By X. Diego. Western Oregon University. 2019.

At the bottom trusted 40mg accutane, the figure also presents two blots generic 30mg accutane with mastercard, only one of which correctly represents the results seen on the autoradiogram cheap accutane 30mg online. Although the repeated sequence is shared by all individuals cheap accutane 10 mg online, the number of repeated units is variable from person to person. They also have a S-year-old daughter who does not have sickle cell anemia but has not been tested for carrier status. The mother is in her 16th week of pregnancy and wishes to know whether the fetus that she is carrying will develop sickle cell disease. The mutation causing sickle cell anemia (G6V) also destroys a restriction site for the restriction endonuclease Mstll. The results are consistent with high-level expression (a 404-kbtranscript) of this gene in brain and testis and lower-level expression in the lung. In the heart, the gene is also expressed, but the transcripts are only 104 kb long. Skeletal Clinical Correlate Muscle Brain Liver Testis Lung Pancreas Heart Fragile X Syndrome Fragile X syndrome is the leading known cause of inherited mental retardation. For example, pre- vious research has suggested that cells from a breast cancer express a variety of genes that are either not expressed or expressed only at a low level in normal cells. The pattern of gene expression (gene expression profiling) may give information about the prognosis for that particular woman, aiding in making choices about the appropriate treatment protocol. Western Blots Western blots separate proteins by gel electrophoresis and use 12sI-labeled probe antibodies to detect the proteins (antigens). Western blots may also be used to identify whether a particular protein is in a cell and therefore represent a way to test for gene expression at the level of translation. This process is repeated for approximately 20 cycles, producing over a million double-stranded copies of the target sequence. Such primers amplify "single-locus" sequences, which are highly polymorphic within the population. Because humans have pairs of chromosomes, each individual will have a maximum of two bands, one from the father and one from the mother. Paternity Testing Are the tested males (Figure 1-7-6) in case 1 and case 2 the fathers of the children? Case 1: The tested male in case 1 may be the father, as he shares a band with the child. We can- not be certain, however, because many other men in the population could have this same band. Matches are required at several different loci to indicate with high probability that a tested male is the father. The wristbands of the two similar-looking infants (A and B) were inadvertently mixed at the pediatric care unit. Parents 1 Parents 2 F1 M1 A B M2 F2 What is the best conclusion from the analysis? Sickle cell anemia is caused by a missense mutation in codon 6 of the ~-globin gene. Which 12-base nucleotide sequence was most likely used as a specific probe complementary to the coding strand of the sickle cell allele? The glucose 6-phosphatase gene is on different chromosomes in the marmoset and in the human. A couple seeks genetic counseling because both the man and the woman (unrelated to each other) are carriers of a mutation causing ~-thalassemia, an autosomal recessive condi- tion. They wish to know whether the fetus in the current pregnancy will have ~-thalassemia. Although unlikely given the situation, another pos- sibility is consistent with the blot. Knowing the son is homozygous for the normal allele, one can conclude that the two restriction fragments shown in his pattern derived from chromosomes without the mutation. The fetus therefore is heterozygous for the mutation and the normal allele of the p-globin gene. The amino acids differ from one another only in the chemical nature of the side chain (R). Classification The amino acids can be classified as either hydrophobic or hydrophilic, depending on the ease with which their side chains interact with water. In general, proteins fold so that amino acids with hydrophobic side chains are in the interior of the molecule where they are protected from water and those with hydrophilic side chains are on the surface. Additional points about some of these amino acids include: Phenylalanine and tyrosine are precursors for catecholamines. The acidic amino acids (aspartic and glutamic acids) have carboxyl groups that are negatively charged, whereas the basic amino acids (lysine, argi- nine, and histidine) have nitrogen atoms that are positively charged. Additional points about some of these amino acids include: • Serine and threonine are sites for O-linked glycosylation of proteins, a posttransla- tional modification that should be associated with the Golgi apparatus. Asparagine is a site for N-linked glycosylation of proteins, a posttranslational modifi- cation that should be associated with the endoplasmic reticulum. Cysteine contains sulfur and can form disulfide bonds to stabilize the shape (tertiary structure) of proteins. He was taken to the hospital, where he was found to have mild anemia, splenomegaly, and rod-shaped crystals in the erythrocytes. To validate the diagnosis, a small aliquot of his blood was subjected to electrophoresis to determine the identity of the hemoglobin in his erythrocytes. After reviewing the data, the physician concluded that he did not have sickle cell anemia, but rather a sickle cell anemia-like hemoglobinopathy with the relatively common mutation of HbC. Episodes of vaso-occlusive pain lasting approximately 1 week are a frequent problem. A widely used method to analyze hemoglobins found in various hemoglobinopathies is electrophoresis at pH 8. In sickle cell anemia, there is a substitution of valine for glutamate at position 6 in Hb, mean- ing that the HbS will have one less negative charge overall compared with HbA. In HbC, there is a substitution of lysine for glutamate at position 6, meaning that HbC will have two additional positive charges compared with HbA. These three hemoglobins can be resolved by electrophoresis, as shown in the figure. Protein breakdown occurs generally in two cellular locations: • Lysosomal proteases digest endocytosed proteins. These amino acids can be derived from digesting dietary protein and absorbing their constituent amino acids or, alternatively, by synthesizing them de novo. The 10 amino acids listed in Table 1-8-1 cannot be synthesized in humans and therefore must be provided from dietary sources. Essential Amino Acids Arginine" Methionine Histidine Phenylalanine Isoleucine Threonine Leucine Tryptophan Lysine Valine "Essential only during periods of positive nitrogen balance.

The oxidase positive colonies must be removed and subcultured within 30 seconds of flooding the plate buy accutane 20mg online. The oxidase test must not be performed buy 40 mg accutane with visa, therefore order accutane 10mg otc, on colonies that produce fermentation on carbohydrate – containing media purchase accutane 30 mg online, such as sucrose fermenting V. Colonies tested from a medium that contains nitrate may give unreliable oxidase test results. Required − Oxidase reagent Freshly prepared This is a 10g/l solution of tetramethyl –p-phenylenediamine dihydrochloride. Method Place a piece of filter paper in a clean petri dish and add 2 or 3 drops of freshly prepared oxidase reagent. Using a piece of stick or glass rod (not an oxidized wire loop), remove a colony of the test organism, and smear it on the filter paper. Carbohydrates (aerobic utilization) Such as Pseudomonas aeruginosa, from those organisms that ferment carbohydrates (anaerobic utilization) such as members of the Entero- bacteriaaceae. Principle The test organism is inoculated into two tubes of a tryptone or peptone agar medium containing glucose (or other carbohydrate) and the indicator bromothymol blue. The inoculated medium in one tube is sealed with alayer of liquid paraffin to exclude oxygen. Oxidative organisms, however, are able to use the carbohydrate only in the open tube. Although most genera of aerobic bacteria are either carbohydrate oxidizers or fermenters, the production of acid may be slow and therefore cultures are usually incubated for 7-14 days. Oxidation fermentation (O-F) medium Glucose, maltose, and sucrose O-F media are the most commonly used. Sterile paraffin oil (liquid paraffin) Method Using a sterile straight wire, inoculate the test organism to the bottom of two bottles (or more if testing several carbohydrates) of sterile O-F medium. Cover the incculated medium in one of the tubes (or one from each carbohydrate pair) with a 10mm deep layer of sterile paraffin oil or molten wax. It is based on the ability of bacteria such as Proteus specdies and some Providencia strains to break down phenylalanine (by oxidative deamination) with the production of phenylpyruvic acid. Principle The test organism is incubated in a Tween 80 buffered substrate that contains the indicator neutral red. Tween hydrolysis is detected by a change in colour of the indicator from amber to pink – red due to the production of oleic acid. Inoculate 4 ml of sterile Tween 80 phosphate buffered substrate with a loopful of growth of the test organism. Examine at 5,10, and 18 days for a change in colour of the substrate from amber to pink-red, as shown in colour. Results Pink-red substrate -------------------------------------- Positive test Tween 80 hydrolyzed No change in colour ------------------------------------ Negative test No hydrolysis of Tween 80 81 Controls Positive Tween hydrolysis control: Mycobacterium kansasii. Principle The test organism is cultured in a medium which contains urea and the indicator phenol red. If the strain is urease-producing, the enzyme will beak down the urea (by hydrolysis) to give ammonia and carbon diaoxide. With the release of ammonia, the medium becomes alkaline as shown by a change iin colour of the indicator to red-pink. Examine for urease production by looking for a red- pink colour in the medium as shown in colour. Results Red-pink medium---------------------------------------- Positive test Urease produced No red-pink colour ------------------------------------- Negative test No urease produced Controls Positive urease control: Proteus vulgaries. At room temperature O (22-293 c), the species is motile and shows a stronger urease reaction. Under alkaline conditions and exposure to the air, the acation produced from the fermentation of the glucose is oxidized to diacetyl which forms a pink compound with the creatine. Inoculate 2ml of sterile glucose phosphate peptone water O with the test organism. Add about 3ml of the sodium hydroxide reagent and shake well, Caution: The sodium hydroxide reagent is corrosive, therefore handle with care and do not mouth – pipette. Results Pink – red colour -------------------------------------- Positive test Acetoine produced No pink – red colour ---------------------------------- Negative test No acetoin produced 84 Controls V-P Positive control: Enterobacter aerogenes or Klebsiella pneumoniae V-P Negative control: Escherichia coli. Col factors: Plasmids which contain genes that code for extracellular toxin (colicines) production that inhibit strains of the same and different species of bacteria. F(fertility) factors: Plasmids that can recombine itself with the bacterial chromosome. It promotes transfer of the chromosome at a high frequency of recombination into the chromosome of a second (recipient) bacterial cell during mating. Transposition Mechanism which enhances genetic flexibility among plasmids and bacterial chromosomes. When transposons transfer to a new site, it is usually a copy of the transposon that moves, the original transposon remaining in situ. Transposons code for toxin production, resistance to antibiotics as wellas other fuctions. Disinfection: Destruction of microbes that cause disease; may not be effective in killing spores. Antisepsis: destruction or inhibition of microorganisms in living tissue there by limiting or preventing the harmful effect of infection. Chemical methods of sterilization and disinfection These chemical agents destroy any type of microbes with out showing any form of selectivity unlike antibiotics. Concentration of the agent There is a relationship between the concentration of the agent and the time required to kill a given fraction of the microbial population. Time of exposure Microbes are killed with a reasonable length of time with chemical agents. The non-ionized form passes through the bacterial cell membrane more readily than the ionized form. Temperature Bactericidal potency of the chemical agent increases with an increase in temperature. Presence of extraneous materials Organic materials like serum, blood or pus makes chemicals inert that are highly active in their absence. Quaternary ammonium compounds (Quates) It causes loss of cell membrane semi permeability leading to loss of nutrients and essential metabolites. Soaps and fatty acids It causes gross disruption of cell membrane lipoprotein frame work. Active at acidic P Phenolic compounds Phenol is highly effective in Gram positive bacteria. Currently used as a standard for measuring bactericidal potency of new chemicals i. Phenol coefficient is the ratio of the concentration of the new chemical agent being tested to the concentration of the reference standard (phenol) required to kill in a specific time. If phenol coefficient is less than one, the new chemical agent is less effective than phenol.

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In the well-fed state buy 30mg accutane free shipping, galactose can enter glycolysis or contribute to glycogen storage Glycogen Glucose 6-P Administration of galactose during hypoglycemia r- buy accutane 40 mg low cost. Along with other monosaccharides effective accutane 40 mg, galactose reaches the liver through the portal blood cheap accutane 40mg on-line. Once transported into tissues, galactose is phosphorylated (galactokinase), trapping it in the cell. Galactose l-phosphate is converted to glucose l-phosphate by galactose I-P uridyltransferase and an epimerase. The pathway is shown in Figure 1-12-5; important enzymes to remember are: Galactokinase • Galactose l-phosphate uridyltransferase Genetic deficiencies of these enzymes produce galactosemia. Cataracts, a characteristic finding Clinical Correlate in patients with galactosemia, result from conversion of the excess galactose in peripheral blood to galactitol in the lens of the eye, which has aldose reductase. Accumulation of galactitol in the Primary lactose intolerance lens causes osmotic damage and cataracts. Deficiency of galactose I-phosphate uridyltransferase produces a more severe disease because, Secondary lactose intolerance in addition to galactosemia, galactose 1-P accumulates in the liver, brain, and other tissues. There are over 100 Common symptoms of lactose heritable mutations that can cause galactosemia, and the incidence is approximately 1 in intolerance include vomiting, 60,000 births. Galactose will be present in elevated amounts in the blood and urine and can bloating, explosive and result in decreased glucose synthesis and hypoglycemia. The symptoms The parents of a z-week-old infant who was being breast-fed returned to the can be attributed to bacterial hospital because the infant frequently vomited, had a persistent fever, and fermentation of lactose to a looked yellow since birth. Blood and urine tests were performed, osmotically active and result in and it was determined that the infant had elevated sugar (galactose and, to a the movement of water into smaller extent, galactitol) in the blood and urine. Diagnosis to bottle-feed the infant with lactose-free formula supplemented with sucrose. Treatment is by dietary restriction of milk Galactosemia symptoms often begin around day 3 in a newborn and include the hallmark and milk products (except cataracts. Jaundice and hyperbilirubinemia do not resolve if the infant is treated with photo- unpasteurized yogurt, which therapy. In the galactosemic infant, the liver, which is the site of bilirubin conjugation, devel- ops cirrhosis. Vomiting and diarrhea occur after milk ingestion because although lactose in contains active Ladobacillus) milk is hydrolyzed to glucose and galactose by lactase in the intestine, the galactose is not or by lactase pills. Failure to thrive, lethargy, hypotonia, and mental retardation are other common and apparent features. If an infant is correctly diagnosed within the first several weeks of life through a newborn screening heel prick test, formulas containing galactose-free carbohydrates are given. Fructose Metabolism Fructose is found in honey and fruit and as part of the disaccharide sucrose (common table sugar). Sucrose is hydrolyzed by intestinal brush border sucrase, and the resulting monosac- charides, glucose and fructose, are absorbed into the portal blood. The pathway is shown in Figure 1-12-6; important enzymes to remem- ber are: • Fructokinase • Fructose 1-P aldolase (aldolase B) Genetic deficiency of fructokinase is benign and often detected incidentally when the urine is checked for glucose with a dipstick. Fructose l-phosphate aldolase deficiency is a severe dis- ease because of accumulation of fructose l-phosphate in the liver and renal proximal tubules. Cataracts are not a feature of this disease because fructose is not an aldose sugar and therefore not a substrate for aldose reductase in the lens. In the absence of the enzyme, fructose challenge results in an accumulation of fructose l-phosphate in hepatocytes and thereby sequestering of inorganic phosphate in this substance. The drop in phosphate levels prevents its use in other pathways, such as glycogen breakdown and gluconeogenesis. Eventually, the liver becomes damaged due to the accumulation of trapped fructose l-phosphate, A 4-month-old infant was breast-fed and developing normally. The mother decided to begin the weaning process and started to feed the baby with fruit juices. Within a few weeks, the child became lethargic and yellow-skinned, vomited frequently, and had frequent diarrhea. The mother thought that the child might have had a food allergy and took the child to a clinic for testing. It found that the child had sugar in the urine but did not read with the glucose dipsticks. If diagnosed early to alleviate complications, a person with fructose intolerance on a diet that excludes fructose and sucrose will develop normally and have a normal lifespan. However, complete exclusion of these sugars is difficult, especially with their widespread use as nutri- ents and sweeteners. Failure to correct the diet and prolonged fructose ingestion could even- tually lead to proximal renal disorder resembling Fanconi syndrome. Pyruvate dehydrogenase in the liver is activated by insulin, whereas in the brain and nerves the enzyme is not responsive to hormones. This control is important in sev- eral contexts and should be considered along with pyruvate carboxylase, the other mitochondrial enzyme that uses pyruvate (introduced in gluconeogenesis, Chapter 14, Figure 1-14-5). Two other enzyme complexes similar to pyruvate dehydrogenase that use thiamine are: • a-Ketoglutarate dehydrogenase (citric acid cycle) • Branched-chain keto acid dehydrogenase (metabolism of branched-chain amino acids) Insufficient thiamine significantly impairs glucose oxidation, causing highly aerobic tissues, such as brain and cardiac muscle, to fail first. In addition, branched-chain amino acids are sources of energy in brain and muscle. In the diagram shown below, the oxygen dissociation curve for hemoglobin in his eryth- rocytes is compared with the curve obtained with normal red cells. Several days later she is jaundiced, her liver is enlarged, and cataracts are noticed in her lenses. Following an early-morning run, a 29-year-old man consumes an all-American breakfast consisting of cereal, eggs, bacon, sausage, pancakes with maple syrup, doughnuts, and cof- fee with cream and sugar. Which of the following proteins will most likely be activated in his liver after breakfast? During their usual nightly gathering at the local bar, he had passed out and they had been unable to revive him. The physician ordered an injection of thiamine followed by overnight parenteral glucose. The next morning the patient was alert and coherent, serum thiamine was normal, and blood glucose was 73 mg/dL (4 mM). Which of the following enzymes is thiamine-dependent and essential for glucose oxida- tion in the brain? At the time of discharge from the hospital, which of the following proteins would have no significant physiologic activity in this patient? After an overnight fast (plasma glucose 73 mg/dL), the liver is producing glucose and glucokinase activity would be insignificant (high Km, low insulin). The other proteins would be needed for aerobic glucose oxidation in the brain or for hepatic gluco- neogenesis. The primary function of the citric acid cycle is oxidation of acetyl-CoA to carbon dioxide. This emphasizes an important (and frequently misunderstood) point about the cycle. It does not represent a pathway for the net conversion of acetyl-CoA to citrate, to malate, or to any other intermediate of the cycle.

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Tobacco use should be determined generic 5 mg accutane with visa, since there is an increased risk for developing a transitional cell carcinoma in smokers accutane 40mg line. Transitional cell epithelium can be found in the bladder discount accutane 10 mg with visa, ureter buy accutane 40mg free shipping, and renal collecting system. Patients with transitional cell cancer typically present with gross hematuria without significant flank pain. However, if the tumor or a blood clot cause obstruction, flank pain may be identical to that produced by a renal calculi. Patients with cardiac arrhythmias presenting with acute, severe flank pain should be evaluated for a possible thromboembolic event. In this situation, a cardiac thrombus suddenly is dislodged and obstructs the main renal artery or one of its branches. The resulting pain is identical to that produced by a renal calculi, so a history of cardiac arrhythmia is essential for establishing the diagnosis. Physical Examination A complete physical examination is indicated for patients presenting with flank pain to help determine the etiology of the pain and provide insight into the severity of the problem. It is important to perform a complete physical examination and resist the temptation to focus on the urinary tract or flank area exclusively. Vital signs are important to determine if the flank pain might be associated with dehydration, infection, or urosepsis (Table 38. In the patient with flank pain, urosepsis is suggested if the patient is febrile, has a rapid pulse and respiration rate, and has labile blood pressure. If urosepsis is suspected, the patient should be hospitalized to prevent septic shock. In this situation, intravenous antibiotics, aggressive fluid replacement, and urologic relief of any hydronephrosis are indicated. Fever from a lower urinary tract infection (bladder) may be low grade, while high spiking temperatures suggest upper tract infection (kidney). It is important to note, however, that one always cannot local- ize the site of the infection by the severity of the temperature. That is, a high temperature necessarily does not indicate upper urinary tract infection and vice versa; this is true especially in children. The carotid arteries should be auscultated for bruits to evaluate for a possible cardiac etiology of the flank pain, such as a renal artery disease or embolus. Heart auscultation for rate, rhythm, and murmurs should be done for the same reason, since renal artery embolism 688 J. If the pain is more severe during the abdominal examination, consider intraabdominal eti- ologies for the flank pain. A rectal examination, with stool for guaiac, should be done to exclude a possible intraabdominal cause for the flank pain. If the patient is pregnant, x-rays should be avoided, and the patient should be evaluated with ultrasound. Both males and females should have a complete genital examination, since referred pain is common. If the bladder is distended, it suggests a possible urologic etiology for the pain (Fig. The flank area should be examined for asymmetry, mass, and per- cussion tenderness. It is uncommon to discover a palpable flank mass, unless there is a large renal tumor present. Patients with acute pyelonephritis or obstructing renal calculi complain of severe pain when the flank is percussed, so it is important to tap lightly in order to maintain patient confidence. To rule out a musculoskeletal etiology for the flank pain, the lower extremities should be examined for motor and sensory function. Laboratory and Diagnostic Studies Laboratory Studies The history and physical examination help determine the most probable etiology of the flank pain and guide the clinician toward the selection of the most appropriate laboratory and diagnostic tests. Evaluation of Flank Pain 689 In almost all cases, a urinalysis should be performed as the initial diagnostic test. In contrast, patients with uric acid stones tend to have an acidic urine, since these stones do not form when the urine is alkaline. A Gram stain should be done in the emergency room or clinic and can help determine if infection is present. The shape of the crystal can be used by the laboratory technician to help identify its composition. The urinalysis may be normal if the etiology of the flank pain is due to cardiac, intraabdominal, musculoskeletal, or psychological problems. Anemia and a low or high platelet count might be seen in the presence of bleeding urologic tumors. The impaired function could be due to dehydration, obstruction, tumor, infarct, or medical renal disease. Moreover, an elevated serum creati- nine indicates bilateral renal disease or disease involving a solitary kidney, since only one healthy kidney is required to maintain a normal serum creatinine. In long-standing renal compromise, it is not un- common to see a fall in serum bicarbonate along with hyperkalemia. Hyponatremia results from volume overload and can cause nausea, vomiting, and seizures. Hyperkalemia especially is dangerous, since it could result in cardiac arrhythmias. Other useful tests might include a serum uric acid level and serum calcium level, if a urinary calculus is suspected. Barone Diagnostic Studies Following the history, physical exam, and laboratory analysis, a plain film of the abdomen can help identify urinary calculi (Fig. The entire film should be viewed for intestinal gas pattern, gallstones, bony structure, and free air, which may provide insight into the etiology of the pain. Renal cell carcinomas are osteolytic tumors, and this can be seen radiographically in metastatic disease. An abnormal intestinal gas pattern, gallstones, or free air suggest intraabdominal pathology. Aortic calcifications and aneurysms should be determined, since they might suggest renal artery disease as the etiology of the flank pain. Urinary calculi typically are seen as calcifications overlying the kidney shadow or along the course of the ureter (Fig. Small stones, 1 to 2mm in size, can cause severe flank pain if they obstruct the flow of urine into the bladder. Following the history, physical examination, urinalysis, and abdom- inal plain film, a preliminary diagnosis is possible in most instances.

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Compromised local intestinal immmunity 237 Both manifest with persistent fever 40mg accutane fast delivery, headache safe 20 mg accutane, malaise order accutane 20 mg without prescription, chills 40mg accutane mastercard, enlargement of liver and spleen, and skin rashes. Paratyphoid fever is milder than typhoid fever Complications: Intestinal perforation Lower gastrointestinal bleeding Dissenmination to different body organs including meninges and brain Mortality rate Untreated cases: 10-15% Treated cases: < 1% 2. Gram reaction: Gram-negative rods Culture: Bacteriologic methods for salmonella isolation 1. Inhibit replication of normal intestinsl flora and permit replication of salmonella Egs. Selenite F broth Tetrathionate broth Non-lactose fermenting, H2S producing colonies in Mac conkey agar. Tube dilution agglutination test Used to determine antibody titers in patients with unknown illness 240 Method: • Serial dilutions of unknown serum are tested against antigens from representative salmonella species. Slide agglutination test/ Kauffman-White system Used to identify unknown cultures with known sera 241 Required: Salmoella O and H polyvalent antiserum Method:. Pathogenesis and Clinical features: Route of infection is fecal-oral route Inoculum dose: 103 organisms Pathogenicity determinant: Toxins: Endotoxin: irritate the bowel wall Exotoxin: Enterotoxin and neurotoxin S. Complication: Dehydration Electrolyte and acid-base disturbance High prevalence: Poor sanitation Poor personal hygiene Polluted water supply Young children are frequently affected. Laboratory diagnosis: Specimen: Stool,serum Gram reaction: Gram-negative non-motile rods. Laboratory diagnosis: Specimen: Urine, pus, blood, ear discharge Smear: Gram-negative rods Culture: Produce characteristic swarming growth over the surface of blood agar. Indole negative Serology: Cross react with Weil-fellix test Treatment: Based on sensitivity testing. Bubonic plague: Fever, vomiting, painful lymphadenitis(buboes) in the groin or axillae 2. Pneumonic plague: Ip is 1-3 days Profuse mucoid or bloody expectoration with signs of pneumonia 3. Septicemic plague Fever, vomiting, diarrhea, hypotension, altered mentation, renal and heart failure, intra vascular coagulopathy Lab. Formalin-killed vaccine for travellers to hyperendemic areas and high risk persons Yersinia enterocolitica and Yersinia pseudotuberculosis Non-lactose fermenting gram negative rods Urease positive Oxidase negative Y. Human infection occurs by contaminated food and drinks from domestic animals or rodents Y. Human infection results from ingestion of food and drinks contaminated by animalfeces Antigenic structure. Diagnosis: Specimen: Stool, blood, rectal swab Culture: Grow in routine enteric media Biochemical tests for species identification Treatment: Fluid replacement for enterocolitis (Antibiotics not required) rd Cephalosporin (3 generation) + Aminoglycosides for sepsis/ meningitis Prevention and control: Conventional sanitary precautions 2. Found in human and animal intestine, water, soil and moist environment in hospitals. Invasive and toxigenic, produces infections in patients with abnormal host defenses Antigenic characteristic:. Exotoxin A: Cytotoxic by blocking protein synthesis Clinical features: Pathogenic only when introduced into areas devoid of normal defenses eg. Urinary tract infection- chronic, complicated Urinary tract infection and associated with indwelling catheter. Otitis externa- Malignant external ear infection in poorly treated diabetic patients. Laboratory diagnosis: Specimen: pus, urine, sputum, blood, eye swabs, surface swabs Smear: Gram-negative rods Culture:. Obligate aerobe, grows readily on all routine media over O wide range of temperature(5-42 C). Bluish-green pigmented large colonies with characteristic “fruity” odor on culture media. Species of medical importance: Vibrio cholerae-01 Vibrio cholerae Characteristics:. Readily killed by heat and drying; dies in polluted water but may survive in clean stagnant water, esp. All strains possess a distinctive O antigen and belong to subgroup I with subdivision into three serotypes; Ogawa, Inaba, Hikojima. ElTor biotype is more resistant to adverse conditions than Classical diotype of V. Little value in identification Clinical features: Route of infection is fecal-oral route. Laboratory diagnosis: Specimen: Stool flecks Smear: Gram-negative motile curved rods Motility of vibrios is best seen using dark-field microscopy. Presumptive diagnosis: Inactivation of vibrios in a wet preparation after adding vibrio antiserum. Observe for large yellow sucrose-fermenting colonies after 18-24 hrs of incubation. Stricly microaerophilic bactria requiring 5-10% o2 and 10% co2 enriched environment. Species of medical importance: 254 Campylobacter jejuni Campylobacter coli Campylobacter jejuni and Campylobacter coli Characteristics: ƒ Gram-negative non-spore forming motile rods with comma, S or ‘gull-wing’ shapes. Enterotoxin Clinical features: 4 Inoculum dose: 10 organisms Source of infection is contaminated food, drinks,and unpasteurized milk The organism multiply in small intestine, invade the epithellium and produce inflammation Campylobacter enteritis manifests with fever, headache, malaise, crampy abdominal pain and bloody mucoid diarrhea, and usually self-limited enteritis in a week period 255 Laboratory diagnosis: Specimen: Stool Microscopy: Typical ‘gull-wing’ shaped gram-negative rods. Typical darting motility of the bacteria under dark field microscopy or phase contrast microscopy Culture: Grow best at 420c on selective media but can be cultured at 37 oc. Watery and spreading or round and convex colonies on solid media at low oxygen tension. Treatment: Erythromycin Shorten the duration of fecal shedding of bacteria Helicobacter pylori General characteristics:. Spiral-shaped gram negative, microaerophilic, motile rods with polar flagella Antigenic structure: Pili Protease U rease Pathogenesis and clinical features: Route of entry: Ingestion of contaminated food and drinks Familial clustering of H. Diadnosis: Specimen: Gatric biopsy, serum Smear: Giemsa or silver stain Culture: Skirrow’s media Tanslucent colonies after 7 days of incubation Biochemical reaction:. Legionnaires disease: Pneumonic presentation with high fever, chills, dry cough, hypoxia, diarrhea, and altered mentation 2. Lack superoxide dismutase and catalase, and susceptible to the lethal effects of oxygen and oxygen radicals. Most anaerobic infections are caused by “moderately obligate anaerobes”, and polymicrobial in nature caused by combination of anaerobes, facultative anaerobes and aerobes. Gram negative Bacteroides fragilis group colon Prevotella melaninogenica Mouth Fusobacterium Mouth/Colon b. Gram positive Actinomyces Mouth Lactobacilli Vagina Propionibacterium Skin Clostridium Colon 2. Gram positive Peptostreptococci Colon clinical features: 260 Representative anaerobic infections Commonly isolated anaerobic bacteria Brain abscess Peptostreptococci Oropharyngeal infection Actinomyces P.

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