The Jordan University-

Faculty of Medicine

Gram-Positive BacilliGram-Positive Bacilli

Prof. Dr. Asem Shehabi and Dr. Suzan Matar

Corynebacteria GroupCorynebacteria Group 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 in healthy conditions.Skin.. Mostly nonpathogenic in healthy conditions.

Corynebacterium diphtheriaeCorynebacterium diphtheriae: : Highly infectious & Highly infectious & Human pathogen .. Spread by droplets by carriers/ Human pathogen .. Spread by droplets by carriers/ Clinical cases , Mostly children.. Severe sore throat .. Clinical cases , Mostly children.. Severe sore throat .. Inflammation Throat-Pharynx-Larynx.. Diphtheria Inflammation Throat-Pharynx-Larynx.. Diphtheria Toxin.. Necrosis Liver, heart. Toxin gene carried on Toxin.. Necrosis Liver, heart. Toxin gene carried on bacteriophage.. Lysogenic strains.. High Fatality bacteriophage.. Lysogenic strains.. High Fatality without antibiotics treatment. without antibiotics treatment.

Prevention: Diphteria Toxoid (Prevention: Diphteria Toxoid (Triple Vaccine, DTPTriple Vaccine, DTP) . ) . Three doses 2-4-6 age months children. Three doses 2-4-6 age months children.

Lab DiagnosisLab Diagnosis: : Albert's stain direct smear Albert's stain direct smear & Throat & Throat culture.. culture.. Tellurite Blood MediumTellurite Blood Medium.. Toxin test to confirm .. Toxin test to confirm C.diphtheria C.diphtheria toxictoxic isolates..Early antibiotic treatment.isolates..Early antibiotic treatment.

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 species causing compounds.. Few Pathogenic species causing disease in humans/Animals. Rapid growth 24-48h disease in humans/Animals. Rapid growth 24-48h

Aerobic Bacilli Group:Aerobic Bacilli Group: Bacillus cereusBacillus cereus: Easily contaminated Food ( Rice, : Easily contaminated Food ( Rice,

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

Aerobic BacilliAerobic Bacilli B. subtilisB. subtilis: Opportunistic Pathogen.. Wound infect , : Opportunistic Pathogen.. Wound infect ,

Sepsis.. Mostly infants, Immunocompromid patients.Sepsis.. Mostly infants, Immunocompromid patients. B. anthracisB. anthracis: : Common cause of intestinal fatal Common cause of intestinal fatal

disease in animals..less humans.. Polypeptide disease in animals..less humans.. Polypeptide capsule.. Other potent virulence factors.. Human capsule.. Other potent virulence factors.. Human Cutaneous Anthrax- chronic Lesions. Cutaneous Anthrax- chronic Lesions. Treatment: Treatment: Surgery & antibioticsSurgery & antibiotics

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.. Rare : Culture Specimens, Skin Ulcer.. Rare Blood / SputumBlood / Sputum .. Culture on Blood & Chocolate Agar. .. Culture on Blood & Chocolate Agar.

Clostridia-1Clostridia-1 2- Anaerobic Clostridia Group2- Anaerobic Clostridia Group:: Spore forming bacilli.. Spore forming bacilli..

Exo- Enterotoxins.. Heat-Stable /Labile .. Exo-& Endogenous Exo- 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 injury ..Release potent neurotoxin binds to the neurons CNS injury ..Release potent neurotoxin binds to the neurons CNS ((Tetanus toxinTetanus toxin / / tetanospasmintetanospasmin), produced by vegetative cells ), produced by vegetative cells grow in necrotic tissues under anaerobic conditions. grow in necrotic tissues under anaerobic conditions.

Cl.tetaniCl.tetani multiplies locally and symptoms appear remote from multiplies locally and symptoms appear remote from the infection site.. Toxin causes spasm in face & jaw ..Overall the infection site.. Toxin causes spasm in face & jaw ..Overall body muscle spasm ..Respiratory & heart failure..Rapid death body muscle spasm ..Respiratory & heart failure..Rapid death

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

Lab Diagnosis:Lab Diagnosis: Aspirated specimens from damaged Tissues.. Aspirated specimens from damaged Tissues.. Direct Gram-stain.. Culture on Anaerobic-blood & chocolate Direct Gram-stain.. Culture on Anaerobic-blood & chocolate agaragar

Clostridium tetani- Clostridium tetani- Cl.perfingensCl.perfingens

Clostridia-2Clostridia-2

Clostridium perfringensClostridium perfringens & Others& Others SpeciesSpecies:: Toxigenic & Invasive .. Toxigenic & Invasive .. Endo or Exo Infections..May be infect intestines.. Release various Toxins & Enzymes /virulence factors .. Collagenese, Hyaluronidase

Infection due to contamination deep wounds..multiplication in damaged tissue causing Gasgangrene – Myonecrosis - Cellulitis.. Septicemia

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

A common cause of Food-Poisoning.. food (meat) or intestine.. Enterotoxin . Incub 6-24 Hrs, Intense watery diarrhea abdominal cramps.. No Fever

Lab Diagnosis: Culture specimens.. Aspirated fluid Wound/Blood .. Gram-stain , PCR detect toxins.

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..destroyed at 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..Now rare cases. ..Now rare cases.

Diagnosis & treatmentDiagnosis & treatment: : Clinical features.. Difficult to Clinical features.. Difficult to detect toxin/bacteria.. Antitoxin serum treatment, detect toxin/bacteria.. Antitoxin serum treatment, Support therapy..High fatality. Support therapy..High fatality.

Clostridia-4Clostridia-4 Clostridium difficileClostridium difficile: Part flora human intestines, 20 : Part flora human intestines, 20

% carriers .. Endo-infection/ Common Nosocomial % carriers .. Endo-infection/ Common Nosocomial infection.. Following long antibiotic usageinfection.. Following long antibiotic usage

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

Pseudomembranous ColitisPseudomembranous Colitis.. .. Bloody Diarrhea.. Bloody Diarrhea.. Antibiotic associated diarrhea.. After Antibiotic associated diarrhea.. After treatmenttreatment with with Amoxicillin, Amoxicillin, Lincomycin-Clindymicin, Cephalosporines) Lincomycin-Clindymicin, Cephalosporines) Fatal.. Stop usage offening antibiotic.. Replace by Fatal.. Stop usage offening antibiotic.. 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