Tag: Diagnosis and Treatment

Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment

Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment

Q. 1

Positive Schick test indicates

 A

Immune to diphtheria

 B

Immune and hypersensitive to diphtheria

 C

Susceptible and hypersensitive to diphtheria

 D

Susceptible to diphtheria

Q. 1

Positive Schick test indicates

 A

Immune to diphtheria

 B

Immune and hypersensitive to diphtheria

 C

Susceptible and hypersensitive to diphtheria

 D

Susceptible to diphtheria

Ans. D

Explanation:

Susceptible to diphtheria [Ref. Park 19th/e p 137]



Q. 2 Schick test in diphtheria is done to know:
 A Carriers
 B Subseceptibles
 C Diseased
 D Immunized
Q. 2 Schick test in diphtheria is done to know:
 A Carriers
 B Subseceptibles
 C Diseased
 D Immunized
Ans. B

Explanation:

Subseceptibles


Q. 3 “Eleks” test is for:
 A Influenza
 B Diptheria
 C Brucella
 D Cholera
Q. 3 “Eleks” test is for:
 A Influenza
 B Diptheria
 C Brucella
 D Cholera
Ans. B

Explanation:

Diptheria

Quiz In Between


Q. 4

Post exposure prophylaxis in health care professionals is indicated in infections with all except?

 A

HBV

 B

Rabies

 C

Diptheria

 D

Measles

Q. 4

Post exposure prophylaxis in health care professionals is indicated in infections with all except?

 A

HBV

 B

Rabies

 C

Diptheria

 D

Measles

Ans. C

Explanation:

Post exposure prophylaxis is used in HIV, HBV, Measles, Rabies, Tetanus, H.influenzae and Meningococcus.

Ref: Park, 20th Edition, Pages 139, 189, 240, 283.

Q. 5

Skin test based on neutralization reaction is/are –

 A

Casoni test

 B

Lepromin test

 C

Tuberculin test

 D

Schick test

Q. 5

Skin test based on neutralization reaction is/are –

 A

Casoni test

 B

Lepromin test

 C

Tuberculin test

 D

Schick test

Ans. D

Explanation:

Ans. is ‘d i.e., Schick test


Q. 6

True about diptheria is –

 A

 Loffer’s serum is highly selective medium for C. diptheria

 B

Elek’s Gel is a precipitation test

 C

Metachromatic granules is produced on stain only by one strain of C. diphtheria

 D

Gm-ve bacilli, non motile, non capsulated

Q. 6

True about diptheria is –

 A

 Loffer’s serum is highly selective medium for C. diptheria

 B

Elek’s Gel is a precipitation test

 C

Metachromatic granules is produced on stain only by one strain of C. diphtheria

 D

Gm-ve bacilli, non motile, non capsulated

Ans. B

Explanation:

Ans. is ‘b’ i.e., Elek’s Gel is a precipitation test 

.  Elek’s is a precipitation test. It is an in vitro test for toxigenicity of the diphtheria bacillus.

.   Selective medium for C. diphtheriae is tellurite blood agar (eg. Mc Leod’s and Hoyle’s media or cystine – tellurite agar – Tinsdale medium).

.  All strains of C. diphtheriae show metachromatic granules on staining.

.  C. diphtheriae is gram (+) ye, nonmotile and non-capsulated.

Based on colonial morphology on tellurite agar and other properties, Mc Leod classified diphtheria bacilli into three bio types – gravis, intermedius and mitis. Gravis causing most serious and mitis the mildest variety of diphtheria.

Quiz In Between


Q. 7

True about Diptheria –

 A

Caused by Gram negative bacilli

 B

Incubation period 2-5 days

 C

Chemoprophylaxis is done with rifampicin

 D

All

Q. 7

True about Diptheria –

 A

Caused by Gram negative bacilli

 B

Incubation period 2-5 days

 C

Chemoprophylaxis is done with rifampicin

 D

All

Ans. B

Explanation:

Ans. is ‘b’ i.e.,Incubation period 2-5 days

.  Diptheria is caused by Gram positive bacilli, Corynebacterium diphtheriae

.   Incubation period of most common form of diphtheria ( faucial/ tonsiliopharyngeal diphtheria) is 2-5 days.

. For chemoprophylaxis erythromycin or penicillin are used.

Previously immunized asymptomatic household contact should receive booster dose of diphtheria toxoid. Those not fully immunized but asymptomatic contacts should receive immunization for their age”.—0.P. Ghai 7th/221 “Lifelong immunity is usually, but not always, acquired after disease or inapparent infection”—health.vic.gov.au> IDAES home > blue book

. So, child recovered from illness is already is immune. No active immunization is required.


Q. 8

The most common ophthalmic effect of diptheria is –

 A

Ptosis

 B

Total ophthalmoplegia

 C

Isolated ocular palsies

 D

Ophthalmoplegia externa

Q. 8

The most common ophthalmic effect of diptheria is –

 A

Ptosis

 B

Total ophthalmoplegia

 C

Isolated ocular palsies

 D

Ophthalmoplegia externa

Ans. C

Explanation:

Ans. is ‘c’ i.e., Isolated ocular palsies 

Complications

o Obstruction of the respiratory tract by pseudomembrane

o Myocarditis

  • Polyneuropathy
  • Post diphtheritic paralysis q Occurs in the 3rd or 4th week

o Palatine and pupillary paralysis is characteristic

Spontaneous recovery is the rule.

  • Pneumonia

o Other less common complications are renal failure, encephalitis, cerebral infarction, pulmonary embolism and bacteremia or endocarditis.


Q. 9

Commonest age group for diptheria is –

 A

1-2 Years

 B

2-5 Years

 C

2-7 Years

 D

2-9 Years

Q. 9

Commonest age group for diptheria is –

 A

1-2 Years

 B

2-5 Years

 C

2-7 Years

 D

2-9 Years

Ans. B

Explanation:

Ans. is ‘b’ i.e., 2-5 years 

Diphtheria

o Diphtheria is an acute infectious disease caused by toxigenic strains of corynebacterium diphtheriae.

o Source of infection –> cases or carriers; carriers are common sources of infection, their ratio is estimated to be 95 carriers for 5 clinical cases.

o Infective period              –> 14 – 28 days from the onset of disease.

o Age group                                     —> 1 to 5 years

o Sex                                    –> Both sexes

o Incubation period            –> 2 – 6 days

Quiz In Between


Q. 10

Regarding schick’s test which of the following is false –

 A

Erythematous reaction in both arms indicates  Allergic type interpreted as Schick type

 B

Positive test means that person is immune to hypersensitivity diphtheria

 C

Diphtheria antitoxin is given intradermal

 D

All

Q. 10

Regarding schick’s test which of the following is false –

 A

Erythematous reaction in both arms indicates  Allergic type interpreted as Schick type

 B

Positive test means that person is immune to hypersensitivity diphtheria

 C

Diphtheria antitoxin is given intradermal

 D

All

Ans. B

Explanation:

Ans. is ‘b’ i.e., Positive test means that person is immune to diphtheria 


Q. 11

Which of the following organism can penetrate the normal cornea :

 A

Gonococcus

 B

Pseudomonus

 C

Diptheria

 D

a and c

Q. 11

Which of the following organism can penetrate the normal cornea :

 A

Gonococcus

 B

Pseudomonus

 C

Diptheria

 D

a and c

Ans. D

Explanation:

A i.e. Gonococcus; C i.e. Diptheria 

The only organisms known to be able to invade normal corneal epithelium are N. gonorrhoea & Cornybacterium diptheria Q

Quiz In Between



Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment

Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment


Introduction

  • Most common in children of 2-5 years.

Incubation period

  • 2-5days

Mode of transmission

  • Droplet spread

Types

  • Faucial(commonest )
  • Laryngeal
  • Nasal
  • Conjunctival
  • Otitic
  • Vulvovaginal
  • Cutaneous mainly around mouth and nose

Respiratory Diphtheria

  • MC type Tonsillopharyngeal (Faucial)
  • Symptoms
    • Fever
    • sore throat
    • Weakness
    • Malignant or hypertoxic or bull neck appearance
  • Complications
  • Mechanical complication
    • Pseudomembrane may extend to the larynx
    • Lead to laryngeal obstruction, asphyxia and death.
  • Systemic effects
    • Myocarditis:Cardiac damage permanent
    • peripheral polyneuropathy of descending type.
  • Risk
    • Involvement larynx or tracheobronchial tree 
    • Children(because of small airway size).
  • First muscle involve in paralysis – palatopharynges.
  • Ciliary paralysis occur but not pupillary paralysis
  • Most common ophthalmic effect of diphtheria is Isolated ocular palsies 
  • Blurred vision with preserved light reflex.
  • Degenerative changes in adrenal, kidney and liver may occur.
  • Cause of death
    • circulatory failure.

Cutaneous Diphtheria

  • Punched out ulcers
  • Caused by non-toxigenic strains.

 Invasive infection

  • Rare
  • Risk factors are 
    • preexisting cardiac abnormalities
    • IV drug abusers
    • alcoholic cirrhosi

Prevention

  • Active immunization by Toxoid
  • Immunization cannot prevent carrier stage.
  • Active immunization –
    • Combined DPT.
  • Perfussis component in DPT increase potency of diphtheria toxoid.
  • Toxoid of diphtheria shows Danysz phenomenon and Ehrlich phenomenon
  • contact isolation is must.

DIAGNOSIS:

Culture:

  • Respiratory diphtheria diagnosis clinical
  • Cutaneous diphtheria requires lab confirmation.

The throat swabs are inoculated on the following culture media:

  • Loefflers serum slope
  • Tellurite blood agar
  • Blood agar

Virulence tests:

  • These tests demonstrate the production of exotoxin by bacteria isolated on culture.

Virulence testing may be done by:                        

  • In vivo: Guinea pigs and rabbits- by subcutaneous or intracutaneous.
  • In vitro: Eleks gel precipitation test ( test for toxigenicity)and tissue culture tests
  • Schick test:
  • Done to demonstrate circulating diptheria antitoxin.
  • Skin test based on neutralization reaction 
CONTROL ARM TEST ARM INFERENCE
No Reaction No Reaction  Immune
No Reaction Positive

Red flush of 1-5 cms diameter,

generally appears within 24-36 hr

reaching its maximum develop-

ment by 4-7 day. 

This fades slowly

Susceptible to

infection

Red flush but less circumscribed

than positive fades by 4th day

Pseudo positive

Red flush equally in both arms

less circumscribed

Allergic type

interpreted as

Schick type

Pseudo positive reaction  Show positive reaction

Combined reaction

 Susceptible

TREATMENT:

  • Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or
  • Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing10 kg).
  • Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.
  • Diphtheria antitoxin is given intradermal
  • Post exposure prophylaxis in health care professionals is not  indicated in infections with diphtheria

Exam Important

Introduction

  • Most common in children of 2-5 years.

Incubation period

  • 2-5days

Mode of transmission

  • Droplet spread

Types

  • Faucial(commonest )
  • Laryngeal
  • Nasal
  • Conjunctival
  • Otitic
  • Vulvovaginal
  • Cutaneous mainly around mouth and nose

Respiratory Diphtheria

  • MC type Tonsillopharyngeal (Faucial)
  • Complications
  • Mechanical complication
    • Pseudomembrane may extend to the larynx
    • Lead to laryngeal obstruction, asphyxia and death.
  • Systemic effects
    • Myocarditis
    • Peripheral polyneuropathy of descending type.
  • First muscle involve in paralysis – palatopharynges.
  • Ciliary paralysis occur but not pupillary paralysis
  • Most common ophthalmic effect of diphtheria is Isolated ocular palsies 

Cutaneous Diphtheria

  • Punched out ulcers
  • Caused by non-toxigenic strains.

 Invasive infection

  • Rare

DIAGNOSIS:

Culture:

  • Respiratory diphtheria diagnosis clinical
  • Cutaneous diphtheria requires lab confirmation.
  • The throat swabs are inoculated.
Virulence tests:

Virulence testing may be done by:                        

  • In vivo: Guinea pigs and rabbits- by subcutaneous or intracutaneous.
  • In vitro: Eleks gel precipitation test ( test for toxigenicity)and tissue culture tests

Schick test:

  • Done to demonstrate circulating diptheria antitoxin.
  • Skin test based on neutralization reaction 
CONTROL ARM TEST ARM INFERENCE
No Reaction No Reaction  Immune
No Reaction Positive

Red flush of 1-5 cms diameter,

generally appears within 24-36 hr

reaching its maximum develop-

ment by 4-7 day. 

This fadesslowly

Susceptible to

infection

Red flush but less circumscribed

than positive fades by 4th day

 Pseudo positive

Red flush equally in both arms

less circumscribed

Allergic type

interpreted as

Schick type

Pseudo positive reaction  Show positive reaction

Combined reaction

 Susceptible

TREATMENT:

  • Erythromycin DOC
  • Procaine penicillin G .
  • Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.
  • Diphtheria antitoxin is given intradermal
  • Post exposure prophylaxis in health care professionals is not  indicated in infections with diphtheria
Don’t Forget to Solve all the previous Year Question asked on Corynebacterium Diphtheria: Clinical manifestation, Complications, Diagnosis and Treatment

Module Below Start Quiz

Bacillus Anthrax:Clinical manifestation, Diagnosis and treatment

Bacillus Anthrax:Clinical manifestation, Diagnosis and treatment


Introduction:

  • Anthrax is a zoonoses
  • Occurs primarily in herbivores.
  • Man is relatively resistant to infection with B. anthrax”
  • Aerosolized anthrax — 10,000 spores required to produce lethal disease. 
  • Few as one to three spores may be adequate to cause disease in some setting
  • According to The Workmen’s Compensation Act, 1923, Anthrax is considered an occupational disease

Routes

  • Humans become infected when B. anthracis spores are introduced into the body by the following routes:
  • Contact with infected animals or contaminated animal products
  • Insect bites
  • Ingestion
  • Inhalation
  • In humans anthrax occurs in following forms

1. Cutaneous anthrax

  • Cutaneous anthrax is most common.
  • It follows the entry of infection through the skin.
  • The whole area is congested and edematous
  • The lesion starts as macule
  • Progress through papular and vesicular or pustular stages
  • Formation of an ulcer with a blackened necrotic eschar.
  • The lesion is painless.
  • It is called malignant pustule.
  • Hide porter’s disease.
  • Caused by contact with contaminated hair, wool, hides or products
  • Satellite nodule around inguinal region
  • Cutaneous anthrax generally resolves spontaneously
  • But 10-20% of untreated patients may develop septicemia.
  • 2. Pulmonary anthrax
  • Woolsorters’ disease
  • Occupational hazard for people who sorted wool
  • Most dangerous form of inhalational anthrax
  • It causes hemorrhagic pneumonia.
  • 3. Intestinal anthrax
  • It is rare.

Laboratory Diagnosis 

  • Mc-Fadyean’s Reaction 
  • Blood films containing anthrax bacilli are stained with polychrome methylene blue stain for few seconds
  • Examined under microscope
  • Amorphous purplish material  is noticed around bacilli.
  • This represents the capsular material and is characteristic of anthrax bacilli. 
  • Culture Characteristics of Bacillus anthracis 
  • On agar plate: Frosted glass appearance
  • On gelatin stab culture: Inverted fir tree appearance
  • Immunofluorescent microscopy
  • confirm identification.
  • Ascoli’s thermoprecipitin /Elek’s gel precipitation test
  • Sample is putrid,
  • demonstrate anthrax antigen in tissue extract. .
  • Antibody by immunoassays
  • Confirm diagnosis.

Treatment

  • Penicillin is drug of choice.
  • In penicillin allergy →
  • ciprofloxacin, erythromycin, tetracyline or chloramphenicol.
Exam Question
 

Introduction:

  • Anthrax is a zoonoses
  • “Man is relatively resistant to infection with B. anthracis” 
  • Few as one to three spores may be adequate to cause disease in some setting
  • According to The Workmen’s Compensation Act, 1923, Antrax is considered an occupational disease

Forms

1. Cutaneous anthrax

  • Cutaneous anthrax is most common.
  • The whole area is congested and edematous
  • The lesion starts as macule
  • Progress through papular and vesicular or pustular stages
  • Formation of an ulcer with a blackened necrotic eschar.
  • The lesion is painless.
  • Its called malignant pustule.
  • Hide porter’s disease.
  • Cutaneous anthrax generally resolves spontaneously
  • But 10-20% of untreated patients may develop septicemia.

2. Pulmonary anthrax

  • Woolsorters’ disease
  • Occupational hazard for people who sorted wool
  • Most dangerous form of inhalational anthrax
  • It causes hemorrhagic pneumonia.

3. Intestinal anthrax(rare)

Laboratory Diagnosis 

Mc-Fadyean’s Reaction 

  • Blood films containing anthrax bacilli are stained with polychrome methylene blue stain for few seconds
  • Examined under microscope
  • Amorphous purplish material  is noticed around bacilli.
  • This represents the capsular material and is characteristic of anthrax bacilli.

Culture Characteristics of Bacillus anthracis

  • On agar plate: Frosted glass appearance
  • On gelatin stab culture: Inverted fir tree appearance
  • Ascoli’s thermoprecipitin /Elek’s gel precipitation test
  • Penicillin G is the DOC
Don’t Forget to Solve all the previous Year Question asked on Bacillus Anthrax:Clinical manifestation, Diagnosis and treatment

Bacillus Anthrax:Clinical manifestation, Diagnosis and treatment

Bacillus Anthrax:Clinical manifestation, Diagnosis and treatment

Q. 1

Which of the following condition causes ‘malignant pustule’ of the skin during its pathological process?

 A

Ulcerating melanoma

 B

Rodent ulcer

 C

Carbuncle

 D

Anthrax of skin

Q. 1

Which of the following condition causes ‘malignant pustule’ of the skin during its pathological process?

 A

Ulcerating melanoma

 B

Rodent ulcer

 C

Carbuncle

 D

Anthrax of skin

Ans. D

Explanation:

The typical lesion of cutaneous anthrax is a painless ulcer with a black eschar (crust, scab) with local edema. The lesion is called a malignant pustule.

Must know:

  • B. anthracis is a large “box car–like” gram-positive rod.
  • Its antiphagocytic capsule is composed of D-glutamate. (This is unique—capsules of other bacteria are polysaccharides.)
  • It is non motile, whereas other members of the genus are motile.
  • Anthrax toxin is encoded on one plasmid, and the polyglutamate capsule is encoded on a different plasmid.
  • Pulmonary anthrax, also known as “woolsorter’s disease”.

Ref: Levinson W. (2012). Chapter 17. Gram-Positive Rods. In W. Levinson (Ed), Review of Medical Microbiology & Immunology, 12e.


Q. 2

Which of the following is true regarding anthrax ‑

 A

M’ Fadyean reaction shows capsule 

 B

Humans are usually resistant to infection

 C

Less than 100 spores can cause pulmonary infection

 D

All

Q. 2

Which of the following is true regarding anthrax ‑

 A

M’ Fadyean reaction shows capsule 

 B

Humans are usually resistant to infection

 C

Less than 100 spores can cause pulmonary infection

 D

All

Ans. D

Explanation:

Ans. is ‘a’ i.e., M’ Fadyean reaction shows capsule; ‘b’ i.e., Humans are usually resistant to infection; ‘c’ i.e., Less than 100 spores can cause pulmonary infection 

.  M’ Fadyean’s reaction represents the capsular material and is characteristic of the anthrax bacillus.

.  “Man is relatively resistant to infection with B. anthracis”. – Green wood 16th/e 226

.   In animal studies, it has been shown that aerosolized anthrax — 10,000 spores required to produce lethal disease. However, it has been suggested that as few as one to three spores may be adequate to cause disease in some setting. – Harrison 17thie 1344

.   Spores are of same width as the bacillary body so that they do not cause bulging of the vegetative cell (in contrast the clostridia have bulging spores).

.  For laboratory diagnosis, specimens to be examined are fluid or pus from a local lesion, blood or sputum. Stained smears often show chains of large gram positive rods.


Q. 3

True regarding anthrax is all except ‑

 A

Caused by insect bite

 B

Caused by rubbing of skin

 C

Cutaneous type is rare nowadays

 D

Pulmonary infection occurs by inhalation

Q. 3

True regarding anthrax is all except ‑

 A

Caused by insect bite

 B

Caused by rubbing of skin

 C

Cutaneous type is rare nowadays

 D

Pulmonary infection occurs by inhalation

Ans. C

Explanation:

Ans. is ‘c’ i.e., Cutaneous type is rare nowadays 

  • Anthrax is a zoonoses caused by Bacillus anthracis, that occurs primarily in herbivores.
  • Humans become infected when B. anthracis spores are introduced into the body by the following routes:

a)         Contact with infected animals or contaminated animal products

b)       Insect bites

c)       Ingestion

d)       Inhalation

  • In humans anthrax occurs in following forms

1. Cutaneous anthrax

  • Cutaneous anthrax is most common.
  • It follows the entry of infection through the skin.
  • The lesion starts as macule then typically progress through papular and vesicular or pustular stages to the formation of an ulcer with a blackened necrotic eschar.
  • The lesion is painless.*
  • Its called malignant pustule.
  • It is also known as Hide porter’s disease.

2. Pulmonary anthrax

  • It is called Wool sorter’s disease.*
  • It follows inhalation of dust from infected wool.
  • It causes hemorrhagic pneumonia.

3. Intestinal anthrax

  • It is rare.



Q. 4

Elek’s gel precipitation test is for – 

 A

Gonococcus

 B

Diphtheria

 C

H. influenza

 D

Anthrax

Q. 4

Elek’s gel precipitation test is for – 

 A

Gonococcus

 B

Diphtheria

 C

H. influenza

 D

Anthrax

Ans. B

Explanation:

Ans. is ‘b’ i.e., Diphtheria 


Q. 5

All are true about cutaneous anthrax except ‑

 A

Extremely painful

 B

The whole area is congested and edematous

 C

Central crustation with black eschar

 D

Satellite nodule around inguinal region

Q. 5

All are true about cutaneous anthrax except ‑

 A

Extremely painful

 B

The whole area is congested and edematous

 C

Central crustation with black eschar

 D

Satellite nodule around inguinal region

Ans. A

Explanation:

Ans. is ‘a’ i.e., Extremely painful 

·    Cutaneous anthrax is painless.


Q. 6

Woolsorter’s disease is –

 A

Pneumonic form of anthrax

 B

Pneumonic plague

 C

Hydatid disease of the lung

 D

Caused by psittacosis

Q. 6

Woolsorter’s disease is –

 A

Pneumonic form of anthrax

 B

Pneumonic plague

 C

Hydatid disease of the lung

 D

Caused by psittacosis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Pneumonic form of Anthrax 


Q. 7

Pasteur developed the vaccine for –             

 A

Anthrax

 B

Rabies

 C

Chicken cholera

 D

All of the above

Q. 7

Pasteur developed the vaccine for –             

 A

Anthrax

 B

Rabies

 C

Chicken cholera

 D

All of the above

Ans. D

Explanation:

Ans. is ‘d’ i.e., All of the above

  • Vaccines for chicken cholera, rabies, and anthrax was developed by pasteur

Q. 8

Commonest form of anthrax is ‑

 A

Wool sorters disease

 B

Alimentary type

 C

Cutaneous type

 D

None of the above

Q. 8

Commonest form of anthrax is ‑

 A

Wool sorters disease

 B

Alimentary type

 C

Cutaneous type

 D

None of the above

Ans. C

Explanation:

Ans. is ‘c’ i.e., Cutaneous type 


Q. 9

Malignant pustule occurs in ‑

 A

Melanoma

 B

Gas gangrene

 C

Ovarian tumour

 D

Anthrax

Q. 9

Malignant pustule occurs in ‑

 A

Melanoma

 B

Gas gangrene

 C

Ovarian tumour

 D

Anthrax

Ans. D

Explanation:

Ans. is ‘d’ i.e., Anthrax 


Q. 10

An abattoir worker presented with a malignant pustule on his hand that progressed to form an ulcer. Smear was taken from the ulcer and sent to laboratory for investigation. The diagnosis

 A

Cutaneous anthrax

 B

Carbuncle

 C

Ulcerating melanoma

 D

Infected rodent ulcer

Q. 10

An abattoir worker presented with a malignant pustule on his hand that progressed to form an ulcer. Smear was taken from the ulcer and sent to laboratory for investigation. The diagnosis

 A

Cutaneous anthrax

 B

Carbuncle

 C

Ulcerating melanoma

 D

Infected rodent ulcer

Ans. A

Explanation:

Ans. a. Cutaneous anthrax

Anthrax

  • Anthrax is a zoonoses, caused by Bacillus anthracis°, that occurs primarily in herbivores

Routes of Infection:

  • Humans become infected when B. anthracis spores are introduced into the body by the following routes:
  • Contact with infected animals or contaminated animal products°
  • Insect bites°
  • Ingestion°
  • Inhalation°

Three major clinical forms in Humans:

  • Cutaneous° (MC)
  • Gastrointestinal (rare)
  • Inhalational or pulmonary (it causes hemorrhagic pneumonia)

Woolsorters’ disease

  • Occupational hazard for people who sorted wool°
  • Most dangerous form of inhalational anthrax

Hide porter’s disease

  • Caused by contact with contaminated hair, wool, hides or products

Malignant pustule

  • Commonly seen in head and neck°
  • Eschar stage that appears 2-6 days after the hemorrhagic vesicle dries to become a depressed black scab° surrounded by redness

Diagnosis:

  • Presumptive diagnosis of the anthrax is made by staining it with polychrome methylene blue stain, called as Mc-Fadyean’s reaction

Anthrax

Mc-Fadyean’s Reaction

  • When blood films containing anthrax bacilli are stained with polychrome methylene blue stain for few seconds and examined under microscope, an amorphous purplish material° is noticed around bacilli.
  • This represents the capsular material and is characteristic of anthrax bacilliQ

Culture Characteristics of Bacillus anthracis

  • On agar plate: Frosted glass appearance°
  • On gelatin stab culture: Inverted fir tree appearance°

Q. 11

According to The Workmen’s Compensation Act, 1923, which of the following is considered an occupational disease

 A

Typhoid

 B

Anthrax

 C

Tetanus

 D

Dengue

Q. 11

According to The Workmen’s Compensation Act, 1923, which of the following is considered an occupational disease

 A

Typhoid

 B

Anthrax

 C

Tetanus

 D

Dengue

Ans. B

Explanation:

Ans. b. Anthrax


Q. 12

All of the following are therapeutic uses of penicillin G, except

 A

Bacterial meningitis 

 B

Rickettsial infection

 C

Syphilis

 D

Anthrax

Q. 12

All of the following are therapeutic uses of penicillin G, except

 A

Bacterial meningitis 

 B

Rickettsial infection

 C

Syphilis

 D

Anthrax

Ans. B

Explanation:

Ans. is ‘b’ i.e., Rickettsial infection 

Antibacterial spectrum of Penicillin G (Benzvl

  • PnG is a narrow spectrum antibiotic
  • Activity is limited primary to gram positive bacteria (and few others).
  • Amongst gram negative organisms, penicillin has activity against gonococci, meningococci, few Ecoli & proteus. 
  • Majority of gram negative bacilli are insensitive.
  • M. Tuberculosis, Ricketsiae, chlamydia, protozoa, fungi and viruses are totally insensitive to penicillin G.

Penicillin G is the DOC for (Laurence 9thie 218. Katzung 7301 

1.

Meningococcal meningitis

7.

Leptospira

2.

Bacillus anthracis (anthrax)

8.

Actinomyces israelii (Actinomycosis)

3.

Clostridium perfringens (gas gangrene)

9.

Borrel i a burgdorferi (Lyme disease)

4.

Clostridium tetani (tetanus)

10.

Enterococci

5.

Corynebacterium diphtheriae

11.

Streptococci

6.

Treponema pallidum (syphilis)

12.

Susceptible pneumococci



Q. 13

All of the following are anthropozoonosis except

 A

Rabies

 B

Plaque

 C

Anthrax

 D

Schistosomiasis

Q. 13

All of the following are anthropozoonosis except

 A

Rabies

 B

Plaque

 C

Anthrax

 D

Schistosomiasis

Ans. D

Explanation:

Ans. is ‘d’ i.e., Schistosomiasis 

Zoonoses

  • Zoonoses are diseases and infections which are naturally transmitted between vertebrate animal and man. 
  • The zoonoses may be classified according to the direction of transmission of disease : ‑

l. Anthropozoonoses

  • Infection is transmitted to man from lower vertebrate animals.
  • Examples -4 Rabies, plague, hydatid disease, anthrax, trichinosis.

2. Zoonthroponoses

  • Infection is transmitted from man to lower vertebrate animals
  • Examples → Human tuberculosis in cattle

3. Amphixenoses

  • Infection is maintained in both man and lower vertebrate animals that may be transmitted in either direction.
  • Examples T cruzi, S. japonicum.


Clostridium Perfringens: Clinical manifestation, Diagnosis and Treatment

Clostridium Perfringens: Clinical manifestation, Diagnosis and Treatment


 Anaerobic myositis or myonecrosis or gas gangrene

  • Abundant formation of exotoxin & production of gas.
  • Clostridiae invade fascial planes(fasciitis)
  • Minimal toxin production but no invasion of muscle tissue.
  • Lesions vary from limited ‘gas abscess’  to extensive involvement of limbs.
  • Seropurulent discharges with offensive odor produced
  • GG is rarely infection of single clostridium; several species found in association:
  • Anaerobic streptococci & facultative anaerobes (E.coli,Stap,Proteus)
  • Cl.perfringens is most frequently encountered(60%)
  • Followed by Cl.Novyi
  • Cl.septicum(20-40%)
  • Essential factor 
  • Trauma
  • lncubation period
  • 10-48 hours
  • Symptoms
  • Pain
  • Crepitus
  • Death is due to circulatory failure
  • Treatment
  • Mainstay of therapy
  • Surgery 
  • Doc
  • Clindamycin + penicillin
  • Hyperbaric O

 Non-traumatic gas gangrene

  • Hematogenous seeding of normal muscle with histotoxic Clostridia principally
  • C. perfringens
  • C. septicum
  • C. novyi
  • Symptoms
  • Confusion
  • Sudden onset of severe pain in absence of trauma.
  • Mortality rate is very high (67-100%)
  • Most serious complication of clostridial invasion of healthy muscle tissue (rhabdomyolysis)

Food poisoning:

  • Usually caused by Type A strains(produces heat resistance spores)
  • Cytotoxin mediated

Gangrenous appendicitis:

  • Cl.perfringens Type A & occasionally by Type D

Necrotizing enteritis:

  • Caused by Type C strains(β toxin)
  • Associated Factor:Ingestion of high protein meal with trypsin inhibitors
  • Symptoms:acute abdominal pain, bloody diarrhea vomiting; signs of peritonitis.

Biliary tract infection:

  • Rare but serious -EC & PCS

Gasterointestinal enteritis necroticans 

  • Associated with C.perfringens type A

Brain abscess & meningitis:

  • Rare

Panophthalmitis:

  • Rare

Thoracic infections

Emphysematous cholecystitis

Urogenital infections(myoglbinuria)

LABORATORY DIAGNOSIS:

Specimen: 

  • Wound swabs
  • human faeces
  • necrosed tissue
  • muscle fragments,
  • exudates from active parts etc.

Microscopy:

  • Gram +ve, non-motile, capsulated bacilli.
  • Spores are rarely observed in Cl.perfringens

Culture:

  • On RCM→ meat turned pink but not digested
  • On blood agar → target hemolysis

Nagler’s Reaction

  • Rapid detection of Cl.perfringens from clinical sample
  • Done to detect the lecithinase activity of alpha toxin
  • Characteristics opalescence is produced around colonies in +ve test due to breakdown of lipoprotein complex in the medium

Reverse CAMP Test:

  • Used for differentiation of Cl.perfringens from other clostridium species.
  • CAMP +ve Group B Streptococcus is streaked in SBA & Cl.perfringens is streaked perpendicular to it  “arrowhead”(enhanced) hemolysis is seen between growth of Cl.perfringens & Group B streptococcus
Exam Question
 

Anaerobic myositis or myonecrosis or gas gangrene

  • Several species found in association:
  • Anaerobic streptococci & facultative anaerobes (E.coli,Stap,Proteus)
  • Cl.perfringens is most frequently encountered(60%)

 Non-traumatic gas gangrene

  • Hematogenous seeding of normal muscle with histotoxic Clostridia principally
  • Most serious complication of clostridial invasion of healthy muscle tissue (rhabdomyolysis)

Food poisoning:

  • Usually caused by Type A strains(produces heat resistance spores)
  • Cytotoxin mediated

Gangrenous appendicitis

Necrotizing enteritis

Biliary tract infection:

Gasterointestinal enteritis necroticans 

  • Associated with C.perfringens type A

Emphysematous cholecystitis

Urogenital infections(myoglbinuria)

LABORATORY DIAGNOSIS:

Specimen: 

  • Wound swabs
  • human faeces
  • necrosed tissue
  • muscle fragments,
  • exudates from active parts etc.

Microscopy:

  • Gram +ve, non-motile, capsulated bacilli.
  • Spores are rarely observed in Cl.perfringens

Culture:

  • On RCM→ meat turned pink but not digested
  • On blood agar → target hemolysis

Nagler’s Reaction

  • Rapid detection of Cl.perfringens from clinical sample

Reverse CAMP Test:

  • CAMP +ve Group B Streptococcus is streaked in SBA & Cl.perfringens is streaked perpendicular to it  “arrowhead”(enhanced) hemolysis is seen between growth of Cl.perfringens & Group B streptococcus
Don’t Forget to Solve all the previous Year Question asked on Clostridium Perfringens: Clinical manifestation, Diagnosis and Treatment

Clostridium Perfringens: Clinical manifestation, Diagnosis and Treatment

Clostridium Perfringens: Clinical manifestation, Diagnosis and Treatment

Q. 1

Regarding clostridium perfringens gas gangrene false is ?

 A

Clostridium perfringens is the most common cause of gas gangrene

 B

Naegler reaction positive

 C

Most important toxin is hyaluronidase

 D

Food poisoning strain of clostridium perfringens produces heat resistant spores

Q. 1

Regarding clostridium perfringens gas gangrene false is ?

 A

Clostridium perfringens is the most common cause of gas gangrene

 B

Naegler reaction positive

 C

Most important toxin is hyaluronidase

 D

Food poisoning strain of clostridium perfringens produces heat resistant spores

Ans. C

Explanation:

Most common toxin is hyaluronidase [Ref Ananthanarayan p. 251, 252, 253; Greenwood 16thie p. 231]

  • Clostridium are gram positive spore forming rods.

– The spores enable these organisms to survive in adverse conditions e.g. in soil and dust and on skin.

–  Most species are obligate anaerobes i.e. their spores do not germinate and growth does not normally proceed unless a suitably low redox potential (Eb) exists.

Clostridium perfringens

Clostridium perfringens cause two important diseases:?

Gas gangrene

  • “Clostridium perfringens is the commonest cause of gas gangrene”.
  • The disease is characterized by rapidly spreading edema, myositis and necrosis of tissues, gas production and profound toxemia.
  • Clostridium perfringens produces several toxins and other substance which have a role in the pathogenesis of gas gangrene.
  • “a Toxin a phospholipase lecithinase” is generally considered to he the most important toxin in the pathogenesis of gas gangrene.

-It is produced by all types of clostridium perfringens and most abundantly by type “A” strains.

– It is the most important toxin biologically and is responsible .for profound toxemia of the gas gangrene. – It is a “phospholipase”.

Other factors which also have a role in virulence:-

Hyaluronida.ve

  • It breaks down intercellular cement substance and promotes the spread of the infection along the tissue planes

Collagenases and other proteinases

  • They break down tissues and virtually liquefy muscles.

Clostridium food poisoning:-

  • Clostridium perfringens is an important cause of food poisoning.
  • The .food poisoning is caused due to ingestion of spores.
  • The spores of the clostridium perfringens strains that cause food poisoning are heat resistant. The unique feature of spores produced by food poisoning strains of clostridium perfringens is that they are heat resistant that can survive boiling for several hours.

Remember

Only those strains of clostridia which are associated with food poisoning produce heat resistant spores Where as

– The classic strains of this species do not have heat resistant spores. These spores are inactivated within few minutes by boiling.

  • Typical, food poisoning strains of clostridium perfringens occur as carrier state.
  • These strains also occur in animals thus meat is often contaminated with heat resistant spores.
  • The vehicle of infection is usually a precooked meat food that has been allowed to stand at a temperature.
  • The heat resistance of the spores ensures their survival in cooking.

– During the cooling period they germinate in the anaerobic environment produced by the cooked meat and multiply.

– Anyone who eats this meat will consume the equivalent of cooked meat broth culture of the organisms.

– Large numbers of clostridia are thus consumed which may pass unharmed by the gastric acid due to high protein in the meat and reach the intestines where they produce the enterotoxin.

– After an incubation period of 8-24 hours abdominal pain diarrhoea set in.

Naegeler reaction

  • ft is used to detect alpha toxin which is a phospholipase (lecithinase C)

– Lecithinase or phospholipase in the presence of Ca++ and Mg ions splits lecithin into phosphorylcholine and diacylglycerol. This reaction is seen as an “opalescence” in serum or egg yolk media.

Procedure

  • CI perfringens is grown on a plate where one half of the plate is covered with alpha antitoxin.
  • The half portion of the plate without the antitoxin produces opalescene.

– Pho.spholipase or a toxin splits the lecithin into phosphorylcholine and diacyl glycerol. Which is seen as opalescnee.

  • The other half of the plate where alpha antitoxin is present does not demonstrate opalescence because here alpha toxin or phospholipase is neutralized by the toxin.

Q. 2

All of the following statements regarding Clostridium perfringens are true, EXCEPT:

 A

It is the commonest cause of gas gangrene

 B

It is normally present in human faeces

 C

The principal toxin of C. perfringens is the alpha toxin

 D

Gas gangrene producing strains of C. perfringens produce heat resistant spores

Q. 2

All of the following statements regarding Clostridium perfringens are true, EXCEPT:

 A

It is the commonest cause of gas gangrene

 B

It is normally present in human faeces

 C

The principal toxin of C. perfringens is the alpha toxin

 D

Gas gangrene producing strains of C. perfringens produce heat resistant spores

Ans. D

Explanation:

Spores of clostridium perfringens are killed within 5 minutes by boiling, it is also killed by autoclaving at 121 degree Celsius for 15 minutes. But spores of clostridium perfringens which produce food poisoning are heat resistant.
 
Clostridium perfringens produces multiple exotoxins and is classified into five types (A to E).

The most important exotoxin alpha toxin, is a phospholipase that hydrolyzes lecithin and sphingomyelin, thus disrupting the cell membranes of various host cells, including erythrocytes, leukocytes, and muscle cells. 
 
Gas Gangrene occur due to alpha toxin. In this, infection passes along the muscle bundles, producing rapidly spreading edema and necrosis as well as conditions that are more favorable for growth of the bacteria.
 
Ref: Sherris Medical Microbiology, 5th Edition, Chapter 29; Principles and Practice of Clinical Bacteriology By Stephen H. Gillespi, 2nd Edition, Page 569; Textbook of Microbiology and Immunology By Parij, Page 239

Q. 3

Life threatening intravascular hemolysis occurs with sepsis due to which organism:

 A

Clostridium perfringens

 B

Mycoplasma pneumonia

 C

Pseudomona

 D

Klebsiella

Q. 3

Life threatening intravascular hemolysis occurs with sepsis due to which organism:

 A

Clostridium perfringens

 B

Mycoplasma pneumonia

 C

Pseudomona

 D

Klebsiella

Ans. A

Explanation:

Life threatening intravascular hemolysis occur due to a toxin with lecithinase activity seen in clostridium perfringens sepsis.

Ref: Harrison’s principles of internal medicine, 18th edition ; Page :881.


Q. 4

Bacteria most frequently cultured in the setting of emphysematous cholecystitis is:

 A

Clostridium

 B

Streptococcus

 C

Salmonella

 D

Klebsiella

Q. 4

Bacteria most frequently cultured in the setting of emphysematous cholecystitis is:

 A

Clostridium

 B

Streptococcus

 C

Salmonella

 D

Klebsiella

Ans. A

Explanation:

Bacteria most frequently cultured in emphysematous cholecystitis include anaerobes, such as C. welchii or C. perfringens, and aerobes, such as E. coli. This condition occurs frequently in elderly men and in patients with diabetes mellitus.


Reference:
Harrisons Principles of Internal Medicine, 18th Edition, Page 2622

 


Q. 5

Gasterointestinal enteritis necroticans is caused by – 

 A

Clostridium difficale 

 B

Clostridium perfringens

 C

Botulinum

 D

C. Jejuni

Q. 5

Gasterointestinal enteritis necroticans is caused by – 

 A

Clostridium difficale 

 B

Clostridium perfringens

 C

Botulinum

 D

C. Jejuni

Ans. B

Explanation:

Ans is ‘b’ i.e. Cl. perfringens 

Necrotising enteritis (enteritis necroticans or Pigbel) is caused by Cl. perfringens.


Q. 6

Naegler’s reaction is shown by ?

 A

Clostradium tetani

 B

Clostridium welchii

 C

Mycobacterium tuberculosis

 D

Mycobacterium leprae

Q. 6

Naegler’s reaction is shown by ?

 A

Clostradium tetani

 B

Clostridium welchii

 C

Mycobacterium tuberculosis

 D

Mycobacterium leprae

Ans. B

Explanation:

Ans. is ‘b’ i.e., Clostridium welchii 


Q. 7

39.Which one of the following organisms is not associatied with synergistic gangrene:

 A

Esherichia

 B

Staphylococcus

 C

Clostridium

 D

Peptostreptococcus

Q. 7

39.Which one of the following organisms is not associatied with synergistic gangrene:

 A

Esherichia

 B

Staphylococcus

 C

Clostridium

 D

Peptostreptococcus

Ans. C

Explanation:

Ans is c i.e. Clostridium 


Q. 8

Rhabdomyolysis and Myoglobinuria may be seen in:

 A

Viperbite

 B

Multiple Hornet Stings

 C

Clostridium Perfringes

 D

All of the above

Q. 8

Rhabdomyolysis and Myoglobinuria may be seen in:

 A

Viperbite

 B

Multiple Hornet Stings

 C

Clostridium Perfringes

 D

All of the above

Ans. D

Explanation:

Answer is D (All of the above):

Bacterial infections from clostridium species and streptococcus and envenomations from Russel Viper and Hornet may all cause rhabdomyolysis.


Q. 9

Which of the following is responsible for crepitations in wounds:        

September 2011

 A

Staphylococcus

 B

Mycobacterium

 C

Streptococcus

 D

Clostridium

Q. 9

Which of the following is responsible for crepitations in wounds:        

September 2011

 A

Staphylococcus

 B

Mycobacterium

 C

Streptococcus

 D

Clostridium

Ans. D

Explanation:

Ans. D: Clostridium

Crepitus may be palpated as a result of infection by gas forming organism

Established pathogens of gas gangrene group are Cl. Perfringenes, Cl. Septicum and Cl. novyi

Crepitus

A sound can be created when two rough surfaces in the human body come into contact— for example, in osteoarthritis or rheumatoid arthritis when the cartilage around joints has eroded away and the joint ends grind against one another

  • When the fracture surfaces of two broken bones rub together, it produces a sound. Crepitus is a common sign of bone fracture.
  • In soft tissues, crepitus can be produced when gas is introduced into an area where it normally isn’t present.
  • The term can also be used when describing the sounds produced by lung conditions such as interstitial lung disease—these are also referred to as “rales”.
  • Crepitus is often loud enough to be heard by the human ear, although a stethoscope may be needed to detect instances caused by respiratory diseases.
  • In times of poor surgical practice, post-surgical complications involved anaerobic infection by Clostridium perfringens strains, which can cause gas gangrene in tissues, also giving rise to crepitus.
  • Subcutaneous crepitus (or surgical emphysema) is a crackling sound resulting from subcutaneous emphysema, or air trapped in the subcutaneous tissues.

Subcutaneous emphysema/ SCE/ SE/ Tissue emphysema/ Sub Q air

  • It occurs when gas or air is present in the subcutaneous layer of the skin.
  • Subcutaneous refers to the tissue beneath the cutis of the skin, and emphysema refers to trapped air.
  • Since the air generally comes from the chest cavity, subcutaneous emphysema usually occurs on the chest, neck and face, where it is able to travel from the chest cavity along the fascia.
  • Subcutaneous emphysema has a characteristic crackling feel to the touch, a sensation that has been described as similar to touching Rice Krispies; this sensation of air under the skin is known as subcutaneous crepitation.


Streptococcus Pneumonia :Clinical Manifestations , Diagnosis and treatment

Streptococcus Pneumonia :Clinical Manifestations , Diagnosis and treatment


DISEASES:

NON-INVASIVE DISEASES:

SINUSITIS(MC)

  • The bacterial pathogens causing acute bacterial sinusitis in children and adolescents include 
  1. Streptococcus pneumoniae (= 30%)
  2. nontypable Haerrophilus influenzae (=20%).

Among community-acquired cases:

  1. S. pneumoniae
  2. Nontypable Haemophilus influenzae 
  • Are the most common pathogens, accounting for 50-60% of cases. 
  • Moraxella catarrhalis causes disease in a signigicant percentage (20%) of children but less often in adults. 

OTITIS MEDIA

  • (middle ear)(MC)
  • otitis media in infants & young children are streptococcus pneumonia (30%), Haemophilus influenza (20%) and Moraxella catarrhalis (12%).

PNEUMONIA

  • Streptococcus pneumonia or pneumococcus is the most common cause of community acquired acute pneumonia.
  • Lobar pneumonia refers to an acute bacterial infection that results in consolidation of a large portion of a lobe or an entire lobe.
  • Streptococcus pneumonia produces a picture of lobar pneumonia.

Empyema

  • Empyema is the most common complication of pneumococcal pneumonia.

INVASIVE DISEASES( bacteremia)

MENINGITIS (CNS)

  • Meningitis is the most common intracranial complication of otitis media
  • ENDOCARDITIS (CVS)
  • PERITONITIS (body cavity)
  • SEPTIC ARTHRITIS
  • UVEITIS
  • SUBDURAL EMPYEMA
  • OTHERS (appendicitis, salpingitis, soft tissue infections)

Produce milk borne diseases

Commonest Post splenectomy infection

Australian syndrome
  • Concurrence of pneumococcal pneumonia,endocarditis and meningitis.
Diagnosis:
  • Gold standard diagnosis:pathological examination of lung tissue.
  • Gram staining and culture of CSF or sputum.
  • Biomarkers:Prolactin levels increase and Passive agglutination testing(CRP)
Treatment
  • Amoxicillin for otitis media/sinusitis/pneumonia
  • Ceftriaxone +vancomycin for meningitis
  • Ceftriaxone/cefotaxime +vancomycin for endocarditis
  • Pencillin resestance due to alteration in pencillin binding protien.
Vaccine
  1. Polyvalent polysaccharide vaccine
  2. Polysaccharide protien vaccine
Indicated to 
  • Pt with dysfunctional spleen
  • Sickle cell anemia
  • Coeliac diseases
  • DM
  • HIV

Contraindicated

  • Child below 2
  • CSF leak
  • Lymhoreticular Maligancies
  • Alcholic Cirrhosis
  • Hodgkin’s disease
  • Organ transplant recepient
Exam Question
 

DISEASES:

NON-INVASIVE DISEASES:

  • SINUSITIS(MC)
  • OTITIS MEDIA (middle ear)(MC)
  • PNEUMONIA (lungs)(lobar & community acquired commonly)
  1. Complication :Empyema

INVASIVE DISEASES( bacteremia)

  • MENINGITIS (CNS)
  • ENDOCARDITIS (CVS)
  • PERITONITIS (body cavity)
  • SEPTIC ARTHRITIS
  • UVEITIS
  • SUBDURAL EMPYEMA
  • OTHERS (appendicitis, salpingitis, soft tissue infections)

Produce milk borne diseases

Commonest Post splenectomy infection

Australian syndrome
  • Concurrence of pneumococcal pneumonia,endocarditis and meningitis.
 Diagnosis:
  • Gold standard diagnosis:pathological examination of lung tissue.
  • Gram staining and culture of CSF or sputum.
  • Biomarkers:Prolactin levels increase and Passive agglutination testing(CRP)
Treatment
  • Amoxicillin for otitis media/sinusitis/pneumonia
  • Ceftriaxone +vancomycin for meningitis
  • Ceftriaxone/cefotaxime +vancomycin for endocarditis
  • Pencillin resestance due to alteration in pencillin binding protien.
Don’t Forget to Solve all the previous Year Question asked on Streptococcus Pneumonia :Clinical Manifestations , Diagnosis and treatment

Streptococcus Pneumonia :Clinical Manifestations , Diagnosis and treatment

Streptococcus Pneumonia :Clinical Manifestations , Diagnosis and treatment

Q. 1

Milk borne diseases are-

 A

Salmonellosis

 B

E. coli

 C

Streptococcus

 D

All

Q. 1

Milk borne diseases are-

 A

Salmonellosis

 B

E. coli

 C

Streptococcus

 D

All

Ans. D

Explanation:

Ans. is All 


Q. 2

Uveitis is caused by

 A

T.B.

 B

Staphylococcus

 C

Streptococcus

 D

a and c

Q. 2

Uveitis is caused by

 A

T.B.

 B

Staphylococcus

 C

Streptococcus

 D

a and c

Ans. D

Explanation:

A i.e. TB; B i.e. Staphylococcus; C i.e. Streptococcus


Q. 3

Common organisms causing sinusitis:

 A

Pseudomonas

 B

Moraxella catarrhalis

 C

Streptococcus pneumoniae

 D

Staphylococcus epidermidis

Q. 3

Common organisms causing sinusitis:

 A

Pseudomonas

 B

Moraxella catarrhalis

 C

Streptococcus pneumoniae

 D

Staphylococcus epidermidis

Ans. C

Explanation:

Q. 4

The most common causative organism for lobar pneumonia is :

 A

Staphylococcus aureus

 B

Streptococcus pyogenes

 C

Streptococcus pheumoniae

 D

Haemophilus influenzae

Q. 4

The most common causative organism for lobar pneumonia is :

 A

Staphylococcus aureus

 B

Streptococcus pyogenes

 C

Streptococcus pheumoniae

 D

Haemophilus influenzae

Ans. C

Explanation:

Answer is C (Stretptococcus pneumonia):

‘Streptococcus pneumonia or pneumococcus is the most common cause of community acquired acute pneumonia –Robbins 7th/748

Lobar pneumonia refers to an acute bacterial infection that results in consolidation of a large portion of a lobe or an entire lobe. Streptococcus pneumonia produces a picture of lobar pneumonia.


Q. 5

Subdural empyema is most commonly caused by:

 A

H influenza

 B

Staphylococcus aureus

 C

Streptococcus pneumoniae

 D

E. Coli

Q. 5

Subdural empyema is most commonly caused by:

 A

H influenza

 B

Staphylococcus aureus

 C

Streptococcus pneumoniae

 D

E. Coli

Ans. C

Explanation:

Answer is C (Streptococcus pneumoniae):

Aerobic and Anaerobic streptococci are the most common aetiological agents for subdural ernphyema.

influenzae is the most common causative organism in Children, and not in Adults.

Subdural Empyema is a collection of pus in the space between he dura and arachnoid.

In most cases a single organism is responsible, but many cultures are sterile because patients are often receiving anti­microbial therapy.

The major pathogens include

  1. Aerobic and anaerobic Streptococci (about 50%)
  2. Staph (about 12-16%)
  3. Aerobic gram –ye bacilli (3-10%)
  4. Other anaerobes (5%)

Q. 6

Community acquired pneumonia is most commonly caused by:          

September 2005 and March 2008

 A

Staphylococcus aureus

 B

Streptococcus pneumoniae

 C

H.influenza

 D

Klebsiella

Q. 6

Community acquired pneumonia is most commonly caused by:          

September 2005 and March 2008

 A

Staphylococcus aureus

 B

Streptococcus pneumoniae

 C

H.influenza

 D

Klebsiella

Ans. B

Explanation:

Ans. B: Streptococcus pneumoniae

The term community-acquired pneumonia is usually reserved for people who have pneumonia caused by one of the more common bacteria or viruses.

Streptococcus pneumonia is the most common cause of community-acquired acute pneumonia.

Gram-negative rods (Enterobacteriaceae and Pseudomonas species) and S.aureus are the most common isolates in hospital­acquuired pneumonia; unlike community-acquired pneumonias, S.pneumoniae is not a major pathogen in hospital­acquuired pneumonia.

Haemophilus influenzae, Chlamydia pneumoniae, and Mycobacterium pneumoniae are the other common bacterial causes.

Common viral causes include respiratory syncytial virus (RSV), adenoviruses, influenza A and B viruses, metapneumovirus, and parainfluenza viruses.


Q. 7

Lobar pneumonia is caused by:    

September 2010

 A

Staphylococcus aureus

 B

Klebsiella

 C

Streptococcus pnuemoniae

 D

Pseudomonas

Q. 7

Lobar pneumonia is caused by:    

September 2010

 A

Staphylococcus aureus

 B

Klebsiella

 C

Streptococcus pnuemoniae

 D

Pseudomonas

Ans. C

Explanation:

Ans. C: Streptococcus pnuemoniae

The most common organism that causes lobar pneumonia is Streptococcus pneumoniae, also called the pneumococcus. Mycobacterium tuberculosis, the tubercle bacillus, may also cause lobar pneumonia if pulmonary tuberculosis is not treated promptly


Q. 8

An infant with a past history of ear infection is suspected to have meningitis. Organism commonly responsible for such a presentation would be:

 A

Haemophilus influenzae

 B

Moraxella catarrhalis

 C

Pseudomonas

 D

Streptococcus pneumoniae

Q. 8

An infant with a past history of ear infection is suspected to have meningitis. Organism commonly responsible for such a presentation would be:

 A

Haemophilus influenzae

 B

Moraxella catarrhalis

 C

Pseudomonas

 D

Streptococcus pneumoniae

Ans. D

Explanation:

 

Meningitis is the most common intracranial complication of otitis media

Most common organism causing acute suppurative otitis media in infants & young children are streptococcus pneumonia (30%), Haemophilus influenza (20%) and Moraxella catarrhalis (12%).


Q. 9

Most common cause for meningitis in adults:

September 2009

 A

H.Influenzae

 B

N.meningitidis

 C

Staph.aureus

 D

Streptococcus pneumoniae

Q. 9

Most common cause for meningitis in adults:

September 2009

 A

H.Influenzae

 B

N.meningitidis

 C

Staph.aureus

 D

Streptococcus pneumoniae

Ans. D

Explanation:

Ans. D: Streptococcus pneumoniae

Streptococcus pneumoniae is the most common cause of meningitis in adults of age over twenty years, accounting for nearly half of the cases.

N. meningitidis accounts for nearly 25% of the cases. Staph.aureus and coagulase negative staphylococci are important causes of meningitis that occurs following neurosurgical procedures.


Q. 10

Most common infection caused by streptococcus pneumonia ‑

 A

Otits media

 B

Sore throat

 C

Meningitis

 D

Pneumonia

Q. 10

Most common infection caused by streptococcus pneumonia ‑

 A

Otits media

 B

Sore throat

 C

Meningitis

 D

Pneumonia

Ans. A

Explanation:

Ans. is ‘a’ i.e., Otitis media

Important infections caused by streptococcus pneumoniae

The source of human infection is the respiratory tract of carriers and less often, of patients. Pneumococci occur in the throat of approximately half of the population sampled at any time.

Str. pneumoniae is the most frequent cause of pneumonia.

The commonest pneumococcal infections are otitis media and sinusitis.

Meningitis is the most serious of pneumococcal infections.

Empyema is the most common complication of pneumococcal pneumonia.



Streptococcus Pyogens: Clinical manifestation, Diagnosis and Treatment

Streptococcus Pyogens: Clinical manifestation, Diagnosis and Treatment


DISEASES Caused by Strep. pyogens

  •  Infections typically begin in the throat or skin. The most striking sign is a strawberry-like rash
  1. Pharyngitis (strep throat):

    Sore Throat is the M/C Streptococcal Infection

  2. Localized skin infection (impetigo)
  3. Erysipelas(Superficial + S/C Tissue) and cellulitis (superficial form of cellulitis)
  4. Necrotizing fasciitis
  5. Scarlet fever:Streptococcal Pharyngitis + Rash with Minute Papules (Sand Paper Skin),

    Associated with Circumoral palor + Strawberry Tounge

  6. Streptococcal toxic shock syndrome
  7. Autoimmune-mediated complications(  rheumatic fever and acute postinfectious glomerulonephritis).
  8. Genital Infections
  • Anaerobic Streptococci are most important cause of puerperal sepsis

9.Bacteremia

  • Bacteremia , Pneumonia and Toxic Shock Syndrome

Non Suppurative  Complications

Acute Rheumatic Fever

 

Acute Glomerulonephritis

 

Post Throat Infection (Any Serotype)

 

Skin / Throat Serotypes 49, 53-55, 59-64, 1 & 12

 

Repeated Attacks Common

 

Not seen

Penicillin Prophylaxis Indicated

 

Not indicated

Course – Progressive / Static

 

Self limiting

ASO Titre Raised

 

May or May not (Skin Infection) Raised

 

Marked Immune Response No Change in Complement

 

Moderate Immune Response with ↓ Complement Level

 

 Lab Diagnosis

  • Acute Pharyngitis – Swab Culture (Gold Standard)
  • Transport Media – Pike’s Media
  • Sheep Blood Agar recommended (As it is inhibitory to H. hemolyticus)
  • ARF and Ac GN retroscpective with ↑ ASO Titres ( ASO > 200)
  • In Ac GN & Pyoderma Anti DNAse and Antihyaluronidase  used for retrospective diagnosis
  • Streptozyme Test :- Passive Haemagglutination Test (Specific and Sensitive for all Streptococcal Infections)

Management

  • Penicillin :- Pharyngitis / Impetigo / Erypsipelas / Cellulitis
  • Penicillin + Empyema Drainage:-Empyema or Pnemonia
  • Penicillin + Clindamycin + Surgical Debridement :-Necrotizing Fascitis / Myositis
  • Penicillin + Clindamycin + i/v Ig :- Streptococcal TSS
Exam Question
 

 DISEASES:

  •  Infections typically begin in the throat or skin. The most striking sign is a strawberry-like rash
  1. Pharyngitis (strep throat)
  2. Localized skin infection (impetigo)
  3. Erysipelas and cellulitis 
  4. Necrotizing fasciitis
  5. Scarlet fever
  6. Streptococcal toxic shock syndrome
  7. Autoimmune-mediated complications(  rheumatic fever and acute postinfectious glomerulonephritis).
Don’t Forget to Solve all the previous Year Question asked on Streptococcus Pyogens: Clinical manifestation, Diagnosis and Treatment

Streptococcus Pyogens: Clinical manifestation, Diagnosis and Treatment

Streptococcus Pyogens: Clinical manifestation, Diagnosis and Treatment

Q. 1

True/False statements regarding cellulitis are:

1. Caused by streptococcus pyogenes
2. Causes SIRS
3. Localised infection
4. Abscess if any should be drained
5. I & D should not be done

 

 A

1,2,3 true and 4,5 false

 B

1,3,5 true and 2,4 false

 C

3,5 false and 1,2,4 true

 D

1,2 false and 3,4,5 true

Q. 1

True/False statements regarding cellulitis are:

1. Caused by streptococcus pyogenes
2. Causes SIRS
3. Localised infection
4. Abscess if any should be drained
5. I & D should not be done

 

 A

1,2,3 true and 4,5 false

 B

1,3,5 true and 2,4 false

 C

3,5 false and 1,2,4 true

 D

1,2 false and 3,4,5 true

Ans. C

Explanation:

It is a non suppurative inflammation spreading along the subcutaneous tissue planes and across intercellular spaces.

The term is a misnomer, as the lesion is one of the connective and interstitial tissue and not of the cells.

The causative organism is mostly the streptococcus pyogenes, through a variety of aerobic and anaerobic bacteria may produce cellulitis.

 
Pathology:
The organism usually gains access through a wound and redness at the area of inflammation, but without definitive localization blebs and bullae form on the skin.

central necrosis may occur at later stages.
 
Clinical Feature:
There is varying degree of fever and toxemia.

The affected part is very much swollen and painful.

diabetic individual often suffers from cellulitis. On examination, the affected part is warm, swollen and tender.

There is pitting oedema and brawny induration.

The surrounding lymph vessels may be seen as red streaks due to lymphangitis.
 
The regional lymph nodes will be enlarged and tender with acute lymphadenitis.
 
Treatment consists of (i) Rest and elevation of the part to reduce oedema.

(ii) Appropriate antibiotics preferably broad spectrum should be administered.

(iii) Failure of inflammatory swelling to subside after 48 to 72 hrs suggests that an abscess has developed.

In that case incision and drainage of the pus should be accomplished.
 
Ref: L & B 25/e, Page 37; Sabiston 18/e, Page 307; Textbook Of Surgery 5/e, Page 68

 


Q. 2

False regarding streptococcus pyogenes

 A

Causes necrotizing fascitis

 B

Beta hemolytic

 C

M. protein is virulece factor

 D

Resistant to bacitracin

Q. 2

False regarding streptococcus pyogenes

 A

Causes necrotizing fascitis

 B

Beta hemolytic

 C

M. protein is virulece factor

 D

Resistant to bacitracin

Ans. D

Explanation:

Ans. is ‘d’ i.e., Resistant to bacitracin

  • Streptococcus pyogenes is bacitracin sensitive.
  • All other options are correct.

Q. 3

Streptococcus causing rheumatic heart disease is ‑

 A

Streptococcus milleri

 B

Streptococcus mutans

 C

Streptococcus pyogenes

 D

Streptococcus equisimilis

Q. 3

Streptococcus causing rheumatic heart disease is ‑

 A

Streptococcus milleri

 B

Streptococcus mutans

 C

Streptococcus pyogenes

 D

Streptococcus equisimilis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Streptococcus pyogenes 


Q. 4

Causative agent of sore throat is:  

September 2005

 A

Staphylococcus aureus

 B

Streptococcus pyogenes

 C

H. Influenzae

 D

Corynebacterium diphtheriae

Q. 4

Causative agent of sore throat is:  

September 2005

 A

Staphylococcus aureus

 B

Streptococcus pyogenes

 C

H. Influenzae

 D

Corynebacterium diphtheriae

Ans. B

Explanation:

Ans. B: Streptococcus pyogenes

The primary site of invasion of human body by streptococcus pyogenes is the throat.

Primary bacterial pathogens that account for approximately 30% of cases of pharyngitis include Streptococcus pyogenes /Group A Beta Hemolytic Streptococci (common), group C streptococci (uncommon), group G streptococci (uncommon), Neisseria gonorrhoeae (uncommon), Corynebacterium diphtheriae (rare), and Corynebacterium hemolyticum (extremely rare). Viruses are isolated in approximately 40% of cases and include rhinovirus, adenovirus, parainfluenza virus, coxsackievirus, coronavirus, echovirus, herpes simplex virus, Epstein-Barr virus (mononucleosis), and cytomegalovirus. Other probable copathogens for pharyngitis in children include Staphylococcus aureus, Haemophilus influenzae, Branhamella catarrhalis, Bacteroides fragilis, Bacteroides oralis, Bacteroides melaninogenicus, Fusobacterium species, and Peptostreptococcus species.


Q. 5

Scarlet fever is caused by

 A

Streptococcus agalactie

 B

Streptococcus pyogenes

 C

Streptococcus pneumoniae

 D

Streptococcus equisimilus

Q. 5

Scarlet fever is caused by

 A

Streptococcus agalactie

 B

Streptococcus pyogenes

 C

Streptococcus pneumoniae

 D

Streptococcus equisimilus

Ans. B

Explanation:

Ans. is ‘b’ i.e., Streptococcus pyogenes

Infections caused by streptococcus pvogenes

  1. Respiratory infections
  • Sore throat is the most common of streptocococcal disease . It may be localised as tonsillitis as in older children and adults or it may involve the pharynx more diffusely (pharyngitis) as in younger children. Otitis media


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