Areas of bone infected in:

1. neonates

2. children

3. adults

1. metaphysis, epiphysis or both

2. metaphysis, long bones w/vascularity

3. metaphysis, epiphysis, subchondral regions, vertebral

Most common sites tuberculous osteomyelitis

irreversible inhibitor of COX-1 and COX-2

  covalent modification of enzyme (acetylation of ser residue)

  toxicity:

  ti

GI infection by Yersinia, Salmonella, Shigella, Campylobacter

Outer cell membranes w/LPS

White-footed mouse- larval and nymph forms of Ixodes

White-tailed deer- adult Ixodes

Either of the following:

Erythema migrans

At least one late manifestation (musculoskeletal, nervous, cardiovascular involvement) and laboratory confirmation of infection

At least one of the following:

Isolation of Borrelia burgdorferi

Demonstration of diagnostic levels of IgM or IgG antibodies to the spirochetes

Significant increase in antiboy titer between acture and convalescent serum samples

Tetanolysin- an oxygen-labile hemolysin

Tetanospasmin- a plasmid-encoded, heat labile neurotoxin, nonconjugative

Has zinc-endopeptidase activity and a large, nontoxic subunit

Complexed w/nontoxic proteins that protect the neurotoxin during passage through the digestive tract

soil and water

Type A- neutral or alkaline soil west of Mississippi

Type B- easter part of country in rich, organic soil

E- wet soil

1. classic of foodborne- consumption of home-canned foods (A and B) and preserved fish (E)

2. infant botulism- consumption of foods w/spores, honey, milk powder, soil

3. wound botulism

4. inhalation botulism- major concern for bioterrorism

1. adequate ventilatory support

2. elimination of organism from GI tract through gastric lavage and metronidazole or penicillin

3. use of trivalent botulinum antitoxin

warmer climates, Japan, Mexico, Brazil, Uruguay, Peru, Clumbia

outbreaks related to forest work, mining, and gardening

zoonotic transmission through armadillo hunters and infected cats

room temp, body temp (pleomorphic)

Appearance of Splendore-Hoeppli material surrounding yeast cells

oral potassium iodide in saturated solution which has frequent adverse side effects

itraconazole also effective

fluconazole last resort

chronic, pruritic, progressive, indolent, and resistant to treatment

Early lesions are small, warty papules and enlarge as multiple, large, cauliflower-like growths

Large lesions are hyperkeratotic

Itraconazole and terbinafine, posaconazole more recently

Squamous cell carcinomas may develop

composed of septate fungal hyphae, frequently distorted and bizarre, large, spherical, thick-walled chlamydoconidia often present

Splendore-Hoepplie material often interdigitates

B. ranarum- through traumatic implantation of the fungus into subcutaneous tissues of thighs, buttocks, and trunk

C. coronatus- through inhalation of fungal spores, which invades the tissues of the nasal cavity, paranasal sinuses, facial soft tissues

10:1 male to female ratio

itraconazole

Oral potassium iodide has been used

All grow as black molds in culture and appear as dark-walled, irregular, hyphal and yeastlike forms in tissue

May require Fontana-Masson melanin stain to confirm

1. Infection begins when meat contains encysted larvae is digested

2. Larvae leaves meat in small intestine and w/in 2 days develop into adult worms

3. Single fertilized female produces more than 1500 larvae in 1-3 months

4. Larvae move from the intestinal mucosa into the bloodstream and are carried in the circulation to various muscle sites throughout the body, where they coil in striated muscle fibers and become encysted

5. Larvae remain viable for many years and are infectious if ingested by a new animal host

What animals have the greatest prevalence of T. spiralis?

when 100 present, significant disease

1000 to 5000 is very serious, sometimes death

few larvae, mild flu-like syndrome

more extensive, persistent fever, GI distress, eosinophilia, muscle pain, periorbital edema

Splinter hemorrhages beneath nails cause by vasculitis from toxic secretions

Severe infecton and death results from myocarditis, encephalitis, pneumonitis, respiratory arrest

As larvae encyst in muscle, edema and inflammation occurs, calcification in 5-6 months

Primarily symptomatic

Mebendazole may halt production of new larvae

Steroids recommended for severe symptoms

1. Larvae migrate from the location of bite to lymphatic system, primarily in arms, legs or groin, where growth adulthood occurs

2. 3 to 12 months after initial infection, adult male worm fertilizes the female, which produces sheathed larval microfilariae that find way into circulation

3. Microfilariae in blood is diagnostic for human disease and is infective for feeding mosquitoes

4. In mosquito, larvae moves through stomach and thoracic muscles in developmental stages and migrate to proboscis

5. In proboscis, become infective, third-stage larvae and transmitted by feeding mosquito

Adult form in humans can persist for 10 years

tropical and subtropical areas and is endemic in central Africa, along Mediterranean coast, in many parts of Asia

No animal reservoir has been identified

Malaysia, India, Thailand, Vietnam and parts of Asia

Animal reservoirs are cats and monkeys

acute presentation arises from inflammatory response to presence of molting adolescent worms and dead or dying adults w/in lymphatic vessels, lymph nodes enlarge involving extremities, scrotum, testes

this may also lead to filarial elephantiasis

1. Infection occurs w/introduction of larvae through the skin during biting and feeding of the Simulium or blackfly vector

2. Larval worms migrate from skin to subcutaneous tissue and develop into adult male and female worms

3. Adults become encased in fibrous subcutaneous nodules w/in which they remain viable for as long as 15 yrs

4. Female worm, after fertilization by male, begins producing as many as 2000 nonsheathed microfilariae each day

4. Microfilariae exit capsule and migrate to skin, eyes, and other body tissues, are infective for feeding blackflies

Surgical removal

Treatment w/ivermectin