GRAM-POSITIVE BACILLI:

BACILLUS & CLOSTRIDIUM

Dr. Elham Borwis
BDS, Dip PCD, MDS
• There are four medically important genera of
gram-positive rods:
▫ Bacillus,
▫ Clostridium,
▫ Corynebacterium, and
▫ Listeria.
 • Bacillus (aerobic)
Spore • Clostridium (anaerobic)
forming

• Corynebacterium
Non-spore • Listeria
forming
• The genus Bacillus includes aerobic, gram-positive
rods occurring in chains.
• Most members of this genus are saprophytic
organisms prevalent in soil, water, and air
• B. anthracis, which causes anthrax, is the principal
pathogen of the genus
 Morphology
spores are
Have square located in the
ends and are center
arranged in
long chains
 Edema
Lethal
Factor Factor

Protective
collectively known antigen
as anthrax toxin,
each toxin consists
of two proteins in an
Capsule
A–B subunit Its
configuration antiphagocytic
capsule
(polypeptide)
Virulence factors
 Lethal factor (LT) Edema factor(EF) Protective antigen

• inhibit • An exotoxin, act • Binds to

activation of as an adenylate specific cell
cyclase that
Mitogen- causes an increase receptors,
activated in the intracellular forms pores in
protein kinase concentration of the human cell
MABK cyclic AMP. This membrane that
causes an allows edema
• This pathway outpouring of fluid
controls the from the cell into factor and
growth of the extracellular lethal factor to
human cells space, which enter the cell
and inhibits manifests as
edema
cell growth.
Pathogenesis
• In humans, the infection is usually acquired by
the entry of spores through
▫ Cutaneous anthrax (injured skin or
▫ the mucous membranes (gastrointestinal
anthrax), or
▫ by inhalation of spores into the lung (inhalation
anthrax).
• In humans, approximately 95% of cases are
cutaneous anthrax , 5% are inhalation and
gastrointestinal anthrax is very rare
Cutaneous anthrax
• A pruritic papule develops 1–7 days after entry
of the organisms or spores through a scratch on
skin.
• The papule rapidly changes into a vesicle or
small ring of vesicles that coalesce, and a
necrotic ulcer develops.
• The lesions typically have a characteristic
central black eschar. Marked edema occurs
(malignant pustule)
Eventually it dries, loosens, and separates;
healing is by granulation and leaves a scar. It
may take many weeks for the lesion to heal
and the edema to subside
Pulmonary (inhalation) anthrax
• Wool sorter’s disease
• The incubation period between (1-7 days).
• Pulmonary (inhalation) begins with nonspecific
respiratory tract symptoms resembling influenza,
especially a dry cough and substernal
pressure.
• This rapidly progresses to hemorrhagic
mediastinitis, bloody pleural effusions, septic
shock, and death
Substernal pain may
be prominent, and
there is pronounced
mediastinal
widening visible on
x-ray chest films
Gastrointestinal anthrax
• Animals acquire anthrax
through ingestion of
spores and spread of the
organisms from the
intestinal tract
• The symptoms of include
vomiting, abdominal
pain, and bloody
diarrhea.
Diagnostic Laboratory Tests
• Specimens to be
examined are fluid or pus
from a local lesion, blood,
and sputum
• Stained smears often
show chains of large
gram-positive rods
• When grown on blood
agar plates, the
organisms produce
nonhemolytic gray to
white colonies with a
rough texture and a
ground-glass
appearance.
 McFadyean reaction
• used for demonstration
of B. anthrax capsule.
McFadyean stain
(Polychrome Methylene
Blue) shows amorphous
purple capsule
surrounding blue bacilli

o Rapid diagnosis can be done by using PCR (polymerase

chain reaction)
o Serologic tests, such as an ELISA test for antibodies
• Ciprofloxacin is the drug of choice.
• Doxycycline is an alternative drug.
• Prevention Ciprofloxacin or doxycycline was
used as prophylaxis in those exposed during the
outbreak in the United States in 2001.
Bacillus cereus
• they are Gram-positive,
motile rods, and they
have the ability to form
spores
• B. cereus causes food
poisoning.
 associated •
Emetic with fried rice,
Type milk and
pasta
Bacillus
cereus
(toxins)
associated with •
Diarrheal
Type meat dishes
and sauces
The emetic type

▫ Associated with, fried rice, milk, and pasta. When

large amounts of rice are cooked and allowed to
cool slowly, the B cereus spores germinate, and
the vegetative cells produce the toxin.
▫ The emetic form is manifested by nausea,
vomiting, abdominal cramps occasionally diarrhea
and is self-limiting, with recovery occurring within
24 hours.
▫ It begins 1–5 hours after ingestion of rice and
occasionally pasta dishes.
The diarrheal type

• has an incubation period of 8-16 hours

and is manifested by profuse diarrhea with
abdominal pain and cramps; fever and
vomiting are uncommon.
• The enterotoxin may be preformed in the
food or produced in the intestine.
Bacillus cereus Diarrheal type Emetic type
Incubation period 8-16 hours 1-5 hours
Toxin Secreted in Formed toxin
intestine (similar (formed in diet,
to E. coli heat similar to S.
labile enterotoxin) aureus
enterotoxin)
Heat Heat labile Heat stable
Food items Meat, vehetables, Rice fried
dried beans,
cereales
Clinical features Diarrhea, fever, Vomiting,
abdominal cramps abdominal
cramps
Treatment & prevention

• Only symptomatic treatment is given.

• No specific means of prevention.
• Rice should not be kept warm for long
periods.