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Pathogenic Gram-Positive Bacilli (Corynebacterium)

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Corynebacterium
 Ubiquitous on plants and in animals and humans
 Colonizes the skin and the respiratory, gastro-intestinal, urinary,
and genital tracts
 Corynebacterium diphtheriae, the cause of diphtheria, is the most
widely known
Corynebacterium 3

 Transmitted from person to person via

respiratory droplets or skin contact
 Endemic in poor parts of the world, lack
adequate immunization
 Diphtheria toxin is responsible for the main
signs and symptoms of diphtheria
 Corynebacteria (Genus Corynebacterium)
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Aerobic or facultatively anaerobic
Small, pleomorphic (club-shaped), gram-positive
bacilli that appear in short chains (“V” or “Y”
configurations) or in clumps resembling “Chinese
letters”
Cells contain metachromatic granules (visualize
with methylene blue stain)
Lipid-rich cell wall contains meso-diaminopimelic
acid, arabino-galactan polymers, and short-chain
mycolic acids
Lysogenic bacteriophage encodes for potent
exotoxin in virulent strains
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 Corynebacterium diphtheriae 7

Respiratory diphtheria (pseudomembrane on

pharynx) and cutaneous diphtheria
Prototype A-B exotoxin acts systemically
• Toxoid in DPT and TD vaccines

Diphtheria toxin encoded by tox gene introduced

by lysogenic bacteriophage (prophage)
Selective media: cysteine-tellurite; serum
tellurite; Loeffler’s
Gravis, intermedius, and mitis colonial morphology
Diphtheria toxin 8

 The toxin consists of 2 polypeptides

 One subunit binds to a heparin binding epidermal growth factor receptor on
the surface of cells (especially cardiac cells and neurons )
 The toxin is internalized by endocytosis
 Inside the cell, the active subunit destroys elongation factor 2 responsible for
polypeptide synthesis
 This action is enzymatic so one molecule of toxin destroys all molecules of
elongation factor in the cell (leading to cell death)
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Disease
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 Diphtheria toxin inhibits polypeptide synthesis which results in

cell death
 Infections are asymptomatic or produce mild respiratory disease
in immune or partially immune individuals
Disease
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 Severe respiratory infections of nonimmune patients produce the

signs and symptoms of diphtheria
 Pseudomembrane results from fluid that has thickened and
adheres throughout the respiratory tract
 The pseudomembrane can completely occlude the respiratory
passages and cause suffocation
 Cutaneous diphtheria causes cell death and formation of a
pseudomembrane on the skin
Diagnosis, Treatment, and Prevention
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 Diagnosis
 Initial diagnosis is based on the presence of pseudomembrane
 Medium: Loffler’s serum medium, blood agar
 Absolute identification of toxin is based on the Elek test
 Antibodies against the toxin react with toxin in a sample of fluid from the patient
 Treatment
 Administration of antitoxin to neutralize toxin before it binds to cells
 Penicillin and erythromycin kill only the bacteria
Diagnosis, Treatment, and Prevention
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 Prevention
 Immunization with the DPT vaccine
 3-4 doses in first year of life
 Booster in school-age children and adults
 Component of penta or hexavalent vaccines
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Listeria monocytogenes

Gram-positive beta-hemolytic bacillus

Multiply at refrigerator temperatures (4oC)
motility at room temperature
CAMP Test positive (like Group B Streptococcus)
 Listeria habitat 15

Intestinal tract of mammals & birds (especially chickens)

Persists in soil
Soft cheeses & unwashed raw vegetables
Raw or undercooked food of animal origin
 Luncheon meats
 Hot dogs
Large scale food recalls have become common
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Epidemiology
of
Listeriosis
 Listeriosis 17
Neonates, elderly & immunocompromised

Granulomatosis infantiseptica
• Transmitted to fetus transplacentally
• Early septicemic form: 1-5 days post-partum
• Delayed meningitic form: 10-20 days following birth
Intracellular pathogen
• Cell-mediated and humoral immunity develop
• Only cell-mediated immunity is protective
Propionibacterium
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 Small, Gram-positive rods that are often found on the skin
 Propionibacterium acnes is the species most commonly involved
in human infections
 Causes much of the acne of adolescents and young adults (85 %)
 May also be an opportunistic pathogen in patients with intrusive
medical devices eg, catheters, artificial heart valves, artificial
joints and cerebrospinal fluid shunts.
 Role in accnea 19
 Excessive oil production (hormones)

 Leucocytes phagocytize the bacteria

and stimulate local inflammation
Role in accnea 20
 A blackhead is formed by a plug of dead bacteria

 In cystic acne, bacteria form inflamed pustules that rupture triggering scar
tissue formation