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Aerobic Gram-Positive Bacilli (1)

No.
1

Micro.
Corynebacterium
diphtheriae

Disease
Diphtheria

Notes of Disease
Pediatric disease
Immune
asymptomatic
carriers:
In the oropharynx
or on the skin.
Transmitted by
Respiratory
droplets.
Hand-to-mouth
contact.
Skin contact.
Possible outcomes
after exposure:
Asymptomatic
colonization in
immune individuals.
Mild respiratory
disease in partially
immune people.
Fulminant disease
in non-immune
patients.
Respiratory
diphteria:
IP: 2 4 days.
The most common
site of infection is
the tonsils or
pharynx.
Sudden onset.
Sore throat.
Fever.
DT is produced
locally
Tissue necrosis and
exudate formation.
Exudative
pharyngitis:
Pseudomembrane.
Systemic disease:
Myocarditis:
+ Heart failure,
arrhythmias
+ Death often is a
result of heart failure
Neuropathy:

Treatment
Administration
of antitoxin: The
most important specifically
neutralize the
exotoxin before it
is bound by the
host cell.
Antimicrobials:
Three major
benefits:
+ It kills the
organism and thus
prevents further
toxin formation.
+ It slows the
spread.
+ It reduces
transmission.
Macrolides
(erythromycin).
Penicillin.

Prevention
Pre-exposure
prophylaxis.
Vaccination:
Inactivated
vaccine diphtheria
toxoid:
+ It is included
in the DTP
vaccine.
+ Ages 2, 4, 6,
15 to 18 months,
and at 4 to 6
years.
+ Booster doses
are
recommended
every 10 years.
Post-exposure
prophylaxis:
Close contacts
need to be
identified,
cultured, and
considered for
antimicrobial
prophylaxis:
+ Single dose of
benzathine
penicillin G or
+ Oral
erythromycin 5
days

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Aerobic Gram-Positive Bacilli (1)

Listeria
monocytogenes

Neonatal disease

Pregnant women
Healthy adults

+ More common.
+ At first, in soft
palate and pharynx.
+ Later, oculomotor
and ciliary paralysis,
with progression to
peripheral neuritis.
+ Reversible and not
serious, unless the
diaphragm is
involved.
Cutaneous
diphtheria:
Uncommon.
Extremely serious.
Early-onset
disease:
Acquired
transplacentally in
utero.
Granulomatosis
infantiseptica:
Severe.
Abscesses and
granulomas in
multiple organs.
High mortality
rate.
Abortion, stillbirth,
or premature birth.
Late-onset disease:
Acquired at or soon
after birth.
2 3 weeks after
birth.
Meningitis: Similar
to S. agalactiae
meningitis.
3rd trimester.
Influenza-like
symptoms.
Neonatal risk.
Most are
asymptomatic:
+ Mild influenza-like
illness.
+ An acute, selflimited

Combination of
ampicillin with
gentamicin:
treatment of
choice for serious
infections.
SXT.
Resistances:
Naturally
resistant to
cephalosporins.
Resistance to
macrolides,
fluoroquinolones,
and tetracyclines
has been
observed.

No vaccine
No postexposure
prophylaxis

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Aerobic Gram-Positive Bacilli (1)

Opportunistic

Bacillus anthracis

Anthrax

gastroenteritis
develops in some
patients.
Invasive listeriosis.
Meningitis is the
most common: high
mortality (20
50%).
Mainly: older
adults, patients
receiving
chemotherapy.
Primary
bacteremia
(sometimes with
endocarditis).
Zoonosis of
herbivores.
The disease is not
spread from animal
to animal.
Humans are
infected primarily as
a result exposure to
animals.
Transmission to
humans:
Inoculation: Hides
(skins), goat hair,
and wool.
Inhalation: Woolsorters disease.
Ingestion: Very
rare in humans.
+ Transmission can
occur from person to
person through direct
contact with skin
lesions.
+ But rarely through
inhalation.
Cutaneous
anthrax:
Wounds
contaminated with
anthrax spores.
IP: 2 3 days.
Papule.

Penicillin
resistance.
Ciprofloxacin or
doxycycline
combined with
one or two
additional
antibiotics:
Rifampin,
vancomycin,
penicillin,
imipenem,
clindamycin,
clarithromycin.
Oral penicillin
(amoxicillin).

Current
vaccines:
Anthrax
vaccine
adsorbed (AVA;
biothrax): The
only anthrax
vaccine licensed
for humans.
Sterne
vaccine:
Veterinary
vaccine
Post-exposure
prophylaxis for
inhalation
anthrax:

Antimicrobials:
Ciprofloxacin
OR
Doxycycline.
Vaccination.
Raxibacumab.

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Aerobic Gram-Positive Bacilli (1)

Ring of vesicles .
Eschar or black
eschar: 1 3 cm in
diameter, sometimes
more.
Painless, nonpurulent.
Gastrointestinal
anthrax:
Ingestion of
spores.
+ Mouth or
esophagus:
Ulcers.
Leading to regional
lymphadenopathy,
edema, and sepsis.
+ Cecum or terminal
ileum:
Nausea, vomiting,
and malaise.
Abdominal pain.
Bloody diarrhea.
Difficult to
diagnose.
Mortality is very
high.
Inhalation
(pulmonary)
anthrax:
Spores are inhaled.
wool-sorters
disease.
IP: range from few
days to ~ 2 months.
At the beginning,
non-specific
symptoms: Mild
fever, fatigue, and
malaise 2 to 5 days
after exposure.
Later, a sudden
severe phase:
Respiratory distress
is common:
+ Dyspnea,
cyanosis, pleural
effusion.

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Aerobic Gram-Positive Bacilli (1)

Enteric disease
Ocular disease

Opportunistic

Intravenous
catheter infection.
Central nervous
system shunt
infections.
Endocarditis in
drug abusers.
Bacteremia.
Meningitis.

Erysipeloid

Uncommon

Bacillus cereus

Erysipelothrix
rhusiopathiae

+ Enlargement of
the mediastinal
lymph nodes.
Followed by
disorientation, coma,
and death.
Very high mortality
rate.
Injectional
anthrax:
Soft tissue
infection.
After injection
drug use.
Necrotizing
fasciitis, organ
failure, shock, coma,
and meningitis.
No black eschar.
Food-borne
intoxication.
Panophthalmitis.

Enteric
intoxications do
not require
antimicrobials,
obviously:
Ocular
infections:
Vancomycin (with
or without an
aminoglycoside)
OR Clindamycin.
Other severe
infections:
Vancomycin.
Alternatives
depending on
sensitivity tests:
aminoglycosides,
carbapenems, and
fluoroquinolones.
Penicillin is the
antibiotic of
choice.
Alternatives:
Cephalosporins,
carbapenems,
fluoroquinolones,
and clindamycin
are also active in

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Aerobic Gram-Positive Bacilli (1)

vitro.
Erysipelothrix is
resistant to
vancomycin.

Pneumonia

Nocardia

Actinomycotic
mycetomas (or
actinomycetomas)

Other cutaneous
infections

Invasive
pulmonary
disease
7

Rhodococcus

Others

The most common


nocardiosis (~66%).
Acquired by
inhalation.
Most are caused by
N. cyriacigeorgica
and N. farcinica.
Usually chronic.
Similar to
tuberculosis.
~50% of
pneumonia can
spread, mainly to the
brain.
N. brasiliensis is
the most common.
Acquired by
inoculation.
Skin or
subcutaneous tissues:
usually in the hands
and feet.
Lymphocutaneous
infections
Cellulitis
Subcutaneous
abscesses
Opportunistic.
Dissemination in
the blood to distal
sites: Lymph nodes,
meninges,
pericardium, skin.
Cutaneous
infections (after
trauma)
Peritonitis
Endophthalmitis
(after trauma)

Antimicrobial
sensitivity varies.
Options:
SXT.
Amikacin.
Imipenem.
Third-generation
cephalosporins.

Including a
macrolide, a
fluoroquinolone,
or a rifamycin.
Beta-lactams
should be avoided
since drug
resistance can
develop during
therapy.

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