‫قسم طب االسنان‬

‫المادة ‪ :‬االحياء المجهرية‬

‫‪MICROBIOLOGY‬‬
‫أ‪.‬م‪.‬د‪ .‬سناء عبد السالم‬
‫‪Lect. 12‬‬
 ‫اﻟﻛﻠوﺳﺗرﯾدﯾم اﻻﻧﯾروﺑك ﺑﺎﺳﯾﻼي ﺗﺣﻠل ﻣﻌظم اﻧواع اﻟﻛﻠوﺳﺗرﯾدﯾم اﻟﺑروﺗﻧﺎت‬
‫او ﺗﺷﻛل اﻟﺳﻣوم و اﻟﺑﻌض اﻻﺧر ﯾﺳوي اﻟﺷﻐﻠﺗﯾن ﯾﺣﻠل ﺑروﺗﯾﻧﺎت و ﯾﺳوي‬
‫ﺳﻣوم ﯾﻛون ﻣوطﻧﮭﺎ اﻟطﺑﯾﻌﻲ ھو اﻟﺗرﺑﺔ او اﻻﻧﺗﯾﺳﻧﺗﺎل ﺗراك اﻻﻣﻌﺎء ﻣﺛل‬
‫اﻟﻧﺑﺎﺗﺎت اﻟرﺧﺎﻣﯾﺔ اھم اﻻﻧواع اﻟﻣﺳﺑﺑﺔ ﻟﻼﻣراض ھﻲ‬
‫)‪Clostridium (Anaerobic Bacilli‬‬
‫‪Most Clostridium species decompose proteins or form toxins and some do both.‬‬
‫‪Their natural habitat is the soil or intestinal tract as saprophytes. The important‬‬
‫اﻟﻛوﻟﺳﯾرﯾدﯾوم ﺑوﺗﯾﻠﻧﯾوم ﺳﺑب اﻟﺗﺳﻣم اﻟﻐذاﺋﻲ اﻟﺑوﺗﯾوﻟزم ‪pathogenic species are:‬‬
‫‪Clostridium botulinum: Causes botulism‬‬
‫اﻟﻛوﻟﺳﯾرﯾدﯾوم ﺗﯾﺗﺎن ﺗﺳﺑب ﻣرض اﻟﺗﯾﺗﺎﻧﯾوس ‪Clostridium tetani: Causes tetanus‬‬
‫اﻟﻛوﻟﺳﯾرﯾدﯾوم ﺑﯾرﻓﯾﻧﺟﯾز ﺗﺳﺑب اﻟﻛﺎﻧﻛرﯾﻧﺎ اﻟﻐﺎزﯾﺔ ‪Clostridium perfringens: Causes gas gangrene‬‬
‫‪Morphology‬‬ ‫اﻟﻣﺎرﻓوﻟوﺟﻲ ﻋﺑﺎرة ﻋن رودز ﻣﺗﺣرﻛﺔ و ﺗﻛون ﻛرام ﺑوزﺗف و ﻻرج اﻧﯾروﺑك‬
‫‪large anaerobic gram positive motile rods.‬‬
‫ﻋﺎدة ﯾﻛون اﻟﺳﺑور اﻋرض ﻣن اﻟرودز ‪The spore is usually wider than the rods.‬‬
‫‪Spores are placed centrally, terminally, or subterminally according to the genus.‬‬
‫اﻟﻛﻠوﺳﺗرﯾدم ﺗﯾﺗن ﺗﻛون ﺗﯾرﻣﻧﺎل ﺳﺑورس‬ ‫اﻟﺳﺑور ﯾﻛون اﻣﺎ ﺳﯾﻧﺗراﻟﻲ او ﺗﯾرﻣﻧﺎﻟﻲ‬
‫‪Clostridium tetani :with terminal spores.‬‬ ‫او ﺳﺑﺗﯾرﻣﻧﺎل ع ﺣﺳب اﻟﺟﻧس‬
‫‪Clostridium perfringens: spore forming bacteria (subterminal spores) that are‬‬
‫‪encapsulated in tissue smears. Vegetative cells are rod shaped, pleomorphic, and occur in‬‬
‫‪pairs or short chains.‬‬
‫‪Clostridium botulinum: These organisms are bacilli with oval, subterminal spores‬‬
‫اﻟﻛﻠوﺳﺗرﯾدﯾوم ﺑوﺗﯾوﻟﯾﻧﯾوم ھﺎي اﻻورﻛﺎﻧزم ﻋﺑﺎرة ﻋن‬
‫اﻟﻛﻠوﺳﺗرﯾدم اﻟﺑﯾرﻓﯾرﻧﺟز اﻟﺳﺑورات ﺗﺷﻛل ﺑﻛﺗﯾرﯾﺎ اﻟﺳﺑﺗﯾرﻣﻧﺎل‬ ‫ﻋﺻﯾﺎت ذات ﺳﺑورات اوﻓﺎل او ﺳﺑﺗﯾرﻣﻧﺎل‬
‫ﺳﺑورز ﺗﻛون ﻣﻐﻠﻔﺔ ﻓﻲ اﻟﺗﺷﯾو ﺳﻣﯾرز اﻟﻔﯾﺟﯾﺗﯾﺗف ﺳﯾﻠز ﺗﻛون ع ﺷﻛل‬
‫رود ﻣﺗﻌدد اﻻﺷﻛﺎل و ﺗﺣدﯾث ﻓﻲ ازواج او ﺳﻼﺳل ﻗﺻﯾرة‬
 ‫اﻟﻛﺎﻟﺟر ﯾﺗم اﻧﺷﺎء ﻛﺎﻟﺟر ﺑظروف ﻻھواﺋﯾﺔ ﻣن ﻗﺑل واﺣد ﻣن ھل ﺷﻐﻼت‬

•Culture ‫اﻻﻛﺎر ﺑﻠﯾﺗز او اﻟﻛﺎﻟﺟر ﺗﯾوب ﺗوﺿﻊ ﻓﻲ وﻋﺎء ﺟﺎر ﻣﺣﻛم اﻟﻲ ﯾﺗم‬
‫ازاﻟﺔ اﻟﮭواء ﻣﻧﺔ و اﺳﺗﺑدال ب ﻧﺎﯾﺗروﺟﯾن و ﺛﺎﻧﻲ اوﻛﺳﯾد ﻛﺎرﺑون‬
Anaerobic culture conditions are established by one of the
following:
1. Agar plates or culture tubes are placed in air tight jar
from which air is removed and replaced by N and C02.
2. Fluid media contain either:
Fresh animal tissue (chopped meat) ‫ﻓرش اﻧﯾﻣل ﺗ اﻟﺷﻔﯾﻠوورﻣدﺛ ﻣﻼﯾدﻟﯾﺎﺣوﺗمﺣﺗﻣوﻔريواﻣﻣﺎﺔ‬
Reducing agent (Thioglycolate) ‫او ﺗﺣﺗوي ع اﻟرﯾدﻛﻧك اﻛﺎر اﻟﺛﯾوﻛﻼﯾﺳوﻟﯾت‬
Colony forms ‫اﺷﻛﺎل اﻟﻛوﻟوﻧﻲ‬
Clostridium perfringens: Large raised colonies with entire
margines ‫اﻟﻛﻠوﺳﺗرﯾدﯾوم ﺑﯾرﻓﯾﻧﺟﯾز ﻋﺑﺎرة ﻋن ﻣﺳﺗﻌرات ﻛﺑﯾرة ﻣﻊ اﻧﺗﯾر ﻣﺎرﺟﻧز‬
Clostridium tetani: Smaller colonies with fine filaments.
‫اﻟﻛﻠوﺳﺗرﯾدﯾوم ﺗﯾﺗﺎﯾن ﻣﺳﺗﻌﻣرات ﺻﻐﯾرة ذات ﺧﯾوط دﻗﯾﻘﺔ‬
 ‫اﻟﻛﻠوﺳﺗرﯾدﯾوم ﺑوﺗﯾوﻟﯾﻧﯾوم‬

Clostridium botulinum
‫ ﺳﺎﻋﺎت وﺗﻘل اﻟﻣﻘﺎوﻣﺔ ﻋﻧد درﺟﺔ اﻟﺣﻣوﺿﺔ و اﻟﻣﻠﺢ‬5 ‫اﻟﻰ‬3 ‫ﺗﺳﺑب ﺗﺳﻣم ﻏذاﺋﻲ ﻓﮭﻲ ﺗﻘﺎوم اﻟﻐﻠﯾﺎن‬
‫ﯾﻧﺗﺞ ﺗوﻛﺳﯾن اﺛﻧﺎء اﻟﺣﯾﺎة و اﻟﺗﺣﻠل اﻟذاﺗﻲ ﻟﻠﺑﻛﺗﯾرﯾﺎ‬
• It causes botulism they resist boiling 3-5 hours. This
resistance is diminished at acidic PH and salt . It
produce toxin during life and autolysis of bacteria.
‫اﻧواع اﻟﺳﻣوم ﻣن اﻟﻛﻠوﺳﺗرﯾدﯾوم ھﻲ ﻣن اﻧواع اي و اج‬
• Toxin Types of Clostridium: They are types A-H
• Toxins of types A, Band E are neurotoxic protein
and highly toxic ‫اﻧواع اﻟﺗوﻛﺳﯾن اي ﺑﻲ و اﻻي ﺳﻣوم ﻟﻼﻋﺻﺎب و ﺗﻛون ﺷدﯾدة اﻟﺳﻣﯾﺔ‬
 ‫اﻟﺗﺳﻣم ﻋن اﻟﺑﺎﻟﻐﯾن ﻧﺎﺟم ﻣن ﺗﻧﺎول اﻟﺳﻣوم اﻟﻣﺷﻛﻠﺔ ﻣﺳﺑﻘﺎ‬
‫ اﺷﻛﺎل اﻟﺔ‬3 ‫ﻣرض اﻟﺗﺳﻣم اﻟﻐذاﺋﻲ ھﻧﺎك‬ ‫ﻓﻲ اﻟﻐذاء ﺗﻧﺑت اﻟﺳﺑورات و ﺗﻧﺗﺞ ﺳﻣوم ﺗﺣت اﻟظروف‬
Pathogenesis ‫اﻻﻧﯾروﺑك ھﺎي اﻻطﻌﻣﺔ ﻋﺑﺎرة ﻋن اطﻌﻣﺔ ﻣﺗﺑﻠﺔ او‬
‫ﻣدﺧﻧﺔ او ﻣﻌﺑﺎة ﺑﺗﻔرﯾﻎ اﻟﮭواء او اطﻌﻣﺔ ﻗﻠوﯾﺔ ﻣﻌﻠﺑﺔ‬
Botulism is intoxication. There are three forms:

(1) adult botulism, caused by ingestion of preformed toxin in

food; spores germinate and produce toxin under anaerobic conditions. These
foods are spiced, smoked, vacuum-packed, or canned alkaline foods.

(2) infant botulism, in which the organism replicates and secretes toxin in
the intestinal tract. It may result from honey feeding and cause signs of paralysis or
‫ﺗﺳﻣم اﻟرﺿﯾﻊ ﺣﯾث ﺗﺗﻛﺎﺛر اﻟﻛﺎﺋن اﻟﺣﻲ و ﯾﻔرز اﻟﺳم ﻓﻲ اﻻﻧﺗﯾﺳﺗﻧﺎل‬
sudden death.
‫ﺗراك ﯾﻧﺗﺞ ﻋن ﺗﻧﺎول اﻟﻌﺳل و ﯾﺳﺑب ﻋﻼﻣﺎت اﻟﺷﻠل او اﻟﻣوت اﻟﻣﻔﺎﺟﺊ‬
(3) wound botulism, in which the organism replicates in the wound and
secretes toxin.
The botulinum toxin is absorbed by the upper part of the GI tract in the
duodenum and jejunum only in a small amount. The toxin acts by blocking the
release of acetyl choline at synapses and neuromuscular junctions causing
flaccid paralysis. Patients who recover don't develop an antitoxin in the blood.
‫اﻟﺗﺳﻣم ﺑﺳﺑب اﻟﺟروح ﺣﯾث ﺗﺗﻛﺎﺛر اﻻورﻛﺎﻧزم ﻓﻲ اﻟﺟرح و ﯾﻔرز اﻟﺳم ﯾﺗم اﻣﺗﺻﺎص ﺗوﻛﺳﯾن اﻟﺑوﺗوﻟﯾﻧﯾوم ﻣن ﻗﺑل اﻟﺟزء اﻟﻌﻠوي‬
‫ﻣن اﻟﺟﮭﺎز اﻟﮭﺿﻣﻲ ﻓﻲ اﻻﺛﻧﻲ ﻋﺷر اﻟﺻﺎﺋم اﻟﺟﯾﺟﯾﻧﯾوم ﻓﻘط و ﺑﻛﻣﯾﺎت ﻗﻠﯾﻠﺔ ﯾﻌﻣل اﻟﺗوﻛﺳﯾن ﻋن طرﯾق ﻣﻧﻊ ﺗﺳﺑب اطﻼق ﻣﺎدة‬
‫اﻻﺳﯾﺗﯾل اﻟﻛوﻟﯾن ﻓﻲ ﻧﻘﺎط اﻻﺷﺗﺑﺎك اﻋﺻﺑﻲ و اﻟوﺻﻼت اﻟﻌﺳﺑﯾﺔ اﻟﻌﺿﻠﯾﺔ اﻟﺷﻠل اﻟرﺧو اﻟﻣرﺿﻰ اﻟﻲ ﯾﺗﺷﺎﻓون ﻣراح ﯾﺗطور ﻋدھم‬
‫ﻣﺿﺎد ﻟﻠﺳم ﻓﻲ اﻟدم‬
 ‫ ﺳﺎﻋﺔ‬24 ‫ اﻟﻰ‬18 ‫اﻻﻋراض ﺧﻼل‬
Symptoms …{within 18-24 hours}
‫اﺿطراﺑﺎت ﺑﺻرﯾﺔ‬
* Visual disturbances
*Inability to swallow ‫ﻋدم اﻟﻘدرة ع اﻟﺑﻠﻊ‬
*Speech difficulty ‫ﺻﻌوﺑﺔ ﻓﻲ اﻟﻛﻼم‬
* Respiratory paralysis or cardiac arrest death
‫ﺷﻠل ﺗﻧﻔﺳﻲ او ﺳﻛﺗﺔ ﻗﻠﺑﯾﺔ و ھل ﺷﻐﻠﺗﯾن ﺗؤدي ﻟﻠﻣوت‬
Lab diagnosis
1- Mice are injected with the specimen and then neutralized by
injections of antitoxin. ‫اول ﺷﻲ ﯾﺗم ﺣﻘن اﻟﻔﺋران ﺑﺎﻟﻌﯾﻧﮫ ﺛم ﺗﺣﯾدھﺎ ﺑواﺳطﺔ اﻻﻧﺟﻛﺷن اوفﻻ اﻧبﺗ دﻲاﯾﺗﻛﻧوﻛزﺳﺳﯾﯾزن‬
2- Culture of food remains, then growth test for toxin production.
Toxin is tested byhemoagglutination or radioimmunoassay (RIA).
‫ﻧﺳوي زراﻋﺔ ﻟﺑﻘﺎﯾﺎ اﻟطﻌﺎم ﺛم اﺧﺗﺑﺎر اﻟﻧﻣو ﻻﻧﺗﺎج‬
‫اﻟﺳﻣوم اﺧﺗﺑﺎر اﻟﺳم ﯾﺗم ﻋن طرﯾق اﻟﺗراص اﻟﻛﯾﻣﯾﺎﺋﻲ او‬
‫ﻣﻘﺎﯾﺳﺔ اﻟﻣﻧﺎﻋﯾﺔ اﻻﺳﻌﺎﻋﯾﺔ اﻻر ااي اي‬
Treatment ‫اﻟطرﯾق اﻟراﺑﻊ ﻣن ﻣﺿﺎد اﻟﺳﻣوم ﺗرﯾﺎق ﺛﻼﺛﻲ اﻟﺗﻛﺎﻓؤ ﻣن ﻧوع اي و ﺑﻲ و دي‬
1- Iv administration of antitoxin (trivalent antitoxin of types A,B
and E ‫ﺗﮭوﯾﺔ ﻣﻧﺎﺳﺑﺔ ﺑواﺳطﺔ ﺟﮭﺎز ﺗﻧﻔس اﻟﻣﯾﻛﺎﻧﯾﻛﻲ‬
‫ﯾﺗم اﻟﺷﻔﺎء ﻣن ﺗﺳﻣم اﻟرﺿﯾﻊ ﻣﻊ‬
2- Adequate ventilation by mechanical respirator. ‫ﺳوﺑرﯾﺗف ﺛﯾرﺑﻲ ﻟوﺣدة‬
3- Infant botulism is recoverd with supportive therapy alone
Clostridium tatani
It causes uterus tetanus, and tetanus neonatrum. It is distributed in soil and
feces of animals. The spores are located at one end of the bacilli (drum-
stick). It is differentiated into several types according to their specific flagellum
antigens . ‫اﻟﻛﻠوﺳﺗﻣروﯾﻗدﻌﯾﮭوﺎمﻓﺗﺎﻲﺗﺎﻧواﻲﺣﯾدﺳﻣﺑنب ﻧﻛﮭﺎزﯾاﺎزتاﻟاﻟرﺑﺎﯾﺣمﺳ وﻼ ايﻟﻛﺟزﻧاﮭزﺎ اﻟﻋوﻟﯾﺻدﺎ ايﻟ ﯾطﻛﺑولنﯾﺗمﻣﻧﺗﺗﻔﺷرﯾرﻘﻓﮭﺎﻲاﻟاﻟﺗﻰرﺑﻋﺔدةواﻧاﻟوﻔاﯾعﺳﯾوزﻓﻘﺎﻣﺎاﻟﻟتﺳﺑاﻟﺳﯾﺣﻔﯾوكاﻧﻓﺎﻼتﺟاﻠﻟمﺳاﺑﻧﺗوﺟرﯾاﻧزت‬
.. Toxin ..
Vegetative cells of Clostridum tetani produce tetanospasmin that has
the followingproperties: ‫ﺗﻧﺗﺞ اﻟﺧﻼﯾﺎ اﻟﺧﺿرﯾﺔ اﻟﻛﻠوﺳﺗرﯾدﯾوم ﺗﯾﺗﺎﻧﻲ اﻟﺗﯾﺗﺎﻧوﺳﺑﯾﺳﻧت اﻟﻲ ﯾﺣﺗوي ع اﻟﺧﺻﺎﺋص اﻟﺗﺎﻟﯾﺔ‬
1- It is a polypeptide in nature. ‫ﯾﻛون ﻣﺗﻌدد اﻟﺑﺑﺗﯾد ﻓﻲ اﻟطﺑﯾﻌﺔ‬
2-Its production is under the control of a plasmid gene. ‫ان ﯾﻛون اﻧﺗﺎﺟﺔ ﺗﺣت ﺳﯾطرة اﻟﺑﻼزﻣﯾد ﺟﯾن‬
3-The proteolytic enzymes split this toxin into two fragments of increased
toxicity. ‫ﺗﻘوم اﻻﻧزﯾﻣﺎت اﻟﻣﺣﻠﻠﺔ ﻟﻠﺑروﺗﯾن ﺑﺗﻘﺳﯾم ھذا اﻟﺳﻣم اﻟﻰ ﺟزﺋﯾن زﯾﺎدة ﻓﻲ اﻟﺗﺳﻣم‬
4. It acts upon CNS ‫ﯾﻌﻣل ع اﻟﺟﮭﺎز اﻟﻌﺻﺑﻲ اﻟﻣرﻛزي‬
Tetanospasmin released from vegetative cells reach the CNS via the blood
result in generalized muscular spasm due to block the release of neuro
transmitters. ‫اﻟﺗﯾﺗﺎﻧوﺳﺑﺎزﻣﯾن اﻟﻣﻧطﻠق ﻣن اﻟﺧﻼﯾﺎ اﻟﻧﺑﺎﺗﯾﺔ اﻟﻰ اﻟﺟﮭﺎز اﻟﻌﺻﺑﻲ‬
‫اﻟﻣرﻛزي ﻋﺑر اﻟدم ﯾؤدي اﻟﻰ ﺗﺷﻧﺞ ﻋﺿﻠﻲ ﻣﻌﻣم ﺑﺳﺑب ﻣﻧﻊ اﻓراز‬
‫اﻟﻧواﻗل اﻟﻌﺻﺑﯾﺔ‬
 ‫ اﯾﺎم او ﻋدة اﺳﺎﺑﯾﻊ ھﻧﺎك ﺗﻘﻠص ﻋﺿﻠﻲ‬5 ‫ اﻟﻰ‬4 ‫اﻟﻧﺗﺎﺋﺞ اﻟﺳرﯾرﯾﺔ ﻟﻠﺗﯾﺗﺎﻧوس اﻟﻣدة ﻣن‬
‫اﻟﻌﺿﻼت اﻻرادﯾﺔ ﻣﻧطﻘﺔ اﻻﺻﺎﺑﺔ اﻻوﻟﻰ ﺛم ﻋﺿﻼت اﻟﻔك ﻣرض ﻗﻔل اﻟﻔك ﻓﻲ وﻗت ﻻﺣق‬
‫ﺗﺗﺳﺑب اﻟﻌﺿﻼت اﻻرادﯾﺔ اﻻﺧرى ﺗﺷﻧﺞ ﻣﻌﻣم ﯾؤدي اﻟﻰ ﺷﻠل ﺗﻧﻔﺳﻲ و ﻓﺷل ﻗﻠﺑﻲ ﻣﻣﺎ ﯾؤدي‬
‫ ووو‬%50 ‫اﻟﻰ اﻟوﻓﺎة ﺑﻧﺳﺑﺔ‬

Clinical findings of tetanus-

• Duration is 4 to 5 days - many weeks. There is muscular contraction of
the voluntary muscles (1st area of infection) then the muscles of the jaw
(Lock-Jaw disease). Later, other voluntary muscles are involved causing
generalized spasm resulting in respiratory paralysis and cardiac failure
which lead to death (50%).
‫ﻛزاز اﻟرﺣم ﯾﺗﺑﻊ اﻟﺳﺑﺗك اﺑورﺷن‬
• Uterus tetanus: Follows septic abortion.
• Tetanus neonatrum: Follows contamination of the umbilical cord of
newborns when it is cut boy contaminated instrument.
‫اﻟﻛزاز اﻟوﻟﯾدي ﯾﺗﺑﻊ ﯾﻌﻧﻲ ﯾﺟﻲ ﺑﻌد ﻣﺎﯾﺻﯾر ﻋﻧدي ﺗﻠوث‬
‫اﻟﺣﺑل اﻟﺳري ﺑﺣددﯾﺛﻲ اﻟوﻻدة ﻟﻣن ﯾﺗم ﻗطﻊ اﻟﺣﺑل اﻟﺳري‬
‫ﺑﺎداة ﻣﻠوﺛﺔ‬
 ‫ﯾﺗﻣﯾز اﻟﺗﯾﺗﺎﻧوس ﺑﺎرﺗﻌﺎش اﻟﻌﺿﻼت ﺣول اﻟﺟرح واﻟم ﻓﻲ اﻟرﻗﺑﺔ و اﻟﻔك و ﺣول اﻟﺟرح ﻻ ﯾﻌﺎﻧﻲ‬
‫اﻟﻣرﺿﻰ ﻣن اﻟﺣﻣﻰ وﻟﻛن ﯾﺗﻌرﻗون ﺑﻐزراة وﺗظﮭر ﺻﻼﺑﺔ و ﺗﺷﻧﺟﺎت ﻋﺿﻠﯾﺔ‬
Tetanus is characterized by twitching of muscles around a wound, pain in neck and jaw
muscles (trismus), and around the wound. Patients have no fever, but sweat profusely and
exhibit muscle rigidity and spasms .
‫اﻟﺗﺷﺧﯾص اﻟﻣﺧﺗﺑري‬
... Laboratory diagnosis.. Diagnosis rests on clinical pictures.
‫اﻻﻧﯾروﺑك ﻛﺎﻟﺟر ﻟﻠﻧﯾﻛوﺗك ﺗﺷﯾو اﻻﻧﺳﺟﺔ اﻟﻣﯾﺗﺔ‬
1. Anaerobic culture of necrotic tissue.
2. Growth is tested for toxin production. ‫ﯾﺗم اﺧﺗﺑﺎر اﻟﻧﻣو ﻻﻧﺗﺎج اﻟﺳم‬
3. Neutralitation of the toxin produced with specific antitoxin .
‫ﺗﺣﯾﯾد او ﻧﻌﺎدل اﻟﺳم اﻟﻣﻧﺗﺞ ﺑﻣﺿﺎد ﺳم ﻣﻌﯾن‬
Prevention ‫اﻟﺗﺣﺻﯾﯾن اﻟﻔﻌﺎل ﻣﻊ اﻟﺗوﻛﺳﯾد اﻟﺳﻣوم ﻟﺗﺣﻔﯾزز اﻻﺟﺳﺎم اﻟﻣﺿﺎدة‬
1. Active immunization with toxoid (detoxified toxin) to stimulate Ab.
2. Proper care of wound (Remove the necrotic tissue).
‫اﻻﺳﺗﺣدام اﻟوﻗﺎﺋﻲ ﻟﻣﺿﺎد اﻟﺗﺳﻣم‬ ‫اﻟﻌﻧﺎﯾﺔ اﻟﻣﻧﺎﺳﺑﺔ ﺑﺎﻟﺟرح ازاﻟﺔ اﻻﻧﺳﺟﺔ اﻟﻣﯾﺗﺔ‬
3. Prophylactic use of antitoxin.
4. Administration of penicillrn (to inhibit Clostridium and pyogenic
‫اﻋطﺎء اﻟﺑﻧﺳﻠﯾن ﻟﺗﺛﺑﯾط اﻟﻛﻠوﺳﺗرﯾدﯾم و اﻟﺑﺎﯾوﺟﯾﻧك ﺑﻛﺗﯾرﯾﺎ‬
bacteria).
5. Treatment with antitoxin in tetanus neonatrum is life saving .

‫اﻟﻌﻼج ﻣﻊ اﻻﻧﺗﻲ ﺗوﻛﺳﯾن ﻓﻲ اﻟﺗﯾﺗﺎﻧﯾوس اﻟوﻟﯾددي ﯾﺣﺎﻓظ ع اﻟﺣﯾﺎة‬

 ‫اﻟﻛﻼﺳﺗروﯾدﯾم ﺑﯾرﻓﯾرﯾﻧﺟز ﯾﻧﺗﺞ ﻋﻧﺔ ﻋدوى ﻏﺎزﯾﺔ وھو ﻣﺳؤول‬
‫ﻣن ﺣﺎﻻت اﻟﻧﺧر اﻟﻌﺿﻠﻲ و اﻟﻛﺎز ﻛﺎﻧﻛرﯾﻧﺎ اﻟﻲ ﺗﺻﯾب‬%90 ‫ﻋن‬
Clostridium perfringens ‫اﻟﺟروح اﻟﻣﻠوﺛﺔ ﻣﺛﻼ ﻣرﻛﺑﺎت ﺗﻛﺳر اﻟرﺣم ﺑﻌدد اﻟوﻻدة ﺗﺳﺑب‬
‫اﯾﺿﺎ اﻟﻛﻠوﺳﺗرﯾدﯾوم اﻟدﯾﺎرﯾﺎ اﻟﻐزﯾرة ﺗﺳﻣم ﻏذاﺋﻲ‬
It produces invasive infection. It is responsible for 90% of myonecrosis and
gas gangrene cases infecting contaminated wounds (e.g. compounds
fracture and post partum uterus). Clostridium perfringens also causes
profuse diarrhea (food poisoning) .

Morphology ...
They are found in the soil and the intestine of man and animals. They are anaerobic large
G+ve rods. They produce subterminal non-bulging spores (rarely produce spores in
laboratory media). They produce capsule the patient's tissue

‫اﻟﻣﺎرﻓوﻟوﺟﻲ ﺗوﺟد ﻓﻲ اﻟﺗرﺑﺔ و اﻣﻌﺎء اﻻﻧﺳﺎن و اﻟﺣﯾوان ﻓﮭﻲ ﺗﻌﺗﺑر ﻻرج اﻧﯾروﺑك و ﺗﻛون‬
‫ﻛرام ﺑوزﺗف رودز ﺗﻧﺗﺞ ﺳﺑﺗﯾرﻣﻧﺎل ﺳﺑور اﻟﻲ ﺗﻛون ﻏﯾر ﻣﻧﺗﻔﺧﺔ ﻧﺎدرا ﻣﺎﺗﻧﺗﺞ ﺳﺑورات ﻓﻲ‬
‫ﻻﺑرﺗري ﻣﯾدﯾﺎ و ﺗﻧﺗﺞ ﻛﺎﺑﺳول ﻓﻲ اﻟﺑﯾﺷﻧت ﺗﺷﯾو‬
 ‫اﻟﺳﻣوم‬ ‫ ﺳﻣوم‬4 ‫ اﻧواع ﻣن اﻟﻛﻠوﺳﺗرﯾدﯾوم ﺑﯾرﻓﯾرﯾﻧﺟز ھﻲ ال اي و ﺑﻲ وﺳﻲ و دي واي ھﺎي ﺗﻧﺗﺟﻠﻲ‬5 ‫ھﻧﺎك‬
Toxins
‫ﻣﺧﺗﻠﻔﺔ ﺳﻛﻣﺎ و ﺑﻲ و اي و ﻟوﺗﺎ‬
There are 5 types of Clostridium perfringens (A, B, C, D, and E). They
are differentiated on the basis of production of 4 major toxins (∝, B, E,
and Iota).
∝ a toxin is responsible for severe toxemia in gas gangrene and has the
‫ھﺎي اﺷﺎرة ﻧﻔﺗرض اﺳﻣﮭﺎ ﺳﻛﻣﺎ ﻋﺑﺎرة ﻋن ﻣﺎدة ﺳﺎﻣﺔ ﻣﺳؤوﻟﺔ ﻋن‬
following properties: ‫اﻟﺗﺳﻣم اﻟﺷدﯾد ﻓﻲ اﻟﻛﺎز ﻛﺎﻧﻛرﯾﻧﺎ و ﺗﺗﺑﯾﻊ اﻟﺑروﺑرﺗﯾز اﻻﺗﯾﺔ‬
1. It is lethal for lab animals. ‫ﺗﻛون ﻗﺎﺗﻠﺔ ﻟﺣﯾواﻧﺎت اﻟﻣﺧﺗﺑر ﻟﯾﺛل‬
2. It is Ca+2, Mg+2- dependent lecithinase.
‫ ﯾﻌﺗﻣد ع اﻟﻠﯾﺳﯾﺛﯾﻧﺎز‬2 ‫اﻟﻛﺎﻟﺳوم و ﻣﻐﻧﯾﺳﯾوم ﺑﻼص‬
3. Causes lysis of RBCs. ‫ﯾﺳﺑب ﺗﺣﻠل ﻟﻠﻛرﯾﺎت اﻟﺣﻣراء‬
4. Produced by all types of Clostridium prefringens.
‫ﺗﻧﺗﺞ ﻋن طرﯾق ﺟﻣﯾﻊ اﻧواع اﻟﻛﻠوﺳﺗرﯾدﯾوم ﺑرﯾﻔرﯾﻧﺟز‬
5. It has necrotizing and hemolytic effect.
‫ﻟﮭﺎ ﺗﺎﺛﯾر ﻧﯾﻛروﺗﺎﯾزﻧك ﻧﺧري و ھﯾﻣوﻻﯾﺗك اﻧﺣﻼﻟﻲ‬
…..Enzymes…
DNAase, Hyaluronidase, Collagenase that digest subcutaneous tissue and
muscles ‫ﺗﮭﺿﻣﻠﻲ اﻟﺳﺑﻛوﺗﯾﻧس ﺗﺷﯾو و اﻟﻣﺻﻠز‬
 ‫اﻟﻛﺎز ﻛﺎﻧﻛرﯾﻧﺎ اﻟﺳﺑورات ﺗﺻل ﻣن اﻟﺗرﺑﺔ اﻟﻰ اﻻﻧﺳﺟﺔ اﻟﻣﺻﺎﺑﺔ او اﻻﻣﻌﺎء ﻣﺎﻟت اﻟﻣرﯾض ھﺎي اﻟﺳﺑورات‬
‫راح ﺗﻧﺑت ﺧﻼﯾﺎ ﺧﺿرﯾﺔ ﻣن ﺗﺗوﻓر اﻟظروف داﺧل اﻟﮭوﺳت ﻓراح ﺗﺗﻛﺎﺛر اﻟﺧﻼﯾﺎ اﻟﺧﺿرﯾﺔ و ﺗﺧﻣر‬
Pathogenesis ‫اﻟﻛﺎرﺑوھﯾدرات ﻣن اﻻﻧﺳﺟﺔ اﻟﻣﻧﺗﺟﺔ ﻟل ﺳﻲ او ﺗو ﺗﺗداﺧل ﻣﻊ اﻟﺑﻠد ﺳﺑﻼي ﻣﻊ اﻓرازات اﻟﺳﻣوم و اﻻﻧزﯾﻣﺎت‬
‫اﻟﻧﺎﺧر اﻟﻰ اﻧﺗﺷﺎر اﻟﻌدوى و ﻧﺧر اﻻﻧﺳﺟﺔة ﯾﻣﺗد اﻟﻧﺧر اﻟﻰ ﻧﻣو اﻟﺑﻛﺗﯾرﯾﺎ و ﻓﻘر اﻟدم اﻟﻣﻧﺟﻠﻲ و اﻟﺗﺳم اﻟﺷدﯾد‬
‫و اﻟﻣوت‬
1. Gas gangrene:

The spores reach traumatized tissue from soil or intestine of patients. The spores will
germinate to vegetative cells. Vegetative cells will multiply and ferment carbohydrates
of tissue producing C02 g interference with blood supply together with secretions of
necrotizing toxins and enzymes →spread of infection and necrosis of tissue.
The necrosis extends → bacterial growth, hemolytic anaemia, and severe toxemia
and death. ‫اﻟﻐﺎز ﻛﻧﻛرﯾﻧﺎ ﯾظﮭر ﻣﻛس اﻧﻔﻛﺷن‬
‫اﻟﯾوﺗرﯾس ﻛﺎز ﻛﺎﻧﻛرﯾﻧﺎ ﻗد ﺗﺗﺑﻊ ﻋﻣﻠﯾﺔ اﻻﺟﮭﺎض اﻻﻟﻲ ﺑﺳﺑب‬
In gas gangrene, a mixed infection is shown. ‫اﻟﻛﻠوﺳﺗرﯾدﯾوم ﺑﯾرﻓﯾرﯾﻧﺟﯾز اﻟﻣوﺟوددة ﻓﻲ اﻟﺟﮭﺎز اﻟﺗﻧﺎﺳﻠﻲ‬
‫ﻣن اﻟواﯾن اﻟﻧﺳﺎء‬%5 ‫ﺑﻧﺳﺑو‬
2. Uterine gas gangrene: May follow instrumental abortion because Clostridium
perfringens is present in the genital tract of 5% of women.
3. Clostridial bacteremia is frequent in patients with neoplasms.
‫ﻣرض ﺗﺟرﺛم اﻟدم ﺷﺎﺋﻊ ﻓﻲ ﻣرﺿﻰ اﻟﻧﯾوﺑﻠﯾﺷﯾﺎ اﻻورام‬
4.Food poisoning due to enterotoxin.
‫اﻟﺗﺳﻣﻣم اﻟﻐذاﺋﻲ ﺑﺳﺑب اﻟﺳﻣوم اﻟﻣﻌوﯾﺔ‬
Clinical findings ‫ اﯾﺎم ﻻﻧﺗﺎج‬3 ‫اﻟﻰ‬1 ‫ﺗﻧﺗﺷر اﻟﻌدوى ﻣن ﺟرح ﻣﻠوث ﺧﻼل‬
The infection spread from a contaminated wound in 1 -3 days to produce:
1. Crepitation in the subcutaneous tissue. ‫ﺗﺷﻘﻘﺎت ﻓﻲ اﻟﺳﺑﻛوﺗﯾﻧﯾس ﺗﺷﯾو‬
2. Foul smelling discharge. ‫اﻓرازات ﻛرﯾﮭﺔ اﻟراﺋﺣﺔ‬
3. Necrosis. ‫اﻟﻧﻛروﺳﯾز‬
4. Fever. ‫ﺣﻣﻰ‬
5. Hemolysis ‫اﻧﺣﻼل اﻟدم‬
6. Toxemia ‫ﺗﺳﻣم اﻟدم‬

7. Shock ‫ﺟﻠطﺔ‬
8. Death ‫ﻣوت‬
Treatment ... ‫اﻻزاﻟﺔ اﻟﺟراﺣﯾﺔ اﻟﻔورﯾﺔ ﻟﺟﻣﯾﻊ ﻟﻼﻧﺳﺟﺔ اﻟﻣﯾﺗﺔ‬
1.Immediate surgical debridement of all dead tissue.
‫ﺗﻧﺎول اﻟﻣﺿﺎدات اﻟﺣﯾوﯾﺔ اﻻﻣﺑﯾﺳﻠﯾن‬
2.Administration of antibiotics (ampicillin).
3.Polyvalent antitoxin could be used. ‫ﯾﺗم اﺳﺗﺧدام ﻣﺿﺎد ﺳم ﻣﺗﻌدد اﻟﺗﻛﺎﻓؤ‬
4.Hyperbaric oxygen detoxifies the patient rapidly
‫اﻻﻛﺳﺟﯾن ﻋﺎﻟﻲ اﻟﺿﻐط ﯾزﯾل ﺳﻣوم اﻟﻣرﯾض ﺑﺳرﻋﺔ‬
laboratory diagnosis
‫اﻟﻌﯾﻧﺔ اﻻﻧﺳﺟﺔ ﺗﺷﻛل ﻣن اﻟﺟروح و اﻟﺑس و اﻟﻣﺳﺣﺎت اﻟﻌﻣﯾﻘﺔ‬
A
1.Specimen: Tissue form wounds, pus, and deep swabs.
2.Gram stain: ‫اﻟﻛرام ﺳﺗﯾن ھﻧﺎ ﺑوزﺗف ﺣﺳب ﻣﺑﺣﺛت ﻋﻧﮭﺎ‬
B
CC
3.Culture on:
‫اﻟﻠﺣوم اﻟﻣﻔروﻣﺔ و اﻟﻛﻠوﻛوز ﻣﯾدﯾﺎ‬
4.Chopped meat and glucose media.
1
5.Thioglycolate
2 media. ‫اﻟﺗﯾوﻛﻠوﻛﯾﻼت ﻣﯾدﯾﺎ‬
6.Blood agar media
33
‫ﺑﻠد اﻛﺎر ﻣﯾدﯾﺎ اﻟﻲ ﺗﻛون ﻏﯾر ھواﺋﯾﺔ‬
Incubated anaerobicly
 ‫ﺗﺎﺛﯾرھﺎ ع اﻟﻣﻠك اﻟﺣﻠﯾب ﺗﺳوﯾﻠﻲ ﺗﺧﻣر ھﺎﺋﺞ‬
D. Action on milk: Stormy Fermentation. ‫اﻟﺑﺎﯾوﻛﻣﺳﺗري ﺗﯾﺳت اﻟﻛﺗﻼﯾز ﻧﻛﺗف و اﻻﻧدول ﺑوزﺗف‬
E. Biochemical test: Catalase: Negative, indole: Positive
F. Lecithin's activity: Bacterial lecithinases break down this lecithin
to an insoluble diglycerides resulting in an opaque halo, surrounding
the colony when grown on the egg yolk agar medium.
‫اﺧﺗﺑﺎر اﻧﺗﺎج اﻟﺳﻣوم‬ ‫اﻟﻼﻛﺛﯾﻧﺎﯾز اﻛﺗﻔﺗﻲ اﻟﻼﻛﺛﯾﻧﺎﯾزﯾز ﺑﻛﺗﯾرﯾﺎ ﺗﻛﺳر اﻟﻠﯾﺛﯾﺳﯾن‬
G. Test for toxin production ‫اﻟﻰ داﯾﻛﻠﯾﺳﯾراﯾد ﻏﯾر ﻗﺎﺑل ﻟﻠذوﺑﺎن ﯾﻧﺗﺞ ﻋﻧﺔ ھﺎﻟﺔ ﻣﻌﺗﻣﺔ‬
‫ﺗﺣﯾط اﻟﻛوﻟوﻧﻲ ﻟﻣن ﺗﻧﻣو ﻓﻲ اﻻﯾك ﯾوﻟك اﻛﺎر ﻣﯾدﯾﺎ‬
Naglers test is important for the identification of alpha toxin of Clostridium
perfringens. Other species of Clostridium shows Negative Naglers reaction.
‫اﻟﻧﯾﻛﻠﯾرس ﺗﯾﺳت ﻣﮭم ﻟﺗﺣدﯾد اﻻﻟﻔﺎ ﺗوﻛﺳﯾن‬
‫ﻟﻠﻛﻠوﺳﺗرﯾدﯾوم ﺑﯾرﻓﯾرﯾﻧﺟز ﻻﻧواع اﺧرى ﻣن‬
‫اﻟﻛﻠوﺳﺗرﯾدﯾم اﻟﻲ ﺗظﮭر ﺗﻔﺎﻋﻼت ﻧﺎﻛﻠر اﻟﺳﻠﺑﯾﺔ‬