AEROBIC GRAM POSITIVE BACTERIA
Aerobic Gram-Positive Bacilli
 Spore-forming genus Bacillus;
 Non–spore-forming bacteria including
- genera Corynebacterium,
- Arcanobacterium
- Rhodococcus
- Listeria
- Erysipelothrix,
- Gardnerella;
 Branching, non–spore-forming aerobic
actinomycetes, including Nocardia
Non–Spore-Forming, Nonbranching Catalase-
Positive Bacilli
 Corynebacterium Genera
- Characteristics
 Based on 16S rRNA sequencing,
corynebacteria are closely
related to mycobacteria and
nocardiae
 Divided into Non-lipophilic and
Lipophilic species.
 Lipophilic corynebacteria-
- Are often considered fastidious
- Grow slowly on standard culture
media
- incubated at least 48 hours before
growth is detected
- Growth is enhanced if lipids are
included in the culture medium.
- Gram Stain
 Slightly curved, gram positive
rods with unparallel sides and
slightly wider ends, producing
the described “club shape” or
coryneform.
 “Diphtheria-like”
- Corynebacterium spp. that produce
disease in humans include:
 Corynebacterium amycolatum,
 Corynebacterium
pseudodiphtheriticum
 Corynebacterium
pseudotuberculosis
 Corynebacterium jeikeium
 Corynebacterium striatum
 Corynebacterium ulcerans
 Corynebacterium urealyticum.
1. Corynebacterium diphtheriae
 Virulence Factors
 Diphtheria toxin
- Is the major virulence factor
associated with C. diphtheriae.
- Lysogenic β-phage, which carries
the tox gene for diphtheria toxin.
- The toxicity is due to the ability of
diphtheria toxin to block protein
synthesis in eukaryotic cells.
- Toxin is secreted by the bacterial
cell and is nontoxic until exposed to
trypsin.
 Clinical Infections
- Two different forms of disease in
humans: Respiratory and
Cutaneous diphtheria.
- Upper respiratory tract and spread
by droplet infection or hand-to-
mouth contact
- Incubation period averages 2 to 5
days.
- Common site: Tonsils or Pharynx
- Cutaneous diphtheria consists of
Non-healing ulcers with a dirty gray
membrane.
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DEPARTMENT OF CAMP
AEROBIC GRAM POSITIVE BACTERIA
 Laboratory Diagnosis
 Microscopy:
- Highly pleomorphic (many shapes)
- Gram-positive bacillus that appears
in palisades (cells lie in parallel
rows) or as individual cells lying at
sharp angles to another in “V” and
“L” formations.
- Stain irregularly, especially when
stained with methylene blue,
beaded appearance
- Babès-Ernst granules- The
metachromatic areas of the cell,
which stain more intensely than
other parts it indicates
accumulation of nutrient reserves
 Culture Characteristics:
- Facultative anaerobe.
- Grows best under aerobic
conditions
- Optimal growth temperature of 37°
- Multiplication occurs within the
range of 15° C to 40° C.
- Growth requiring eight essential
amino acids
- Grows on nutrient agar
- Better growth is usually obtained
on a medium containing blood or
serum, such as Loeffler serum or Pai
agars
- Cystine-tellurite blood agar (CTBA)
- CTBA is both a selective and a
differential medium.
- Potassium tellurite inhibits many
noncoryneform bacteria.
- When grown on CTBA,
corynebacteria form black or
brownish colonies from the
reduction of tellurite
- A brown halo surrounding the
colony, owing to cystinase activity,
is a useful differentiating feature
because only C. diphtheriae, C.
ulcerans, and C. pseudotuberculosis
produce a brown halo on CTBA
 Identification
- All medically important
corynebacteria are catalase-
positive and nonmotile.
- C. diphtheriae is distinguished from
the other two species by its lack of
urease production
- C. diphtheriae ferments glucose
and maltose, producing acid but
not gas, and reduces nitrate to
nitrite.
Other Corynebacteria
Corynebacterium amycolatum
- Most frequently recovered
Corynebacterium species from
human clinical material
- Often associated with prosthetic
joint infection and has been
reported to cause bloodstream
infection and endocarditis, typically
in immunocompromised patients or
in patients in a health care setting.
- Colonies are flat, dry, have a matte
or waxy appearance, and are
nonlipophilic
Corynebacterium jeikeium
- Named after Johnson and Kaye,
who first linked this organism with
human infections, appears to be
part of the normal skin microbiota
- Most common cause of
Corynebacterium-associated
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prosthetic valve endocarditis in
adults.
- Causes septicemia, meningitis,
prosthetic joint infections, and skin
complications such as rash and
subcutaneous nodules.
- Lipophilic
- Strict aerobe
- Non-hemolytic
- Urease Negative
- Nitrate-reduction- negative.
- Resistant to a wide range of
antimicrobials, including penicillin,
cephalosporin, macrolides, and
aminoglycosides.
- MDR cannot be used
Corynebacterium pseudodiphtheriticum
- Part of the normal biota of the
human nasopharynx
- Infrequent cause of infection.
- Causes endocarditis, urinary tract
infections (UTIs), and cutaneous
wound infections in
immunocompromised patients
- Does not show a pleomorphic
characteristic
- Cells stain evenly and often appear
in palisades. The species grows well
on standard laboratory media,
reduces nitrate, and produces
urease.
Corynebacterium pseudotuberculosis
- Primarily a veterinary pathogen
- Human infections typically have
been associated with contact with
sheep
- Causes a granulomatous
lymphadenitis in humans.
- Dermonecrotic toxin that causes
death of various cell types
- Can produce diphtheria toxin.
Similar to C. diphtheriae
- Produces a brown halo on CTBA
- Urease positive
- On SBA forms small yellowish white
colonies
Corynebacterium striatum
- Part of human skin and
nasopharynx microbiota
- Frequently isolated in clinical
microbiology laboratories
- often considered a commensal or
skin contaminant
- Has been most commonly
associated with device-related
infection
- Non-lipophilic
- Pleomorphic
- Produces small, shiny, convex
colonies in about 24 hours
- Resistance to penicillin, macrolides,
and fluoroquinolones
- Susceptible to other β-lactams and
to vancomycin.
Corynebacterium ulcerans
- Isolated from humans with
diphtheria-like illness, and a
significant number of isolates
produce the diphtheria toxin.
- It has been isolated from skin
ulcers and exudative pharyngitis.
- Veterinary pathogen, causing
mastitis in cattle and other
domestic and wild animals.
- It grows well on Loeffler agar and
produces a brown halo around the
colonies on CTBA.
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DEPARTMENT OF CAMP
AEROBIC GRAM POSITIVE BACTERIA
- The organisms grow well on SBA
and produce a narrow zone of β-
hemolysis.
- Nitrate Negative
- it is urease-positive.
Corynebacterium urealyticum
- Is most commonly associated with
UTIs.
- Lipophilic
- Strict aerobe
- Urine - Pinpoint, Non-hemolytic,
white colonies that have
characteristic coryneform
microscopic morphology.
- Nitrate-negative
Listeria monocytogenes
- Catalase-positive
- Rapidly urease positive within
minutes after inoculation on a
Christensen urea slant.
- Resistance has been reported for a
broad range of antimicrobials,
including β-lactams,
aminoglycosides
- Drug of choice: vancomycin.
Rothia
- Gram-positive cocci that can appear
rodlike that belong to the family
Micrococcaceae.
- Six species, two of which are
regarded as clinically significant,
comprise the genus Rothia.
- Rothia mucilaginosa has been
linked to bacteremia, endocarditis,
pneumonia, and other infections.
- Rothia dentocariosa is a member of
the normal human oropharyngeal
microbiota and may be found in
saliva and supragingival plaque.
- Microscopically, this organism
resembles the coryneform bacilli,
forming short gram-positive bacilli
but also branching filaments that
resemble filaments of facultative
actinomycetes
- In broth, the species produces
coccoid cells, a characteristic
differentiating it from
actinomycetes.
- Rothia is nitrate-positive,
nonmotile, esculin hydrolysis-
positive, and urease-negative.
 General Characteristics
- Listeria contains 10 species.
- Listeria monocytogenes is
considered an important human
pathogen
- Listeria ivanovii is primarily an
animal pathogen.
- L. monocytogenes has long been
known to cause illness in many
species of wild and domestic
animals
- Human and animal asymptomatic
carriers.
- Listeriosis is recognized as an
uncommon but serious
- Infection primarily of neonates,
pregnant women, elderly adults,
and immunocompromised hosts.
- Virulence Factors. L.
monocytogenes produces many
products that have been proposed
as virulence factors. These include
hemolysin (listeriolysin O), catalase,
superoxide dismutase,
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phospholipase C, and a surface
protein (p60).
- Protein p60 induces phagocytosis
through increased adhesion and
penetration into mammalian cells.
- Listeriolysin O damages the
phagosome membrane, effectively
preventing killing of the organism
by the macrophage.
- Nonhemolytic isolates are found to
be avirulent and demonstrate no
intracellular spread of the
organism.
 Clinical Infections.
- Disease in Pregnant Women.
During pregnancy, listeriosis is most
commonly seen during the third
trimester
- It has been postulated that L.
monocytogenes is responsible for
spontaneous abortion and stillborn
neonates.
Laboratory Diagnosis
 Microscopy
In direct smears
- L. monocytogenes appears as a
gram-positive coccobacillus. With
subculturing, cells become
coccoidal
- Older cultures often appear gram-
variable.
- Cells may be found singly, in short
chains, or in palisades. Depending
on the culture conditions
- L. monocytogenes can resemble
Streptococcus when found in the
coccoid form and Corynebacterium
when the bacillus forms prevail.
Organisms are not usually seen on
the CSF smear.
Cultural Characteristics
- L. monocytogenes grows well on
SBA and chocolate agar as well as
on nutrient agars and in broths such
as brain-heart infusion and
thioglycolate.
- The organism prefers a slightly
increased carbon dioxide (CO2)
tension for isolation.
- The colonies are small, round,
smooth, and translucent.
- They are surrounded by a narrow
zone of β-hemolysis, which may be
visualized only if the colony is
removed. The colonies and
hemolysis resemble those seen with
S. agalactiae
- optimal growth temperature: 30° C
to 35° C
- L. monocytogenes grows at 4° C, a
technique called cold enrichment
- Catalase-positive, motile at room
temperature, β-hemolytic, and
hydrolyzes esculin.
- In wet mount preparations,
tumbling motility (end-over-end
motility)
- Microscopically. In motility
medium, the characteristic
“umbrella” pattern is seen when
the organism is incubated at room
temperature (22° C to 25° C) but
not at 35° C
- Hippurate hydrolysis and bile
esculinhydrolysis-positive and
produces a positive CAMP reaction
(produces a “block” type hemolysis)
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DEPARTMENT OF CAMP
AEROBIC GRAM POSITIVE BACTERIA

Non–Spore-Forming, Nonbranching Catalase-  erysipeloid, which is a localized

Negative Bacilli skin disease, and most infection
 Septicemia, which is often
Erysipelothrix rhusiopathiae associated with endocarditis
General Characteristics  and a generalized, diffuse
cutaneous infection.
- 3 species: Erysipelothrix
rhusiopathiae, Erysipelothrix Laboratory Diagnosis
tonsillarum, and Erysipelothrix
 Microscopy
inopinata.
- E. rhusiopathiae
- E. rhusiopathiae
 is a thin, rod-shaped, gram
 is the only species in the genus
positive organism that can form
known to cause disease in
long filaments.
humans.
 It is arranged singly, in short
 It is a gram-positive, catalase
chains, or in a V shape
negative, non–spore-forming,
 E. rhusiopathiae decolorizes
pleomorphic rod that has a
easily, so it may appear gram-
tendency to form long
variable.
filaments.
 Culture Characteristics
 Commensal or a pathogen in a
 Tissue biopsy or aspirates from
wide variety of vertebrates and
skin lesions.
invertebrates, including
 These should be inoculated to a
domestic swine, birds, and fish.
nutrient broth with 1% glucose
 Human cases typically result
and incubated in 5% CO2 at 35°
from occupational exposure.
C.
Individuals whose work involves
 Grows slow on standard culture
handling fish and animal
media, including SBA and
products are most at risk.
chocolate agar.
 The usual route of infection is
 Subcultures from both should
through cuts or scratches on
be inoculated daily to SBA
the skin.
plates
 Resistant to salting, pickling,
 On SBA, the colonies are usually
and smoking
nonhemolytic and pinpoint
 Survives well in environmental
after 24 hours of incubation.
sources such as water, soil, and
plant material. Identification.

Clinical Infections - Similar gram-positive bacilli.

- Catalase-negative, non-motile,
- E. rhusiopathiae produces three
pleomorphic
types of disease in humans:
- Aerobic or facultative anaerobic
gram positive rod that is hydrogen

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sulfide–positive is suspicious for E.
rhusiopathiae.
- Urease-negative, Voges-Proskauer–
negative, and does not hydrolyze
esculin.
- Growth of E. rhusiopathiae in a
gelatin stab culture yields a highly
characteristic “test tube brush–
like” pattern at 22° C
Arcanobacteriu
- Nine species.
- Three Arcanobacterium species are
considered medically important:
Arcanobacterium haemolyticum
(formerly Corynebacterium
haemolyticum), Arcanobacterium
pyogenes, and Arcanobacterium
bernardiae.
- A. pyogenes is an animal pathogen
that is best known for causing
infections in cattle.
- A. bernardiae is also a rare cause of
infections in humans and has been
associated with bacteremia, wound
infections, UTIs and septic arthritis.
- Pharyngitis caused by A.
haemolyticum can be mild or
severe and is often clinically
indistinguishable from pharyngitis
caused by β-hemolytic streptococci.
- Most patients develop cervical
lymphadenopathy
- Catalase-negative.
- A. haemolyticum produces small
colonies on SBA that demonstrate a
narrow zone of β-hemolysis after 24
to 48 hours of incubation similar in
appearance to β-hemolytic
streptococci
- Frequently, a black opaque dot is
observed on the agar when the
colony is scraped away. Pitting of
the agar beneath the colony has
also been reported.
- A. haemolyticum is both lipase- and
lecithinase-positive. It exhibits a
reverse CAMP reaction (CAMP
inhibition reaction), penicillin
resistant
- TX: Erythromycin
Gardnerella vaginalis
General Characteristics
Gardnerella vaginalis
- is a short, pleomorphic gram-
positive rod or coccobacillus that
often stains gram-variable or gram-
negative.
- G. vaginalis has a gram-positive
type of cell wall
- G. vaginalis is the only species in
the genus and was first described in
1953. It is found as normal biota in
the human urogenital tract.
Clinical Infection
- Primarily known for its association
with bacterial vaginosis (BV) in
humans.
- BV is a polymicrobial disease in
which G. vaginalis and other
bacteria, such as Prevotella spp.,
Peptostreptococcus spp.,
Porphyromonas spp., Mobiluncus
spp., Atopobium vaginae, and
Mycoplasma hominis, are involved.
BV is characterized by a malodorous
discharge and vaginal pH greater
than 4.5.
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DEPARTMENT OF CAMP
AEROBIC GRAM POSITIVE BACTERIA

- BV generally results from a - Human blood bilayer Tween (HBT)

reduction in the Lactobacillus agar. V (vaginalis) agar – Medium
population in the vagina, followed choice
by an increase in vaginal pH; this - Also contains human blood and is
results in overgrowth by G. vaginalis used for recovery of this organism.
and other BV-associated organisms. When cultured on human blood,
- G. vaginalis can also play a role in colonies are β-hemolytic, small,
UTIs in men and women. gray, and opaque.
- TX to treat BV: metronidazole, - G. vaginalis also produces β-
although clindamycin is also often hemolytic colonies on media made
used. with rabbit blood but not sheep
blood.
Laboratory Diagnosis
Identification
 Microscopy.
- pleomorphic, gram-variable - G. vaginalis is catalase-negative,
coccobacillus or short rod. oxidase-negative, and hippurate-
- The cells often stain gram-negative hydrolysispositive. β-Hemolytic
and are 1.5 to 2.5 µm in length. colonies on HBT agar should be
- Can be visualized in wet mounts of suspected as G. vaginalis. Some
vaginal fluid when BV is suspected. laboratories use 16S rRNA gene
The observation of “clue cells,” sequencing for definitive
- Stained smears are examined and identification of G. vaginalis.
scored for the presence of
Non–Spore-Forming, Branching aerobic
Lactobacillus, Gardnerella, and
Actinomycetes
Mobiluncus morphotypes.
Nocardia General
Culture Characteristics
Characteristics
- Vaginal discharge most common
specimen used - Aerobic, branched, beaded gram-
- Because it is part of the urogenital positive bacilli.
microbiota, the organism can also - Finely beaded, branching rods are
be isolated from urine - Weakly acid-fast, using weak acid as
- It often takes longer than 24 hours the decolorizer during acid-fast
to develop visible colonies staining
- G. vaginalis grows best in 5% to 7% - This characteristic is also referred to
CO2 at a temperature of 35° C to as modified acid-fastpositive.
37° C. - Can be recovered on standard
- Vaginalis grows on SBA as pinpoint, nonselective media; however,
non-hemolytic colonies. It also growth may take 1 week or longer.
grows on chocolate agar.

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- most commonly encountered
species are Nocardia brasiliensis,
Nocardia cyriacigeorgica, Nocardia
farcinica, and Nocardia nova.
Virulence Factors
- No virulence factors have been
identified
- Nocardia spp. Produce superoxide
dismutase and catalase
- That may provide resistance to
oxidative killing by phagocytes.
They also produce an iron chelating
compound called nocobactin.
Clinical Infections
- Infection occurs by two routes:
pulmonary and cutaneous.
- Pulmonary infection by Nocardia
occurs from the inhalation of the
organism present in dust or soil.
The disease appears to be
associated with impaired host
defenses
- Infection with Nocardia spp. can be
serious.
- Most pulmonary infections are
caused by N. cyriacigeorgica and N.
farcinica.
- The most common manifestation of
infection is a confluent
bronchopneumonia that is usually
chronic but may be acute or
relapsing. The disease generally
progresses more rapidly than
tuberculosis and is measured in
months rather than years.
- N. brasiliensis is the most frequent
cause of this form of nocardiosis,
which is usually seen in the hands
and feet as a result of outdoor
activity.
- N. brasiliensis is the most common
cause of actinomycotic mycetoma.
Laboratory Diagnosis
Microscopic
- Treatment. Treatment of
nocardiosis often involves drainage
and surgery along with
antimicrobials. The organisms are
resistant to penicillin but
susceptible to sulfonamides
- The gram-positive, beaded
branching filaments characteristic
of Nocardia are often seen in
sputum and exudates or aspirates
from skin or abscesses. The
specimen often contains
coccobacillary bodies as well.
- The beaded appearance of
Nocardia may be confused as chains
of gram-positive cocci
Treatment
- The organisms are resistant to
penicillin but susceptible to
sulfonamides
Other Actinomycetes
Actinomadura
- The aerobic actinomycetes of
clinical importance belonging to the
genus Actinomadura include
Actinomadura madurae and
Actinomadura pelletieri, formerly
classified as members of the genus
Nocardia.
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- They are etiologic agents of
mycetomas, which are identical to
those caused by Nocardia. The
microscopic and colony morphology
of Actinomadura spp. are very
similar nocardia
Streptomyces
- Streptomyces spp. is primarily
saprophytes found as soil
inhabitants and resemble other
aerobic actinomycetes with regard
to morphology and the diseases
they cause. Streptomyces
somaliensis is an established human
pathogen associated with
actinomycotic mycetoma in many
countries. More recently,
Streptomyces anulatus (formerly
Streptomyces griseus) has been
increasingly isolated from many
clinical specimens, including
sputum, wound, blood, and brain.
Gordonia
- are aerobic, catalase-positive,
gram-positive to gram-variable,
partially acid-fast, and nonmotile.
They grow with mycelial forms that
fragment into rod-shaped or
coccoid elements—hence the term
nocardioform
- Gordonia spp. are susceptible to
several antimicrobial agents,
including many β-lactams,
quinolones, aminoglycosides,
macrolides, and other agents active
against gram-positive organisms. In
the absence of clear guidelines,
treatment should be guided by
susceptibility test results.
Tsukamurella
- Gram-positive, aerobic, catalase-
positive, and partially acid-fast.
- 16S rRNA gene sequencing and
fatty acid analysis have been used
to provide correct identification and
speciation.
Rhodococcus
Rhodococcus equi (formerly Corynebacterium
equi),
- The most common human isolate in
this genus, is found in soil and
causes respiratory tract infections
in animals.
- On Gram stain, R. equi may
demonstrate filaments, some with
branching. & may be partially acid-
fast or acid-fast.
- On SBA, the colonies resemble
Klebsiella and can form a salmon
pink pigment on prolonged
incubation, especially at room
temperature.
- Biochemical identification is difficult
because it does not ferment
carbohydrates and shows a variable
reaction to many characteristics
Tropheryma whipplei
- is the agent of Whipple’s disease.
- T. whipplei is a facultative
intracellular pathogen first
identified by PCR from a duodenal
biopsy specimen in 1991.
- Phylogenetic analysis has revealed
that T. whipplei is a gram-positive
actinomycete,
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DEPARTMENT OF CAMP
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- Diagnosis is best made by
microscopic examination of
endoscopic biopsy specimens. The
presence of characteristic periodic
acid–Schiff staining is strongly
suggestive of Whipple’s disease.
- The organism has been cultivated in
stable cell lines and has been
adapted to an axenic culture
medium supplemented with
essential amino acids; however,
these techniques are not easily
performed in the clinical
microbiology laboratory.
- T. whipplei can be identified by PCR
or 16S rRNA gene
Spore-Forming, Nonbranching Catalase-Positive
Bacilli
Bacillus
General Characteristics
- Members of the genus Bacillus
stain gram-positive or gram
variable; they are aerobic or
facultative anaerobic bacilli that
form endospores.
- Commonly used enriched media but
typically do not grow on Columbia
CNA. Colony characteristics vary
considerably among the species and
are often influenced by the type of
media used.
- Most species form non-pigmented
colonies. They are catalase-positive
and form endospores under aerobic
and anaerobic conditions. Members
of the genus Bacillus can be
confused with aerotolerant strains
of the other primary endospore-
forming genus, Clostridium.
- Clostridium spp. are typically
catalase-negative, although some
strains may form trace amounts.
- Bacillus spp. form endospores
aerobically, whereas Clostridium
spp. form endospores anaerobically
only.
Bacillus anthracis
Virulence Factors
- depends on a glutamic acid capsule
and a three-component protein
exotoxin
- The capsule, which protects the
organism from phagocytosis, is a
polypeptide of D-glutamic acid.
- Anthrax toxin consists of three
proteins: protective antigen (PA),
edema factor (EF), and lethal factor
(LF), each of which individually is
nontoxic but which together act
synergistically to produce damaging
effects.
- PA serves as a necessary binding
molecule for EF and LF, permitting
their attachment to specific
receptors on the host cell’s surface.
The effect of EF and LF is seen when
either is combined with PA. Edema
results from the combination of PA
with EF, whereas death occurs
when PA and LF combine.
- EF is an adenylate cyclase that
increases the concentration of
cyclic adenosine monophosphate
(cAMP) in host cells.
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- LF is a protease that kills host cells
by disrupting the transduction of
extracellular regulatory signals
Clinical Infections
- Anthrax is a common disease in
livestock worldwide when the
vaccine is not used.
- Terms such as woolsorter’s disease
and ragpicker’s disease were used
to describe infection with the
spores of B. anthracis as a result of
handling contaminated animal
fibers, hides, and other animal
products.
- Three main forms of anthrax are
recognized in humans: cutaneous,
inhalation or pulmonary, and
gastrointestinal.
- A fourth form, called injectional
anthrax, has emerged more
recently and is being recognized as
an additional form of clinical
infection. Infection results from
direct injection of spores into tissue
generally during the administration
of drugs of abuse.
Cutaneous Anthrax
- can occur when wounds are
contaminated with anthrax spores
acquired through skin cuts,
abrasions, or insect bites.
- A small pimple or papule appears at
the site of inoculation 2 to 3 days
after exposure.
- The eschar is normally 1 to 3 cm in
diameter, although it may be more
extensive.
- The eschar begins to heal after 1 to
2 weeks. The lesion dries, separates
from the underlying base, and falls
off, leaving a scar
- Inhalation anthrax, also called
woolsorter’s disease, is acquired
when spores are inhaled into the
pulmonary parenchyma.
Gastrointestinal Anthrax.
- occurs when the spores are
inoculated into a lesion on the
intestinal mucosa after ingestion of
the spores.
- Because this form of the disease is
difficult to diagnose, the fatality
rate is higher than in the cutaneous
form.
- Injectional anthrax is characterized
by soft tissue infection associated
with “skin popping” or other forms
of injection drug use and results
from the direct injection of the
spores into tissue
- Cutaneous form of anthrax is the
most common and has the lowest
mortality
- Injectional anthrax can be
associated with necrotizing fasciitis,
organ failure, shock, coma, and
meningitis, and it has a much higher
rate
Laboratory Diagnosis
Microscopy
- B. anthracis is a large (1.0 to 1.5 µm
× 3.0 to 5.0 µm), square-ended,
GALANG, JIREH MASICLAT
DEPARTMENT OF CAMP
AEROBIC GRAM POSITIVE BACTERIA
gram-positive or gram-variable rod
found singly or in chains (When in
chains, the ends of the single cells
fit snugly together; this, together
with the unstained central spore,
gives the appearance of bamboo
rods.
- Young cultures stain gram-positive;
as the cells age, or if they are under
nutritional stress, they become
gram-variable.
- In Gram stain preparations of
clinical samples, vegetative cells can
appear with clear zones around the
cells, representing the presence of a
capsule.
- To stimulate capsule production,
cultures can be incubated in an
atmosphere containing increased
CO2; this is an important
characteristic for laboratory
identification.
Cultural Characteristics
- On SBA, colonies of B. anthracis
are nonhemolytic, large (2 to 5
mm), gray, and flat with an irregular
margin because of outgrowths of
long filamentous projections of
bacteria that can be seen with a
dissecting microscope.
- The term Medusa head has been
used to describe the colony
morphology of B. anthracis.
Colonies have a tenacious
consistency, holding tightly to the
agar surface, and when the edges
are lifted with a loop, they stand
upright without support. This has
been described as having the
appearance or characteristic of
beaten egg whites. Although B.
anthracis is nonhemolytic on SBA
- weak hemolysis may appear under
areas of heavy growth after
prolonged incubation
- Although some strains of B.
anthracis grow on phenylethyl
alcohol (PEA) medium, growth is
usually weak.
- CDC recommend, PEA agar for
stools suspected to contain B.
anthracis
- SBA and other commonly used
media.
Identification
- Catalase-positive and grows
aerobically or anaerobically.
- Non-motile, distinguishing it from
most other members of the genus
Bacillus.
- Ferments glucose, it fails to ferment
mannitol, arabinose, or xylose.
- B. anthracis produces lecithinase;
an opaque zone can be seen around
colonies growing on egg-yolk agar.
This species grows in high salt (7%
sodium chloride) and low pH (<6).
In contrast to B. cereus
- Motility can be tested by either wet
mount preparation or inoculation
into motility test medium.
- Lack of motility is unusual among
Bacillus spp.; B. mycoides is also
nonmotile.
- Capsule production by B. anthracis
can be detected by the India ink
stain on blood or CSF specimens or
on cells isolated in media
GALANG, JIREH MASICLAT
DEPARTMENT OF CAMP
AEROBIC GRAM POSITIVE BACTERIA

supplemented with sodium - Treatment with vancomycin or

bicarbonate. clindamycin with or without an
aminoglycoside has been
Treatment successful.
- Most isolates of B. anthracis are - B. cereus can be grown aerobically
susceptible to penicillin, but at 37° C on SBA. A β-hemolytic
resistance can occur in the absence frosted glass–appearing colony
of β-lactamase production; containing spore-forming, gram-
penicillin should not be used alone positive bacilli that are motile, able
in treatment. The organism is often to ferment salicin, and
susceptible to many broad- lecithinasepositive
spectrum antimicrobial agents,
Other Bacillus Species
including tetracycline,
fluoroquinolones, and - Infections by other members of the
chloramphenicol. genus Bacillus are rare; these
- The CDC recommends that include but are not limited to
ciprofloxacin or doxycycline be used Bacillus subtilis, Bacillus
for initial intravenous therapy until licheniformis, Bacillus circulans,
antimicrobial susceptibility results Bacillus pumilus, and Bacillus
are know sphaericus.
- These organisms have been
Bacillus cereus reported to cause food poisoning,
- B. cereus is a relatively common bacteremia, meningitis, pneumonia,
cause of food poisoning and and other infections. However, they
opportunistic infections in are more commonly seen as
susceptible hosts. contaminants.
- Food poisoning caused by B. cereus
takes two forms: diarrheal and
emetic.
- The diarrheal syndrome, usually
associated with ingestion of meat
or poultry, vegetables, and pastas,
is characterized by an incubation
period of 8 to 16 hours.
- The average duration of the illness
is 24 hours.
- B. cereus is resistant to penicillin
and all of the other β-lactam
antibiotics except for the
carbapenems.

GALANG, JIREH MASICLAT

DEPARTMENT OF CAMP