Lecture 29 - Clostridium Infections

== Botulism ==
=== Food Poisoning (20%) ===
Clostridium botulinum causes of all food poisoning by producing a very deadly neurotoxin - Botulinum toxin. The type A Botulinum toxin, the deadliest one, too, is also known as botox.
It is found in anaerobic environments such as canned foods, and prefer a less acidic environment for growth. Its spores can survive improper autoclaving, and germinate within a few days.
Botox is age labile and heat labile; it will degrade after 6 months of just chilling there and 10 minutes in boiling water. 
Symptoms of botulism food poisoning do not include vomiting/diarrhea, but rather causes muscle paralysis. It can lead to blurred vision and other muscle paralysis. Symptoms start showing within 12-36 hours and develops to diaphragm paralysys in 3-7 days.
A respirator is used to treat the muscle paralysis, and an antitoxin (Trivalent) can be used early to treat toxins type A,B and E. A laxative can be used to get the food out before one absorbs it.
=== Wound Botulism (8%) ===
Wound botulism doesn't usually infect people because of the pH in blood, but black tar heroin is basic, and people who inject it may get the botulism infection. The DOC for wound botulism is penicillin G.
=== Infant Botulism (60%) ===
Honey and corn syrup contains traces of botulism spores, which can grow in the GI tract of infants because they don't have much gut flora.
12% cannot trace back how they got the botulism infection.
== Tetanus ==
Clostridium tetani, found in feces and soil, will only grow locally but releases the neurotoxin tetanospasmin, which is a strong neurotoxin. It will cause involountary, violent contractions of volountary muscles. It will cause lockjaw, and will kill you if it hits the diaphragm. There are only about 20 cases a year in the US, but about 1 million cases worldwide.
=== Treatment ===
* Respirator
* Muscle relaxants
* Antitoxins
** Tetanus immunoglobulin (TIG)
*** Human source with fewer side reactions, CDC recommended
** Tetanus antitoxin (TAT)
*** Horse source, used as second choice, and in veterinary medicine.
* Flagyl
=== Prevention ===
DTP (Diphtheria and Tetanus toxoids, and Pertusis vaccine adsorbed) was used until 2002 with children, which have higher doses of diphtheria and pertussis antigens. It is adsorbed, meaning it's less soluble and will stimulate the immune system for a longer duration. The toxoids are damaged toxins that will trigger an immune response but not function as a toxin.
DTaP (Diphtheria and Tetanus toxoids and acellular Pertussis vaccine absorbed) is the current form of the vaccine, and has fewer side effects because they do not use whole cells of pertussis.
Tdap (Tetanus and diphtheria toxoids and acellular pertussis adsorbed) is a booster shot for 11-12 year olds. 
Td (tetanus diphitheria toxoids) is the adult booster shot, which is given every 10 years. 
DT (Diphtheria & Tetanus toxoids absorbed) do not have pertussis, which are for children allergic to acellular pertussis.
== Gas Gangrene ==
Clostridium perfringens is an anaerobe that comes out as part of the normal GI tract. It produces a gas which tissues normally do not. DOC is penicillin G. 
=== Anaerobic Bellulitis ===
Characterized by rotting, black tissues, Clostridium perfringens grows on dead skin and usually stays local.
=== Myonecrosis ===
Myonecrosis is a growth on muscle tissue, and can be treated by surgery to remove dead tissue and to expose the anaerobe to air, killing it.
== Antibiotic Associated Colitis ==
Treated with metronidazole, Clostridium difficile is resistant to the more broad spectrum antibiotics that is used to treat other infections.