How is Typhoid fever transmitted?
Mostly transmitted when a person eats food or drinks beverages that have been handled by a person shedding the salmonella tyhi bacteria.
The bacteria are also transmitted when sewage contaminated with salmonella typhi get into water used for drinking and washing food.
Where is typhoid fever transmission most common?
Areas of the developing world including parts of Asia, Africa and latin America
Slowly progressive fever as high as 104 degrees f (40 degrees c)
Gastroenteritis- inflammation of the Digestive tract
Untreated has 4 stages
A slowly rising temp
Leucopenia- decrease in WBCs
The classic widal test is negative
What is the Widal test?
Test for salmonella in the blood
What happens in stage two or the second week of typhoid infection?
Bradycardia- slowing of the heartbeat
Delirium is frequent
Spleen and liver begin to be enlarged
Diarrhea can occur
Widal reaction is strongly positive
Bacteria begins to eat away at your intestine
What happens at stage or week three of infection with typhoid?
Number of complications may arrive
Intestinal hemorrhaging (bleeding)
Encephalitis- brain swelling
What is Intestinal perforation?
Macrophage phagocytosis of bacteria
In other words, bacteria are eating holes through your intestine and macrophages try to eat the bacteria but fail because theres too much
Bloody infections on your skin that you start to get all over your body
What happens during the fourth stage/week of typhoid infection?
Symptoms become worse
Made up by….
-àthe widal test
The discovery of oral rehydration therepy provided a simple way to prevent many of the deaths and diarrheal diseases in general, because the diarrhea dehydrates you
Treatment of choice is a fluoroquinolone such as ciprofloxacin
How many vaccinations are there against typhoid fever? What are they?
Currently 2 vaccinations recommended by the world health organization to prevent typhoid
1. The live, oral Ty21a vaccine- sold as Vivotif Berna
2. The injectable Typhoid Polysaccharide vaccine
Sanitation and hygene are the critical measures that can be taken to prevent
Typhoid can only spread in environments where human feces/urine are able to come into contact with food/beverages
Careful food preparation and handwashing
What is Botulism?
A disease that mainly affects the nerves
Explain the organism that causes botulism?
Clostridium Botulinum- name
Obligate anaerobe bacillis- rodshape that will die around oxygen
Ubiquitous- they are everywhere
Resistant to heat, light, drying, and radiation
Specific conditions for germination
What are spores
They almost like hibernate
Don’t need anything and can lie almost dorman and can later replicate and become dangerous when germinating
What are the conditions that Clostridium Botulinum needs to germinate?
Anaerobic (non oxygen) condidions
Warmth- 10-50 degrees C
Whatt does Clostridium Botulinum release?
What are neurotoxins?
An exotoxin that affects your nerves
How many different types of neurotoxins are there? Explain
Different types affect different species
All cause flaccid paralysis
Only a few nanograms can cause illness
Binds neuromuscular junctions- blocks acetylcholine, a messanger that makes your skeletal muscles work
What is the exotoxin-toxin?
Destroyed by boiling
Need higher temps to be inactive
Harder to kill then the toxins released
Which neruotoxins affect humans?
A, B, E, and F
Who discovered Botulism? When? Where did he discover it?
1793- Justinius Kerner discovered it in cow stomach being used to store meat
He was nicknamed wurstgift
What is Botulus Latin for?
Who was Emile Von Ermengem?
In 1895 he isolated the organism during a Belgium outbreak
What did US botulism outbreaks lead to?
Improved Industry Processing
How is Botulism Tranmitted?
Ingestion of the organism, spores, or neurotoxin
Person to person is not documented
Some heroin addicts get it from needle contamination
What are the types of botulism?
What is wound botulism?
When the bacteria gets into an open wound- rarest form of botulism
Develops under anaerobic conditions
From ground in dirt or gravel
Does not penetrate the skin
Associated with addicts of black tar heroine
What is Infant botulism?
Infants under one (94% under 6 months) usually get it from eating honey, food, dust, corn syrup
Most common in US
Spore ingestion- spores germinate then toxin released and colonize in L. Intestine
What is Foodbourne Botulism?
Preformed toxin ingested from contaminated food
Most common from home canned foods such as asparagus, green beans, beets, corn, baked potatoes, garlic, chile peppers - type a
Improperly fermented fish (Alaska)- type E
What is the Epidemiology of Botulism?
In US, average of 110 cases per year
Appx 25% foodbourne
Appx 72% infant form
Appx 3% wound form
What is the fatality rate?
What is the infective dose for Botulism?
A few nanograms
What and When was the largest botulism outbreak?
Michigan- 59ppl- 10% died
Poorly preserved jalepino peppers
What other state is associated with botulism? Explain.
Nausea, Vommitting Diarrhea
Double vision (separates from other similar diseases)
Difficulty speaking/ swallowing
Descending weakness or paralysis
-àshoulders to arms to thights to calves
Respiratory Muscle paralysis
What are the Infant Clinical Signs of Botulism?
Failure to thrive
What is the Diagnosis of Botulism
Clinical signs may show it
Toxin in serum, stool, suspected food
Culture of stool or gastric aspirate can be used but takes 5-7 days for result
Electromyography – testing of muscles
Mouse Neutralization test- results in 48 hours
What is the treatment for Botulism?
If it gets to stage 3 you may be on a ventilator for respiratory failure
Botulism immune globulin- infant cases of type a
Explain Botulinum anti toxin
Derived from equine source (horses)
CDC distributes it
Used on a case by case basis
How does Botox work?
Works to relax the contraction of muscles by blocking nerve impulses
What is the result of Botox?
Muscles that can no longer contract, causing wrinkles to relax and soften
How long does it take to see cosmetic improvement for botox?
How long do the effects of botox last?
Most patients require retreatment to remove wrinkles and after each injections the wrinkles are less and less severe as the muscles are trained to relax
How can Humans prevent botulism?
Don’t feed honey to kids under 1
Proper food preservation methods
-àproper time, temp and pressure- 80 degrees for 30 mins and 100 degrees for 10 mins
Prompt refrigeration of food
Boil foods for more than 10 mins
What is decontamination
Where you boil suspected food before discarding
Boil or chlorine disinfect utensils used
How is botulism a potential bioterrorism threat?
Aum Shinriky cult tried to do it
Extremely potent and lethal
Its easily produced and transported
What are signs of deliberate aerosol or foodbourne releases of toxin? (signs that someone is trying to use botulism for terrorism)
No common source
Large number of cases clustered
Uncommon toxin type (C,D,F,G)
What is the point source aerosol release? (what could it do if used for terrorism?)
Encapaciate or kill 10% of persons within .5 km downwind
CDC surveillance system for prompt detection of botulism related events
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