SPORE FORMING GRAM POSITIVE RODS

Bacillus (aerobes): B. Cereus and B. Anthracis

Clostridia (anaerobes): C. Perfringens, C. Tetani, C. Bolulinum, C. Difficile

BACILLUS ANTHRACIS
CHARACTERISTICS
- Large gram + rods with square ends (boxcar-like)
- Aerobic
- Endospore forming (central or subterminal spores)
- Non motile
- Possesses antiphagocytic, poly-D-glutamate capsule
o (protein capsule of polypeptide)
o (others have a polysac. Capsule)
- Habitat is soil spores persist in soil for years
- Can be used as a potential biowarfare agent

ANTHRAX TOXIN
- Includes 3 protein components
o Protective agent (B- component): forms pores in human cell memb., allows entry of LF & EF (exotoxins)
o Lethal factor (LF): protease that kills cells
o Edema Factor (EF): adenylate cyclase which causes increase in intracellular cAMP
out pouring of fluid into extracellular space edema

DISEASE AND TRANSMISSION

- anthrax common in animals but rare in humans
- cutaneous anthrax
o humans infected cutaneously by traua to skin, allowing spores from animal products (eg. goat hair
(commonest) hides, bristles, wool) to enter
contact w/ infected animals
o clinical findings
incubation period: 1-15 days
painless ulcer w/ black eschar malignant pustule
papule papule w/ vesicle central necrosis eschar w/ erythematous border
edema is locally prominent
if untreated progresses to bacteremia and death

- pulmonary or inhalation anthraxe

o occurs when spores are inhaled
o moves to mediastinal lymph nodes causing a hemorrhagic mediastinitis
o clinical findings
pulmonary anthrax (wool sorters disease)
begins w/ non-specific resp. symptoms similar to influenza, esp. dry cough and
substernal pressure
rapidly progresses to
hemorrhagic mediastinitis
bloody pleural effusions
dyspnea, diaphoresis, cyanosis, facial edema
septic shock and death
mediastinal widening (on x rays)
hemorrhagic meningitis complication
 SPORE FORMING GRAM POSITIVE RODS

- gastrointestinal anthrax
o occurs when contaminated meat ingested
o clinical findings
rare and has high mortality rate
exotoxin causes necrotic lesions within the intestine
vomiting, abdominal pain, bloody diarrhea
LAB. DIAGNOSIS
- large, gram + rods in chains in smear
- aerobic growth on blood agar with non-hemolytic colonies
o (aka medusa head colonies)
- non-motile: in comparison to other bacillus species
- PCR
- Direct fluorescent antibody test

TREATMENT, PREVENTION
- CIPROFOLXACIN: drug of choice
o Alternative: doxycycline
- Vaccine containing purified protective antigen (acellular vaccine) given to individuals in high risk occupations

BACILLUS CEREUS
CHARACTERISTICS
- Aerobic, gram +, spore-forming rod
- Endospores form centrally within cells
- Habitat: grains eg. rice
- Endospores survive boiling, grow if rice is kept warm
- Portal of entry is GI tract

PATHOGENESIS AND CLINICAL FINDINGS

- Cholera-like enterotoxin
o Diarrheal toxin
o Increases cAMP, leading to efflux of water and Cl-
- Staphylococcus-like enterotoxin
o Emetic toxin
- 2 syndromes:
1. ENTERIC FORM: Short incubation period (1-6 hours); lasts 8-10 hours
Symp. Are nausea, severe vomiting and diarrhea (similar to staph. Aureus food poisoning)
Found in fried rice, Chinese restaurants
2. DIARRHEAL FORM: Longer incubation period (18 hours); lasts 20-36 hours
water, non-bloody diarrhea (clostridial gastroenteritis-like diarrhea)
associated with meats, sauces
MORE:
Lab. Diagnosis
- not done routinely diagnosed on clinical ground
- gram staining and culture of implicated food
Treatment
- Self-limiting symptomatic Rx.
Prevention
- no vaccine
- dont eat rice that has been kept warm for too long