L46

Question 1

What is a main virulence factor of clostridium? Gram stain and shape.

Answer 1

GP
Rods
SPORE forming

Question 2

Where are clostridium found? Aerobe vs anaerobe?

Answer 2

GI tract - into body:
- Puncture wounds
- Contaminated surg
Obligate anaerobe

Question 3

Which clostridium causes teatnus? Include virulent properties/mechanism of disease.

Answer 3

Clostridium tetani
A-B toxin
- B into motor neurons –> signals internalization of A via vesicles
Retrograde transport to anterior horn (spinal cord) or brain stem
Can’t release inhibitory NTs –> unregulated excitation

Question 4

What are the 4 types of tetanus?

Answer 4

Generalized
Localized - likely to progress into generalized
Cephalic - head or neck
Neonatal

Question 5

Symptoms of generalized tetanus

Answer 5

SPASTIC PARALYSIS 
Trismus = lockjaw
Risus sardonicus 
Opisthotonos
Airway obstruction

Question 6

Diagnose tetanus

Answer 6

History + symptoms

Tests unhelpful

Question 7

Treatments for tetanus

Answer 7

Metronidazole
IM immunoglobulin
Tetanus vaccine
Maintain airway + clean wound

Question 8

Action of clostridium botulinum toxin

Answer 8

X ACh release @ NMJ

DESCENDING flaccid paralysis w/ full consciousness

Question 9

What are the 4 types of botulism?

Answer 9

Foodborne
Wound
Infant
Inhalation (bio-terrorism)

Question 10

Explain how you get botulism from food.

Answer 10

Canned foods - stored in basic pH
Ingest TOXIN
Resistant to degradation by GI enzymes

Question 11

Why/how do infants get botulism?

Answer 11

Eat honey/ingest SPORES (not toxin)

Spores colonize GI

Question 12

What are symptoms of infants with botulism?

Answer 12

Hypotonia - flaccid baby
Drooling
Ptosis
Poor feeding

Question 13

Treat botulism

Answer 13

Metronidazole
Trivalent antitoxin (botulism toxin A, B, E)
Ventilator

Question 14

Gram stain, shape, air environment, characteristics of clostridium perfringens

Answer 14

GP
Rectangular rods
Aerotolerant
Double zone of hemolysis

Question 15

What are the clinical diseases resulting from clostridium perfringens? Name the virulence factor involved.

Answer 15

Food poisoning 
- Entertoxin (heat labile)
- WATERY diarrhea 
ST infections - gas gangrene
Bacteremia

Question 16

Drugs for clostridium perfringens

Answer 16

Penicillin - uniformly active
+
Clinda - stops toxin synthesis

Question 17

What toxins are produced by C.diff?

Answer 17

Enterotoxin

Cytotoxin

Question 18

Where do patients get C.diff? Presentation.

Answer 18

HOSPITAL - nosocomial

Diarrhea –> pseudo-mem colitis

Question 19

What is most common cause of C.diff infection?

Answer 19

Antibiotic suppression of normal flora that keeps C.diff in check

Question 20

Diagnose C.diff

Answer 20

PCR of toxin genes
- BUT not specific enough to det colonization vs infection
MUST have symptoms to differentiate

Question 21

Treat C.diff - severe vs non-severe disease

Answer 21

Severe:
- Metronidazole
Non-severe:
- PO vanco
OR
- IV metronidazole

Question 22

How do health care workers stop the spread of C.diff?

Answer 22

WASH HANDS

Spores not removed by hand sanitizer

Question 23

What is a complication of C.diff?

Answer 23

Toxic megacolon - must remove infected area

Question 24

In general, which anerobes do you use clinda for?

Answer 24

Oral anaerobes

*B.frag RESISTANCE

Question 25

Which drugs are B.frag resistant to?

Answer 25

Clind
Penicillin
Ampicillin
Amoxicillin
Moxifloxacin

Question 26

Which drugs have broad anaerobic activity?

Answer 26

Amox/clavulanate
Ampicillin/sulbactam
Piperacillin/tazo
Carbapenems
Tigecycline