Tetanus & Botulism

Question 1

What are the oxygen requirements for clostridium species?

Answer 1

Obligate anaerobes

Question 2

Which clostridium species produce neurotoxins that ultimately lead to sxs? (2)

Answer 2

C. tetani (tetanus) C. botulinum (botulism)

Question 3

What 2 characteristics of C. tetani and C. botulinum contribute to their infectious capabilities?

Answer 3

Produce environmentally resistant spores and produce exotoxins (disease progression)

Question 4

What is the morphology of C. tetani and what is important about the toxin production?

Answer 4

G+ bacillus Toxin production is plasmid-mediated

Question 5

Disease with C. tetani can arise from where?

Answer 5

Contaminated soil or human/ animal feces (then introduced via trauma)

Question 6

How does the tetanus organism infect the host? (5 steps)

Answer 6

1. C. tetani bacteria introduced to the skin via trauma
2. Remain localized at the site of infection
3. If anaerobic conditions present, exotoxins released
4. Toxin absorbed by local nerve and transported through neurons to blood and lymph
5. Toxin absorbed/ spread = sxs

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Question 7

Toxin activity of C. tetani ultimately results in what sxs?

Answer 7

Disruption of central motor control = unopposed muscle contraction and spasm (rigors)

Question 8

What are the 3 clinical forms of tetanus and which is the most common?

Answer 8

1. Generalized (including neonatal) = most common 2. Localized 3. Cephalic

Question 9

What is the early manifestation of a tetanus infection and what does this often lead to?

Answer 9

Spasm of the jaw muscles (lockjaw or trismus) Leads to a grimace (risus sardonicus)

Question 10

What more serious complications may be caused by a tetanus infection?

Answer 10

Respiratory complications

Question 11

What is the most reliable diagnosis for tetanus?

Answer 11

Clinical findings > lab methods

Question 12

How is tetanus prevented?

Answer 12

Immunizations (TDAP and tetanus booster, 4 doses)

Question 13

What is recommended for treatment-neutralization for tetanus and what should be used in addition to PCN for DOC?

Answer 13

HTIG (human tetanus immunoglobulin) PCN + antitoxin

Question 14

What 3 characteristics are unique about the botulism spore?

Answer 14

Subterminal = Bacillus has distended shape Heat resistance

Question 15

How is botulism often transmitted?

Answer 15

Food poisoning (soil/ sediments along GI tracts of birds, fish, mammals)

Question 16

There are 8 serologically distinct botulism toxins. Which are involved in human disease/ medical and commercial use?

Answer 16

A and B

Question 17

What is unique about the neurotoxin of botulism?

Answer 17

On chromosome, therefore always present

Question 18

What type of botulism is the most deadly?

Answer 18

H (no standard anti-toxin)

Question 19

What are the 3 clinical forms of botulism?

Answer 19

Infant (honey, spores) Foodborne Wound (deep bc reproduce in anaerobic environment)

Question 20

What are the main sxs of infection with botulism?

Answer 20

Afebrile, flaccid paralysis, GI disturbance (if foodborne)

Question 21

What form of botulism is associated with lethal systemic effects?

Answer 21

Infant (probable cause of infant sudden death)

Question 22

How is dx of botulism toxin infection confirmed?

Answer 22

Demonstration of toxin in fecal samples

Question 23

What is the treatment for infection with botulism toxin?

Answer 23

Antitoxin (no abx)