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infectious diseases > uncommon bacterial infections > Flashcards

uncommon bacterial infections Flashcards

1
Q

Botulism

  • organism
  • Toxin does what?
  • Infant botulism occurs when
  • No ___ during first one year of life
  • Foodborne botulism from what
  • when is it a medical emergency?
A

Clostridium botulinum – anaerobic organism
Toxin inhibits the release of acetylcholine at the neuromuscular junction
Infant botulism-Between the ages of 2 and 6 months
Floppy baby
No honey during first one year of life
Foodborne botulism-Canned food
Wound botulism-Medical emergency, can be fatal

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2
Q

Toxin inhibits the release of acetylcholine at the neuromuscular junction

A

Clostridium botulinum

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3
Q

Diplopia(12-36 hours after ingestion)
Dilated pupils
Facial weakness with drooping eyelids
Dysphagia – drooling

Nausea, vomiting and abdominal cramps
Dry mouth

Diaphragmatic paralysis – Trouble breathing

Dysarthria
Afebrile
Symmetric neurologic symptoms

A

adult botulism symptoms

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4
Q

botulism symptoms (3)

A

Signs of symmetrical muscle weakness or paralysis
Weakening voice
Drooping eyelids

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5
Q 
Infant
Ptosis
Slow pupillary reaction
Flaccid expression
Poor anal sphincter tone
A

infant botulism symptoms

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6
Q

infant botulism symptoms (4)

A

Ptosis
Slow pupillary reaction
Flaccid expression
Poor anal sphincter tone

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7
Q

Physical exam
Signs of symmetrical muscle weakness or paralysis
Weakening voice
Drooping eyelids

A

botulism

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8
Q

botulism treatment (4)

A

**Antitoxin available from the CDC
Breathing assistance
Mechanical ventilator
Rehabilitation therapy – for paralysis

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9
Q

botulism tests (5)

A
  • specific antiserum mouse inoculation with pts serum
  • Blood tests
  • Feces
  • Gastric aspiration
  • Wound culture
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10
Q

Cholera

  • organism? describe the appearance
  • transmission
  • Common in what places
  • toxin does what
A
  • Vibrio cholerae – Gram negative, comma shaped with a single flagellum
  • Fecal oral route
  • Common in places with poor sanitation and crowding
  • Toxin produced by the bacteria results in hypersecretion of water and Chloride.
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11
Q 
Dehydration
Rapid heart rate
Loss of skin elasticity
Dry mucous membranes, to include the inside of the mouth, throat, nose, and eyelids
Low blood pressure
Thirst
Muscle cramps
-“Rice water” diarrhea and lots of it! 10-20 liters (3-5 gallons) per day!
A

cholera

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12
Q

“Rice water” diarrhea

A

cholera

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13
Q

Diagnosis of cholera (3)

A

Physical assessment
Stool cultures
Cholera dipstick tests

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14
Q

describe cholera main symptom

A

“Rice water” diarrhea

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15
Q

cholera treatment (3)

A

Fluids!! Oral is sufficient most cases
Electrolyte replacement
Intravenous fluids – for severely dehydrated affected people
Self limiting, but antibiotics will speed up recovery and shorten the course.
Doxycycline
Azithromycin

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16
Q

Diphtheria

  • organism? describe appearance
  • Most commonly causes a ___infection.
  • main exam sign
  • Endotoxin affects what
  • Fatal?
A

-Corynebacterium diphtheriae – Gram positive, facultative anaerobic
-Most commonly causes a pharyngeal infection.
-Grey pseudomembrane covers the pharynx and may cause obstruction
-Endotoxin which may affect heart and nerve tissue
Fatal in 5-10% of cases

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17
Q

-Grey pseudomembrane covers the pharynx and may cause obstruction

A

Diphtheria

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18
Q
  • Gram positive, facultative anaerobic
  • Gram negative, facultative anaerobic rod
  • Gram negative, comma shaped with a single flagellum
  • Gram negative rod (Ingestion of contaminated food or water)
  • Gram positive, obligate anaerobe, rod
A
  • Corynebacterium diphtheriae
  • Shigella
  • Vibrio cholerae
  • Salmonella
  • tetanus
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19
Q 
I came in to see my physician assistant because of…
Fever and chills
Sore throat
Cough – barking
Stridor
Hoarseness
Difficulty breathing
Bloody nasal discharge
Malaise
A

Diphtheria

20
Q

Diphtheria symptoms FINDINGS (9)

A 
Fever and chills
Sore throat
Cough – barking
Stridor
Hoarseness
Difficulty breathing
Bloody nasal discharge
Malaise
21
Q

Adherent grey pseudomembrane covering tonsils

Lymphadenopathy

A

Diphtheria

22
Q

Diphtheria exam (2)

A

Adherent grey pseudomembrane covering tonsils

Lymphadenopathy

23
Q

Diagnosis tests for diptheria

A

Physical exam

Throat swab for culture – growth of C. diphtheriae

24
Q

diptheria treatment (3)

A

Antitoxin
Antibiotics(Penicillin or Erythromycin)
Laryngoscopy to remove pseudomembrane

Intubation may be necessary
Isolation and treatment of contacts
Cases must be reported to CDC

25
Q

Salmonellosis

  • organism and shape
  • Typhoid ___days
  • transmission
  • (most common presentation)
  • incubation?
  • course is ___days
A 
Salmonellosis
Things you should know
Salmonella enterica – Gram negative rod
Ingestion of contaminated food or water
Typhoid 5-14 days
Gastroenteritis (most common)
incubation is 8-48hrs
course is 3-5 days
26
Q 
Prodrome (General malaise, Cough, Fever)
Abdominal pain / distention
Constipation / Diarrhea – Pea soup stool
High fever
Elevated heart rate
Abdominal tenderness
Pink papular rash on TRUNK
Delerium
Hypovolemic shock
A

typhoid fever

27
Q

Pea soup stool

Pink papular rash on TRUNK

A

typhoid fever

28
Q

Crampy abdominal pain
Fever
Nausea / vomiting
Bloody diarrhea

A

Gastroenteritis/ typhoid fever

29
Q

Diagnosis tests for typhoid fever

A

Stool analysis/ Fecalysis
Blood culture
Urine culture

30
Q

typhoid fever treatment

  • enteric fever (2)
  • gastritis (3)
A 
Replacement of fluids and electrolytes!
**Enteric fever
Fluoroquinolones – ciprofloxacin
Third generation cephalosporin – ceftriaxone
**Gastritis
Self limiting
Bactrim or cipro may be used
31
Q

Shigellosis

  • describe organism
  • Mode of transmission
  • This is often found where?
  • reactive arthritis?
A

Shigella – Gram negative, facultative anaerobe, rod
Mode of transmission: fecal-oral route
This is often found in day care centers, nursing homes, refugee camps, and other places where conditions are crowded and sanitation is poor
Patients with HLA-B27 may develop reactive arthritis

32
Q 
Diarrhea
Presence of blood, pus, or mucus in stools
Fever
Rectal tenesmus
Abdominal discomfort/cramps
A

shigella

33
Q

shigella s/s (5)

A 
Abdominal discomfort/cramps
Diarrhea
Presence of blood, pus, or mucus in stools
Fever
Rectal tenesmus
34
Q

Diagnositic tests for shigella (3)

A

Stool analysis for RBC’s and WBC’s
Stool culture
Sigmoidoscopy

35
Q

Treatment for shigella (4)

A

Fluids and electrolytes!

Medications (Bactrim, Cipro, Ampicillin)

36
Q

Tetanus

  • organism and description
  • Neurotoxin which causes what
A

Clostridium tetani – Gram positive, obligate anaerobe, rod
Neurotoxin which causes uncontrollable muscle spasms
Wound contamination – puncture wounds

37
Q

Signs and Symptoms
Pain and spasticity at the site of inoculation
Trismus – lockjaw; spasms and stiffness along the jaw muscles
Risus sardonicus – facial spasms
Stiffness of the neck muscles
Difficulty swallowing
Stiffness of the abdominal muscles
Painful body spasms lasting for several minutes
Spasm of the respiratory muscles

A

tetanus

38
Q

main symptoms with tetanus

A

Trismus – lockjaw; spasms and stiffness along the jaw muscles
facial and respiratory muscles spasms
Stiffness of the neck and abdominal muscles
Difficulty swallowing
Painful body spasms lasting for several minutes

39
Q

tetanus treatment and vaccination

A

Vaccination with a booster every 10 years
Mild cases
Tetanus immunoglobulin IM
Metronidazole, Diazepam
Tetanus immunoglobulin injected intrathecally like a spinal anesthesia
Tracheostomy and mechanical ventilation
Magnesium prevent muscle spasm

40
Q

Patient presents complaining of a huge volume of diarrhea which he describes as milky. He is a little blue. What is the most likely dx?

What is the first line treatment for all diarrhea?

What is the treatment for a gram negative diplococci we talked about today?

A grey pseudomembrane covering the pharynx should make you think of what diagnosis?

A

Patient presents complaining of a huge volume of diarrhea which he describes as milky. He is a little blue. What is the most likely dx?
Cholera
What is the first line treatment for all diarrhea?
Fluids!!!!!
What is the treatment for a gram negative diplococci we talked about today?
IM Ceftriaxone
A grey pseudomembrane covering the pharynx should make you think of what diagnosis?
Diphtheria

41
Q

Salmonella typhi – following ingestion it attacks the mucosa of the intestines and begins to replicate
Incubation is___ days

what is (Typhoid Mary)?

name 3 symptoms

A

Salmonella typhi – following ingestion it attacks the mucosa of the intestines and begins to replicate
Incubation is 5-14 days

Some people can become carriers. They are asymptomatic though they may continue to release bacteria in their stool for years. (Typhoid Mary)

Progressive fever reaching over 103 as things get worse, peaks at 7-10 days
Rose spots = small red/pink spots on belly and chest which fade with pressure
Splenomegaly

42
Q 
Progressive fever reaching over 103 as things get worse, peaks at 7-10 days
Malaise
Abdominal pain/distention/tenderness
Severe fatigue
Weakness
Delirium
Rose spots = small red/pink spots on belly and chest which fade with pressure
Bradycardia
Splenomegaly
A

typhoid fever

43
Q

salmonella typhoid fever tx

A

Fluid and electrolyte replacement
Ampicillin, Chloramphenicol and Bactrim.
Treatment of carriers is typically ineffective

44
Q

This presentation is most common in immunosuppressed patients(salmonella)

  • describe course
  • Treatment is similar to what
A
  • Bacteremia
  • Long term, recurrent fever with multiple local infections
  • Treatment is similar to typhoid fever which we will talk about next
45
Q

Presentation is 8-48 hours after ingestion
Abdominal pain, fever, chills, diarrhea, nausea, vomiting
Patient may also have bloody diarrhea

A

Gastroenteritis/Enterocolitis (salmonella)

46
Q

One of the most common types of food poisoning

Think under cooked chicken, eggs, stuffing

A

Gastroenteritis/Enterocolitis

Most common presentation of Salmonella

47
Q

Gastroenteritis/Enterocolitis (salmonella)

  • definitive test
  • primary treatment
  • symptoms last how long
A

Stool culture is definitive test
Primary treatment is fluid and electrolyte replacement
Symptoms typically last 2- 5 days

infectious diseases (7 decks)

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