chapter 19 gram-positive bacilli of medical importance
TRANSCRIPT
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Chapter 19
Gram-Positive Bacilliof Medical Importance
Spore-formersnon-spore-formers
acid fast
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Important Bacilli
Bacillis anthracisBacillus cereus
Clostridium perfringensClostridium tetani
Clostridium botulinumCorynebacterium diphtheriaeMycobacterium tuberculosis
Mycobacterium leprae
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Gram positive bacilli
• spore-forming bacilli, motile;
• Spore - survival structureresists heat, drying,
radiation, chemicals
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Bacillus spore
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Gram Positive Bacilli
• Aerobes: –Bacillus - Aerobic, catalase +, degrades complex macromolecules
– exoenzymes - antiboitics– Endospore - widespread dispersal -
dust, water, plants, animals fur
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Bacillus anthracis
• BIG - square 3-5 X 1-1.2 microns, central spores– Polypeptide capsule, Exotoxins
produce necrosis and swelling– Easily grows, sporulates in soil -
grazing animals– Common in cattle - vaccines,
destroy herds - US cases - fur trimmed souveniers BIOTERRORISMBIOTERRORISM
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Bacillus anthracis
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Bacillus anthracis
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Bacillus anthracis–Cutaneous Anthrax - spores enter skin
through small cuts, abrasions–Lesion lump (papule) -black, enlarging,
eschar–Pulmonary Anthrax (woolsorter's disease) -
handling wool spores in dust– Spores in lungs - germinates exotoxins -
septicemia - death in a few hours - capillary clots, shock
–Gastrointestinal Anthrax - eating rare contaminated meat
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Cutaneous Anthrax
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Bacillus anthracis
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Bacillus anthracis–Treatment: penicillin, tetracycline -
toxemia not affected by treatment
–Prevention: vaccines of live attenuated spores and toxoid used on livestock
–Purified toxoid used in at risk humans (vets, now military)
–Contaminated animals disinfected, carcasses burned, not buried. Fur, hides, etc gas sterilized
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Bacillus cereus
– Spores land on food, rice, potatoes, meat
– Spores survive cooking, reheating
– Enterotoxins: N/V/D abdominal cramps -
usually self-limiting in about 24 hours
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Bacillus cereus
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Bacilluscereus
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Anaerobic Gram Positive Bacilli
Clostridium perfringensClostridium difficileClostridium tetani
Clostridium botulinum
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Clostridium sp.gram-positive, (terminal, swollen) spore-
forming rods, anaerobic, catalase -–Ubiquitous in environment - infectious
diseases not communicable -– spores enter skin, through wounds - grow
release exotoxins,– spores enter foods, grow and release
toxins
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Clostridium sp.
• C. perfringens = gangrene• C. difficile = colitis• C. tetani = tetanus• C. botulinum = botulism
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Clostridium perfringensGas gangrene -–1. anaerobic cellulitis - only in damage
tissue, toxin and gas, does not spread
–2. myonecrosis quickly progressive, toxins diffuse to healthy tissue
– Surgical, compound fractures, sores, septic abortions, puncture gunshot wounds, crushing injuries with dirt.
– Not very invasive, need dead tissue, anaerobic conditions
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Clostridium perfringens
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Clostridium perfringens
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Clostridium perfringens
–Exotoxin - alpha toxin = Lecithinase, rupture RBCs, swelling, tissue destruction
– Collagenase, hyalurminidase, DNase– Ferments carbohydrates in muscle- gas
–Treatment: debridment - surgical removal of damaged, infected tissues
– Cephalosporin (cefoxitin) or penicillin– Hyperbaric oxygen
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Clostridium difficileAntibiotic-associated colitis -
• normal flora of GI tract - after treatment with ampicillin, clindamycin, cephalosporins, patient develops diarrhea since C.d. able to grow.
• Diarrhea, cramps, fever, WBC'selevated - inflammation, epithelium sloughs off with fibrin attached.
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Clostridium difficile
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Clostridium difficile
• Stop antibiotics, restored electrolytes• Oral vancomycin - several weeks,
intestinal flora restore (yoghurt)• Cecal perforation fatal• Spores in stools, prevent spread to
others
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Clostridium tetani
Tetanus /lockjaw–Spores enter through wound, burns,
umbilical stumps, surgical procedures
–Spores grow
–Exotoxins - tetanospasmin - neurotoxin -local nerves to spinal neurons block release of neurotransmitter that inhibits "inappropriate contraction" so muscles contract without control
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Clostridium tetani
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Clostridium tetani
Tetanus /lockjaw
– Jaw muscles one of first to be affected,
then back, death due to respiratory
collapse
–Treatment:Antitoxin (human tetanus
immune globulin) - binds and inactivates
toxin
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Tetanus
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Clostridium botulinum• rare but more serious - intoxication -
Spores found in soil, water, intestinal tract of animals – “limber neck”
• Poorly preserved foods, low acid -vegetables, meat, fish, dairy.
• Spores - improperly processed -anaerobic conditions - store at room temp
• No effect on taste or smell
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Clostridium botulinum
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Clostridium botulinum
• Swallowed toxin absorbed into small intestine, circulatory tract and lymphatics
• Affect neuromuscular junction of muscles, block release of acetylcholine (signal for contraction)
• 12-72 hours - constipation, vision (double), difficulty swallowing, dizziness, respiratory complications
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Clostridium botulinum
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Clostridium botulinum• Infant Botulism -
– 2 weeks and 6 months old, spores ingested - honey implicated
– poor sucking, limp-baby
• Wound botulism - flaccid paralysis (IDU)
• Treatment: antitoxin, ID foods; penicillin
• Prevention: home-canning improved, boiled for 10 min
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Clostridium botulinum
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Gram Positive Regular Non-Spore-forming Rods• Regular - stain uniformly, • rod-shaped--• Lactobacillus, Listeria, Erysipelothrix,
Kurthia, Caryophanon, Bronchothrix, Renibacterium
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Listeria monocytogenes
• Ubiquitous, motile, short to long filaments in palisades, beta-hemolytic, resists cold, heat, salt, pH extremes and bile.
• Contaminated dairy, poultry, meat, especially raw milk cheeses - Listeriagrows during aging process
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Listeria monocytogenes
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Listeria monocytogenes• Adults: mild, fever, sore throat,
diarrhea• Transmitted to fetus/ neonate
intrauterine - premature abortion, neonates -meningitis
• Treatment: penicillin, ampicillin, erythormycin
• Prevention: cook foods, pasteurize dairy products
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Erysipelothrix rhusiopathiae– Animals and environment (tonsils of pigs-
swine erysipelas ), water, sewage– Handlers, slaughterhouse workers, butchers,
vets– Via scratch or abrasion - lesion: swollen,
dark red, burning itching –Endocarditis and septicemia–Treatment: penicillin or erythromycin–Vaccine for pigs, not effective in humans
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Gram-positive Irregular Non-spore-forming Rods
• Pleomorphic, stain unevenly, catalase +, mycolic acid (waxy) peptidoglycan
• Corynebacterium, Mycobacterium, Nocardia
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Corynebacteriumdiphtheriae
• Respiratory tract infection, Cutaneous form
• Prevented with successful vaccine, seen in unvaccinated 1-10 yo, healthy carriers
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Corynebacteriumdiphtheriae
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Corynebacteriumdiphtheriae -
• Aerosole transmission• Fomites• milk
– local infection - tonsils,pharynx, larynx, trachea
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Corynebacteriumdiphtheriae -
• toxin production - diffusion -toxemia – toxin
• two polypeptide fragments - B fragment heart and nervous cells A blocks protein synthesis
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Corynebacteriumdiphtheriae -
–local inflammatory response
–low-grade fever
–sore throat,nausea, vomiting enlarged
lymph nodes, severe swelling in neck
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Corynebacteriumdiphtheriae -
–pseudomembrane - greenish-gray solidified fibrous exudate cells and fluid develop in pharynx stuck on pull off-bleeding
–Toxemia - heart = inflamed nerves/cranium - weakness and paralysis
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Corynebacteriumdiphtheriae -
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Corynebacteriumdiphtheriae -
• Untreated - asphyxiation, respiratory collapse, heart damage
• ID quickly, gram stain or alkaline methylene blue
• Treatment: diphtheria antitoxin (horses) Pencillin, erythromycin
• Prevented: vaccine DPT
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Additional species
• Proprionibacterium -
• Aerotolerant anaerobe, no toxins
• Proprionibacterium acnes– oil glands - acne vulgaris
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MycobacteriumAcid-Fast
• Mycolic acids in layers - waxy coat - resists drying, chemicals, acids,
• Long slender straight or curved, filamentous or branching, granules, no spores aerobic
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Mycobacterium tuberculosis
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Mycobacterium tuberculosis
• TB very prevalent up to about 50 years ago - antibiotic therapy
• Predisposing conditions: poverty, inadequate nutrition, unsanitary living conditions, underlying debilitation of immune system, lung damage, genetics.
• No toxins or enzymes, waxes help prevent destruction even when phagocytised
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Mycobacterium tuberculosis
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tubercles
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Mycobacterium tuberculosis
• Infants infected, stays dormant, reactivated in 20's 15 mil in US 1/3 of world carry TB
• ONLY 5% of those infected may manifest the disease
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Mycobacterium tuberculosis–Primary TB - tiniest aerosols, inhaled into
alveoli About 10 cells to start infection -phagocytized by macrophages, multiply intracellularly, mild fever
–3-4 weeks - cell mediated response -monocytes migrate - tubercules
–Tubercle = TB, then macrophages, then fibroblasts and lymphocytes and neutrophils
–Necrosis of tubercle = calcification
–Tuberculin reaction
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Mycobacterium tuberculosis
Caseation, lesions
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Mycobacterium tuberculosis– Secondary TB - tubercles expand and drain into
bronchioles - coughing, greenish or bloody sputum, fever, anorexia, weight loss, extreme fatigue, night sweats, chest pain wasting of body = consumption
– Extrapulmonary - lymph nodes, kidneys, long bones, genital tract, brain, meninges
– Detection: • 1 tuberculin test
• 2. X ray
• 3. ID acid-fast
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Mycobacterium tuberculosis–Tuberculin testing - purified protein
derivative – cell- mediated hypersensitivity
–Treatment: sufficient to kill bacillus 6-24 months
–Two drugs - Isoniazide, rifampin, ethambutol, streptomycin, pyrazinamide, thioactazone, para-aminosalicylic acid
–Prevention: vaccine BCG (bacille Calmet-Guerin strain of M.bovis - 20-80% protective for several years
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Mycobacterium leprae
• Hansen's bacillus– Strict parasite (armadillo), slow grower
– Leprosy - chronic progressive disease skin and nerves - severe disfigurement
– Not readily communicated - no even sure of transmission
– 15 leper colonies in Asia, Africa, Central and South American and Pacific Islands, Siberia, Korea, China, Hawaii, Texas, California, Louisiana 2-3K
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Mycobacterium leprae
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Mycobacterium leprae
King Uziahas painted byRembrandt.
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Mycobacterium leprae
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Mycobacterium leprae–T cell response factor determines
progressiveness
–Tuberculoid - shallow skin lesions
–Leproid - nose, eyes, eyebrows, chin, testes - thickening –lepromas
–Treatment dapsone
–Rifampin and dapsone for tuberculoid
–Rifampin, dapsone and clofazimine (2-10 years)