Biosciences Chemistry: Clostridial Gas Gangrene Pathophysiology Case

This assignment presents a case study analysis of Clostridial Gas Gangrene and a separate case involving a 22-year-old female with a urinary tract infection (UTI). The gas gangrene analysis delves into the pathogens responsible, primarily Clostridium perfringens, and explores treatment strategies such as antibiotics, surgery, and hyperbaric oxygen, highlighting the benefits and disadvantages of each. It further discusses the toxins produced by Clostridium perfringens, specifically alpha and theta toxins, and their impact on disease development and outcomes. The UTI case study details the initial diagnostic assessment, including patient history, physical examination, and diagnostic tests like urine culture and blood culture, identifying Enterococcus species as a key pathogen. It also examines the role of adhesins in Enterococcus species, facilitating their attachment to uroepithelial tissue and contributing to UTI development. Finally, it involves a case study of an infant developing fever and tachycardia after birth, with the diagnosis revealing meningitis. The analysis includes the medical history of the mother and infant to get a detailed diagnosis and treatment for the child.

BIOSCIENCES AND
CHEMISTRY

Table of Content
ANSWER 1....................................................................................................................................3
i)...................................................................................................................................................3
ii)..................................................................................................................................................4
Answer 2.........................................................................................................................................5
Pathogens that can cause clostridial gas gangrene. Treatment strategies available for
the management of this condition with benefits and disadvantages of each approach.
.....................................................................................................................................................5
Numerous toxins that contribute to the pathophysiology of these pathogens with
impact on the development of disease within the host and the effect on disease
outcomes of toxin production..................................................................................................6
Answer 3.........................................................................................................................................7
1 Initial diagnostic assessment...............................................................................................7
2 Virulence factors....................................................................................................................9
REFERENCES............................................................................................................................11

ANSWER 1
i)
Initial diagnosis:
Patient history:
Patient history shows that there is a persistence of high fever persist in 22 year
old female. Shaking and chills was also a common phenomenon. This means patient
usually suffers from the disease of high fever. Dysuria and flank pain also exist in
patient which means she is suffering from high pain in lower abdomen along with
urinary infection.
Physical exam:
 The current physical exam shows a result that her temperature was 39.7 C.
 Heart rate persist at 75bpm. Along with this exam, it will also include percussion under which doctor will make
examination of abdomen by tapping it with other. Through this unusual lumps,
organ size and shape will also be analysed. This will lead to make analysis of
pinpoint of the patient as she is suffering from the problem of for Dysuria and
flank pain.
Patient complaint and symptom:
Here patient complaint will be analysed. As patient is complaining that she
usually suffer from high fever. Also she is facing the problem of for Dysuria and flank
pain. Intense pain in lower abdomen and urinary problem is also included in her
complaint.
Diagnostic test:
This testing will be followed up by diagnostic test under which culture test, urin
analysis, urine culture will be performed in order to make careful identification of
disease along with determination of further treatment.
Reason for diagnosis:
Diagnosis refers to a process that will lead to determine the patient illness or
disease through the analysis of its symptoms and signs. In case of this patient which
was showing symptoms of high fever, intense lower abdomen pain and Dysuria, urine
culture test, urin analysis and blood culture is performed. The laboratory results of these

tests shows that there is an existence of Gram-negative rods which is one of the most
common pathogen in relation with Urinary Tract Infection. Presence of Gram pathogens
shows that UTI infection is increasing with a increased resistance to trimethoprim,
quinolones and beta-lactams. In addition of this as Urine culture laboratory result also
shows the presence of red colonies which indicate the existence of Enterococcus
species which again indicate that patient is facing the issue of abdominal pain and UTI.
Microorganism in association with inspection:
As per the concerned diagnostic test and laboratory reports there is an existence
of Enterococcus species which clearly indicate that patient is suffering from a disease of
UTI and Dysuria and flank pain among the host body or human being.
ii)
Adhesins:
It refers to cell surface component or appendages of bacteria that helps to
adherence to other cells or surface of the host body which they are infecting or living in.
it is a type of virulence factor. In other words adhesins enable the bacteria to get
attached with host cells.
With regard to Enterococcus species plasmid-encoded aggregation substance is
associated that enable them to survive and get attached with uroepithelial tissue.
Synthetic peptide containing Fbronectin motif, Arg-Gly-Asp-Ser also act as adhensin that
enable the Enterococcus species to get bind with the cell and lead to raising the rate of
infection. Aggregation substance (AS) and pheromone-inducible surface proteins acts as
main element that lead to conjugal plasmid transfer. This protein also act as a major
element that will lead to make binding with surface. Likewise, it is also to be noted that apart
from the existence of adhensins several natural phenomenon will also assist the
Enterococcus species to get attached with the cell membrane and lead to raise infection
rate. As when sulfatase will remove sulphate from mucin, then it will lead to easy
degradation of mucin by glycosidases and facilitates bacterial infection. As adhesins
enable the Enterococcus species to get attached with the urinary tract epithelial cells and
Girardi heart cell line which will lead to further raising in the rate of UTI. This will act as

helping agent for the Enterococcus species to grow and raise the infection among host
body or patient.
As this protein will be co-localize in the bladder and not in the Kidneys which
suggest that these proteins has tissue whioch is specified with bladder epithelium.
Plasmid-encoded surface protein is also considered as one of the important adhesins or
aggregation substance that facilitate Enterococcus to get cultured in intestinal epithelial
cells. It is also to be noted that along with existence of adhesins Enterococcus are well
adapted with intrinsic ruggedness that plays a major role in interacting with overtly drug-
resistant microbes which will further lead to raise in the rate of infection. Since,
Enterococcus species are naturally present in the gastrointestinal tract and majorly
transmitted due to poor hygiene and in addition of this EfbA which is a PavA-like fibronectin
adhesin also act as major binding protein that will lead and assist the Enterococcus
species to grow and get infect the host body or human being with relation to UTI
infection.
Answer 2
Pathogens that can cause clostridial gas gangrene. Treatment strategies available for
the management of this condition with benefits and disadvantages of each
approach.
Clostridial gas gangrene is a kind of infection which is highly lethal necrotizing
soft tissue infection in skeletal muscle. It is majorly caused by gas and toxin producing
Clostridium species (Leiblein and et. al., 2020). This deadly form of gangrene is majorly
caused by a specific species of Clostridium known as Clostridium perfringens bacteria.
An individual get affected from this disease only if they have not been vaccinated from
tetanus.
Clostridial gas gangrene is a kind of medical infectious condition which should be
provided immediate attention and treatment when it is detected. No delay in this
condition should be done and immediate treatment should be given to patient. There
are two most commonly used strategies that be used for providing effective treatment
for management of this disease.
First treatment strategy is provision of antibiotics. One of the main benefits of
provision of antibiotics to patient suffering from clostridial gas gangrene is that use of

antibiotics can directly help in making adjustment in this condition and also making
adjustments so that worsening of this condition can be prevented. Not only this, it can
significantly bring improvement within survival rate of an individual (Zhang and et. al.,
2020). But this treatment has its own disadvantage which that adoption of only antibiotic
treatment cannot penetrate the ischemic muscle and cannot permanently cure this
condition. This treatment cannot completely cure this condition but can only help in
increasing survival chances of individual.
Another most commonly used treatment is Surgery. It is one of the best
treatments that can be given to any person suffering from clostridial gas gangrene. In
surgery all the dead and infected tissues are removed. But many times, this treatment is
clubbed with antibiotics treatment when just before surgery antibiotics such as penicillin
and clindamycin so that dead and infected tissues can be easily removed. But before
opting this treatment strategy first of all consult from surgeon should be taken. It is a
combination of antibiotics, surgery, and hyperbaric oxygen. But there is a disadvantage
of this strategy removal of highly infected tissues can many times result in blockage of
blood vessel that can increase risk of patient’s life.
Other than this, there are various other kinds of supportive therapies Some of
these therapies are intravenous fluids and supplemental oxygen. One of the main
benefit of this therapy is that it can help in providing log term safety to individual and
effectivity of other treatments increases. But there is disadvantage of these therapies
i.e., it cannot help in controlling or curing this condition.
Numerous toxins that contribute to the pathophysiology of these pathogens with impact
on the development of disease within the host and the effect on disease outcomes
of toxin production
Clostridium perfringens bacteria can grow and multiply. It is been swallowed or
inserted within an individual’s body it can develop harmful toxins that can cause
diarrhoea. Clostridium perfringens bacteria uses its large arsenal of protein toxins to
produce infection within an individual (Buboltz and Murphy-Lavoie, 2020). This
bacterium is mostly found in soil, normal gut flora etc. This bacterial species product two
main types of toxins that are alpha and theta toxins, one of them produce necrotizing
damage to tissues and another causes gas gangrene. It mostly works in deeper fascial

layer of skin and discharge infection that can increase threat to a patient’s life. If it is not
focused upon and detected at earlier stage then it can increase risk to life of individual
and changes of mortality can also increase.
Impact of development of this condition on host is quite severe. First of all, this
infection can spread quickly and within few hours patient may develop overwhelming
shock, sepsis, and death. It can also damage some important tissues and blood supply
within it can also get damaged (Srivastava and et. al., 2017). Many times, while
diagnosis it has been identified that many times tissues get damaged till such an extent
that blood supply within those tissues can get affected. Its impact upon host can vary
from person to person and can affect arms, legs. In several causes it was identified that
it has led people towards loss of limb or sometimes to death. Shock is one of the most
common symptoms and can spread quite rapidly. As per the cause study 57-year-old
man was presented with shock after crash injury was neglected. It can easily be noticed
by large, blackened sores formation, loud and distinctive crepitus caused by gas
escaping the necrotic tissue etc. If it is not detected in timely manner then development
of this condition can result in development of air or fluid in subcutaneous tissue, Pain
following site of either accident or surgery. In some causes it can also result affect host
as they can suffer from fever, rapid heart rate etc.
As it has already been discussed that it produces two main types of harmful
toxins as an outcome alpha and theta toxins. Both of them can cause tissue damage
(Srivastava and et. al., 2017). Out of both the type of toxin production as an outcome
alpha toxin is associated with development of gas gangrene as it is one of the main and
vital factor whilst invading its host. And affect all the tissues, blood supply within it.
Answer 3
1 Initial diagnostic assessment
The baby developed fever of 40. 2°C and tachycardia of 170 bpm, where patient history
enables to analyze information that mother had temperature of 37.4 C and heart rate
was 70 bpm. Evaluation of patient historical analysis also further explains that
tachycardia was diagnosed in child which resulted in increase in new born heart rate.
The mother of child medical history analysis, explains that there was gastrointestinal

issues found, where mild flu like symptoms were there. After delivery of baby, infant
develops fever where microscopic analysis of cerebral spinal fluid has been done for
further analyzing disease and microorganism further reducing efficiency in living
standard. Medical history analysis of mother will enable to get detailed diagnosis and
treatment of child further worked on, where infant health conditions has been declining.
The rise in temperature also lead to symptoms in baby of dizziness, weakness
and fever which further made baby uncomfortable. The diagnosis reveals that the baby
is suffering from meningitis, which has created high rise in body temperature and
tachycardia. This can be concluded on account of the symptoms and the laboratory
tests. The symptoms found in baby, when diagnosed that infant had been suffering from
meningitis, where it indicated presence of microorganism in body. Infant has found to be
pale, and having problem to breathe properly where medical history of mother has been
severely crucial for health decline. Tachycardia is an abnormally high fast rate found in
children, leading to weakness and uncomfortable breathing which beats more than 160
times per minute. The case analysis also heads on focus towards analyzing varied
importance leading to mutation, where virulence factors also further needsto be
identified (Raymond and et.al, 2021).
The laboratory tests revealed that cerebral spinal fluid contained gram positive
bacillus that were motile. Also, when cultured on Ottaviani and Agosti agar, colonies
which were blue colored with an opaque halo were seen. Clinical diagnosis, where this
is also indicative of the presence of listeria monocytogenes, which further causes
meningitis within body. Listeria Monocytogenes, has been researched as the third most
frequent cause of bacterial meningitis, where this gram positive bacillus is principally
spread by contaminated food. Diagnosis of meningitis further also focused on
symptoms such as rise in body temperature, high weakness and dehydration which
reduces ability for proper breathing. Listeria is able to have further impact extended on
adjacent cells within body, where it spreads form cell to cell with minimal contact within
host immune system. Listeria Monocytogenes, has been diagnosed as the main
microorganism which has led to meningitis within baby, which clinically has been proven
as main reason.

2 Virulence factors
Virulence factors, plays strong role where it helps bacteria to invade the host
and cause disease, evade host defenses which signifies aspects which enables
microorganism to effect. Monocytegenes, for organizing its surface for virulence with
special focus on protein which works behind the frontline, either supporting virulence
effectors. This ensures survival of bacteria within its host, which plays strong role in
form of strengthened aspect which leads to virulence factor. Monocytogenes to organize
surface for virulence, holds specific interrelation with murine cerebral listeriosis. In gram
positive bacteria, secretion of protein requires translocation of polyptides across bacterial
membrane into highly charged bacterial membrane, into highly charged environment within
membrane cell wall interface. Virulence factors, further also identifies Listreia Monocyte genes
mutilation on surface, temperature needed for entering into body (Nath and et.al, 2021).
The Listeria Monocytegenes for virulence, needs protein to be folded and delivered
across matrix of the cell wall, where secretion of gram negative bacteria possesses both inner
and outer membrane. The gram positive pathogen is responsible for manifestation of human
listeriosis, which is an opportunity for food borne disease to be associated with high mortality
rate. It also correlates with capacity of bacterium to trigger its internationalization, by non
phagocyctic cells to survive. The replication of phagocyte is also found to be majorly caused by
cell mutilation (Mishra and et.al, 2021). Also it has been researched that pregnant women are
10 times more likely to be infected with Listeria microorganism, than the general population
which further enhances ability to evaluate further case study depth factors.
The molecular determinants of Listeria Virulence and their mechanism of actions
summarizes current knowledge of pathophysiology where listreiosis and cell biology responses
to infection which is the prime reason. From case analysis, it can be understood that baby
being suffering from Metigenisis, where Listeria Monocytogenes is the third most frequent cause
for bacteria to be invaded within human body. It also enables to gain knowledge in detail the
molecular determinants of Listeria virulence and their mechanism of action and
summarizes the current knowledge on the pathophysiology of listeriosis and the cell
biology and host cell responses to Listeria infection. Tachycardia in infant has been further
leading to fever and infection, hypothydroidism which further increases metabolic rate variedly in
baby. It has been identified and extensively characterized that molecular and cell biological

levels are stringently connected for analysis and several reasons for it to be mutated. Gram
positive pathogenic bacterium Listeria monocytogenes is caused by food borne disease
associated with sever manifestations such as meningitis within pregnant women (Denoncourt
and Downey, 2021).

REFERENCES
Books and journals
Buboltz, J. B. and Murphy-Lavoie, H .M., 2020. Gas gangrene. StatPearls [Internet].
Denoncourt, A. and Downey, M., 2021. Model systems for studying polyphosphate
biology: a focus on microorganisms. Current Genetics, pp.1-16.
Dufrêne, Y.F. and Viljoen, A., 2020. Binding strength of Gram-positive bacterial
adhesins. Frontiers in Microbiology. 11. p.1457.
Fiore, E., Van Tyne, D. and Gilmore, M.S., 2019. Pathogenicity of
enterococci. Microbiology spectrum. 7(4). pp.7-4.
Ike, Y., 2017. Pathogenicity of enterococci. Nihon saikingaku zasshi. Japanese journal
of bacteriology. 72(2). pp.189-211.
Leiblein, M., and et. al., 2020. Clostridial Gas Gangrene‐A Rare but Deadly Infection:
Case series and Comparison to Other Necrotizing Soft Tissue
Infections. Orthopaedic Surgery, 12(6), pp.1733-1747.
Leiblein, M., and et. al., 2020. Clostridial Gas Gangrene‐A Rare but Deadly Infection:
Case series and Comparison to Other Necrotizing Soft Tissue
Infections. Orthopaedic Surgery, 12(6), pp.1733-1747.
Mishra, S., and et.al, 2021. Recent advanced technologies for the characterization of
xenobiotic-degrading microorganisms and microbial
communities. Frontiers in Bioengineering and Biotechnology, 9, p.31.
Nath, D., and et.al, 2021. High throughput techniques for the rapid identification of
electroactive microorganisms. Chemosphere, p.131489.
Raymond, N. S., and et.al, 2021. Phosphate‐solubilising microorganisms for improved
crop productivity: a critical assessment. New Phytologist, 229(3). pp.1268-
1277.
Selleck, E.M., Van Tyne, D. and Gilmore, M.S., 2019. Pathogenicity of
enterococci. Microbiology spectrum. 7(4).
Srivastava, I., and et. al., 2017. Spontaneous C. ásepticum gas gangrene: A literature
review. Anaerobe, 48, pp.165-171.
Srivastava, I., and et. al., 2017. Spontaneous C. ásepticum gas gangrene: A literature
review. Anaerobe, 48, pp.165-171.
Zhang, J., and et. al., 2020. Verbascoside Protects Mice From Clostridial Gas Gangrene
by Inhibiting the Activity of Alpha Toxin and Perfringolysin O. Frontiers in
Microbiology, 11, p.1504.
Zhang, J., and et. al., 2020. Verbascoside Protects Mice From Clostridial Gas Gangrene
by Inhibiting the Activity of Alpha Toxin and Perfringolysin O. Frontiers in
Microbiology, 11, p.1504.