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Botulism
- 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
- Caused by ingesting spores – No honey during first one year of life
- Adult botulism
- Caused by ingesting spore
- Canned food
- Wound botulism
- Medical emergency, can be fatal
Clinical Presentation
- Adult
- Afebrile
- Symmetric neurologic symptoms
- Nausea, vomiting and abdominal cramps
- Dry mouth
- Diplopia
- Dilated pupils
- Facial weakness with drooping eyelids
- Slurred speech or weak voice
- Dysphagia – drooling
- Dysarthria
- Diaphragmatic paralysis – Trouble breathing
- Descending weakness
- Infant
- Ptosis – upper eyelid droop
- Slow pupillary reaction
- Flaccid expression
- Poor anal sphincter tone
Diagnosis
- Physical exam
- Signs of descending symmetrical muscle weakness or paralysis
- Decreased or absent pupillary reflex
- Wound culture
Treatment
- Antitoxin – prevents binding of toxin to nerve cells
- Breathing assistance
- Mechanical ventilator
- Rehabilitation therapy
Campylobacter Jejuni
- Gram negative bacilli
- Food borne – most commonly associated with poultry
- Self limiting diarrhea in most cases
- Associated with the development of Guillain Barre syndrome due to cross reactivity
Clinical Presentation
- Watery and possibly bloody diarrhea
- Abdominal pain
- Headaches
Diagnosis
- Stool culture
Treatment
- Typically self limiting
- Fluids & electrolytes
- Azithromycin may be used in specific cases
Chlamydia
- Chlamydia trachomatis
- Most common sexually transmitted bacteria
- The most common cause of nongonococcal urethritis in men
- In woman may cause cervicitis, salpingitis and pelvic inflammatory disease (A major cause of infertility)
- Once the leading cause of blindness in the world
- Triad of arthritis, conjunctivitis and urethral inflammation
Clinical Presentation
- Most often no symptoms at all
- Men
- Watery discharge
- Less painful than gonococcal urethritis
- Burning and itching around the opening of the penis
- Pain and swelling around the testicles
- Women
- Abnormal vaginal discharge that may have an odor
- Bleeding between periods
- Painful periods
- Abdominal pain with/without a raised temperature
- Pain when having sex
- Itching or burning in or around the vagina
- Pain when urinating
Labs and studies
- Nucleic Acid Amplification Tests
- PCR – polymerase chain reaction
- TMA – transcription mediated amplification
- SDA – strand displacement amplification
- Discharge sample for women is taken from the cervix
- Discharge sample for men is taken from the urethra
- Urine sample is also effective
Treatment
- Prevention
- Abstinence
- Use of barrier protection
- Limited sexual partners
- Screening
- Woman under 25 who are at risk
- Pregnant woman
- Medications
- Azithromycin
- Doxycycline
- All sexual partners need to be treated
Cholera
- The Ghost Map by Steven Johnson
- 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 hyper-secretion of water and chloride
- Last outbreak in the United States was in 1910
Clinical Presentation
- “Rice water” diarrhea and lots of it! 10-20 liters (3-5 gallons) per day!
- 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
Diagnosis
- Physical assessment
- Stool cultures
- Cholera dipstick tests
Treatment
- 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
Diphtheria
- Corynebacterium diphtheriae – Gram positive, facultative anaerobic
- Most commonly causes a pharyngeal infection
- Severe cases may have a grey pseudomembrane covers the pharynx and may cause obstruction
- Vaccination has been very successful. Only two cases between 2000 and 2012 reported in the U.S.
- Endotoxin which may affect heart and nerve tissue
- Most patients are asymptomatic but may be fatal in 5-10% secondary to obstruction of the airway and disseminated diphtheria toxin
Clinical Presentation
- Fever and chills
- Sore throat
- Cough – barking
- Stridor
- Hoarseness
- Difficulty breathing
- Bloody nasal discharge
- Malaise
Physical exam
- Adherent grey pseudomembrane covering tonsils
- Lymphadenopathy
Diagnosis
- Throat swab for culture – growth of C. diphtheriae
Treatment
- Antitoxin – prevents toxin from binding but does not affect toxin already bound to tissues
- Antibiotics – does not show improvements in patients receiving antitoxin, but does decrease transmission rates
- Penicillin
- Erythromycin
- Laryngoscopy to remove pseudomembrane
- Intubation may be necessary
- Isolation and treatment of contacts
- Cases must be reported to CDC
