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Anaerobes-Diseases-
DIAGNOSIS OF TETANUS
Primary upon clinical features
History and presence of wound
C. Tetani may not be isolated in wound
TREATMENT OF TETANUS
Stimulation kept at a minimum
Muscles relaxant e.g. diazepam
Tracheostomy if needed
TETANUS IMMUNE GLOBULIN (TIG):
* dose of 500 units IM immediately
( for
toxins outside the CNS)
* TIG 250 units ,intra-thecally
Debridement of wound, then treated
with
penicillin or metronidazole
Adrenergic
blocking
agents
or
morphine may be required for severe
autonomic reactions
Active immunization started
VIRULENCE FACTOR
Toxin A
Enterotoxin
Enterotoxin which causes intestinal
inflammation
resulting
in
fluid
secretions and hemorrhagic necrosis
resulting in bloody diarrhea.
Toxin B
Cytotoxin
Cytotoxin causing destruction of
interstitial epithelium.
Can be detected in stool samples from
patients with C. difficile disease by
adding the stool filtrate to a tissue
culture monolayer and observing for
cytotoxic effect or through the
detection of the toxin by EIA
PSEUDOMEMBRANOUS COLITIS
CAUSED BY Clostridium difficile
Antibiotic therapy that disrupts normal
bowel flora predisposes patients to
what is termed antibiotic associated
diarrhea
A severe form of this syndrome is
pseudomembranous colitis is caused
by C. difficile.
It tends to occur in hospitalized
patients who are exposed to c. difficile
spores remaining in the hospital from
previous patients with the disease.
ACC
Treatment:
Discontinue antibiotics
Give oral vancomycin or metronidazole
to suppress Clostridium difficile and
stop toxin production
Clostridium
botulinum
Gram positive; strict anaerobe
Motile perithrichious flagella
Spores oval, subterminal
Some withstand boiling for several
hours
Destroyed by moist heat at 120C in 5
minutes
Spores of type E, less heat resistant
Growth ; optimum at about 35C; some
strains grow and produce toxins at 15C
HABITAT
Saprophyte found in :
- Soil,
- Vegetables, fruits, leaves
- Silage
- Manure
- Mud of lakes and sea mud
Toxins of C. botulinum
Results: symmetrical,
descending flaccid paralysis
*
Acetylcholine
contraction
needed
for
Virulence Factors
The Botulinum toxin (Botulism) is an
extremely potent neurotoxin that
prevents acetylcholine release from
nerve endings resulting in flaccid
paralysis
Toxin
binds
to
the
Presynaptic
membrane
Botulism
- Life threatening disease characterized by
descending flaccid paralysis
Types of Botulism
Food Poisoning
Infant Botulism
Wound Botulism
FOOD POISONING
Botulinum toxin is the most potent
exotoxin known
Botulism is an intoxication illness
associated with improperly preserved
food
Although exceedingly rare, the
usual source is canned foods (an
DISEASE
(INFANT
Infant
botulismfloppy
child
syndrome-due to toxins produced by
organisms in the gut)
Neonates are at risk of the syndrome
known as infant botulism if they ingest
C. botulinum spores which then
germinate in the intestinal tract and
subsequently
cause
the
same
syndrome
as
with
intoxication
botulism.
On the food sources implicated such in
cases is raw honey.
Adults are not susceptible to this type
of infection apparently because the
spores do not germinate in the adult
gut.
* Adults are infected by the preformed toxins in the food that we
eat. Babies, on the other hand, may
be infected with spores from raw
honey, since spores can germinate in
an infants gut.
Clinical Features of Botulism
1. Incubation period , 1-2 days after
ingestion ( may be longer)