Академический Документы
Профессиональный Документы
Культура Документы
*Definition of terms:
bacterial growth in relation with respiratory
processes (use of O2, CO2)
Obligate aerobes need oxygen because they cannot
ferment or respire anaerobically (e.g. Mycobacterium
tuberculosis)
Fetid odour
Purulent aspect
Necrotic tissues
Gas (e.g. gas gangrene
wound infected by Clostridium
perfringens)
Endogenous nonsporulating
Gram negative bacilli:
Family Bacteroidaceae:
Bacteroides, Prevotella,
Prophyromonas,
Fusobacterium
Genus Clostridium;
Bacillus spp (B. anthracis).
Genus Clostridium
- Clinical significance Exogenous infections:
Gas gangrene
Tetanus
Botulism
Food poisoning
Endogenous infections:
Clostridium difficile
Clostridium perfringens
- Antimicrobial susceptibility Sensitivity to: penicillin G, erythromycin, ampicillin,
metronidazole
Natural resistance to tetracyclines
Endogenous nonsporulating
Gram negative bacilli:
Family Bacteroidaceae:
Bacteroides, Prevotella,
Prophyromonas,
Fusobacterium
Clostridium tetani
Clostridium botulinum
Clostridium difficile* (may
cause both exogenous and
endogenous infections)
Clostridium tetani
Habitat: intestinal tract of animals (sheep, cattle);
vegetative bacteria eliminated with faceces;
contamination of soil (spore formation)
Infection occurs via:
Skin lesions contaminated with spores e.g. wound highly
contaminated with dirt, dust; extensive wounds with crushed
tissues and foreign bodies (accidents);
spores germinate into vegetative bacteria which multiply at the
entry and produce tetanic toxin (disseminated) 2 components:
Tetanospasmin muscle spasms
Tetanolysin cardiotoxic
Clostridium tetani
Clinical significance:
Tetanus = Generalized tetanus (most comon form):
onset with trismus (spasms of the face and chewing muscles
popularly called lockjaw characteristic facial expression risus
sardonicus or sardonic grin);
further evolution: swallowing becomes increasingly difficult;
severe spastic hyperextension of head, neck and spine
(opisthotonos)
(effects of the tetanus exotoxin: tetanospasmin)
Tetanus
Vaccine preventable disease: several vaccines used to
prevent tetanus among children, adolescents, and
adults; e.g. combined vaccines against diphteria,
pertusis and tetanus (e.g. DTaP) or tetanus and diphteria
(e.g.TD) Immunization schedules
In Romania: tetanus containing vaccines given at the
ages of:
2, 4, 6, 13 months, 4 years (DTP) + 14 years (dT) +
(recommended) dT every 10 years
Clostridium tetani
Laboratory diagnosis only required in suspicion of
iatrogenic infections e.g. infection of umbilical cord
stump, post-partum infections, etc
In most cases diagnosis relies on clinical aspect and
history (tetanigenic circumstances e.g. wounds
contaminated with dirt, faeces, saliva, soil; puncture
wounds; animal bites, burns, frostbite)
IMPORTANT FACTS:
no human to human transmission
Vaccine preventable
Endogenous nonsporulating
Gram negative bacilli:
Family Bacteroidaceae:
Bacteroides, Prevotella,
Prophyromonas,
Fusobacterium
Clostridium botulinum
Clostridium difficile* (may
cause both exogenous and
endogenous infections)
Clostridium botulinum
- Clinical significance Foodborne Botulism:
Ingestion of botulinic toxin
contained in canned
vegetables, fish, meat (toxin
production generated gas
can lid appears
bulging/swollen)
Toxin resists gastric acidity,
enters the intestine lymph
vessels blood stream acts
on nervous system:
progressive flaccid paralysis
Wound botulism: i.v. / intradermic
drug users
Clostridium botulinum
- Clinical significance - continued
Onset symptoms: double
vision, blurred vision,
drooping eyelids, slurred
speech, difficulty
swallowing, dry mouth,
and muscle weakness
if untreated: descending
flaccid paralysis; death
by paralysis of respiratory
muscles
Treatment: botulinum
antitoxin asap!!
Clostridium botulinum
- Laboratory diagnosis Performed in reference
laboratories
Specimens: blood for
serology, vomit, faeces,
suspected food
Identification based on:
Gram stain: Gram positive
bacilli + spores;
anaerobic growth;
neurotoxin detection:
experimental disease in
mice; immunoassay;
molecular techniques
Endogenous nonsporulating
Gram negative bacilli:
Family Bacteroidaceae:
Bacteroides, Prevotella,
Prophyromonas,
Fusobacterium
Clostridium difficile
- Clinical significance
Clostridium difficile
- Prevention guidelines in clinical settings Examples:
http
://www.documents.hps.scot.nhs.uk/about-hps/hpn/clostridiu
m-difficile-infection-guidelines.pd
f
http://www.idsociety.org/uploadedFiles/IDSA/GuidelinesPatient_Care/PDF_Library/cdiff2010a.pdf
http://d2j7fjepcxuj0a.cloudfront.net/wp-content/uploads
/2013/04/ACG_Guideline_Cdifficile_April_2013.pdf
Endogenous nonsporulating
Gram negative bacilli:
Family Bacteroidaceae:
Bacteroides, Prevotella,
Prophyromonas,
Fusobacterium
Gram negative
Bacteroides, Prevotella,
Prophyromonas,
Fusobacterium
- Normal flora
- Isolation in naturally
sterile sites always
pathological
Gram negative
Veillonella normal oral
flora; may be involved in
purulent alveolar
infections