CLOSTRIDIUM 2

CLOSTRIDIUM TETANI
CULTURE
T - 37’C
pH - 7.4
surface colonies are difficult to obtain as the growth has tendency to swarm over the
surface
Drum stick appearance
FILDE’S METHOD – to isolate tetanus bacilli
Water of condensation at bottom of nutrient slope agar
Incubate anaerobically for 24 hrs
Subcultures from top of tube gives pure culture
Deep agar shake culture FLUFFY BALL
Gelatin stab culture FIR TREE SHAPE
RCM - turbid, no digestion, turned black
Blood agar – initially a hemolysis, later b hemolysis due to tetanolysin

CLASSIFICATION
10 types based on agglutination
All produce same toxin
Type 6 are non flagellates

TOXINS
1. Tetanolysin
2. Tetanospasmin
3. Non spamogenic peripherally acting neurotoxin

TETANOLYSIN
Heat and O2 labile
Similar to other O2 labile Clostridium hemolysins
No signigicance in pathogenesis

TETANOSPASMIN
O2 stable and heat labile
Plasmid coded
Toxoided spontaneously or in presence of low concentration formalin
Tetanus and botulinum toxin resemble in AA sequence
Susceptibility varies depending on species

TETANUS
CAUSES
Puncture wounds
Surgery
Otogenic
Septic abortion and unhygienic practices of delivary (tetanus neonatarum, uterine tetanus)

PATHOGENECITY
Little invasive power
Convulsion pattern is extensor type as they are more powerful
Toxic only parenterally

Toxin absorbed by motor N ends

Transmitted intraaxonally to CNS

Avidly fixed by gangliosidesof grey mater of CNS

Blocks synaptic inhibition in spinal cord (at inhibitory terminals using glycene and
GABA) presynaptically [strychnine acts post synaptically]

Uncontrolled spread of impulses initiated anywhere in CNS

TYPES
Based on experiments
1. Local – soon after im inoculation of one of hind limbs. Only in the hind limb as
toxin affects only the part of SC supplying it
2. Ascending – toxin spreads and tetanus extends cranially
3. Descending – on iv injection of toxin

PROPHYLAXIS
1’ routine immunization for children
2’ surgical attention
Simple cleansing to radical excition
Antibiotic treatment
Long acting penicillin injection im
Administration 4 hr after injection is effective. Not if later than 8 hrs
Passive immunization
ATS from horse serum – 1500 IU
Don’t prevent disease, but prolong incubation period
Equs ATS – immune elimination
Hypersensitivity
TIG – 250 IU 3-5 wks half life
Active immunization
Like diphtheria
Full course gives immunity for 10 yrs, after that, booster dose

TREATMENT
Patients kept in isolation to protect from noise and light
Tracheostomy, +ve P respiration, feeding
Human TIG 10000IU – iv infusion
5000 IU – later if needed
TIG cant neutralize toxin already bound to nerve tissue
Antibacterial therapy – penicillin

After patients recovery from tetanus, a full course of active immunization must be given
as it dosent confer full immunity

CLOSTRIDIUM BOTULINUM
Non capsulated
Motile

CULTURE
Strict anaerobe
T - 35’C
Large irregular semitransparent colonies
Spore produced in alkaline glucose gelatin media

CLASSIFICATION
8 types based on toxins A, B, C1, C2, D, E, F, G
Toxins have similar actions pharmacologically (except C2 which is enterotoxic) but are
neutralized only by homologous antisera

TOXIN
Exotoxin
Released after death of the organism by autolysis
Initially nontoxic prototoxin lysed by trypsin to toxin
Neurotoxin
Acts slowly
Can be toxoided an is antigenic
Block production of Ach at NMJ

C/F
Diplopia, dysphagia, dysarthria, descending paralysis
Detoxified by pressure cooking for 20 mins

PATHOGENECITY
Noninvasive
Non infectious
Small qty of botulinum type A toxin injected to a muscle

Atrophy

Recovery after 2-3 months (as terminal axon sprouts)

This is used in the treatment of strabismus. Safe symptomatic therapy for many NM
diseases

TYPES
Food borne
Wound
Infant

Food borne
Type A, B, E in humans
Symptoms 12-36 hrs after injestion
Vomiting, thirst, constipation, ocular paresis, difficulty in swallowing, breathing
Coma, death due to respiratory failure

Wound
Very rare
Type A
No GI manifestations

Infant
Infants below 6 months
Spores are injested-----Establish in gut------Produce toxin
Constipation, poor feeding, pooled oral secretion, altered cry, loss of head control
Excrete toxin and spores in feaces
Management – supportive care, assisted feeding
Antitoxin and antibiotics are not indicated

IMMUNISATION
Active - Al2SO4 adsorbed toxoid is effective
A--------------B----------booster
10 wks 1 yr
Passive – antiserum to type A, B, E may be administered as soon as diagnosis is made

CLOSTRIDIUM DIFFICLE
Causes antibiotic associated colitis
Ampicillin, tetracycline, chloramphenicol, linomycin, clindamycin all causes
pseudomembranous colitis
Drug of choice is metronidazole