1. Created by : Himanshu R Pardeshi S.Y. B-pharm

2. Learning objectives ;
To Study Morphology, pathogenesis, clinical features , treatment & prevention of :
Clostridium tetani
Clostridium bolutinum
By- Himanshu R Pardeshi

3. Clostridium titani
Tetanus
By- Himanshu R Pardeshi

4. Morphology
Distributed in soil, & grows in intestine of humans and horses.
Size : 5µm x 0.5 µm
Shape : slender rods with parallel sides & rounded ends with spherical terminal spores (drumstick)
Non-Specific, gram positive, Motile, forms spore.
By- Himanshu R Pardeshi

5. Growth of cl.tetani Obligate anaerobe , at 37°C
Grows on ordinary media, and improved when blood or serum is included in agar media.
On Blood agar it has tendency to swarm over the surface.
By- Himanshu R Pardeshi

6. Identification tests: Forms indole & liquefies gelatin slowly.
Do not ferment sugars
MR & VP tests are negative.
H₂S not formed.
Nitrates are not reduced to nitrites.
By- Himanshu R Pardeshi

7. Mechanism
It grows in the wounds in anaerobic condition as a consequence, toxin is liberated there. The toxin travels along the nerves to reach the nervous system and produces tetanus by two ways :
By Blocking acetylcholine at myoneural junc.
Countering inhibitory influences on muscle reflex.
Thus lowers the lower motor activity leads to muscle rigidity & spasm
Once toxin reaches the spinal cord the toxin can no longer be neutralised by antitoxin.
By- Himanshu R Pardeshi

8. Removal of inhibitory influences on ANS causes increased autonomic activity such as tachycardia sweating & hypotension
By- Himanshu R Pardeshi

9. Clinical significance:
Incubation period :5-15 days/ longer
Stage of rigidity: Stiff jaws. Further spreads to neck within 24 hrs.
Stage of spasm :Painfull contractions devlop within muscles due to rigidity of spasm. Period is called as ‘period of onset’.
The spasms causes the grimacing of the face and arching of neck and back, & even causes respiratory failure.
In mild cases only spasm over localised area become rigid.
By- Himanshu R Pardeshi

10. Treatment Immunoglobin 20,000 IU.
Sedation: Diazapam used to control mild spasm
Fluid and electrolyte balance is imp.
Neonatal-Unique problem in developing countries.
By- Himanshu R Pardeshi

11. Prevention :
Immunisation with tetanus toxoid provides protection for atleast ten years/ longer.
Universal childhood immunisation with 3 primary dose followed by boosters at school entry and leaving in developing counteries.
Wounds should be thoroughly cleaned and foreign bodies or dead bodies must removed.
Penicillin for contaminated wounds may reduce likelihood of tetanus.
By- Himanshu R Pardeshi

12. Clostridium botulinum
Botulism
By- Himanshu R Pardeshi

13. Morphology; Occurs in soil, veges, hay & silage
Gram positive of 5µm x 1µm in size.
Non-capsulated & motile by peritrichate flagelle.
Produces buldging spores.
Obligate anaerobe at 35°C
By- Himanshu R Pardeshi

14. Resistant to heat survives for several hours at 100°C.
Identification
Liquefies coagulated serum and produces a saccharolytic or proteolytic reactions.
Resistance:
Resistant to heat survives for several hours at 100°C.
By- Himanshu R Pardeshi

15. Pathogenesis
Produces powerful exotoxin responsible for its pathogenicity. This toxin is pure crystalline protien & probably is the most toxic substance known to humans.
Normally occurs in inactive form and is probably converted to active toxins by action of proteolytic enzyme.
Its toxin acts as neurotoxin, blocking the action of acetylcholine at synapses & neuromuscular junctions & leads to paralysis.
Death occurs due to respiratory paralysis.
By- Himanshu R Pardeshi

16. Clinical features
In food poisoning botulism, after incubation period there is onset of vomiting, tiredness, thirst & bulbar & ocular muscle paralysis.
Followed by flacid paralysis of limb & trunk muscles & Death due to respiratory failure .
In Infants: Severe with occurrence of difficulty in feeding.
By- Himanshu R Pardeshi

17. Treatment & Prevention
Its activity can be neutralised by specific antitoxin.
Standard Canning to prevent occurrence of botulism; most of the out breaks are due to inadequate home preservation of food.
In home preservation it should be pressure cooked or should be boiled for 20 minutes.
By- Himanshu R Pardeshi

18. Thank
you!!!
By- Himanshu R Pardeshi