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gram negative rod GPR gram positive coccus
Clinical bacteria gram positive bacillus microscope
Gram Positive Bacilli


Anaerobic gram-positive bacilli are more well known than some of their aerobic counterparts; everybody in the known world has heard of the Clostridia. There were only a few genera of them so we decided to begin with them.

Actinomyces sp. Filamentous gram positive obligate anaerobic rods cause actinomycosis. The most common species is A. israeli.
Infection is usually the result of trauma. Pus and fluid at the site of infection have characteristic sulfur granules. DOC: penicillin or tetracycline.

Two images from Bristol Biomedical Image Archive: http://www.brisbio.ac.uk/ROADS/subject-listing/actinomyces.html

Bifidobacterium are bone shaped gram positive obligate anaerobic opportunistic pathogens which are normal inhabitants of the gut. The ends of the rods show characteristic splitting on gram stain and the organism shows branching filaments as well. B. dentium is the most common species.
Clostridium sp.
The University of Wisconsin online Textbook of Microbiology has an excellent section on the clostridia. In fact, there is an excellent gram stain image of pus from a mixed anaerobic infection. Gram stains are the, "real world of clinical microbiology," and represent the routine view of what clinicians actually see of bacterial organisms. In contrast EM images are more popularly viewed by laypersons. The following quote lists the general characteistics of clostridia.
"The clostridia are relatively large, Gram-positive, rod-shaped bacteria. All species form endospores and have a strictly fermentative mode of metabolism. Most clostridia will not grow under aerobic conditions and vegetative cells are killed by exposure to O2, but their spores are able to survive long periods of exposure to air. The clostridia are ancient organisms that live in virtually all of the anaerobic habitats of nature where organic compounds are present, including soils, aquatic sediments and the intestinal tracts of animals."
Clostridium botulinum Everybody knows that you have to be careful when canning meat, fish, fruits and veggies so that you don't get botulism. Didn't your grandmother ever tell you that botulism is the world's worst poison, so you have to be very careful? Well, guess what? It is. Don't even taste foods suspected to be spoiled by clostridium botulinum. But just to get your ducks in a row; botulinum is the name. Botulism is the condition. Botulin is the poison itself. People who work in clinical bacteriology are very unlikely to see this bacterium unless:
1) You work in a bacteria bank where they keep lyophilized specimens of every strain of bacteria.
2) You are doing epidemiology work for the CDC and are trying to locate the source of an outbreak of botulism poisoning.
3) You are doing research work involving gene sequencing of C botulinum strains.
According to the CDC, "In the United States an average of 110 cases of botulism are reported each year. Of these, approximately 25% are foodborne, 72% are infant botulism, and the rest are wound botulism. Outbreaks of foodborne botulism involving two or more persons occur most years and usually caused by eating contaminated home-canned foods." http://www.cdc.gov/ncidod/dbmd/diseaseinfo/botulism_g.htm
However these cases of botulism usually involve the toxin instead of the organism itself.
Clostridium difficile They probably named them, "difficile," because they are difficult. Or possibly because of the difficulty in remebering that it causes, "pseudomembranous colitis." Probably some people have known of someone who had strong antimicrobial therapy to clean out their intestines for one reason or another who ended up with a nasty form of enteritis caused by C. difficile which wasn't killed off by the antibiotics on the first go around. The doctor didn't even have to do a culture, he knew what had happened, didn't he? When he performed an endoscopy even the patient could see all those big white spots. He zapped those bugs on the second go around though. What a relief. It's like hitting yourself on the head with a hammer. It feels so good when it stops. This little difficulty with Clostridium difficile occurs in Americans, Europeans and Japanese. C. difficile is an equally opportunistic organism.
Clostridium perfringens is an invasive pathogen which posesses a, "huge array of invasins and toxins," http://www.bact.wisc.edu/MicrotextBook/disease/botulism.htmlcauses wound and surgical infections and also severe uterine infections, especially when coat hangers are used for abortions. Old timers remember someone who got gas gangrene while living in the trenches in WWl. Some called it foot rot, or boot rot. The foot and leg swell up due to the gas produced and if you press down on it, the gas bubbles out. It smells really fetid like the putrid smell of rotted meat. Guess what? It is rottet meat. Your rotted meat. The Clostridia which includes C. perfringens are at the bottom of the food chain. They live in soil and they breakdown not only the proteins but, the amino acids. When they break down lysine and arginine, the straight chain amines putrecine and cadaverine are produced. These small volatile molecules float through the air and when they reach the receptors in the nostrils, they elicit an electrical impulse which travels along a special pathway to a particular part of the brain. Over millions of years humans who have reacted to the resulting sensation of a, "stinky," smell by assiduously avoiding its source have survived by not being breakfast for these organisms.
Bristol biomedical image archive: "Gas gangrene," gram stain.
Clostridium tetani Everybody knows that if you cut yourself with a metal object or get dirt in a cut, you have to get a nasty tetanus shot. A lot of people know that Clostridia form spores but, they can't remember which Clostridia form which kind of spores. Here's a hint, "T" is for terminal and also tetani, get it? It's a little demonic mnemonic to help you remember on your medical micro proficiency exam.
GPR sporeHere's a scanning electron micrograph of Clostridium tetani at a magnification of x11,200. Both vegetative and spore stages are shown. The spore forms are the ones with the big bulges. There are faint blue strands which are flagella on the vegetative cells.

Clostridium tetani

The most beautiful examples of electron microscopy come from THE master of the art, Dennis Kunkel, at a University in Hawaii. Some guys have the luck. Clicking the thumbnail will take you to the website where you can see electron micrographs of all types of life forms. He calls bacteria prokaryotes. You might not find that unusual. Heck you might even call bacteria prokaryotes. Twenty five years. He's been doing electron microscopy for twenty five years. He's recieved a few awards.
gram positive bacillus
Aerobic gram-positive bacilli, in alphabetical order:
Bacillus anthracis , a real bad boy. Does B anthracis sporm fores? Ok who hasn't heard all about anthrax? Raise your hands. Right. You'll want to visit: http://www.bact.wisc.edu/MicrotextBook/disease/anthrax.html where you can view both a gram stain and the original light micrographs taken by Dr Robert Koch of the anthrax bacillus which was the very first bacterium shown to be the agent of a disease in 1877. The gram stain image is superb in clarity and detail. Long chains and spores can be seen.
You will also want to visit the CDC. The disease listing of bacterial and mycotic diseases has anthrax at the top of the alphabetical list;
Bacillus cereus , causes food poisoning.
Here's a representative image of Bacillus cereus from Buckman laboratories of a special staining method, a Schaeffer-Fulton stain showing chains and spores.http://www.buckman.com/eng/micro101/228a.htm
"B. cereus food poisoning is the general (disease) description, although two recognized types of illness are caused by two distinct metabolites. The diarrheal type of illness is caused by a large molecular weight protein, while the vomiting (emetic) type of illness is believed to be caused by a low molecular weight, heat-stable peptide." http://vm.cfsan.fda.gov/~mow/chap12.html


Bacillus sp. and Streptococcus pneumoniae

Bacillus sp. and Streptococcus pneumoniae. SEM x48,000

Erysipelothrix rhusiopathiae Causes a really nasty skin rash. But since you'll never see it, you can include it on the next CD backup you burn off. But you can cross it off the list of things you keep in your active memory directory. "The most common human infection by E rhusiopathiae is erysipeloid, a well-defined, violet or wine-colored inflammatory lesion of the skin of the fingers or hand. Itching is typical. " "This species is transmitted occasionally from infected pigs to farmers or veterinarians, in whom it causes primarily inflammatory infections of the skin. Septicemia and endocarditis may develop secondarily."" In contrast to L monocytogenes, they are nonmotile, nonhemolytic, and catalase negative. The production of H2S is highly indicative, since very few other Gram-positive bacteria have this property." "without fever." http://gsbs.utmb.edu/microbook/ch016.htm
Perhaps you can't forget the nasty picture of an erysipeloid skin rash which you may have seen in a medical textbook. If you want to use the name of the organism in conversations with your colleagues or with your friend, you'll have to practise the pronunciation. Just take it one syllable at a time. This one is not real difficult. The h is silent in the species name. If it weren't it would sound really strange like, "er-hoo-zee-ah-pa-thee-ee," with the the th sounded as in the name theodore and that silly double vowel without elision at the end which makes the pronunciation of so many latinized species names sound affected if not ridiculous.

gram positive bacillus

Lactobacillus sp. Normal flora. Useful for the dairy industry. "The most common application of Lactobacillus is industrial, specifically for dairy production. This genus also contains several bacteria that make up part of the natural flora of the human vagina." There is a gram stain image at the UTH med center website of Lactobacillus, http://medic.med.uth.tmc.edu/path/00001446.htm It can be opportunistic. It also characteristically produces an acidic environment which can inhibit growth of other organisms which cause genitourinary tract infections. What can you say about it. It's another freebie if you recieve one in your laboratory accreditation test samples. It seems kind of mean to short change Lactobacillus by not even writing a full paragraph about it. Umm. Do you want to know about the connection between lactic acid and the genus name? Oh, you already know that. Well, what about the latest mention in the MMWR? Oh, right there is none. Ok, well let's go on to the next gpr.

Listeria monocytogenes , is a potential pathogen. The CDC lists it as a notifiable disease and as such statisics are published in the MMWR. For the year 2000, 570 cases of listeriosis had been cumulative as of November 1, 2000."In the United States, an estimated 2,500 persons become seriously ill with listeriosis each year. Of these, 500 die."http://www.cdc.gov/ncidod/dbmd/diseaseinfo/listeriosis_g.htm

The CDC lists the syptoms of listeroisis as, "A person with listeriosis has fever, muscle aches, and sometimes gastrintestinal symptoms such as nausea or diarrhea. If infection spreads to the nervous system, symptoms such as headache, stiff neck, confusion, loss of balance, or convulsions can occur." http://www.cdc.gov/ncidod/dbmd/diseaseinfo/listeriosis_g.htm

"Most human cases occur in patients with debilitating disease or in prenatal or neonatal infants. Sepsis, meningitis, and disseminated abscesses occur in infected patients. Meat, vegetables, and various milk products are the most common sources of infection." http://gsbs.utmb.edu/microbook/ch016.htm

Pregnant women don't want any of these bacteria. Histologic section micrograph of placental microabcess caused by Listeria monocytogenes: http://medstat.med.utah.edu/WebPath/PLACHTML/PLAC034.html

Listeria monocytogenes can cause really serious problems especially in CSF, cerebrospinal fluid. If there are enough organisms in the centrifuged cerebrospinal fluid specimen so that a few organisms can be seen after viewing the gram stain slide for five minutes, one can be sure that in the ER or on the ward a patient will be in a bad condition. Depending on the situation and timing it may be a very bad condition.

But hey we aren't in the hospital right now so let's lighten up a little. Can you say listeriosis five times ? Good, now say it really fast. Lister first identified the organism and it causes monocytes to increase in number because they eat Listeria monocytogenes for breakfast. So naturally they called it Listeria monocytogenes.

It is found frequently in test samples to check laboratories for accreditation. In such cases it's basically a freebie. It's an aerobe. It's not fastidious and grows easily so it's hard to miss. A few of these are seen each year in patients in large hospitals. After you've seen a few it loses it's novelty. It becomes just another gram positive rod.
Neal has a page with links to LM gram stain images of most, if not all clinically relevant bacteria, including L monocytogenes which are helpful for the clinician and the technologist since they will view similar shape, color and size at similar x1,000 magnification in a routine clinical laboratory setting.

You can get a really good idea of the exact shape from Dennis Kunkel's beautifully artistic electron microscopic imaging. Formerly, the term, "pleiomorphic gram positive rod," had been applied to Listeria, Corynebacterium, and Propionibacterium and attempts were made to lump them together due in part to similarities in morphology. DNA analysis has subsequently supported classification as three distinct genera. Some of the rods in the electron micrograph are quite long, some are short and some are stacked or folded back over one another. At the magnification of a normal light microscope, the organisms in this electron micrograph would have the characteristic, "chinese character," or pleiomorphic shape. The magnification of this SEM is x 29,665.

Listeria monocytogenes

Nocardia sp.

Definition of Nocardia, "Nocardiosis is defined as disease resulting from either local or disseminated tissue invasion by aerobic actinomycetes of the genus Nocardia. Nocardia are aerobic, Gram-positive branching filamentous bacteria which often appear beaded on staining. Many strains of Nocardia are weakly acid-fast when stained in tissue or from primary isolation media, but often lose acid-fast staining on serial culture." "Since Nocardia are not part of our normal flora and are rarely laboratory contaminants, any isolate of Nocardia from tissue or normally sterile body fluids should never be ignored." For diagnosis, "Nocardiosis can be diagnosed rapidly by examination of sputum or pus with the Gram stain and a modified acid-fast stain (Ziehl-Neelsen stain decolorized by 1% H2SO4 instead of acid alcohol). The finding of delicate, filamentous, branching Gram-positive bacteria which stain with a modified acid-fast stain provide a rapid diagnosis. Final diagnosis is best confirmed by culture not by serologic testing." Treatment is described as, "Therapy is usually with sulfonamides or T-S and requires long term therapy to prevent relapse. Sulfonamide therapy (e.g. Sulfadiazine 6-10 gm/day given in 3-6 divided doses/day) have been used for decades. Presently trimethoprim-sulfamethoxazole (T-S) given in doses from 160mg/ 800mg to 320mg/1600mg every 6-8 hours has gained popularity. In severe cases, CNS disease, or sulfa allergy consider Ceftriaxone 2 gm q 12 hrs. + Amikacin 400 mg q 12 hrs."http://www.ccm.lsumc.edu/BugBytes/Volume3/Bb-v3n6.htm

Excellent images of Nocardia, http://home1.gte.net/vsjslsk1/nocardia.htm and a description of their morphology, "Nocardia can be described as being rather short filaments irregularly bent, and displaying "true branching". Nocardia has cells that are 1.0 µm wide and 1.0-2.0 µm long. The overall length of a Nocardia filament is between 10-20 µm long." "Once you have seen Nocardia under the microscope you will never forget the way it looks. The next time you see it you will readily identify it without the use of a stain. Nocardia is Gram positive"

Nocardiosis hilights from the CDC, "in the United States, an estimated 500-1,000 new cases of Nocardia infection occur annually." "Overall, 80% of cases present as invasive pulmonary infection, disseminated disease, or brain abscess; 20% present as cellulitis." "Approximately 10% of cases with uncomplicated pneumonia are fatal. Case-fatality rate increases with overwhelming infection, disseminated disease, or brain abscess. Surgical drainage may be indicated and may improve patient outcome." "The drug of choice is trimethoprim-sulfamethoxazole." "A new combination drug therapy (sulfonamide, ceftriaxone, and amikacin) has shown promise for infections difficult to treat. Application of newer molecular diagnostic and subtyping methods may assist in earlier diagnosis and outbreak investigation."http://www.cdc.gov/ncidod/dbmd/diseaseinfo/nocardiosis_t.htm

Streptobacillus Moniliformis, is a technically a gram negative rod. It stains irregularly and can be mistaken for gram positive pleiomorphic rods which also exhibit gram-variability. If you work in a routine clinical bacteriology laboratory, you may as well disabuse yourself of any hope that you would ever see this organism. It is very rare. It is very fastidious, i. e., it is difficult to grow. And the clinical circumstances are unique. This organism must be looked for in order to make a definitive diagnosis. If rat bite is part of the patient clinical history, a specimen may be sent to a specialized reference laboratory. If the physician does not establish a rat bite in the patient's clinical history, a serendipitous finding of gram variable rods on gram stain which can not be cultured may or may not result in a specimen being sent to a specialized reference laboratory, where it may or may not be successfully identified. Streptobacillus moniliformis, "causes the clinical disease called rat bite fever. At the site of the rodent bite, an ulcer appears; this may heal spontaneously. Occasionally, the infection spreads to the regional lymph nodes, and bacteremia has been observed. General malaise and fever may be present after a few days. This generalized disease may be fatal. Colonization of various parts of the body, such as joints or endocardium, may lead to chronic disease accompanied by local symptoms. Rat bite fever also is caused by Spirillum minus, a very different bacterium. Streptobacillus moniliformis is a Gram-negative, nonmotile rod of variable length. The individual cells are not regularly shaped or stained, and thus pleomorphism is seen in smears. There is a tendency for spontaneous development of cell-wall-deficient L-forms. Consequently, growth on artificial media depends on certain additives, such as serum or ascitic fluid, which are not always present in common culture media. Growth is best under a CO2 atmosphere."

Corynebacterium diptheriae , is a gram positive pleiomorphic rod. It can exhibit gram variability as well as the classic, "chinese character," and club shapes. The presence of polyphosphate inclusions called metachromatic granules may also be demonstrated.. Corynebacterium diptheriae is the causative agent of diptheria, a condition which in its untreated form can lead to death by suffocation. "CDC describes diphtheria as "an upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent membrane of the tonsil(s), pharynx, and/or nose". Diphtheria is a rapidly developing, acute, febrile infection which involves both local and systemic pathology. A local lesion develops in the upper respiratory tract and involves necrotic injury to epithelial cells. As a result of this injury, blood plasma leaks into the area and a fibrin network forms which is interlaced with with rapidly-growing C. diphtheriae cells. This membranous network covers over the site of the local lesion and is referred to as the pseudomembrane." http://www.bact.wisc.edu/MicrotextBook/disease/diphtheria.html
Toxin production: "Toxin is synthesized in high yield only after the exogenous supply of iron has become exhausted ." "Only those strains of Corynebacterium diphtheriae that that are lysogenized by a specific Beta-phage produce diphtheria toxin. A phage lytic cycle is not necessary for toxin production or release. The phage contains the structural gene for the toxin molecule." http://www.bact.wisc.edu/MicrotextBook/disease/diphtheria.html
Immunization: The incidence of this disease has reached levels approaching zero due to vaccination programs. "From 1980-1989, the number of cases in the United States dropped to 24; two cases were fatal and 18 occurred in persons 20 years of age or older. Most cases have occurred nonimmunized (or inadequately immunized) individuals."
"Because of the high degree of susceptibility of children, artificial immunization at an early age is universally advocated. Toxoid is given in 2 or 3 doses (1 month apart) for primary immunization at an age of 3 - 4 months. A booster injection should be given about a year later, and it is advisable to administer several booster injections during childhood. Usually, infants in the United States are immunized with a trivalent vaccine containing diphtheria toxoid, pertussis vaccine, and tetanus toxoid (DPT or DTP vaccine)."http://www.bact.wisc.edu/MicrotextBook/disease/diphtheria.html

Propionibacterium acnes This bacterium can be secondarily involved in the dermatological condition known as acne. When it is, it is rarely if ever the primary causative agent. It has been linked to endocarditis, wound infections and abcesses but again, when it is, it is rarely if ever the primary causative agent. When isolated in culture, it is frequently disregarded as being a contaminant, particularly in blood cultures. When the needle used to collect the blood culture specimen penetrates the skin at the point of a hair follicle where the organism typically resides, a contamination often results. P. acnes grows best under microaerophilic or anaerobic conditions. It can stain unevenly on gram stain leading some to call it a gram-variable rod.
Propionibacterium produces a smelly acid, propionic acid which gives some French cheeses, toe jam, and Japanese fermented beans, "natoh," the same stinky smell. Which is why our stomach turns whenever we are encouraged to eat natoh.

Propionibacterium acnes from a blood culture.

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