Clostridium and klostridiozy - Causes, Symptoms and Treatment .MF .
Clostridium - it is a large group of microorganisms which representatives are not the only cause minor health problems but also serious infections, the mere mention of which is alarming - it's tetanus, botulism, gas gangrene.Moreover, specific prevention, namely vaccination, developed only in tetanus, while other diseases caused by clostridia, may affect different segments of the population, occurring mainly in the form of sporadic cases.
Clostridium (Clostridium) - is Gram-positive bacteria (Gram staining acquire a blue-violet color), relating to Clostridiacae family, the genus Clostridium.The first description of Clostridium dated 1880 Polish scientist microbiologist A. Prazhmovskim.Coli represent the size of 0.5 to 20 microns, mobile, have different proteolytic activity (the ability to produce enzymes), depending on the species.The ability to form spores, which resulted in the purchase form of the "spindle" in connection with the fact that swell in the c
The genus Clostridium are 100 or more species of bacteria.The most famous of these C. botulinum (the causative agent of botulism), C. tetani (tetanus), C. septicum, C. perfringens, C. oedematiens, C. novyi (pathogens of gas gangrene), C. difficile, C. hystoliticum, C. sporogenes, C. clostridioforme, C. acetobutylicum, C. colicanis, C. aerotolerans, C. bifermentans, C. tertium, C. piliforme, C. laramie, C. ramosum, C. fallax, C. formicaceticum and others.
Clostridia are widespread in nature, can be detected in the soil, in water bodies.Some clostridia (eg, C. difficile) are representatives of the normal microflora of several human body systems, ie they are saprophytes.Most often they are found in the gut, skin, oral mucosa, female reproductive system, respiratory tract.Still, the main habitat - the intestines.Normally, a perfectly healthy people the amount of clostridial depends on age and is: in children under 1 year - to 103 CFU / g (colony forming units per gram of feces), children with 1 year and adults to 60 - 105 CFU / g,over 60 years - up to 106 cfu / g.C. difficile is often plated from soil and water, where, because of the formation of endospores, it may be stored up to 2 months or more.
Factors of pathogenicity of Clostridium
Feature clostridia and diseases caused by them, is the development of toxins and the symptoms associated with them, that is klostridiozy - poisoning.
1) toxin - a factor pathogenic clostridia.Some species of clostridia (C. botulinum, C. tetani, C. perfringens) produce some of the strongest bacterial exotoxin (botulinum toxin, tetanus toxin - tetanospazmin, ε-toxin that destroys red blood cells).Exotoxins have neurotoxicity (the nervous system), gemotoksichnostyu (erythrocytes and leukocytes), nekrotoksichnostyu (causing tissue necrosis).
2) Another factor is the invasiveness of pathogenicity - the ability of local tissue injury by producing a number of proteolytic enzymes.In particular, C. perfringens is capable of producing proteinase (breaks down proteins), collagenase, hyaluronidase.Such aggression factors like proteinase Lecithinase, hyaluronidase, collagenase, are the result of life of many species of Clostridia.
main feature of the pathogenic action of clostridial necrotic processes is the prevalence of inflammatory tissue, severity of which is minimal.Thus, clostridial vital functions carried out under anaerobic (without oxygen) conditions, followed by elaboration of toxins, enzymes and proteins, which determine gas formation and necrosis in the tissues, as well as a general toxic effect on the patient's body (usually it is the effect of neurotoxic).
Common causes of contracting infections caused by clostridia
source of infection can be patient and support both man and animal excrement with which clostridia into the soil at the bottom of ponds, where they can be stored for several months.Mechanisms of infection - alimentary (food), contact-household.Depending on the type of disease and symptoms of a clostridial infection healthy person transmission occurs at certain factors.Factors transmission eating ways are food products (meat products, fruits and vegetables, milk and dairy products), for a number of diseases such as botulism, for example, are the products with the creation of anaerobic conditions without preliminary heat treatment (canned, salted, smoked, dried foods, sausageshomemade).Contact-home mechanism is realized through the path wound infection, clostridial spores when certain fall to the damaged skin.cases of neonatal disease have also been described (in violation of the rules under sterile conditions), which is in tetanus, botulism and other klostridiozah.
Diseases caused by clostridium
Botulism (C. botulinum)
Tetanus (C. tetani)
Gas gangrene (. Perfringens type A,. Septicum, C. oedematiens, C. novyi)
pseudomembranous colitis (C. difficile,.perfringens type a)
Antibiotic- diarrhea (C. difficile)
Necrotic enteritis, food poisoning (perfringens type a)
Botulism (pathogen C. botulinum) -. acute infectious disease characterized by lesions of the nervous system with the development of paresis and paralysis smoothand striated muscle.The main feature of the causative agent - the ability to produce one of the strongest microbial toxins - botulinum toxin, which triggers the development of disease symptoms.More details about this disease in his article "Botulism".
Tetanus (pathogen C. tetani) - as an acute infectious disease with lesions of the nervous system and tonic contraction of striated muscle group.This pathogen also has a distinctive feature - the production of a strong toxin - tetanus exotoxin, causes severe disease clinic.Read more about tetanus in the article "tetanus".
Gas gangrene (pathogens perfringens type A, septicum, C. oedematiens, C. novyi..) - an infection that develops under anaerobic conditions with the active participation of some species of Clostridia, which develops in the large areas of damaged tissue.Developed after extensive injuries, trauma, traumatic amputations, gunshot wounds.Terms of occurrence of gas gangrene - the first 2-3 days from the date of injury or other serious injury.The focus of Clostridium infections are favorable conditions for reproduction (the absence of oxygen, dead skin cells and tissues), produce toxins, causing the intoxication of the whole organism and the possible defeat of toxins of other organs and systems.A patient in a local outbreak occurs tissue swelling, flatulence, tissue necrosis, spread to healthy parts of the process.There are several forms - the classic, edematous-toxic, putrid and abscess.Help the patient need to provide as soon as possible, otherwise the process spread might cost the patient's life.
pseudomembranous colitis or PLA (often called C. difficile, but can also play a role. Perfringens type A) .PMC also develops as a result of antibiotic treatment, which are frequent culprits lincomycin, ampicillin, tetracycline, chloramphenicol, clindamycin, cephalosporins rarely.The consequence of this treatment is rough intestinal dysbiosis with a pronounced activity of one of the germs before us - C. difficile.Vital activity of clostridia causes inflammation of the intestinal mucosa, mainly in distal of his department, the formation of so-called "pseudomembranous" - fibrinous raids on the mucous membrane.These violations threaten the development of complications - perforation of the intestinal wall, which can lead to death.Groups at risk for the development of PMK: the elderly (over 65 years), as well as those with concomitant diseases (oncology, patients after surgical operations, etc.).The patient developed fever and intoxication (weakness, headache), but these symptoms are not necessary.It is also characterized by a disorder of the chair, which is frequent, watery.In debilitated patients may experience symptoms of dehydration.The chair can resemble changes in cholera (watery, whitish, frequent and abundant), but in severe cases, severe pain may appear chair with blood.
Endoscopic picture of PMC
Antibiotic- diarrhea or AAD (caused by C. difficile,. Perfringens) , but may be microbial association with fungi of the genus of Candida, Klebsiella, Staphylococcus and others.Most recorded in the conditions of medical institutions in patients requiring antibiotic treatment due to a particular disease.It is in these conditions and formed drug-resistant forms of clostridia.Often observed in the appointment of broad-spectrum drugs (cephalosporins, ampicillin, etc.).There are Antibiotic- diarrhea due to concomitant suppression of growth of both pathogenic and saprophytic (quite normal) microflora of the human digestive system.The risk of a diarrhea is not directly related to the amount of antibiotic in the body (which can occur when the first reception and repeated administration of the drug).Groups at risk for the development of the AMA - patients receiving cytotoxic agents and with immunodeficiency.AMA
symptoms are fever and intoxication (weakness, malaise), the appearance of watery stools with pathological impurities (mucus, sometimes blood), pain in the umbilical region, and then across the abdomen.Upon infection, C. difficile is not uncommon to re-Clinic (relapse) after 4-6 days due to the stability of clostridia spores to treatment.In children the first 3 months, given the small intestine contamination and are breastfed AMA is rare.
Necrotic enteritis (the cause is. Perfringens type F) .Nekrotoksin clostridia cause necrosis of the bowel wall and the formation of ulcers and errozirovannyh surfaces (ie the destruction of the intestinal wall).At the site of the lesion observed inflammatory changes in mucosal edema.There is a risk of bleeding and perforation of the ulcer, as well as the development of small-vessel thrombosis.Patients complain of fever, vomiting and diarrhea with blood and foam abundance.
food poisoning caused.perfringens lasts a few days.Clinically, small differences from the poisoning of another etiology.Symptoms of the disease are caused by clostridium toxin, and appear in a few hours (usually it is 6-12 hours) after eating poor quality food (usually meat products).Patients complain of diarrhea, nausea, rarely vomiting, pain in the abdomen.
defeat of the genitourinary system. In some cases, Clostridia may be the prime cause of acute prostatitis.
clostridial sepsis can occur when distributing large amounts of toxins through the body and toxic lesions of various organs and systems, including vital (kidneys, brain, liver).
preliminary diagnosis is based on symptoms of a particular clinical picture of the disease due to a major trauma, administration of antibiotics, the consumption of specific foods and the like.The diagnosis is confirmed after laboratory and instrumental diagnostics.
Laboratory diagnosis includes:
1) Bacterioscopy primary materials for research.
2) Bacteriological method in which the identification of the causative agent.The material for the study is the discharge from the wounds, feces, and others depending on the clinical form.Sepsis may be blood, urine.Material seeded on selective culture medium (e.g., Kita-Tarotstsi medium) and grown anaerobically.
with Clostridium bakposeve
3) of biological samples to detect toxins clostridia, with the aim of which is used neutralization reaction specific antitoxic sera.
4) Paraclinical research methods (general analysis of blood, urine, coprogram, biochemical blood tests).
5) Diagnostics.When X-ray can detect the accumulation of gas in the subcutaneous space and the muscle tissue that is positioned on the preliminary findings of clostridia (gas can be found in other anaerobic infections).At PMC, endoscopy, in which a picture is visible focal or diffuse (widespread) pseudomembranous colitis with education.
clostridium difficile under a microscope
Patients with infections klostridioznymi be hospitalized if indicated and severity.
Diseases such as botulism, tetanus, gas gangrene treated only in a hospital and require immediate help to save the patient's life. Some types of nosocomial diarrhea are therefore also treated in hospital.
Pharmaceutical care includes:
1) Introduction of specific products to neutralize toxins in botulism (protivobotulinicheskaya serum immunoglobulin) and tetanus (tetanus serum immunoglobulin).These products are subject to careful calculation and setting strictly under medical supervision in a hospital.Sera alien, so be ready for a possible implementation antishock measures.
2) antibacterial therapy, the purpose of which is appointed by the antibiotics, which have a sensitivity-reducing clostridia.These include: nifuroxazide, metronidazole, rifaximin, tinidazole, doxycycline, tetracycline, clindamycin, clarithromycin, penicillin, levofloxacin.The choice of drug is only for the attending doctor, who suspected and confirmed the diagnosis of certain clinical forms klostridioznoy infection.That caused this state of a medicament for the treatment of antibiotic-intestinal lesions, overturned.For causal treatment can be recommended for oral vancomycin, metronidazole.
3) Surgical treatment (when relevant gas gangrene) and reduced to the excision of damaged areas of the wound, followed by antibacterial sanitation.
4) Symptomatic treatment depending on the clinical syndrome (which may be probiotics uroseptiki, gepatoprotektory, antipyretics, anti-inflammatory drugs and other groups).
One important rule - a careful personal hygiene at home and in the social environment: hand washing after using the toilet, careful treatment of food products, including heat.Preventive measures also apply to health professionals: control and dynamic monitoring of the appointment of antibacterial drugs, especially immunocompromised patients to intensive care departments, hematological hospitals, recipients of organs and tissues.
infectious disease doctor Bykov NI