3. Morphology/ culture
• Spores: wider than diameter of bacillus
• Position: centre, terminal, subterminal
• Motile: peritrichous flagellae
• CULTURE: AnO2, BA
• COLONIES: SMALL, LARGE, HEMOLYSIS
• GROWTH: Sugar fermentation, protein digestion, milk
stormy fermentation ie clot torn by gas
• ENZYME : Different
4. CLOSTRIDIUM BOTULINUM
• Botulism
• World-wide
• Soil, rarely animal feces
• Spores: heat resistant 100 C many hours
• R decreased by acid, salt
• TOXIN: Released on growth, autolysis
• Ag types: A-G
• Human pathogen ; A,B,E
5. TOXIN ….CONTD
• A……FOODS
• E…..FISH
• C ….BIRDS
• D…..MAMMALS
• MOL. WT: 150,000( 100,000 &50,000 fragments by s-s bond
• Absorbed by gut
• Bind to pre synaptic memb of motor neurons
• Cranial nerves, PNS
6. toxin
• Neuron proteins( SNARE) inhibit release of
Ach at synapse
• Lack of muscle contraction….paralysis
• Most lethal toxin: 1-2ug
• Destroyed by heat at 100 for 20min
7. PATHOGENESIS
1. FOOD: Intoxication; not infection
• Canned, alkaline, eaten raw,
• Vacuum packed, spiced, smoked
• Spores: germinate, release toxin in AnO2
• Ach release blocked and FLACCID PARALYSIS
2. WOUND: A&B
8. CLINICAL FINDING
• Food ingestion…..18-24 hrs
• Visual disturbance: in-coordination of eye muscle, double
vision
• Speech difficulty
• Swallowing difficulty
• Bulbar paralysis
• Death, respiratory/cardiac arrest
• Pt conscious till death
• Fever; absent, no anti-toxin in blood if recovery
9. INFANT BOTULISM
• Common in US
• Food ingestion
• Floppy baby: poor feed, weak, paralysis
• Honey; vehicle
• Feces: CB, toxin
• Serum: none
10. Lab diagnosis
TOXIN: in serum & food left overs
Mice: I/P injection; death
Ag type: neutralization in mice
CULTURE: Food remains
test for toxin; RIA, Hagglut.
Infant: bowel, toxin & CB; not in serum
11. TREATMENT
1. TRIVALENT ANTI-TOXIN
• 3 potent anti-toxins; A,B,E
• Prepared in Horses
• GIVE I/V
2.Mechanical respiration
• Mortality brought down
INFANTS:
• Recover on support
• Anti-toxin given
12. EPIDEMIOLOGY
• SOIL; vegetables, fruits,
• Canning; destroy spores,
• boil ; 20 minutes before use
• Home canning: beans, corn, peppers, olives,
peas, fresh fish, smoked fish
• TOXIC: spoiled, ranscid, swelled cans
• Toxoids: for cattle
• Bioterrorism, warfare
13. CLOSTRIDIU TETNAI
• Soil
• Animal feces
• O Ag –same
• Flagellar- several
• Toxin- same, neurotoxin
• TOXIN: Tetanospasmin
• MW: 1,50,000(100,000 & 50,000); s-s bond
• Motor neurons: Binds pre-synaptic membranes
• Retrograde axonal movement to neurons SC, B STEM
14.
15. • Toxin moves to inhibitory cells, degrades
synaptobrevin, a protein that docks vesicles to
pre synap memb.
• Release of inhibitor is blocked & cells are not
inhibited
• Hyper-reflexia & muscle spasm ensues
• V. small amounts may be lethal
17. CLINICAL FINDINGS
• Incubation: 4-5 days….weeks
• Tonic contraction of voluntry muscles of
• Injury
• Jaw…lock jaw
• Tetanic spasm on external stimulus
• Painful
• Conscious
• Death…resp failure
• High mortality
18.
19. DIAGNOSIS
• H/O injury
• d/d strychnine poisoning
• Culture
• Anti-toxin given
PREVENTION:
• Active immunization by TOXOID
• CARE OF WOUND WITH SOIL CONTAMINATION
• PROPHYLACTIC USE OF ANTI-TOXIN
• PENCILLIN
20. 1.Human anti toxin or Tetanus immune globulin
• 250-500 units I/M….2-4 weeks OR
• 3000-10,000units to N unbound toxin
• Neutralizes toxin fixed to nervous tissue
2.Active immunization also done
Muscle relaxants, sedation
Assisted ventilation
Surgical debridement
Pencillin; prevent CT growth & super added infection
Immunized individual: TOXOID; recall injection
21. CONTROL
• Preventable
• Universal Immunization: TOXOID
• Formalin treat toxin; concentrate
• AL –salt adsorbed toxoids usedchild: 1 st year
• 3 injections
• Booster: after 1 year
• then before school entry
• 10 years apart
• Maintain serum level at 0.01units/ml
• Children : DPT
