Term
| gold standard for dx of anthrax? |
|
Definition
culture of organism for skin/aspirate/blood/pleural fluid/csf
but initially a clinical dx requiring a high index of suspicion
Features can include a metabolic acidosis and raised creatinine |
|
|
Term
| ddx of cutaneous anthrax? |
|
Definition
necrotising arachism
staph infection
cutaneous diptheria
ulceroglandular tularemia |
|
|
Term
| in nature anthrax is mainly a disease of?... |
|
Definition
|
|
Term
|
Definition
| ciprofloaxain or Doxycycline until penicillin sensitivity proven |
|
|
Term
| bacillus anthrax is a gram positive soil bacteria. what can it produce? |
|
Definition
spores.
these spores can survive dormant in soil for decades |
|
|
Term
| what can happen to spores? |
|
Definition
| they can be inhaled, ingested or infect an abrasion |
|
|
Term
| how can you get cutaneous anthrax? |
|
Definition
| following contact with animals and their meat..gets into an abrasion/cut |
|
|
Term
| which types of countries does cutaneous anthrax commonly occur in? |
|
Definition
LMIC
animal workers e.g farmers and vets, those who work with animal products e.g meat, wool, bristle or hide (leather) |
|
|
Term
| clinical features of cutaneous anthrax? |
|
Definition
single painless vesicle >ulcer> eschar
There is often significant oedema |
|
|
Term
| describe the characteristic of a cutaneous anthrax eschar? |
|
Definition
| there is often significant oedema |
|
|
Term
| how to dx cuteanous anthrax? |
|
Definition
fluid from under eschar for MC+S and pcr
Rx: Doxy/Ciprofloaxacin |
|
|
Term
| how does GI anthrax occur? |
|
Definition
following ingestion of infected meat
IV cipro or PO doxycycline + penicillin or macrolide or rifamp or vanco |
|
|
Term
| how do you get inhalation anthrax? |
|
Definition
inhalation from contaminated hides
symptoms are generic flu like symptoms progressing to sepsis. |
|
|
Term
| Mortality of inhalation anthrax? |
|
Definition
90%
Rx:Iv cipro or doxy + penicillin or macrolide or rifamp or vanco |
|
|
Term
| anthrax meningitis is a complication of ? |
|
Definition
all 3 types of anthrax (cut/inh/gi anthrax)
Causes a haemorrhagic meningitis |
|
|
Term
|
Definition
vaccinate live stock and high risk workers
PEP usually cipro/doxy
Disposal of livestock carcus to avoid pasture contamination
Appropiate decontamination of abbatoirs
PPE for animal workers
education, dx and rx facilities |
|
|
Term
| difference between cutaneous anthrax and rickettsial eschar? |
|
Definition
| cutaneous anthrax has surrounding oedema |
|
|
Term
|
Definition
| bacillus anthracis forms spores > inhabits soil > herbivores eat spores whilst grazing > spores germinate into bacilli>multiply in spleen and lymphs>animal dies and its fluids and contaminated carcass recontaminates environement |
|
|
Term
| how can anthrax be spread in the environement? |
|
Definition
as fomites by insects
on the legs of vultures who have fed on infected carcasses |
|
|
Term
| anthrax endospores are resistant to? |
|
Definition
| drying, heat, UV light, gamma radiation and many disinfectants |
|
|
Term
| virulence factors for anthrax |
|
Definition
| endospore formation and exotoxins |
|
|
Term
| describe anthrax proteins and toxins |
|
Definition
| anthrax bacilli produce 3 proteins that make 2 toxins that can lead to death |
|
|
Term
| what stain is used to demonstrate the anthrax endospore capsule? |
|
Definition
| M Fodyean stain (Polychrome methylene blue) |
|
|
Term
|
Definition
No it is not.
The only known reservoir for corynebacterium diptheria is humans! |
|
|
Term
| name 4 forms of diphteria |
|
Definition
cutaneous
Faucal
Malignant
Traceholaryngeal diptheria |
|
|
Term
| what does the diptheria toxin inhibit? |
|
Definition
| it inhibits protein translation |
|
|
Term
| the most profound effects of diptheria toxin are on the .... |
|
Definition
myocardium (myocarditis)
peripheral nerves (demylination)
Kidneys (acute tubular necrosis) |
|
|
Term
| clinical features of faucal diptheria? |
|
Definition
psuedomembrane on tonsils
strong unpleasant odour
painful dysphagia |
|
|
Term
|
Definition
diptheria anti toxin
penicillin or erythromycin should be given to hasten clearance of organism and to cease further toxin production. give for 2/52 |
|
|
Term
| can diptheria carriage be asymptomatic? |
|
Definition
|
|
Term
| name three body parts diptheria affects? |
|
Definition
heart myocarditis
nerves demyelination
kidneys ATN |
|
|
Term
| how is diphtheria spread? |
|
Definition
|
|
Term
| hallmark sign of diptheria? |
|
Definition
| grey-white pseudomemebrane that is adherant to underlying skin and bleeds when it is pulled away |
|
|
Term
| in which form of diptheria do you get a bulls neck appearance? |
|
Definition
Malignant diptheria. the most severe form
as rapid extension of pseudomebrane and cardiac involvement leading to heart block |
|
|
Term
| does infection with diptheria confer immunity? |
|
Definition
| No you still need to give the vaccine |
|
|
Term
| prevention outbreak for diptheria |
|
Definition
immunisation
prompt dx, isolation and household prophylaxis |
|
|
Term
| child from low immunisation country with cardia and neurotoxicity ddx? |
|
Definition
|
|
Term
| transmission fo diptheria? |
|
Definition
p2p via acute cases or asymptomatic carriers
Resp droplets or direct contact with secretions from resp tract |
|
|
Term
| what should you keep nearby when administering diptheria anti toxin? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| why do you get bulls neck appearance in malignant diptheria? |
|
Definition
| cervical adenitis and oedema |
|
|
Term
|
Definition
|
|
Term
| commonest source of infection leading to tetanus is? |
|
Definition
|
|
Term
| tetanus is common and serious in which groups? |
|
Definition
| newborn babies and pregnant women who havent been immunised with tetanus toxoid containing vaccines |
|
|
Term
| leading cause of deat in tetanus? |
|
Definition
|
|
Term
|
Definition
| clinical features. does not require lab confirmation |
|
|
Term
|
Definition
Abx to eradicate source of infection
Neutralise unbound toxin with human tetanus Ig
Est and maintain a secure airway
Control muscle spasms with muscle relaxants or neuromuscular blocking agents
stabilise autonomic effects |
|
|
Term
| appearance of clostridum tetani on microscopy? |
|
Definition
drumstick appearance
gram + anaerobic baccillus |
|
|
Term
| Spores of c tetani are... |
|
Definition
|
|
Term
| how does c tetani toxin get to the cns? |
|
Definition
| travels from muscle > gangliosides > retrograde axonal transport > CNS. Toxin exerts inhibition on inhibitory GABA neurons. This leads to unopposed contractions |
|
|
Term
| Pathophysiology of tetanus infection |
|
Definition
Toxin inhibits GABA neurons. This leads to unopposed contractions
increased muscle tone, trismus, risus sardonicus, opisthonus |
|
|
Term
| how does tetanus affect respiratory system? |
|
Definition
| can affect respiratory and laryngeal muscles |
|
|
Term
|
Definition
|
|
Term
| WHO definition of neonatal tetanus |
|
Definition
| illness occuring in infant who has normal ability to suck and cry in 1st 2 days of life but who loses this ability between 3-28 days of life and becomes rigid or has spasms |
|
|
Term
|
Definition
supportive care
hydration
nutrition
BDZ for spasms
MgSO or morphine for autonomic instability
analgesia
quiete side room - noise can trigger spasms |
|
|
Term
| which abx can be given in tetanus to prevent further toxin release? |
|
Definition
|
|
Term
| does infection with tetanus confer immunity? |
|
Definition
NOPE
give tetanus vaccine 3 doses in babies from 6/52 weeks old + 3 boosters |
|
|
Term
|
Definition
| 3 doses in bbies from 6/52 old. then 3 booster doses |
|
|
Term
|
Definition
umbilical cord care
wound care - cleaning and abx
tetanus vaccination (maternal 5 x dose started in pregnancy)
neonatal tetanus surveillance to target elimination efforts |
|
|
Term
| drumstick shaped gram + bacilli? |
|
Definition
tetanus bacteria
anaerobic conditions it favors |
|
|
Term
| space between tetatnus vaccines |
|
Definition
initial 3 doses spaced 4/52 apart. Start at 6/52
booster doses
start at 12-24 m
4-7 years
9-15 years |
|
|
Term
| what to give in a pregnant women with unknown tetanus vaccine hx? |
|
Definition
2-3 doses of toxoid vaccine.
The last dose should be 2-4 weeks pre delivery |
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