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Chapter 50 :

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Abstract:

The genus comprises obligately anaerobic, gram-positive rods. Although species are usually catalase and superoxide dismutase negative, trace amounts of the enzyme activities may be detected in some strains, such as . Common predisposing factors are surgical procedures, trauma, vascular stasis, bowel obstruction, malignancy, immunosuppressive agents, diabetes mellitus, prior aerobic infection, and use of antimicrobial agents with poor activity against clostridia. Strains that carry only the genes for the binary toxin CdtA/B do not cause infection (CDI) or pseudomembranous colitis. There are four naturally occurring types of botulism: (i) classical foodborne botulism; (ii) wound botulism; (iii) infant botulism; and (iv) botulism due to intestinal colonization in children and adults. Laboratories with high throughput are increasingly utilizing detection of glutamate dehydrogenase (GDH), as the method of choice for screening stool samples for . The clinical hallmark of botulism is an acute flaccid paralysis, which begins with bilateral cranial nerve impairment involving muscles of the eyes, face, head, and pharynx and then descends symmetrically to involve muscles of the thorax and extremities.

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50

Key Concept Ranking

Food Microbiology
0.923218
Infectious Diseases
0.54505086
Acute Flaccid Paralysis
0.46708208
Gastrointestinal Diseases
0.46507993
Cardiovascular Diseases
0.46343654
Skin Infections
0.45062524
Restriction Fragment Length Polymorphism
0.42378256
0.923218
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Figures

Image of FIGURE 1
FIGURE 1

(top row, left) Gram stain of . Note the thin, Gram stain-variable bacilli with distinct spores. Reprinted with permission from reference .

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50
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Image of FIGURE 2
FIGURE 2

(top row, right) Lecithinase reaction on egg yolk agar. Note the opacity of the agar surrounding colonies due to precipitation of complex fats. Reprinted with permission from reference .

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50
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Image of FIGURE 3
FIGURE 3

(middle row, left) on CCFA. Note the yellow, ground-glass appearance of colonies. Reprinted with permission from reference .

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50
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Image of FIGURE 4
FIGURE 4

(middle row, right) on blood agar showing a double zone of beta-hemolysis. Reprinted with permission from reference .

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50
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Image of FIGURE 5
FIGURE 5

(bottom row, left) on blood agar after 12 h of incubation. Note the spreading colonies. Courtesy of E. J. Baron.

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50
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Image of FIGURE 6
FIGURE 6

(bottom row, right) Gram stain of . Note the long, filamentous bacilli with rare spores. Courtesy of E. J. Baron.

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50
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References

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Tables

Generic image for table
TABLE 1a

Characteristics of species of clinical significance

+, positive reaction; –, negative reaction; v, variable reaction; w, weakly positive reaction; ST, subterminal; T, terminal. A superscript indicates rare variability. Boldface type indicates key reactions. Capital letters indicate major metabolic products from PYG, lowercase letters indicate minor products, and parentheses indicate a variable reaction for fatty acids as follows: A, acetic; P, propionic; IB, isobutyric; B, butyric; IV, isovaleric; V, valeric; IC, isocaproic; L, lactic; S, succinic; and PA, phenylacetic.

is urease negative, and is urease positive. usually forms chalk-white colonies on egg yolk agar.

A toxin neutralization test is required for identification. Send suspected isolates or -containing material to the appropriate local or state public health agency.

Nonproteolytic.

L-Proline aminopeptidase differentiates is positive, and is negative.

Swarming.

Cigar shaped. is lactose and β-NAG negative, is lactose positive and β-NAG negative, and is lactose and β-NAG positive.

, , and most isolates grow aerobically.

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50
Generic image for table
TABLE 1b

Characteristics of species of clinical significance

+, positive reaction; –, negative reaction; v, variable reaction; w, weakly positive reaction; ST, subterminal; T, terminal. A superscript indicates rare variability. Boldface type indicates key reactions. Capital letters indicate major metabolic products from PYG, lowercase letters indicate minor products, and parentheses indicate a variable reaction for fatty acids as follows: A, acetic; P, propionic; IB, isobutyric; B, butyric; IV, isovaleric; V, valeric; IC, isocaproic; L, lactic; S, succinic; and PA, phenylacetic.

is urease negative, and is urease positive. usually forms chalk-white colonies on egg yolk agar.

A toxin neutralization test is required for identification. Send suspected isolates or -containing material to the appropriate local or state public health agency.

Nonproteolytic.

L-Proline aminopeptidase differentiates is positive, and is negative.

Swarming.

Cigar shaped. is lactose and β-NAG negative, is lactose positive and β-NAG negative, and is lactose and β-NAG positive.

, , and most isolates grow aerobically.

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50
Generic image for table
TABLE 2

Commonly used tests for the diagnosis of disease

CTA, cell culture-based cytotoxicity assay; LA, latex agglutination; EIA, enzyme immunoassay; ICA, immunochromatographic assay.

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50
Generic image for table
TABLE 3

Rapid identification of some lecithinase-positive and/or swarming spp. of clinical significance

EYA, egg yolk agar. For other abbreviations and symbols, see Table 1 , footnote .

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50
Generic image for table
TABLE 4

Activities of various drugs against spp. (Wadsworth agar dilution procedure)

Clinical and Laboratory Standards Institute (CLSI) approved method M11-A6 ( ) data from the Wadsworth Anaerobic Bacteriology Laboratory.

According to the CLSI-approved breakpoints (M11-A6) ( ), the intermediate category is susceptible.

Strains producing β-lactamase should be considered resistant.

Five or fewer strains were tested.

ND, no data.

Citation: Stevens D, Bryant A, Berger A, von Eichel-Streiber C. 2011. , p 834-857. In Versalovic J, Carroll K, Funke G, Jorgensen J, Landry M, Warnock D (ed), Manual of Clinical Microbiology, 10th Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816728.ch50

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