Blood And Lymph - Dugan - Zoonotic Infections 2

Front 1

Of the two types of Yersinia we talked about, Yernisia pestis and Yersinia Enterocolitica, which one caused the bubonic plague?

Back 1

Yersinia pestis = killed 1/3 of population in Europe in 14th century. Kinda like the effect of George Bush on our national spirit: Soul-Crushing

Front 2

Someone who comes down with Yersinia pestis obtained it from what areas of the US?

Back 2

out west = makes sense b/c reservoir is ground squirel or prarie dog. Transmitted by fleas (in CITIES out west it will be in rat reservoirs but still transmitted via fleas)

Front 3

Which of the diseases we've talked about have the potential to pull an Osama Bin Laden and KILL everyone? (ie which is considered an agent of bioterrorism?)

Back 3

Yersinia pestis = causes bubonic plague

Front 4

What is a typical clinical manifestation for pt who has been camping out west and now has Yersinia pestis?

Back 4

2-3 days after infection from flea transmission (reservoir - prarie dog, ground squirrel, or in urban areas rats) we'll see enlarged regional lymph nodes in AXILLA or GROIN

Vomiting or Diarrhea with sepsis --> rapid vascular collapse with DIC --> blackened skin = "BLACK DEATH"

HypOtension, altered mental state, renal and cardiac failure

Front 5

Whats your chance of death if you are NOT treated and have Yersinia pestis ie the plague?

Back 5

50%

Front 6

What are the virulence factors of Yersinia pestis?

Back 6

Slime capsule (protein polysacchardide termed F-1 antigen) = helps them survive intra-cellularly

Exotoxin (=Bacteriocin ie pesticin)

Endotoxin


Several other enzymes

Front 7

What 3 diseases have we learned about that have Gram neg rods?

Back 7

Yersinai pestis (plague)
Francisella (dead animals ie Rodent, Rabbit, Beaver, muskrat, Nantucket, Martha's Vineyard)
Brucella (Animal STD)

Front 8

Lab results show a gram neg organism with Giemsa stain with slime capsule. What do you tx pt with and what do you tell them to do before they go camping out west the next time?

Back 8

Tx = Streptomycin or gentamicin

Before they go camping out west next time get the Yersinia pestis plague vaccine, however the BEST mechanism of defense is to destroy the vector and host (ie kill all those fleas rats ground squirrels and prarrie dogs)

Front 9

Pt recently consumed unpasteurized milk products from a dairy farm. What TWO things have we talked about that could be the cause of the pts symptoms? How do you tell them apart?

Back 9

Brucella and Yersinia Enterocolitica

Yersinia Enterocolitica = Lactose neg, Oxidase neg, Urease positive, bloody diarrhea, pain n lower right quadrant mimicking appendicitis, Nothing in stool cultures.

Brucella = nonmotile, urease positive, nitrate positive, aerobic Erythritol Growth factor in placenta or fetal tissues, survives in macrophages, Hepatospenomegaly, granulomatous nodules in liver, spleen, bone, fever that rises in afternoon and falls at night

Front 10

Pt presents with a recent history of dog bite as well as cat scratch. You isolate an organism that is a gram neg coccobacilli oxidase positive. Whats the treatment?

Back 10

Pt prob has pasteurella multocida = normal oral flora of ogs and cats

Tx = Amoxicillin/ clavulanate = preferred empirical tx of animal bite wounds

Front 11

Pt recently was scratched by a cat. What symptoms are likely associated with what you believe is the Dx? Symptoms

Back 11

We're thinking Bartonella henselae = Small abcesses at site of cat scratch or bite

Symptoms will be fever, localized lymphadenopathy

Front 12

Pt recently was scratched by a cat. What do you believe is the Tx?

Back 12

Azithromycin

Front 13

If your pt was scratched or bitten by a cat, what symptom or set of symptoms might lead you to believe the cause is Bartonella henselae over Pasteurella multocida?

Back 13

Bartonella henselae will present with LYMPHADENOPATHY and fever, swelling (Pasteurella multocida will present with ulcers)

Front 14

Whats significant about an HIV+ AIDS pt being scratched or bitten by a cat?

Back 14

If infected with Bartonella henselae, they will develop a specific rash from this we only see in AIDS pts = bacillary angiomatosis = localized infection of skin that results in cytokines being produced = proliferation of small blood vessels = bacillary angiomatosis

OVERALL IDEA: Bartonella has a special presentation in AIDS pts.