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Infection control fundamentals
Chapter 5 infection control prinicples and practices
The microorganism clostridium botulinum is mainly associated with
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History
Clostridium botulinum has a rich history dating back to 19th century Europe where it first contaminated sausages, causing outbreaks of foodborne botulism. (1-3) In fact, the term botulism is derived from the Latin term botulus, meaning sausage. (1,3) Microbiologist Emile Pierre Marie van Ermengem first described the etiologic agent in 1897, (1-3) following isolation of the anaerobic bacillus from ham and splenic tissue obtained upon autopsy. (2,3) Although first referred to as Bacillus botulinus, it was eventually renamed Clostridium botulinum to distinguish it from the aerobic spore-forming genus Bacillus. (2) Importantly, the presence of a toxin was noted at this time, as cell-free extracts were capable of causing disease. (1,2) By 1943 and 1976, wound botulism and infant botulism were also respectively described. (1)
Organism Description
The bacterium Clostridium botulinum is a strict anaerobic Gram-positive bacillus. (1,2,4) A noteworthy feature is the ability to form resistant sub-terminal endospores. (1,4) The species is classified into four different groups, based on physiological, metabolic, and genetic characteristics. (2) Group I strains are proteolytic in culture, produce toxin types A/B/F, and form heat-stable endospores. (1-3) Group II strains are non-proteolytic in culture, produce toxin types B/E/F, and are psychrotrophic. (1-3) Lastly, Group III strains produce toxin types C and D; Group IV strains only produce toxin type G. (1,2) Regardless of group, C. botulinum is not part of the normal gastrointestinal flora; it is exogenously acquired. (2,4)
Botulinum toxin serotypes A and B have been approved for both therapeutic and cosmetic purposes. (1,4) Medical treatment for conditions such as strabismus (...
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...o public health. Weaponization involves aerosolizing the toxin to particles between 1-5µm in diameter (4) which facilitates inhalation of the toxin and access to the lower respiratory tract. (1,4) After the toxin crosses the pulmonary alveolar epithelium, it gains access to the bloodstream and nervous system, causing symptoms similar to foodborne botulism. (1) Thankfully, there have been no major successes in this area because the exposure of the toxin to heat, acid, and ultraviolet light during weapon deployment are likely to degrade its activity. (4) Bioterrorism may also involve contamination of food or beverage supplies within a community, resulting in foodborne botulism. (1)
Conclusion
Clostridium botulinum is an anaerobic bacillus of clinical significance. Although relatively rare, physicians need to be cognizant of its presence and detrimental symptoms.
Clostridium difficile, otherwise known as C. diff, is a species of spore-forming, anaerobic, gram-positive bacteria that is known to cause watery diarrhea. 1 The genus name, Clostridium refers to the spindle shape of the organism while Difficile means difficult in Latin due to the fact that this organism thrives in unfavorable conditions and is very difficult to isolate.4 The incidence of getting CDI has increased over the years due to new strains of increased toxin production of the bacteria and increased resistance to antibiotics.2 It is a gastrointestinal infection, and the most common cause of infectious diarrhea.1 C. difficile was first identified in the feces of healthy newborns back in the 1930’s and by 1935, it was considered normal flora. 2 During 1974, researchers conducted that about 21% of patients that were treated with an antibiotic called clindamyacin reported diarrhea and about 10% of them reported to have conducted pseudomembranous colitis as a side effect of this treatment. 2 It was in 1978 where C. diff had been known to cause anti-biotic associated diarrhea and pseudomembranous colitis. 2 It is known to form spores that resist many disinfectants; it also survives for several months on different surfaces.1 It is a common form of a nosocomial infection and the prevalence of becoming infected with C. diff is about 0-15% in a health care setting. 3 The spores survive well in environments such as soil, water and animals and is distributed worldwide. 4 CDI produces two toxins (Toxin A and B), which are cytotoxic and cause tissue necrosis.4
In this lab project, the microbiology students were given 2 unknown bacteria in a mixed broth each broth being numbered. The goal of this project is to determine the species of bacteria in the broth. They had to separate and isolate the bacteria from the mixed broth and ran numerous tests to identify the unknown bacteria. The significance of identifying an unknown bacteria is in a clinical setting. Determining the exact bacteria in order to prescribe the right treatment for the patient. This project is significant for a microbiology students because it gives necessary skills to them for future careers relating to clinical and research work.
The results of these tests prove that the unknown organism is Citrobacter freundii hereby referred to as C. freundii. C. freundii is a member of the Enterobacteriaceae family, like all the other unknowns given in this test. The species is a facultative anaerobic and is a gram-negative bacilli. C. freundii is a non-spore forming, motile bacteria that are long rod-shaped with a typical length of 1-5 μm.
The purpose of this laboratory is to learn about cultural, morphological, and biochemical characteristics that are used in identifying bacterial isolates. Besides identifying the unknown culture, students also gain an understanding of the process of identification and the techniques and theory behind the process. Experiments such as gram stain, negative stain, endospore and other important tests in identifying unknown bacteria are performed. Various chemical tests were done and the results were carefully determined to identify the unknown bacteria. First session of lab started of by the selection of an unknown bacterium then inoculations of 2 tryptic soy gar (TSA) slants, 1 nutrient broth (TSB), 1 nutrient gelatin deep, 1 motility
Metronidazole and vancomycin are indicated for treatment of C.difficile and two studies in animal model suggest that use of culture-specific probiotics, such as S. boulardii can up-regulate anti-toxin a secretary IgA. According to one large study, well-designed study A Randomized Placebo-Controlled Trial of Saccharomyces Boulardii in Combination with Standard Antibiotics f...
As stated in Chan-Tack and Bartlett’s article Botulism, “The incidence of foodborne botulism is approximately 24 cases per year. The incidence of wound botulism is 3 cases per year. The incidence of infant botulism is 71 cases per year, with a mean age of 3 months.” (2010). In addition, in merely fifteen percent of the Clostridium botulinium outbreaks are the toxin type undetermined. The first case descriptions of botulism were reported by Dr. Justinus Kerner, a German physician, in 1822. He had conducted experiments on himself and laboratory animals, which gave him this case findings (Taillac, & Kim, 2010).
Gut bacteria keep humans healthy by stimulating the digestive process within the large intestines. In order for nutrients to be successfully absorbed in the colon, non-digestible carbohydrates are degraded by beneficial gut microbial. One example of an anaerobically respiring bacterium which dominates the large intestine is bacteroide thetaiotaomicron. This bacteri...
JIU-CONG, Z., LI, S.,& QING-HE, N. (2010). Botulism, where are we now?. Clinical Toxicology (15563650), 48(9), 867-879. doi: 103109/15563650.2010.535003
Fries, A. A., & West, C. J. (1921). Chemical warfare,. New York [etc.: McGraw-Hill book company, inc..
So, what is Botox? Botox is the market name for type A botulinum toxin which is a purified form of the toxin produced by the bacteria, clostridium botulinum. This bacteria is commonly associated with food poisoning and is lethal in large doses. The botulism toxin could paralyze vital muscles needed for breathing. Although related to botulism food poisoning, the amounts of Botox given are so minimal and localized, that the toxin will not spread to any other muscles in the body, thus making it a safe and harmless procedure. When used cosmetically, tiny amo...
Among hospitalized patients around the world, Clostridium difficile is the primary source of infectious diarrhea. Previously, continuously unbalanced intestinal microbiota, usually due to antimicrobials, was deemed a precondition for developing the infection. However, recently, there have been alterations in the biology from virtually infecting the elderly population exclusively, wherein the microbiota in their guts have been interrupted by antimicrobials, to currently infecting individuals within of all age groups displaying no recent antimicrobial use. Furthermore, recent reports have confirmed critical occurrences among groups previously assumed to be of minimal risk—pregnant women, children, and individuals with no previous exposure to antimicrobials, for instance. Unfortunately, this Gram-positive, toxin-producing anaerobic bacterium is estimated to cost US critical care facilities $800 million per year at present, suggesting the need for effective measures to eliminate this nosocomial infection (Yakob, Riley, Paterson, & Clements, 2013).
While Botox is incredibly safe in the hands of skilled physician, it is still part of the cosmetic surgery world and, as such, should be treated with the same respect as you would give any other life-altering procedure. Botox is not something that you want done at a "party" or other special event, you want to use the same set of skills to choose a Botox provider as you would for Fraxel laser treatments, breast augmentation, liposuction, or a tummy tuck. Choosing a plastic or cosmetic surgeon who is certified by the American Board of Plastic Surgery (ABPS) ensures that you receive the finest care from a physician who has years of training and experience in surgery, reconstruction, and cosmetic procedures. In fact, an ABPS certified physician must have a minimum of five years of progressive clinical surgery experience and be able to qualify for American Board of Surgery certification before they even begin their plastic surgery residency. These doctors must keep current on all of the latest technologies through continuing medical education and training, and they follow a very strict code of
Bacterial cells, like plant cells, are surrounded by a cell wall. However, bacterial cell walls are made up of polysaccharide chains linked to amino acids, while plant cell walls are made up of cellulose, which contains no amino acids. Many bacteria secrete a slimy capsule around the outside of the cell wall. The capsule provides additional protection for the cell. Many of the bacteria that cause diseases in animals are surrounded by a capsule. The capsule prevents the white blood cells and antibodies from destroying the invading bacterium. Inside the capsule and the cell wall is the cell membrane. In aerobic bacteria, the reactions of cellular respiration take place on fingerlike infoldings of the cell membrane. Ribosomes are scattered throughout the cytoplasm, and the DNA is generally found in the center of the cell. Many bacilli and spirilla have flagella, which are used for locomotion in water. A few types of bacteria that lack flagella move by gliding on a surface. However, the mechanism of this gliding motion is unknown. Most bacteria are aerobic, they require free oxygen to carry on cellular respiration. Some bacteria, called facultatibe anaerobes can live in either the presence or absence of free oxygen. They obtain energy either by aerobic respiration when oxygen is present or by fermentation when oxygen is absent. Still other bacteria cannot live in the presence of oxygen. These are called obligate anaerobes. Such bacteria obtain energy only fermentation. Through fermentation, different groups of bacteria produce a wide variety of organic compounds. Besides ethyl alcohol and lactic acid, bacterial fermentation can produce acetic acid, acetone, butyl alcohol, glycol, butyric acid, propionic acid, and methane, the main component of natural gas. Most bacteria are heterotrophic bacteria are either saprophytes or parasites. Saprophytes feed on the remains of dead plants and animals, and ordinarily do not cause disease. They release digestive enzymes onto the organic matter. The enzymes breakdown the large food molecules into smaller molecules, which are absorbed by the bacterial cells. Parasites live on or in living organisms, and may cause disease. A few types of bacteria are Autotrophic, they can synthesize the organic nutrients they require from inorganic substances. Autotrophic bacteria are either photosynthetic or Chemosynthetic. The photosynthetic bacteria contain chlorophyll that are different from the plant chlorophyll. In bacterial photosynthesis, hydrogen is obtained by the splitting of compounds other than water.
“Botox is a neurotoxin derived from Clostridium botulinum, an organism found in the natural environment where it is largely inactive and non-toxic” (Nichols). It temporarily paralyzes the muscles. Clostridium botulinum can be found in the forest and cultivated soils, and in the sediments of lakes, streams and untreated waters. The bacteria can be found also in the intestines of mammals and fish. It can also be found in the organs of crabs and other shellfish. This
Food borne illnesses are caused by consuming contaminated foods or beverages. There are many different disease-causing microbes, or pathogens. In addition, poisonous chemicals, or other harmful substances can cause food borne illnesses if they are present in food. More than two hundred and fifty different food borne illnesses have been described; almost all of these illnesses are infections. They are caused by a variety of bacteria, viruses, and parasites that can be food borne. (Center 1)