Difference between revisions of "Clostridium species"

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Revision as of 09:41, 25 September 2008


Infectious agents and parasitesWikiBugs Banner.png
BACTERIA



Overview

  • Organisms present in the soil, alimentary tract and faeces
  • Endospores may be present in liver and may be reactivated to cause disease
  • Neurotoxic clostridia, Clostridium tetani and Clostridium botulinum affect neuromuscular function but cause no tissue damage
  • Histotoxic clostridia cause localised lesions in tissues and may cause toxaemia
  • C. perfringens cause inflammatory lesions in the gastrointestinal tract and enterotoxaemias in sheep


Characteristics

  • Large Gram-positive rods
  • Obligate anaerobes
  • Fermentative, catalase negative, oxidase negative
  • Straight or slightly curved
  • Motile by flagellae
  • Require enriched media for growth
  • Produce endospores which vary in shape and location and cause bulging of mother cell


Pathogenesis and pathogenicity

  • Produce extracellular digestive enzymes and toxic substance known as exotoxins
  • Exotoxins cause necrosis, haemolysis and death
  • Collagenase, hyaluronidase and DNase enymes facilitate spread through tissues


Diagnosis

  • Anaerobic transport medium
  • Culture on blood agar enriched with yeast extract, vitamin K and haemin
  • Anaerobic culture with hydrogen supplement and 5-10% carbon dioxide for 48 hours
  • Colonies of C. perfringens are 5mm diameter, circular, flat and grey and surrounded by a zone of double haemolysis
  • Positive cAMP test with Sreptococci agalactiae
  • Biochemical tests
  • Toxins identified in body fluids by toxin neutralisation or protection tests in lab animals
  • Nagler reaction to detect alpha toxin - plate neutralisation test
  • Fluorescent antibody tests for histotoxic clostridia
  • ELISA, PCR for toxin detection
  • Sudden death in unvaccinated farm animals may suggest C. perfringens types B, C and D
  • Post mortem
  • Gram positive rods present on intestinal smears suggests clostridial enterotoxaemia


Neurotoxic clostridia

Clostridium tetani

  • Causes tetanus
  • Acute, potentially fatal intoxication affecting many species
  • Horses and man particularly susceptible; carnivores fairly resistant
  • Found in horse faeces
  • Characteristics:
    • Terminal, spherical endospores give mother cells a drumstick appearance
    • Enodospores resistant to boiling and chemicals but susceptible to autoclaving
    • Swarming growth and haemolytic on blood agar
    • Many serotypes but all produce same neurotoxin, tetanospasmin, therefore antibodies neutralise all
  • Pathogenesis:
    • Endospores introduced via damaged tissues e.g. penetrating wounds
    • Damaged tissue creates an anaerobic environment, allowing germination of spores
    • Tetanospasmin made by bacteria replicating in damaged tissue
    • Absorbed toxin affects neuromuscular junction distant from site of toxin production
    • Neurotoxin binds irreversibly to ganglioside receptors on motor neurons and is transported to nerve cell body
    • Toxins transported across synapse to terminals of inhibitory neurons where they block transmission of signals
    • Spastic paralysis by constant tensing of muscles results
    • Toxin can be blood-borne and bind to motor terminals throughout the body as well as in the CNS
  • Clinical signs:
    • Incubation period 5-10 days
    • Stiffness, localised spasms, altered heart and respiratory rates, dysphagia, altered facial expression, lock-jaw from mastigatory muscle spasm
    • Tonic muscle contraction easily stimulated
  • Treatment:
    • Antitoxin IV or into subarachnoid space on 3 consecutive days
    • Toxoid subcutaneously to promote active immune response
    • Penicillin to kill vegetative cells
    • Debridement and flushing of wound with hydrogen peroxide
    • Fluids, sedatives, muscle relaxants
  • Control:
    • Toxoid vaccine for farm animals
    • Debridement of wounds in horses


Clostridium botulinum

  • Ubiquitous organism
  • Oval, subterminal endospores; spores survive boiling for hours
  • Causes botulism, a potentially fatal intoxication
  • Germination of endospores, growth of bacterial cells and toxin production in anaerobic conditions e.g. decaying carcasses and vegetation
  • Disease in animals consuming rotting carcasses and in herbivores through contamination of feed
  • Pathogenesis:
    • Intoxication on ingestion and absorbtion of toxin from GIT into the blood
    • Occasionally germination of spores in wounds or GIT
    • Neurotoxin carried to peripheral nervous system
    • Toxin binds gangliosides irreversibly at the neuromuscular junction
    • Blocks release of acetylcholine
  • Clinical signs:
    • Dilated pupils, dry mucus membranes, decreased salivation, tongue flacidity, dysphagia in farm animals
    • Incoordination and knuckling followed by flacid paralysis and recumbency
    • Paralysis of respiratory muscles leads to death
    • Flacid paralysis of legs and wings in birds
  • Diagnosis:
    • Mouse inoculation with infected serum
    • Toxin detection by PCR, ELISA
    • Toxin neutralisation tests in mice
  • Treatment: polyvalent antiserum neutralises unbound toxin
  • Toxoid vaccine used in endemic regions
  • Implicated in equine grass sickness


Histotoxic infections

  • Exotoxins cause local tissue necrosis and systemic effects which can be fatal - toxaemia
  • C. chauvei and C. septicum present in muscle as latent spores which can germinate to cause infection
  • C. novyi type B and C. haemolyticum have latent spores in the liver
  • When inoculated into wounds, cause malignant oedema and gas gangrene
  • Endospores persist in the soil
  • Most ingested spores excreted in faeces, but some become dormant in tissues
  • Tissue injury leads to reduced oxygen tensions allowing germination and replication of bacteria
  • Exotoxins cause local necrosis
  • Activated spores in the liver and muscles cause endogenous infections including blackleg, infectious necrotic hepatitis and bacillary haemoglobinuria
  • Inoculation of wounds causes exogenous infections including malignant oedema and gas gangrene


Clostridium chauvei

  • Black leg:
    • Acute disease of cattle and sheep
    • Endogenous infection in young cattle with latent spores in muscles, activated by trauma
    • Exogenous infection via wounds in sheep of any age
    • Gangrenous cellulitis and myositis caused by exotoxins leads to rapid death
    • Skeletal muscle damage with lameness, swelling and crepitus due to gas accumilation
    • Dyspnoea due to lesions in tongue and throat muscles
    • Myocardial and diaphragmatic lesions can cause sudden death
    • Fluorescent antibody test for diagnosis
  • Causes gas gangrene, along with Clostridium septicum


Clostridium septicum

  • Causes malignant oedema:
    • Infection via wounds
    • Cellutis with minimal gangrene and gas formation
    • Tissue swelling die to oedema; coldness and discoloration of overlying skin
    • Toxaemia with depression; death may be rapis if extensive lesions
  • Causes braxy:
    • Abomasitis of sheep
    • Disease occurs during winter
    • Rapidly fatal; anorexia, depression, fever
  • Causes gas gangrene and myositis


Clostridium novyi

  • Infectious necrotic hepatitis/black disease:
    • Acute disease of sheep, occasionally cattle
    • Hepatic necrosis caused by exotoxins of C. novyi type B in liver damaged by Fasciola hepatica
    • Rapid death
    • Dark discoloration of skin caused by subcutaneous venous congestion
    • Fluorescent antibody test diagnostic
  • Causes gas gangrene and myositis.
  • May be involved in cutaneous lesions
  • Causes big head in rams - oedema of subcutaneous tissues of the head, neck and cranial thorax; necrotising lethal alpha toxin


Clostridium perfringens type A

  • Gas gangrene and myositis
    • Extensive bacterial invasion of damaged muscle
    • Gas production causing subcutaneous crepitus
    • Similar manifestations as malignant oedema


Clostridium haemolyticum

  • Causes bacillary haemoglobinuria in cattle, occasionally sheep
  • Endogenous infection - endospores dormant in liver
  • Fluke migration allows germination
  • Beta toxin causes intravascular haemolysis and hepatic necrosis
  • Haemoglobinuria due to destruction of red blood cells


Clostridium sordelli


Treatment of histotoxic infections

  • Early penicillin
  • Vaccination with bacterin or toxoid at 3 months and booster after 3 weeks, then annually


Enteropathogenic and enterotoxaemic clostridia

  • General:
    • Clostridium perfringens types B, C and D
    • Found in soil, feaces and intestinal tract
    • Survive in soil as spores
    • Husbandry, changes in diet and environment predispose to proliferation in the intestine
    • Abrupt changes to rich diets and intestinal hypomotility due to overeating
  • Pathogenesis and pathogenicity:
    • Clostridial replication and overgrowth in the interstinal tract of sheep
    • Production of potent exotoxins which cause local and systemic effects of enterotoxaemia
    • Type of toxins produced determine clinical syndrome
    • Haemolysins, collagenases and hyaluronidases also produced


C. perfringens type A

  • Necrotising enterocolitis in pigs and necrotic enteritis in chickens (alpha toxin with lecithinase activity)
  • Canine haemorrhagic gastroenteritis (cytotoxic enterotoxin)
  • Typhlocolotis in horses, possibly associated with Colitis X


C. perfringens type B

  • Lamb dysentery
  • Up to 30% morbidity and high mortality
  • Affects lambs in first week of life
  • Abdominal distension, pain, bloody faeces, sudden death
  • Bacterial overgrowth in the intestine of the lamb due to immature bacterial flora
  • Lack of proteases in the immature gut prevents cleavage of the beta toxin, allowing it to cause disease
  • Also alpha and epsilon toxins
  • Haemorrhagic enteritis and ulceration in the small intestine
  • Fluid in the peritoneal cavity and pericardial sac due to increased capillary permeability (beta toxin)
  • Fatal haemorrhagic enteritis in newborn foals, calves and adult goats


C. perfringens type C

  • Acute enterotoxaemia in adult sheep, 'struck'
  • Sudden death or terminal convulsions in sheep at pasture
  • Beta toxin (lethal, necrotising) plays major role in pathogenesis of the disease - increases intestinal and capillary permeability
  • Also alpha toxin (lecithinase)
  • Post mortem: jejunal ulceration; hyperaemia in small intestine; fluid accumulation in peritoneal cavity; congestion of peritoneal vessels; petechial haemorrhages
  • Haemorrhagic enteritis in piglets
    • Peracute enterotoxaemia often of entire litter with mortality rates 80%
    • Infection from sow's faeces
    • Death within 24 hours in young piglets
    • Chronic disease in older piglets
    • Dullness, anorexia, bloody faeces, perianal hyperaemia
    • Post mortem: necrosis of terminal small intestinal mucosa, caecum and colon and blood-stained contents; serosanguinous fluid in pleural and peritoneal cavities
  • Necrotic enteritis in chickens:
    • Broilers under 12 weeks
    • Acute enterotoxaemia, sudden onset and high mortality
    • Necrosis of small intestine
    • Predisposing factors include diet changes, coccidial infection and intestinal hypomotility
  • Acute enterotoxaemia with haemorrhagic enteritis in calves, lambs, foals, goats
  • Peritonitis in cattle - sudden death in feedlot cattle


C. perfringens type D

  • Pulpy kidney disease in well-fed 3-10 week-old lambs
  • Follows overeating high grain diet or luchious pasture
  • Starch from partially digested food enterering the intestine from the rumen allows rapid clostridial proliferation
  • Epsilon toxin activated by proteolytic enzymes causes toxaemia
  • Epsilon toxin increases intestinal and capillary permeability; also alpha toxin
  • Lambs found dead or with opisthotonos, convulsions, coma in acute phases
  • Blindness and head pressing in subacute disease; bloat in later stages
  • Hyperglycaemia, glycosuria
  • Post mortem: hyperaemia in intestine; fluid in pericardial sac; kidney autolysis with pulpy cortical softening (acute death)
  • Subacute death causes symmetrical encephalomalacia and haemorrhage in basal ganglia and midbrain
  • Enterotoxaemia in kids and adult goats


C. perfringens type E

  • Enteritis in rabbits, haemorrhagic enteritis in calves
  • ALpha and iota toxins


Treatment and control of enterotoxaemic infections

  • Hyperimmune serum
  • Vaccination - vaccinate ewes with toxoid 6 weeks before lambing to allow passive protection of lambs
  • Vaccination of lambs with toxoid before 2 months of age to protect against pulpy kidney
  • Avoid sudden dietary changes


C. piliforme

  • Spore-forming filamentous Gram negative intracellular pathogen
  • Only grows in tissue culture or embryonated eggs
  • Causes Tyzzer's disease - severe hepatic necrosis
  • Sporadic disease in foals, calves, dogs, cats
  • Foals under 6 weeks, found dead or comatose
  • Incubation period up to 1 week
  • Depression, anorexia, fever, jaundice, diarrhoea
  • Hepatomegaly and necrosis on post mortem
  • Diagnosis: Warthin-Starry silver impregnation technique demonstrates organisms in hepatocytes


C. difficile

  • Dogs with chronic diarrhoea
  • New born foals with haemorrhagic enterocolitis
  • Possibly associated with acute colitis in adult horses following antibiotic therapy or grain overload


C. colinum

  • Enteritis in poulty and game birds
  • Shed in faeces of clinically affected and carrier birds
  • Intestinal ulceration and hepatic necrosis
  • Therapeutic antibiotics in drinking water

C. spiroforme

  • Spontaneous and antibiotic-induced enteritis in rabbits
  • Enterotoxaemia, fatal within 48 hours
  • Oral antibiotics upset the intestinal flora, allowing overgrowth of clostridia