Medical microbiology

Gram positive Bacilli

Lec 6
 Gram Positive bacilli

• Ubiquitous
• they form spores, they can survive in the environment
for many years
• Bacillus species are aerobes and the Clostridium species
are anaerobes
 Bacillus
• aerobic, gram-positive rods, occurring in chains.
• Most members of this genus are saprophytic organisms prevalent in
soil, water, and air, and on vegetation (eg, Bacillus subtilis).
• B.cereus can grow in foods and cause food poisoning by producing
either an enterotoxin (diarrhea) or an emetic toxin (vomiting).
• B anthracis, which causes anthrax, is the principal pathogen of the
genus.
 1. Bacillus anthracis
• Anthrax is primarily a disease of herbivores , sheep, cattle, horses,
and so on; other animals.

• Humans become infected incidentally by contact with infected

animals or their products.

• The infection is usually acquired by the entry of spores through

injured skin (cutaneous anthrax) or rarely the mucous membranes

(gastrointestinal anthrax) or by inhalation of spores into the lung

(inhalation anthrax).
 Diagnostic tests &Treatments
• Specimens to be examined are fluid or pus from a local lesion,
blood, pleural fluid, and cerebrospinal fluid in inhalational
anthrax associated with sepsis and stool or other intestinal
contents in the case of gastrointestinal anthrax.

• When grown on blood agar plates, the organisms produce non

hemolytic gray to white, tenacious colonies with a rough
texture and a ground-glass appearance. Comma-shaped
outgrowths (Medusa head, “curled hair”) may project from the
colony.
Bacillus anthracis on blood Cutaneous anthrax
agar
 Treatments
• Many antibiotics are effective against anthrax in humans,
but treatment must be started early. Ciprofloxacin is
recommended for treatment
• prophylaxis with ciprofloxacin or doxycycline should be
given for 60 days and three doses of vaccine (AVA
BioThrax) should be administered.
 Virulence factors of B.anthracis
• The poly-γ-d-glutamic acid capsule is antiphagocytic.

• Anthrax toxins are made up of three proteins, protective antigen

(PA), edema factor (EF), and lethal factor (LF).

• the lethal toxin can quickly kill the animals by impairing both
innate and adaptive immunity, allowing organism proliferation
and cell death.
 Clinical findings

• Cutaneous anthrax generally occurs on exposed surfaces of the arms

or hands followed in frequency by the face and neck.

• A pruritic papule develops 1–7 days after entry of the organisms or

spores through a scratch. After 7–10 days, the eschar is fully
developed.

• The incubation period in inhalation anthrax may be as long as 6

weeks. The early clinical manifestations are associated with marked
hemorrhagic necrosis and edema of the mediastinum.
 Bacillus cereus
• Food poisoning caused by B cereus has two distinct forms :

• the emetic type : which is associated with fried rice, milk, and pasta, The
emetic form is manifested by nausea, vomiting, abdominal cramps, and
occasionally diarrhea and is self-limiting, with recovery occurring within 24 hours.

• the diarrheal type :which is associated with meat dishes and sauces.

• The diarrheal form has an incubation period of 1–24 hours and is manifested by
profuse diarrhea with abdominal pain and cramps; fever and vomiting are
uncommon.
• ingested spores that develop into vegetative cells of B cereus secrete one of

three possible enterotoxins which induce fluid accumulation and other physiological
responses in the small intestine.
 Clostridium species
• The clostridia are large anaerobic, gram-positive,
motile rods.
• Their natural habitat is the soil, marine sediments,
sewage, or the intestinal tract of animals and humans,
where they live as saprophytes.
• Pathogenic species can cause botulism, tetanus, gas
gangrene, and pseudomembranous colitis.
 Clostridium Botulinum

• C . botulinum, which causes the disease botulism, is worldwide in

distribution; it is found in soil and occasionally in animal feces.

• Produce toxin, Spores of the organism are highly resistant to heat,

withstanding 100°C for several hours.

• During the growth of C botulinum and during autolysis of the

bacteria, toxin is liberated into the environment.

• Seven antigenic varieties of toxin (serotypes A–G) are known.

 Botulisms types
• wound botulism : caused by types A or B toxin

• Food poisoning : most cases of botulism represent an intoxication

resulting from the ingestion of food in which C botulinum has grown and

produced Toxin

• infant botulism : honey is the most frequent vehicle of infection.

The infant ingests the spores of C botulinum, and the spores germinate

within the intestinal tract. The vegetative cells produce toxin as they

multiply; the neurotoxin then gets absorbed into the bloodstream , That

result in flaccid paralysis.

 Clinical findings of Botulism
• Symptoms begin 18–24 hours after ingestion of the toxic food, visual
disturbances, inability to swallow, and speech difficulty; signs of bulbar
paralysis are progressive, and death occurs from respiratory paralysis or
cardiac arrest.

Treatment
• Supportive care, especially intensive care, is key in the management of
patients with botulism. Adequate respiration must be maintained by
mechanical ventilation if necessary and in severe cases may need to be
maintained for up to 8 weeks.

• antitoxins to three types of botulinum toxins, must be promptly

administered intravenously with customary precautions
 Clostridium tetani
• which causes tetanus, is worldwide in distribution in the soil and in the
feces of horses and other animals.

• all produce the same antigenic type of neurotoxin, tetanospasmin.

• • C tetani is not an invasive organism. The infection remains strictly

localized in the area of devitalized tissue (wound, burn, injury, umbilical
stump, surgical suture) into which the spores have been introduced.

• Bacteria produce toxin which cause inhibition the neurotransmitter that

inhibits motor neurons.

• • Hyperreflexia, muscle spasms, and spastic paralysis result.

 Clinical diagnosis:
• •The incubation period may range from 4 to 5 days up to 3 weeks. The
disease is characterized by tonic contraction of voluntary muscles.
• Muscular spasms often involve first the area of injury and infection and
then the muscles of the jaw (trismus, lockjaw), which contract so that the
mouth cannot be opened.
• Gradually, other voluntary muscles become involved, resulting in tonic
spasms

Control
immunization with tetanus toxoid should be mandatory
Three injections comprise the initial course of immunization followed by
another dose about 1 year later. Initial immunization should be carried out in
all children during the first year of life.
 Clostridium perfringes
• can produce invasive infection (including myonecrosis and gas gangrene) if

introduced into damaged tissue. An enterotoxin of C perfringens is a common

cause of food poisoning.

• The alpha toxin of C perfringens type A is a lecithinase, also aggregates

platelets, there by leading to formation of thrombi in small blood vessels
and adding to poor tissue profusion and extending the consequences of
anaerobiosis, namely, destruction of viable tissue (gas gangrene).

• C perfringens enterotoxin, CPE When a high number of vegetative cells are

ingested and sporulate in the gut, CPE is formed. It induces intense diarrhea
in 7–30 hours
 Diagnostic Laboratory Tests:
• • Specimens consist of material from wounds, pus, and tissue.
• • The presence of large gram-positive rods in Gram-stained smears suggests gas
gangrene . clostridia spores are not regularly present

Treatment

• The most important aspect of treatment is prompt and extensive surgical

debridement of the involved area and excision of all devitalized tissue, in which
the organisms are prone to grow.
• Administration of antimicrobial drugs, particularly penicillin, is begun at the
same time.
• Food poisoning caused by C perfringens enterotoxin usually requires only
symptomatic care.