fun bacterial infections

Question 1

clostridium botulinum?

Answer 1

anaerobic, spore forming bacillus found in soil

Question 2

what is the main cause of problems in botulism?

Answer 2

the toxins that are produced: letters A-G

Question 3

what toxins cause illness in humans?

Answer 3

A, B, E and rarely F

Question 4

how to humans inadvertently ingest it?

Answer 4

it may get packed in food (home canned, smoked, or commercial) where the toxin in produced and stored until ingested

Question 5

what are the three types of botulims?

Answer 5

foodborne, wound, and infant

Question 6

what does the botulinum toxin do?

Answer 6

inhibits the release of acetylcholine at the neuromuscular juction

Question 7

what causes infant and would botulims?

Answer 7

exposure to the bacteria or spores and elaboratio of the toxin invivo

Question 8

why has the prevalance of wound botulism increased in the past few years?

Answer 8

injection of black-tar heroin

Question 9

what are the initial clinical symptoms of a botulism infection?

Answer 9

visual changes, including diplopia and loss of acommodation

Question 10

how soon after ingestion do sx appear in botulism infection?

Answer 10

12-36 hours

Question 11

what are other manifestations of botulims?

Answer 11

ptosis, impaired extraocular muscle movements, fixed, dilated pupils

• cranial nerve palsies
• dysphonia
• dry mouth
• dysphagia
• N, V

Question 12

what are the complications of botulism?

Answer 12

respiratory paralysis!

Question 13

is AMS or sensory deficits apparent in botulism?

Answer 13

nope!

Question 14

what are some sx seen in infants dx with botulism?

Answer 14

lethargic, feed poorly, constipated, weak cry and poor muscle tone

-floppy baby syndrome

Question 15

what are ddx for botulism?

Answer 15

Guillian Barre, stroke, MG

Question 16

how do you test for botulism?

Answer 16

• find toxin in serum, stool, or wound
• testing must be done at a state health department
• nerve conduction studies
• identify toxin using specific antiserum after mouse inoculation with the pts serum

Question 17

was is the tx of botulism?

Answer 17

antitoxin that is available through the CDC

-supportive care: intubation, mechanical ventilation

if dysphagia persists, then IV nutritional support and hyperalimentation

Question 18

TETANUS?

Answer 18

produced by Clostridium tetani

Question 19

what kind of bacteria is clostridium tetani?

Answer 19

a gram positive anaerobic rod

Question 20

what acutally causes the problems of tetanus?

Answer 20

the exotoxin produced by the bacteria

-called tetanospasmin

Question 21

what is the pathophysiology of tetanus?

Answer 21

humans usually contract via wound and the spores regenerate under anaerobic conditions and disperse via blood stream

Question 22

where are the spores of C. tetani most likely to be found?

Answer 22

in animal feces and soil

-highly resistant

Question 23

what do the toxins of C. tetani do?

Answer 23

act on central and peripheral nervous systems interfering with release of NT

Question 24

what is the incubation period for tetansu?

Answer 24

3-21 days (4-14 for neonatal)

**shorter the incubation, higher the likelihood of death

Question 25

what population is most at risk for tetanus?

Answer 25

those with puncture wounds, elderly, migrant workers, newborns and injection drug users

diabetics, unimmunized, recent tattoo or body peircing

Question 26

what is the most common presentation of tetanus?

Answer 26

the generalized type that follows a descending pattern

• pain and tingling at the site of inoculation
• trismus, stiffness of the neck, difficulty swallowing, rigidity of the abdominal muslces

Question 27

what are other sx of generalized tetanus?

Answer 27

fever, sweating, elevated BP, and episodic rapid heart rate

-

Question 28

what are complications of untreated tetanus?

Answer 28

possible tonic convulsion, spasm of the glottis and respiratory muscles, and asphyxia

Laryngospasm
Fractures
Hypertension
Nosocomial infections due to prolonged hospitalization
Pulmonary embolism, especially in drug users or elderly (immobilization)
Aspiration pneumonia
Death

Question 29

how often an dhow long can spasms of tetanus occur?

Answer 29

frequently! last for several minutes and continue for 2-4 weeks!

-complete recovery may take mnths

Question 30

what is the neonatal generalized type?

Answer 30

• occurs in newborns to a mom who is not immune

- typically occurs through infected umbilical stump (cut with dirty tools)

Question 31

what is the localized type of tetanus?

Answer 31

spasms and contractions localized to the region/area of the wound

Question 32

how is tetanus diagnosed?

Answer 32

clinical findings

• no specific labs
• wound cultures often negative
• get good hx, S/S. and absence of other more likely explanations

**some ppl can be carries of C. tetani

Question 33

what is the treatment of tetanus?

Answer 33

• mostly supportive: hospitalization, wound debridement, airway protection/support, tx of muscle spasms
• tetanus immune globulin via IM + Tetanus toxoid
• PCN is given to all pts

Question 34

what are the 4 T’s of tetanus?

Answer 34

Trismas or lackjaw
Top to bottom
tetany
no Test 
TIG and Tetanus Toxoid

Question 35

what are the tetanus vaccines?

Answer 35

1) DTaP: Tetanus and diphtheria toxoids and acellular pertussis
2) DT
3) TD
4) Tdap

Question 36

what is DT?

Answer 36

diphtheria and tetanus toxoids are licensed for infants and children younger than 7 years of age

Question 37

what is Td?

Answer 37

Tetanus and diphtheria toxoids and tetanus toxoid (TT) are licensed for children 7 years of age and older and adults

Question 38

what is Tdap?

Answer 38

Two tetanus and diphtheria toxoids and acellular pertussis formulation for adolescents and adults were licensed in 2005

Question 39

what must you give if pt gets a majore injury and its been more tha 5 years since last booster?

Answer 39

additional booster

passive immunization with Tetanus Toxoid recommended in those w/ major wounds and uncertain tetanus status