effective recommended
Treatment of systemic B anthracis infection with penicillins, cephalosporins or TMP-SMX is not recommended
because bioterrorism-related strains may be resistant to these drugs
Supportive care includes controlling pleural effusions
Prophylaxis
Ciprofloxacin or Doxycycline
Given for 4 weeks while 3 doses of vaccine is being given
Given for 8 weeks if no vaccine
Prevention
Clinical suspicion should be high for bioterrorism-related inhalational anthrax
In the event of a presumptive bioterrorism event, medical personnel must be alert to coordinate testing, packaging &
transporting with the public health laboratory (obtain appropriate specimens)
Suspected or confirmed anthrax cases must be reported immediately to local or state departments of health
Direct contact with wound or wound drainage should be avoided
Disposal of animal carcasses by burning or by deep burial in lime pits
Decontamination (autoclaving) of animal products
Protective clothing & gloves for handling potentially infected materials
Active immunization of domestic animals with live attenuated vaccines
Immunization of persons with high occupational risk
Bacillus cereus
FOOD POISONING
Emetic type – associated with fried rice
Begins 1-5 (mean 2) hours after ingestion of rice, pasta dishes
Nausea, vomiting, abdominal cramps, occasional diarrhea
Self-limiting; recovery within 24 hours
Soil organism that commonly contaminates rice
When large amount of rice is cooked and allowed to cool slowly, spores germinate & vegetative cells
produce the toxin (heat stable) during log-phase growth or during sporulation
Diarrheal type – associated with meat dishes &sauces
Incubation period: 1-24 hours (mean 9)
Profuse diarrhea with abdominal pain and cramps
Fever & vomiting uncommon
Enterotoxin (heat labile) may be preformed in the food or produced in the intestine
Produces toxins that cause disease intoxication > food-borne infection
Diagnostic: concentration of 105 bacteria or more/ gram of food
EYE INFECTIONS
Severe keratitis
Endophthalmitis Associated with trauma
Panophthalmitis
SYSTEMIC INFECTIONS
Endocarditis
Meningitis Predisposed by presence
Osteomyelitis of medical device or IV drug use
Pneumonia
Colony Forms
Some clostridia produce large raised colonies (C. perfringens)
Some produce smaller colonies (C. tetani)
Some form colonies that spread on the agar surface
C perfringens produces multiple zones of hemolysis around colonies
Double zone
-hemolysis
Growth Characteristics
Can ferment a variety of sugars; many can digest proteins
Milk is turned acid by some, digested by others & undergoes “stormy fermentation” (clot torn by gas)
Various enzymes produced by different species
With peritrichous flagella except: C. perfirngens, C. ramosum, C.innoculum
All have swollen sporangia except: C. perfringens, C.bifermentans
All are non-encapsulated except: C. perfringens
All are single hemolytic except: C. perfringens (double zone)
Classification
Histotoxic group/Gas Gangrene
o Tissue death due to ischemia (lack of blood flow)
o Cause sever infection of the muscle termed as clostridial myonecrosis
Clostridium perfringens
Toxigenic group
o Clostridium tetani
o Clostridium botulinum
SNARE proteins
Synaptobrevin
Cleaved by toxin B
SNAP 25
Cleaved by toxins A and E
Syntaxin
C. botulinum toxins are among the most toxic substances known
3 kinds of botulism:
Infant botulism (72%) Floppy Baby Syndrome
is caused by swallowing the spores, which then grow inside of the infant's intestines and release toxin
Causes SIDS by feeding contaminated “honey”, corn syrup
Foodborne botulism (25%)
is caused by eating foods that contain the botulinum toxin
spiced, smoked, vacuum-packed, home-canned alkaline (pH >4.6) foods (fruits, sausage, fish products)
“bulging” cans
Wound botulism (3%)
is caused by a nerve toxin produced from an infected wound
CLINICAL FINDINGS
- symptoms begin 18-24 hours after ingestion of the toxic food
- visual disturbances (incoordination of eye muscles, double vision)
- inability to swallow & speech difficulty
- respiratory paralysis & cardiac arrest
- GI symptoms not regularly prominent
- (-) fever
- conscious until shortly before death
- high mortality
- Patients who recover do not develop antitoxin in the blood
- Infant botulism: poor feeding, weakness, signs of paralysis (floppy baby), may be a cause of sudden infant death
syndrome
-
Clinical Findings:
Contaminated wound:
crepitation in the subcutaneous tissue & muscle
foul-smelling discharge
rapidly progressing necrosis
Fever
Hemolysis
Toxemia
Shock
Death
Food poisoning:
Onset of diarrhea within 6-18 hours after ingestion of large inocula frown in warmed meat dishes
No vomiting & fever
Last only 1-2 days
Diagnostic Laboratory Tests:
Specimens:
material from wounds, pus, & tissue
Gram-stained smears:
presence of large gram-positive rods
spores not regularly present
Culture:
inoculated into chopped meat-glucose medium & thioglycolate medium & unto blood agar plates.
incubated anaerobically
Culture:
a clot torn by gas in 24 hrs when the growth from one media is transferred into milk
Identified by chemical reactions (various sugars in thioglycolate, action on milk), hemolysis, colony form
lecithinase activity evaluated by the precipitate formed around colonies on egg yolk media
Final identification rests on toxin production and neutralization by specific antitoxin
Reverse camp test
Treatment
prompt and extensive surgical debridement of the involved area, excision of all devitalized tissue
administration of antimicrobial drugs, particularly penicillin
hyperbaric oxygen
Antitoxins
food poisoning due to enterotoxin requires symptomatic care only
Prevention and Control
early & adequate cleansing of contaminated wounds
surgical debridement
antimicrobial drugs
antitoxins