L17: Tetanus+Botulism+Fungi

Question 1

spores of clostridium tetani

Answer 1

Terminal spores: tennis racket appearance

Question 2

tetanus diagnosis is

Answer 2

clinical

Question 3

clostridium tetani reservoir

Answer 3

Contaminated soil

Human/animal feces

Question 4

toxin production of clostridium tetani comes from

Answer 4

1 plasmid: all have 1 serotype

Question 5

DTaP

Answer 5

4 doses starting at 6 weeks

→ booster: preschool/kindergarden

Question 6

Td

Answer 6

booster q 10 years

Question 7

neutralization treatment for tetanus

Answer 7

Human tetanus immune globulin (HTIG):

Question 8

How do you get tetanus?

Answer 8

Trauma→ entry of spores
1. Bacteria remain localized
OR
2. Anaerobic conditions→ lowered oxidation/reduction potential→ multiply, release tetanospasmin (exotoxin) → absorbed by local nerve endings (or blood, lymph)→ transported through neurons→ disrupts central motor control

Question 9

general tetanus symptoms (most common)

Answer 9

Lockjaw/trismus, risus sardonicus (grimace), HA, fever, sweating, difficulty swallowing, arching of back, flexion of arms, extension of lower extremities
+/- respiratory complication, cardiac complications → death

Question 10

Tetanus in Neonates

Answer 10

infection of umbilical stump

Question 11

Localized tetanus in

Answer 11

immunocompromised

Muscle spasms confined to are close to injury

Question 12

Cephalic tetanus (least common)

Answer 12

Lesions on head/face, ear infections

Only facial muscles, but can progress

Question 13

Clostridium botulinum spores

Answer 13

less swollen, heat resistance, give bacillus distended shape

Question 14

Clostridium botulinum toxins

Answer 14

8 serologically distinct toxins: A-H

Question 15

Clostridium botulinum toxins used in botox and human disease

Answer 15

A, B

Question 16

Clostridium botulinum toxins that cause human disease

Answer 16

E, F

Question 17

Clostridium botulinum toxins that cause animal disease

Answer 17

C, D, G

Question 18

Clostridium botulinum is found

Answer 18

Spores in soil nad sediments worldwide, GI tracts of birds, fish mammals→ food poisoning

Question 19

Clostridium botulinum toxin mechanism of paralysis

Answer 19

Toxin is neurotoxic on chromosome→ prevents acetylcholine release→ flaccid paralysis

Question 20

Clostridium botulinum toxin can be isolated from _____ for diagnosis

Answer 20

fecal samples

Question 21

Botulism symptoms

Answer 21

NO FEVER
Symptoms: double vision, difficulty swallowing, blurred vision, dry mouth, droopy eyelids, slurred speech, muscle weakness (descending from shoulders)

Question 22

Type H botulism

Answer 22

most deadly substance ever:

Inhalation (13 ng) or injection (2 ng) → kill an adult, no antitoxin

Question 23

Infant botulism

Answer 23

ingestion (honey) → germinate, colonize intestine, release toxin→ lethal systemic effects→ sudden infant death
<6 months (no established gut flora)

Question 24

Foodborne botulis

Answer 24

improperly canned/processed/preserved foods→ GI disturbance, toxemia→ neuroparalytic illness

Question 25

Wound botulism

Answer 25

Follows entry by bacteria anaerobic environment→ germination, reproduction→ neuroparalytic illness from toxin Usually IVDU

Question 26

cryptococcus neoformans serotypes

Answer 26

A,D, A/D

Question 27

cryptococcus gattii serotypes

Answer 27

B, C

Question 28

cryptococcus morphology

Answer 28

Capsule: evade phagocytosis | Serotypes A-D

Question 29

cryptococcus epidemiology

Answer 29

Exogenous infections Soil, bird droppings NOT communicable

Question 30

Cryptococcus gattii epidemiology

Answer 30

originally goats, immunocompetent hosts, fatal

Question 31

of the 2 cryptococci, which one is more common

Answer 31

Cryptococcus neoformans

Question 32

Cryptococcus MOA

Answer 32

Immunodeficient: AIDS, lymphoma Inhalation of dessicated yeast cells→ pulmonary infection: asymptomatic or flu-like → resolve without intervention OR Skin/pulmonary infection→ progress to CNS→ meningoencephalitis

Question 33

Cryptococcus meningoencephalitis symptoms

Answer 33

Fever, HA, stiff neck, change in mental status, increased CSF amount and pressure, low glucose, lesions on tissue FATAL

Question 34

Culture of cryptococcus can grow on

Answer 34

Grows at 37 C | canavanine glycine bromothymol blue (CGB) medium

Question 35

Direct exam of cryptococcus

Answer 35

``` Encapsulated yeast (india ink) Serology***: detection of capsule antigen in ```

Question 36

detection of cryptococcus in CSF or serum

Answer 36

latex agglutination test

Question 37

sabouraud dextrose agar, potato dextrose agar culture of cryptococcus

Answer 37

Creamy, mucoid colonies

Question 38

cryptococcus culture on bird seed agar/caffeic acid medium

Answer 38

Diphenol oxidase (laccase) melanin from phenol containing substrates (birdseed agar in mixed infections)

Question 39

Toxoplasma gondii transmission/epidemiology

Answer 39

Foodborne, zoonotic in soil (up to 1 year), congenital, blood transfusions/organ transplant (rare), inhalation from litter box Hot, humid climates No person-to-person

Question 40

Toxoplasma gondii control

Answer 40

Cook meat thoroughly Wear glove during gardening, wash hands after Keep outdoor sandboxes covered Pregnant women should not: clean litter boxes, adopt new cats

Question 41

Toxoplasma gondii life cycle

Answer 41

host for sexual stage is cats. | Other hosts involve birds, mice, livestock

Question 42

Toxoplasma gondii can be isolated from

Answer 42

CSF, difficult: Zoitocytes and trophozoites

Question 43

Toxoplasma gondii serology

Answer 43

ELISA: IgG or IgM in pregnant women

Question 44

Toxoplasma gondii molecular diagnosis

Answer 44

PCR: parasite DNA in amniotic fluid

Question 45

Toxoplasma gondii in immunocompetent

Answer 45

Asymptomatic/mild flu in immunocompetent hosts

Question 46

Toxoplasma gondii severe complication occur in

Answer 46

immunocompromised hosts, women newly infected in pregnancy

Question 47

Congenital toxoplasma gondii

Answer 47

damage is more severe the earlier infected in pregnancy→ blindness, epilepsy. Triad: chorioretinitis, hydrocephalus, intracranial calcifications

Question 48

Post-natal Toxoplasma gondii

Answer 48

fever, myalgia, blurred vision

Question 49

Naegleria fowleri cysts

Answer 49

single nucleate: arises from amoeboid form under harsh conditions

Question 50

Naegleria fowleri flagellate trophozoites

Answer 50

2 flagella, arises in minutes based on changes in ionic environment or lack of nutrients Infectious form

Question 51

Naegleria fowleri epidemiology

Answer 51

Soil, freshwater free living: pools, streams, ponds Summer months in southern states No person-to-person, no drinking water

Question 52

Naegleria fowleri ameboid trophozoites

Answer 52

reproductive form which arises from flagellate form when conditions improve, only form in tissue and that feeds (on bacteria), phagocytose RBC, WBC, destroy tissue

Question 53

Naegleria fowleri is a

Answer 53

Facultative environmental pathogen

Question 54

Naegleria fowleri mechanism

Answer 54

Flagellate form enter nasal passages→ ameboid form→ migrates (lobopodia) along olfactory nerve to the brain → necrosis in olfactory bulbs and brain tissue by sucker apparatus, consumes brain cells → Primary Acute Meningoencephalitis

Question 55

Naegleria fowleri symptoms

Answer 55

Acute Meningoencephalitis: Mimic bacterial meningitis +/- confusion, hallucinations, seizures Rapidly fatal: death within 2 days

Question 56

Naegleria fowleri wet mount

Answer 56

motile amoeba

Question 57

Naegleria fowleri control

Answer 57

``` Avoid swimming in stagnant ponds Do not disturb sediment in freshwater Keep head above water Distilled/purified water in neti pots Salination for decontamination (chlorine ineffective) ```

Question 58

Naegleria fowleri tissue sections

Answer 58

trophozoites: atypical mononuclear cells

Question 59

Naegleria fowleri culture

Answer 59

Clearing zones on E. coli covered agar plates: drop of CSF→ clearing→ pick up amoeba, place in distilled water→ look for flagellated form