Slide 1

: : Gram(+) -

H2

(Clostridia) , , , Gram , , , , , (. )

Domain: BacteriaPhylum: FirmicutesClass: ClostridiaOrder: ClostridialesFamily: ClostrdiaceaeGenus: Clostridium- Clostridium botulinum Clostridium tetani Clostridium difficile Clostridium perfringens Clostridium septicum Clostridium oedematiens (Clostridium botulinum), , (1000C) 3-5h (1200C) 20 min , , , 7 ,

, Zn 2+ 100 0C 20 Min

7 A, B, C, D, E, F G A, B E C D , C2 ,

Murray G9 , . , . ( ) ( ) ( Cl. botulinum) ( 6 - 6 , ) ( )

- , 6 , 10 . , 18-36 12 80 18-36 h :

() ( )

: , , Cl. botulinum /

Murray14 (A, B E)

!!!

:

2008: 0,02 100.000

:

2006 ( ) 2007 ( ) 2007 ( ) (Clostridium tetani), , , Gram(+) , 150 0C 1h, 5% 1%0 1

- , 5 56 0C

( )

() , 3-21 ( 7-10 ) . . , : , ( ) : - () 50%

/ Cl. tetani , , ,

, 100% :

10 5 . .

, Tdap TdTIGTdap Td

TIG

3 (1) (2)

10. Lf , (DT) (DTaP/ Tdap) . 100% 10 To 2, 4, 6, 15-18 4-6 . (Tdap Td) 10 11-12 . Tdap Td . 7-10 , 3 Tdap Td 4 Td 6-12

www.cdc.gov/tetanus/surveillance

2008: 0,02 100.000

(Clostridium difficile)Gram (+) , , , ,

CDI Cl. difficile

3-5%

cFarland et al 399 Cl. Difficile Cl. Difficile 21% Cl. Difficile

Patients are exposed toC. difficilespores through contact with the hospital environment or health care workers. After taking an antibiotic, they develop CDI if they acquire a toxigenicC. difficilestrain and fail to mount an anamnestic serum immunoglobulin G (IgG) antibody response to toxin A (ToxA; also known as TcdA)64; if they can mount an antibody response they become asymptomatically colonized withC. difficile. If they acquire a non-toxigenicC. difficilestrain, they also become asymptomatically colonized. Colonized patients have been shown to be protected from CDI126.37

TcdA TcdB CDI

(LCC)

GTP-binding signal proteins Ras ,

TcdA , TcdB

C. difficilecolonizes the intestine (colon) after disruption of the normal intestinal flora. To what extent adhesion and biofilm production are involved in the pathogenesis ofC. difficileis unknown; in the schematic, bacterial cells are shown as free cells and attached to host cells. Toxigenic strains produce toxin A and toxin B (TcdA and TcdB). TcdA binds to the apical side of the cell and, after internalization, causes cytoskeletal changes that result in disruption of tight junctions and loosening of the epithelial barrier, in cell death or in the production of inflammatory mediators that attract neutrophils. Disruption of tight junctions enables both TcdA and TcdB to cross the epithelium. TcdB binds preferentially to the basolateral cell membrane. Both toxins are cytotoxic and induce the release of various immunomodulatory mediators from epithelial cells, phagocytes and mast cells, resulting in inflammation and the accumulation of neutrophils. In an animal model, TcdB was shown to have a tropism for cardiac tissue, which would require that TcdB enter the bloodstream.40

CDI

Cl. Difficile CDI : (, , ) Cl. Difficile ,

CDI : 2-3 , >3 Cl.difficile ( ) 20 ml 5ml ( ) 2h 4 0C 3 -70 0C

CDI Cl.difficile :

CDIM ( )Saccharomyces boulardii ( ) ( CDI)Updated guidance on the management and treatment of Clostridium difficile infection

CDIFactors contributing to the development ofClostridium difficilecolonization and diarrhea49

CDI causes severe diarrhea, intestinal inflammation and cell death as a result of toxin-mediated infection with the pathogenic bacteria. Patients with CDI are typically treated with antibiotics, which not only kill the pathogenicC. difficilebut also exhibit activity against the dominant colonic microbiota phyla. Incomplete antibiotic eradication ofC. difficilecan result in recurrent CDIs. Transplantation of fecal microbiota from a healthy donor into an individual with CDI can restore the healthy gut microbiota in the patient's diseased colon, leading to resolution of symptoms. Abbreviations: CDI,Clostridium difficileinfection; FMT, fecal microbiota transplantation.50 (Clostridium perfringens)Gram(+) ,, , , , 1 , Nagler

12 - , , Nagler , Nagler - Cl.perfringens

5 A-E - B, D, E C

Cl. Perfringens (CPE), , 7-30h 1-2d

, ( , ) , ,

Cl. Perfingens - - ()

: / , ( ) /

: Cl. Pefringens Cooked-meat broth 16-50. - . , Cl. Pefringens 4h 4 0C. 60 0C

!!!