fun bacterial infections Flashcards
clostridium botulinum?
anaerobic, spore forming bacillus found in soil
what is the main cause of problems in botulism?
the toxins that are produced: letters A-G
what toxins cause illness in humans?
A, B, E and rarely F
how to humans inadvertently ingest it?
it may get packed in food (home canned, smoked, or commercial) where the toxin in produced and stored until ingested
what are the three types of botulims?
foodborne, wound, and infant
what does the botulinum toxin do?
inhibits the release of acetylcholine at the neuromuscular juction
what causes infant and would botulims?
exposure to the bacteria or spores and elaboratio of the toxin invivo
why has the prevalance of wound botulism increased in the past few years?
injection of black-tar heroin
what are the initial clinical symptoms of a botulism infection?
visual changes, including diplopia and loss of acommodation
how soon after ingestion do sx appear in botulism infection?
12-36 hours
what are other manifestations of botulims?
ptosis, impaired extraocular muscle movements, fixed, dilated pupils
- cranial nerve palsies
- dysphonia
- dry mouth
- dysphagia
- N, V
what are the complications of botulism?
respiratory paralysis!
is AMS or sensory deficits apparent in botulism?
nope!
what are some sx seen in infants dx with botulism?
lethargic, feed poorly, constipated, weak cry and poor muscle tone
-floppy baby syndrome
what are ddx for botulism?
Guillian Barre, stroke, MG
how do you test for botulism?
- 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
was is the tx of botulism?
antitoxin that is available through the CDC
-supportive care: intubation, mechanical ventilation
if dysphagia persists, then IV nutritional support and hyperalimentation
TETANUS?
produced by Clostridium tetani
what kind of bacteria is clostridium tetani?
a gram positive anaerobic rod
what acutally causes the problems of tetanus?
the exotoxin produced by the bacteria
-called tetanospasmin
what is the pathophysiology of tetanus?
humans usually contract via wound and the spores regenerate under anaerobic conditions and disperse via blood stream
where are the spores of C. tetani most likely to be found?
in animal feces and soil
-highly resistant
what do the toxins of C. tetani do?
act on central and peripheral nervous systems interfering with release of NT
what is the incubation period for tetansu?
3-21 days (4-14 for neonatal)
**shorter the incubation, higher the likelihood of death
what population is most at risk for tetanus?
those with puncture wounds, elderly, migrant workers, newborns and injection drug users
diabetics, unimmunized, recent tattoo or body peircing
what is the most common presentation of tetanus?
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
what are other sx of generalized tetanus?
fever, sweating, elevated BP, and episodic rapid heart rate
-
what are complications of untreated tetanus?
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
how often an dhow long can spasms of tetanus occur?
frequently! last for several minutes and continue for 2-4 weeks!
-complete recovery may take mnths
what is the neonatal generalized type?
- occurs in newborns to a mom who is not immune
- typically occurs through infected umbilical stump (cut with dirty tools)
what is the localized type of tetanus?
spasms and contractions localized to the region/area of the wound
how is tetanus diagnosed?
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
what is the treatment of tetanus?
- 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
what are the 4 T’s of tetanus?
Trismas or lackjaw Top to bottom tetany no Test TIG and Tetanus Toxoid
what are the tetanus vaccines?
1) DTaP: Tetanus and diphtheria toxoids and acellular pertussis
2) DT
3) TD
4) Tdap
what is DT?
diphtheria and tetanus toxoids are licensed for infants and children younger than 7 years of age
what is Td?
Tetanus and diphtheria toxoids and tetanus toxoid (TT) are licensed for children 7 years of age and older and adults
what is Tdap?
Two tetanus and diphtheria toxoids and acellular pertussis formulation for adolescents and adults were licensed in 2005
what must you give if pt gets a majore injury and its been more tha 5 years since last booster?
additional booster
passive immunization with Tetanus Toxoid recommended in those w/ major wounds and uncertain tetanus status
