Академический Документы
Профессиональный Документы
Культура Документы
I. Bacillus anthracis
Capsule. Important virulence factor. Inhibits phagocytosis. Found in clinical specimens but not always on laboratory
media.
Exotoxin. Protein complex. Composed of:
1. Protective antigen.
2. Oedema factors.
3. Lethal factors.
Increase vascular permeability & lead to shock.
Virulence dependent on presence of two Plasmids. One codes for the capsule & the other the toxin. Must be
present in virulent strains.
C. Epidemiology
D. Clinical Infections.
Gastrointestinal anthrax.
Rare mode of transmission.
Outbreaks follow ingestion of spores from contaminated meat.
Clinical symptoms depend on site of infection.
Invasion of upper intestinal tract results in formation of ulcers in mouth or oesophagus lead to regional
lymphadenopathy, oedema & sepsis.
Bacteria in the caecum or terminal ileum result in symptoms of nausea, vomiting and malaise which progress to
systemic disease.
Haemorrhagic diarrhoea and death.
Mortality rate as high as 100%.
E. Laboratory diagnosis.
1. Specimens: Skin or Fluid from vesicles, sputum, faeces or blood.
2. Microscopy: Gram-positive, large rectangular bacilli. Stains from cultures show long chains with spores.
• Fluorescent Staining: Rapid detection.
3. Culture: Blood Agar shows large, waxy, irregular, grey colonies. Nutrient agar show “Medusa” head colonies.
4. Confirmatory Tests: Non-motile, Gelatin liquification.
5. Serological tests: ELISA. Retrospective value, NOT useful for rapid diagnosis.
6. Animal virulence tests: Used previously.
7. Toxin production tests:
8. PCR. Rapid detection.
F. Treatment.
1. First choice: Ciprofloxacin.
2. Alternative drugs: Penicillin, Erythromycin, tetracyclines or chloramphenicol after suitable anti-microbial testing.
******
II. Bacillus cereus : Food poisoning.
A. Morphology
Morphology & characteristics like B.anthracis.
Differs, is motile & lacks glutamic acid capsule.
Saprohyte: In vegetation, soil & water.
Spores are heat resistant & most strains produce toxins.
Associated with foods such as cereals and specially rice.
Produces food-borne intoxication.
Frequently associated with “Chinese food”.
B. Clinical symptoms.
2. Diarrhoeal Disease:
• Diarrhoea about 8-24 h after ingestion.
• Action of enterotoxins.
• Heat labile.
• Formed in intestine following ingestion. These toxins are similar to toxins produced by Salmonella and E.coli.
• Foods involved are; contaminated meat, vegetables and sauces.
• Symptoms: Diarrhoea, nausea and abdominal cramps.
1. Specimen:
Food if available.
Faeces not useful because colonization is common. Faecal isolation in cluster of cases may be useful.
2. Microscopy:
Gram-positive bacilli with spores.
3. Culture:
Blood agar.
Show large numbers of organisms present per gram of food >108.
Treatment.
Self-limiting disease.
Treatment - Fluid & electrolyte replacement.
Antibiotics not required.
Control.
Disease prevented by proper cooling and storage of food.
Ideally use fresh food.
Adequate heating when using previously prepared foods.
Motile No Yes
******
Clostridium species
Characteristics.
B. Pathogenesis.
C.tetani produces tetanus “lock jaw” syndrome.
Drum stick appearance (terminal spores).
Highly motile (peritrichious flagella).
Spores enter through wound. Superficial abrasions, Puncture, Gunshots, burns or animal bite. Post-operative wounds
& in babies umbilical stump infection “Tetanus neonatarum”.
Not invasive disease. Remains in localised area of tissue.
Require anaerobic environment to germinate and grow.
Antigens: Many serotypes all produce same exotoxin. Immunity directed against exotoxin.
Toxin producing strains have large plasmid. Loss of plasmid converts to a non-virulent strain.
C. Virulence Factors.
D. Clinical symptoms.
4.Neonatal tetanus: “Tetanus neonatarum”. Umbilical stump infection can lead to generalised tetanus. Mortality rate more
than 90%.
E. Laboratory diagnosis.
F. Treatment.
1. Debridement of wound.
2. Metronidazole eliminate vegetative bacteria.
3. Passive immunisation with tetanus immunoglobulin (anti-toxic serum). Specially in un-vaccinated individuals or those
with out boosters.
4. Active immunisation: Vaccination with tetanus toxoid (DPT).
G. Prevention.
****
A. Characteristics
C.perfringens causative agent of gas gangrene.
Other species sometimes involved are; C.novyi, C.histolyticum & C.septicum.
Large, rectangular, Gram-positive bacilli.
Spores subterminal, not bulging, spores rarely in-vivo or in-vitro isolation.
Non-motile.
Culture: Haemolytic colonies on blood agar.
Ferments carbohydrates and produces gas.
Produces at least 12 different toxins and numerous enzymes as virulence factors.
Diseases: (1).Severe necrotising wound infection
(2).Self-limiting gastroenteritis.
(3).Severe haemorrhagic diarrhoea.
B. Virulence factors
1. Infection follows contamination of wounds with spores (invasive infection in damaged tissue).
2. Wounds could be result of; military casualties, automobile or farm equipment accidents.
3. Bacteria & spores found in human & animal excreta.
4. Spores indirectly derived from; dirty clothing, street dust or air in hospital operating theatres from poorly designed
ventilation system.
5. Bacteria germinate then secrete exotoxins & enzymes cause tissue destruction. Disease spreads rapidly in a necrotic
environment.
6. Bacteria ferment carbohydrates & produce gas in tissues.
F. Laboratory Diagnosis.
******
III. Clostridium botulinium.
A. Characteristics
C.botulinium found in soil & water globally.
Causative agent of “botulinium” food poisoning with canned or preserved food.
Heterogenous group. Fastidious,spore forming, anaerobic bacilli.
Motile with peritrichious flagella.
Spores are oval, bulging & sub-terminal.
Grows best 35–37°C. Some strains grow & produce toxin at low temperatures.
Spores survive boiling for hours. Killed by autoclaving.
Seven antigenically distinct toxins A – G. Human disease caused by A, B, E and F.
B. Pathogenesis
Botulism neurotoxin toxin the most poisonous natural substances.
1ml of culture fluid lethal for 2 million mice and 1µg lethal for humans.
Preformed neurotoxin is absorbed from GIT. NOT destroyed by intestinal enzymes.
After absorbtion into blood stream it binds irreversibly to presynaptic nerve endings of peripheral nervous system and
cranial nerves where it inhibits (neurotransmitter) acetylcholine release.
Also produces a binary toxin with two components that affect vascular permeability.
1. Foodborne botulism.
Neurotoxin present in food.
From preserved foods (often canned). Insufficient heating important cause in home canning.
Types A & B in home-canned foods & type E in preserved fish. Smoked, salted or spiced meat also involved.
Food does not look spoiled but small taste causes symptoms.
Incubation period 1-2 days (or longer).
Oculomotor muscles affected.
Initial symptoms; blurred vision, diplopia, drooping eye lids, dilated pupils, dry mouth, nausea, vomiting,
constipation & abdominal pain. Problems in speech & swallowing.
Signs of “bulbar” paralysis are progressive with weakness & sleepiness.
Death is due to respiratory or cardiac failure.
Mortality rate was as high as 70% now reduced to 10%.
2. Infant botulism
Bacteria from environment or food. Honey sometimes associated with this disease.
Colonises GIT of babies. Absence of normal flora helps colonisation.
Adults also exposed to C.botulinium but it cannot proliferate because of normal flora.
Neurotoxin produced in GIT of infants (different from foodborne disease).
Disease affects children less than 1 yr (usually 1-6 m).
Clinical symptoms non-specific. Include; constipation, weak cry and “failure to thrive”.
3. Wound Botulism
Wound botulism not always in serious wounds.
Even with minor wounds needs to considered in patients with typical symptoms.
Symptoms: Blurred vision, weakness and difficulty in swallowing. Abdominal symptoms less pronounced than in
food borne infections.
C. Laboratory Diagnosis.
Specimen: Food sample, faeces or vomit. Isolation from faeces improved by heating. Wound exudate or serum. Detect
bacteria or toxin.
Microscopy: Typical appearance.
Culture: Anaerobic culture on blood agar.
Confirmatory tests: Lipase production, Hydrolyse Gelatin, Ferment Glucose and digest milk products.
Toxin detection: Toxin –antitoxin neutralisation test. Detect toxin in food or in patient’s blood. Administered to mice
with and without anti-toxin. Small amounts of toxin are lethal for mice. Care should be taken in carrying out tests
because of virulence of toxin.
D. Treatment.
E. Control.
*******
IV. Clostridium difficile
B. Pathogenesis
C.difficile produces antibiotic associated gastrointestinal diseases ranging from mild self limiting diarrhoea to severe
life threatening ‘pseudomembranous colitis’.
Diarrhea may be watery or bloody with abdominal cramps, leukocytosis & fever.
Antibiotics particularly associated are clindamycin & ampicillin. Some cephalosporins also implicated and there is
virtually no antibiotic which is blame free.
Produces two toxins;
1. Toxin A: Potent Enterotoxin produces diarrhea & has cytotoxic activity binds to brush border membranes of the gut
at receptor sites.
2. Toxin B: Potent Cytoxin. Has lethal effects.
C. Laboratory diagnosis
Specimen collection, microscopy and culture on selective media.
Confirmatory test: Demonstrate the presence of toxin.
Both toxins can be detected in faecal samples.
Cytoxin (toxin B) shown in tissue culture cells.
D. Treatment.
E. Control.
1. Difficult as bacteria commonly exists in hospitals specially in areas near infected patients.
2. Spores difficult to destroy hence bacteria may survive in environment for months and is a major cause of nosocomial
outbreaks.
******