1. Gram-positive bacilli ( Spore forming, Non-Spore-forming )
임창하 자료조사&피피티제작
김덕호 자료조사&피피티제작
심예슬 자료조사&피피티제작
이소윤 자료조사&피피티제작
박혜란 자료조사&발표

2. Content Gram positive Spore-forming bacilli - Bacillus - Clostridium
Gram positive Non-Spore-forming bacilli
- Listeria
- Erysipelothrix,
- Corynebacterium
- Propionibacterium

3. Gram positive bacilli 분류

4. Central, Sub-Terminal, and Terminal spores

5. The Genus Bacillus B.cereus : cause of one type of food poisoning
Aerobic, Catalase(+), not fastidious
Spore disperse by means of dust
Versatility in degrading complex macromolecule common source of antibiotics
Primary medical importance
B.anthracis : cause of anthrax
B.cereus : cause of one type of food poisoning

6. Bacillus anthracis Central spores Block-shape, angular Anthrax의 원인균
The largest of all bacteria pathogen
Morphology
3~10μm long , 1~1.15μm width
Characteristic
Non-motile, Catalase +
Central spores
Block-shape, angular
Virulence factor
-polypeptide capsule
-exotoxin

7. Anthrax Anthrax type Cutaneous(95% of human cases) hemorrhagic vesicle
covered black crust

8. Anthrax 2. Pulmonary (100% fatal) capillary thrombosis
cardiovascular shock
3. GIT/systemic (rare)
vomiting, diarrhea, toxemia, death

9. Anthrax Treatment -penicillin, tetracycline
-vaccination of animal herds and people in endemic areas is performed

10. Bacillus cereus flagella Central spore Morphology facultative anaerobe
Characteristic
β-hemolytic,
Central spore
Airborne & dust-borne contaminant
Multiple readily in cooked food
toxin-mediated food poisoning
: fried rice, meat or vegetables

11. Bacillus cereus nauseam vomiting, abdominal cramps, diarrhea Symptoms
no specific treatment symptoms diasppear within 24 hours
Two toxins
Short incubation period : vomiting (dairy product)
Long incubation period : diarrhea (meat)

12. Bacillus subtilis Characteristic : Spore & flagella β-hemolytic (BAP)
non-toxic
non-toxic 비병원성

13. The Genus Clostridium Characteristic Anaerobic Catalase nagertive
Endospore forming gram-positive bacilli
Reside in a variety of habitats
Infection occur when spores are introduced into injured skin
혐기성
카탈라아제 음성 > bacillus 속
아포형성 그람 양성 간균
여러곳에서 서식함
아포는 피부 상처를 통해 유입되 감염

14. Pathogens grouped according to toxin effect
Neurotoxic
C.botulinum : flaccid paralysis
C.tetani : spastic paralysis
Enterotoxic
C.difficile : antibiotic associated diarrhea
C.perfringens : gangrene, food poisoning
신경독소
이완성마비
강축성마비
2. 장독소
항생제 관련된 설사
괴저, 식중독

15. Clostridium perfringens
found in soil, on human skin, intestine and vagina
Non-motile
Capsule
Hemolysis on BAP-double zone
Subterminal spore

16. Clostridium perfringens
Gas gangrene
- Damaged or dead tissue, Oxygen-poor internal muscles
- anaerobic cellulitis , myonecrosis
Produces toxin (lecithinase C)
- red blood cell rupture, edema,
tissue destruction
Produces enzymes
- collagenase, DNase, hyaluronidase
=> Pain, edema, bloody exudate, fever, tachycadia, blackned necrotic tissue
가스괴저
손상되거나 죽은 조직, 산소가 부족한 내부근육에서 발병
무산산소성 연조직염(봉와직염), 근괴사
독소를 생성 – 세포막에 구멍을 뚫음, 장->장관염, 적혈구 -> 용혈 => 적혈구 파괴, 부종, 조직파괴
효소를 생성 => 콜라겐분해효소, Dnase, 하이알루론산분해효소
통증 부종 피고름 열 심박급속증 흑색 괴사 조직

17. Gas gangrene

18. Treatment, Prevention surgical repair, amputation
debridement of diseased tissue
Hyperbaric oxygen therapy
Immediate cleansing
잘라내는것이 가장 효과적 (수술적 제거나 절단)
고압산소 요법은 산소의 증가로 인해 혐기성 세균의 증식과 독소생산을 막아 감염의 심각성을 줄일수 있다.
예방은 즉각적이고 철저한 세척

19. Clostridium tetani
C.Tetani is recovered from the wound in only 30% of acases
Motile
Terminal spore (drumstick)
Strict anaerobe

20. Tetanus Tetanospamin – neurotoxin Symptoms
Clenching of the jaw -> Extreme arching of back -> Flexion of the armsextension of the legs -> Dead
테타노스파민
운경신경말단까지 퍼짐-> 척수의 축삭 -> 척수신경에 결합(골격근의수축을억제하는) -> 신경전달 물질의 방출을 억제
증상 – 턱에 경련 -> 등이 아치형으로 휨 -> 팔이 굽고 다리가 곧게 펴짐 그리고 경련미소가 동반 -> 호흡근육마비 -> 사망

21. Treatment and prevention
Throughly cleansing and removing
Penicillin, tetracyclin, muscle relaxants
Antitoxin therapy
-tetanus immune globulin(TIG)
-tetanus antitoxin(TAT)
Vaccine : tetanus toxoid
이미 진행중이라면 감염조직을 세척및 제거 -> 테트라싸이클린,페니실린,근육이완제를 사용
의심가는 사람은 항독소 치료를 행한다
- 파상풍면역글로불린 -> 비싸고 효과가 좋다
- 파상풍 항독소 -> 알레르기 반응이 일어날수도 있다
예방은 백신을 통해서 할수 있는데 백신은 파상풍변이독소가 들어있다.

22. Clostridium botulinum
Commonly inhabit soil, water, and intestinal tracts of animals
Motile (flagella)
β-hemolysis
Botulism toxin (botulin)
-Causes food poisoning
Subterminal spore
토양과 물 동물의장관에 서식
운동성 있음
베타용혈성
보튤리즘 독소를 갖음(보튤린)
8개의 형이 존재 -> 빨강은 사람에게 감염
식중독의 원인
Subterminal spore

23. Botulism 1. foodborne botulism
- enters the small intestine with food -> absorbed into the lymphatics -> neuromuscular junction of skeletal muscles -> prevent the release of acetylcholine-> most potent microbial toxin
- improperly sterilized canned food
2. wound botulism
- infected wound / inject heroin /symptoms similar to those of food-borne botulism
3. infant botulism
- In children between the ages 2 weeks and 6 months
음식매개 보튤리눔독소증
음식과함께 섭취 -> 작은창자에 도달 -> 림프계와 순환계로 흡수 -> 골격근의 신경근 접합부에 도달 -> 아세틸콜린(근육수축) 방출을 막음
원인 : 살균이 안된 캔음식
증상 : 복시, 연하곤란, 현기증 -> 하행근육마비, 호흡계손상
2. 외상 보툴리눔독소증
파상풍처럼 외상을 통해 감염 하지만 증상은 식품매개 보튤리늄과 비슷하다
피부에 마약을 주입하는사람에게선 감염률이 증가한다.
3. 유아 보튤리눔독소증
2주~6개월 유아가 아포를 섭취하여 발생함
증상 : 이완성마비, 긴장저하영아증후군, 호흡합병증

24. Treatment and Prevention
- type A, B, E trivalent horse antitoxins
- respiratory and cardiac support systems
- penicillin
Prevention
- home-preserved foods : preservatives
(sodium nitrate, salt, acid)
- toxin is heat-sensitive, rapidly inactivated
at 100℃ boiled for 10mins before eating 치료
3개의 말 항독소 A B E 형을 투여
심호흡지지장치
페니실린 예방
보존제 첨가 (질산나트륨 소금 식초
독소는 열에 감수성이 강함 따라서 100도씨에서 10분간 가열해주면 빠르게 불활성화됨

25. Clostridium difficile
flagella
subterminal spore
Produces
A(enterotoxin) and B(cytotoxin) toxins
CDAD ; Clostridium difficile associated disease
운동성
독소를 생성
항생제 관련 위막성 대장염

26. CDAD ; Clostridium difficile associated disease
Antibiotic associated diarrhea
Pseudomembranous colitis
Treatment and Prevention
vancomycin, metronidazole
Vaccin : : C.difficile toxoid
ELISA testing
항생제 관련 설사
위막성 대장염
엠피실린 클린다마이신 세파로스포린과 같은 광범위 항생제로 치료중에 생김
장독소 -> 창자벽 괴사(비침습성) -> 설사 -> 복부경련 열 백혈구증가 위막탈락
치료 – 반코마이신 메트로니다졸 경구 복용
예방 – 백신 –위독소
- ELISA를 통해 빠르게 감별
ELISA 항체나 항원에 효소를 표지하여 효소의 활성을 측정하여 항원-항체 반응의 강도와 그 양을 정량적으로 측정하는 방법
= 효소 결합 면역 침강 분석법

27. Diagnosis of clostridial species
gas chromatography :
- analyzes the chemical differences
among species
direct (ELISA) testing of isolates
toxicity testing in mice or guinea pigs
serotyping with antitoxin neutralization tests
클로스트리듐 종의 감별진단
가스크로마토그래피 – 종들간의 화학적 차이를 분석 -> 복잡함
분리주의 직접 ELISA 검사
쥐나 기니피그를 이용한 독성검사. 항독소 중화를 이용한 혈청형 검사

28. Listeria monocytogenes An Emerging food-borne pathogen
Gram(+) Regular Non-spor-forming bacilli
From cocobacilli to long filaments
in palisades formation
Tumbling motility with one to four flagella
not capsules or spores
Not fastidious,
(resistant to cold, heat, salt, pH extremes, bile)
β-hemolytic
Unique multiplication cycle

29. 1) Epidemiology & Pathology
The primary reservoir (water, soil)
Secondary sources of infection
(plant materials, the intestines of healthy mammals, birds, fish, invertebrates)

30. Predisposing factor : weakened condition of host
defenses in intestine mucosa
In normal adults : mild of subclinical infection
(fever, diarrhea, sore throat)
In immunocompromised patients,fetuses,neonates : infection of the brain and meninges → septicemia
Pregnant women : Transmitted to the infant
Intrauterine infection → premature abortion, fetal death
Neonatal infections → damage to the nervous system

31. 2) Diagnosis
Cold enrichment
ELISA
Immunofluorescence
3) Treatment
Ampicillin, Erythromycin
trimethoprim-sulfamethoxazole
Cold storage
: not an effective control measure

32. Erysipelothrix rhusiopathiae A zoonotic pathogen
Gram(+) Regular Non-spor-forming bacilli
1)Epidemiology, Pathology
Primary reservoir : tonsils of healthy pigs, sheep, chickens, fish
In sewage, seawater, soils, foods
Swine erysipelas

33. Penicillin, erythromycin
Erysipeloid
Swollen, inflamed,
dark red lesions
that burn and itch
2) Treatment
Penicillin, erythromycin

34. Corynebacterium Gram-Positive Irregular Non-Spore-Forming Bacilli
Motility x
Spore x
Stain → Metachromatic granule
C.xerosis, C.striatum, C.diphtheriae

35. Corynebacterium diphtheriae
Most human disease associated with C. diphtheriae
Morphology
1. Pleomorphic variants
2. Metachromatic granule
3. Straight or somewhat curved rod, tapers at the ends
4. Club, filamentous and swollen shapes
Pleomorphic : 형태학적 다양함
Palisade : 울타리
granule : 과립

36. Epidemiology of Diphtheria
Significant cause of mortality but rate have steadily declined
Most cases occur in non-immunized children living in crowded, unsanitary situations
Still, many populations harbor a reservoir of healthy carriers

37. Pathology of Diphtheria
Contact with droplets from human carriers or active infections
Local infection (Cutaneous diphtheria)
Toxin production & Toxemia
Primary infection site : upper respiratory tract
Cutaneous diphtheria starts from virulence factors that assist in its attachment and growth -> deep, erosive ulcers
Not invasive but usually remain localized at portal of entry
Erosive ulcer : 부식성 궤양
혈액 내에 침입하지 않고도 독소로 인해 전신증상을 나타낼 수 있다.

38. Diphtherotoxin and Toxemia
- C. diphtheriae 가 감염부위에서 생성하는 매우 강력한 외독소
- Consisted of : Fragment A & B
1. Fragment A : interacts metabolically with factors in the
cytoplasm and stops protein synthesis.
2. Fragment B : Binds to target cells in
heart and nerve system
쉽게 말해 B가 target cell에 부착하면 A가
분리되고 cytoplasm으로 들어가서 독작용
Cardinal : 가장 중요한

39. Diphtherotoxin and Toxemia
Local infection
Inflammatory reaction, swelling neck and fever
Systemic infection
-Pseudomembrane
Greenish-gray film, solidification of fluid in pharynx
-Toxemia (독혈증)
Toxin absorbed from throat carried by blood
to heart and nerves
-> Asphyxiation, Heart damage, Muscle weakness
Pseudomembrane – 단단하게 붙어있어 떼려고 하면 출혈, 기도에 생겨 질식 유발
Myocarditis and abnormal EKG patterns : 심근염과 부정맥
Asphyxiation : 질식

40. Diagnosis for Corynebacterium
Positive Schick test
- Diphtheriae 변성 독소를 주입하여 반응 여부 검사
빨갛게 변함(+) : 백신 접종 필요
반응 없음(-) : 굳이 백신 접종할 필요가 없음
- 백신의 이차적인 부작용 결과를 최소화
디프테리아 변성독소(Toxoid)를 주입하여 체내에서 이 독소에 반응할 수 있는 능력이 있는지를 살핌.
빨갛게 변함(+) : 백신 접종이 필요함
아무 반응 없음(-) : 굳이 백신 접종을 할 필요가 없음.
디프테리아 변성독소에 양성반응을 보인 경우에만 항독소를 주입하는 백신을 접종하게 되었기에 백신의 이차적인 부작용 결과를 최소화 할 수 있게 되었다.

41. Treatment and Prevention of diphtheria
- DAT (Diphtheria Anti-Toxin) : 말 혈청에 대한 allergy test필요
- Penicillin + erythromycin
Prevention
- DPT : Vaccination with toxoid
- DTaP : DPT의 부작용을 최소한 한 Vaccine.
- D : Diphtheria
T : Tetanus by Clostridium tetani (파상풍)
P : Pertussis by Bordetella pertussis (백일해)
DAT : 말의 혈청이용, 말의 혈청에 대한 allergy test를 먼저 진행해야함.
DTaP : D,T는 Toxoid, aP는 bacterial protein 성분.
항원 : Toxoid – 독작용 x 항원작용 o
Bacterial protein 성분 포함

42. The Genus Propionibacterium
Gram-Positive Irregular Non-Spore-Forming Bacilli
Different by aerotolerant or anaerobic, nontoxigenic
Propionibacterium acnes
- Glands of human skin
Genetic and hormonal factors
Resemble Corynebacterium in morphology and arrangement
P. acnes : 여드름 (화농성) 유발

43. QUIZ

44. In genus Clostridium, which make an Antibiotic-Associated Colitis?
Clostridium difficile
Clostridium tetani
Clostridium perfringens
Clostridium botulinum
Clostridium novyi
답 1번

45. What is correct characteristic of Listeria monocytogens?
Producing capsule and spore
Growing in fastidious condition
Causing premature abortion
Not living in 4℃
Invading tonsil
답. 3번.

46. Which of the following is not C.diphtheriae’s morphological type?
Curve rods
Filamentous
Club shape
Lancet shaped
Palisades arrangement
답. 4번.

47. Which is not used for treatment & prevention of C.diphtheriae?
DTaP
DAT
Penicillin
Erythromycin
None of these
답. 4번.