Genus CLOSTRIDIUM

Clostridiaceae
There are more than 200 species,divided in 19 clusters based on SrRNA gene
sequence analysis.
Most clinically related species belong to the Cluster І :
 COMMON CHARACTERISTICS
gram(+)rods,spore forming,anaerobs,motile

• HABITAT
Soil,marine sediments,sewage,intestinal tract of animals and humans
THEY ARE SAPROPHYTIC BACTERIA

• CULTURE
Some clostridia produce large raised colonies (C. perfringens) others produce smaller
colonies ( C. tetani)
Some produce zone of β-hemolysis
Ferment a lot of sugars → saccharolytic
Can digest proteins → proteolytic
 About SPORES
their shape and position varies among species
usually they are wider than the diameter of the rods in which are formed

• Central or equatorial
• Sub terminal
• Oval and terminal
• Spherical and terminal
 C. tetani
MORPHOLOGY
• Gram (+)rod shaped ,tennis rockets
• Motile-peritrichous flagella
• Spore-forming in the terminal region
Two forms: vegetative form and spore form
 Vegetative form: actively secretes toxin and cause disease
 Spore form: Dormant and metabolically inert,
resilient important in disease transmission
 C.tetani
PHYSIOLOGY
• Obligate anaerobs
• Grow well at 37 ˚C
• pH of 7.4
• Catalase (-) ve
Grow on blood agar or cooked meat medium ,growth can be improved by
adding serum or blood into ordinary media.
 C.tetani spores enter its host through devitalized tissue
(wound,burn, injury, umbilical stump,surgical suture)

VIRULENCE FACTORS
Tetanospasmin (causative agent) - heat labile neurotoxin
• Cleaves SNARE proteins
• Blocks the release of inhibitory neurotrasmitters such us GABA and glycine on Renshaw cells
• Renshaw cells fail to work → α motor neurons without inhibititory control → substained
excitatory discharge.
Tetanolysin - heat stable hemolysin
• Unknown significance in pathogenesis of tetanus
• Has a local necrotizing effect, which may facilitate the spread of C. tetani.
 PATHOGENESIS
The lethal dose of tetanospasmin for humans is approximately 2.5 ng/kg of body weight

1. Tetanospasmin is cleaved by a bacterial protease

into two peptides linked by disulfide bond
2. The larger peptide migrates by the retrograde
axonal transport system to the cell bodies of the
motor neurons to the spinal cord and brainstem.
3. The toxin diffuses to terminals of inhibitory
cells
4. Release of the inhibitory glycine and GABA is
blocked, and the motor neurons are not
inhibited
 DISEASE
Tetanus Incub. period 4-5 days to 3 weeks

Generalized tetanus → spastic paralysis GENERAL SYMPTOMS

Sudden, involuntary muscle tightening
• Risus sardonicus or lock-jaw (muscle spasms) – often in the
• Opisthotonous - exaggerated arching of the back stomach.
Painful muscle stiffness all over the
Localized tetanus → low quantities of toxin are body.
produced Trouble swallowing
Neonatal tetanus → very high mortality rate Seizures
Changes in blood pressure and fast
Cerebral tetanus → very rare heart rate.
 TREATMENT
• Patients who develop symptoms of tetanus should receive muscle relaxants
(diazepam ), sedation, and assisted ventilation. Sometimes,they are given
very large doses of antitoxin intravenously.
• Surgical debridement is vitally important because it removes the necrotic
tissue that is essential for proliferation of the organism.
• Penicillin strongly inhibits the growth of C. tetani and stops further toxin
production.
 EPIDEMIOLOGY-PREVENTION

Case fatality rate ranges from 10-80% and is highest among infants and the elderly.
Worldwide - present in the environment. In 2001 an estimated 282,000 died worldwide
from tetanus, mostly in Asia, Africa and South America.
BUT IT IS A TOTALLY PREVENTABLE DISEASE
Immunisation is the only effective prevention of tetanus. Tetanus toxoid is an effective,
safe, stable and inexpensive vaccine that can be given to all ages, to pregnant women and to
immunocompromised individuals → toxoid vaccine (toxoid is formaldehyde-treated toxin)
usually given to children in combination DPT (diphtheria-pertussis-tetanus) by means
of 3 doses in different intervals of time.