Micro Anaerobic Gram-Positive Bacilli

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ANAEROBIC GRAM-POSITIVE BACILLI

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seldom cause diseases

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. Clostridium species

-found
-gram

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Common normal flora of people, animals, and soil
2. Large, spore-forming gram-positive rods

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Clostridium perfringens

4 things
1.from
-6 features
-inflammation?
-mediated by what, will see what with few what?

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1. Gas gangrene: Rare, rapidly progressive infection in traumatic and surgical wounds. Destruction of muscle, gas in tissue, hemorrhagic bullae, foul watery discharge, liver and renal failure, shock and death unless aggressively debrided. Little- inflammation. Mediated by production of toxin - will see massive necrosis of tissue with few inflammatory cells or bacteria.

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2.Necrotizing fasciitis or cellulitis
-aeorbic state
-what tissue
-doestnt involve what?
-more or less localized
-lethality
-inflamation/bacteria?

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Mixed aerobic, anaerobic infection in traumatized or poorly vascularized tissue. Doesn't involve muscle, more localized and less lethal. Marked inflammation in tissue with many bacteria

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3. Puerperal sepsis

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. Necrosis of uterus with bacteremia and intravascular hemolysis following incomplete abortion or incomplete removal of products of concept at delivery

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4. Food poisoning

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Sudden onset of nausea, vomiting, abdominal pain within a few hours of ingestion of toxin

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Clostridium tetani
-found
-vegative vs. spores
-tetanospasmin;
-spores in wounds
-generalized vs. localized
-severe cases

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Widely present in nature, a common component of gastrointestinal flora of man.
(ii) Vegetative forms easily killed, but spores survive 120 degrees for 10-15 min., and most chemical disinfectants.
(iii) Tetanospasmin inhibits postsynaptic reflexes in the spinal cord inhibiting antagonist muscle activity, and binds to cerebral gangliosides.
(iv) Spores introduced into wounds, and become vegetative in the presence of tissue destruction.

(v) Disease may be localized to the area of involvement, the cranial nerves if inoculation occurs on the head, or generalized. Generalized disease characterized by trismus, stiff neck, difficulty swallowing, rigidity of abdominal muscles, and fever. Severe cases
accompanied by risus sardonicus, and opisthotonis. Some cases associated with autonomic disturbances with fluctuating blood pressure, tachycardia, sweating, hyperthermia and cardiac arrhythmia’s

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Clostridium botulinum
-found in
-known toxins
-A, B, E

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-Common soil organism
(ii) Eight known toxins, require the presence of bacteriophage for production, and only one type produced by any one organism. Type A found most often west of Mississippi, type B most often east of the Mississippi, type E most often around bodies of water.

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Clinical manifestations of food-borne botulism begin with 6 things
-then what for how long and accompanied by problems with what senses
-finally
-fever?

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weakness, malaise, and dizziness, dry mouth.^.'A constipation, and urinary retention. Descending paralysis follows in one to three days with diplopia, blurred vision, photophobia, dysphonia, dysarthria, and dysphagia first, then weakness of extremities in descending order. Disease should be suggested by a combination of postural hypotension, dilated, unreactive pupils, dry mucous membranes, descending paralysis with progressive respiratory weakness, and the absence of fever

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Wound botulism

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occur in innocuous appearing lesions from 4 to 14 days after injury and appears similar clinically to food-bourn disease

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Infant botulism is characterized by what 3 things?
the absence of what?
descending what?
-and problems with what sense organ?

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by a 3 to 20 week old infant with constipation, weak suck, feeble cry, pooling of secretions in the mouth, absent gag reflex, descending flaccidity, ptosis, and ophthalmoplegia. This syndrome has now also been described in adults.

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(d) Clostridium difficile
-associated with what and in what organ system?
-develop what 3 general things and something unique with one organ?
-failure to treat may lead to what 2 things?
-syndrome is caused by what?

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Well recognized association with antibiotic associated pseudomemranous colitis
(ii) Patients receiving antibiotics develop fever, diarrhea, abdominal pain with exudate and ulcer formation in large intestine. Failure to recognize and treat may lead to bowel perforation and peritonitis.
(iii) Syndrome is caused by production of toxins by the organism

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other anearobic gram +
Propionibacterium acnes
-prominent what
-common what?
-causes infections in what 2 things and is associated with what?

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Prominent normal skin flora
2. Significance
Common contaminant
Causes infections in prosthetic devices, especially central nervous system shunts
Associated with acne

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ACTINOMYCETES

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Nocardia, Actinomyces

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nocardia

Actinomyces

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. Common soil organism
2. Generally not part of normal human flora
3. Significance:
Most commonly associated with pneumonia that produces cavities and extends to the chest wall if untreated 50% of patients with infection are immunocompromised, and infection often disseminates to multiple organs, especially brain May also be inoculated directly into skin and cause chronic draining lesions with sinus tracts
4. Laboratory diagnosis: cultures of sputum, pleural fluid, skin biopsies, other involved sites
Characteristic beaded, branching gram-positive filamentous organisms. Organisms are "partially acid-fast" meaning that they are not decolorized by a dilute concentration of the acid used to decolorize mycobacteria. Growth only aerobically


Found as normal flora in the upper and lower Gl tract of humans and animals.
2. Unlike Nocardia, is a strict anaerobe.
3. Unlike Nocardia, is best treated with penicillin. Nocardia must be treated with sulfonamide containing preparations.
4. Significance:
Cause infections of mucosal surface areas with some local damage.
Once initiated will continue to borough through tissue planes without treatment.
Drainage that occurs often contains small, yellow-orange, hard colonies of
organisms called sulfur granules.
Sites of infection include mouth and jaw, especially following dental work, lung
with abscess formation and spread to the pleura, abdomen following GI tract
problems, and pelvis, especially of the endometrium in 1UD users.
5. Laboratory diagnosis: Culture of draining lesions, histologic examination of tissue biopsies.
Characteristic branching gram-positive bacilli not partially acid-fact.
Growth only anaerobically.
May be only a clinical diagnosis since the number of organisms may be small and
the yield from cultures is also small.