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gram positive 剩下 (no-spore (Corynebacterium diphtheria (Culture, toxin,…

- - - - immunocomprimise
    - - intracellular move
        
        facutative intracellular
      - cold enrichment
- - - - Antiphagosis capsule(from PXO2) : poly-D-glutamic acid
      - Exotoxin (from PXO1)
        
        Edema factor
        
        increased cAMP :green_cross: neutrophil :check: edema
        
        Lethral factor
        
        stimulate TNFa and IL1 secretion --> shock
      - found mainly in herbivores (cows and sheep)
        
        Anthrax
        
        Respiratory Anthrax :red_flag:
        (woolsorter's syndrome)
        
        flu-like symptoms --> Pulmonary hemorrhage, mediastinal hemorrhage, mediastinitis --> widen CXR :star:
        
        Vaccine(protective factor) woolsorters and soilders
        
        Cipro, doxycyclin :explode:
        
        Nasal swab PCR
        
        GI Anthrax
        
        high mortality :warning:
        
        GI necrosis, hemorrhage
        
        Cutaneous Anthrax :red_flag:
        
        Malignant pustule
        
        80-90 % self remission
        
        PCN :explode:
        
        from EF
    - - food(cooking rice) poisition :star:
        
        heat stable enterotoxic
        
        self remission, no need anti
        
        D/D with SA (Food poisition)
  - - - Neurotoxin
        
        :no_entry:SNARE spinal cord Renshaw cell
        no :star: GABA and Glycine
        
        Trimus(lockjaw), Sirsus Sardonicus, Opsithotonos :star:
        
        Toxoid Vaccine
        
        Dtap
        
        Acellular pertussis, Tetanus toxoid, Diphthernia toxoid
        
        2,4,6 month + 6y/o
        10 year reboost :star:
      - trauma patient :explode:
        
        no vaccine history
        
        booster+antitoxin (tetanus Ig)
        
        with tetanus symptom
        
        immune induce
        
        booster + tetanus Ig
        
        clear Bac
        
        PCN or metronidazole + debride
        
        symptom relief
        
        ventilator + muscle relaxant
        
        Vaccine 10 years before
        
        Booster
    - - Adult botulium :red_flag:
        
        4 Ds : diplopia, dysphargia, dysarthia, dyspenia (res failure) :star:
        
        Botulinum antitoxin and ventilation :explode:
        
        BOT :smiley: food, zip-lock freezer bag --> anaerobic environment
        
        wound botulinum
        
        febrile + adult botulinum
      - Infant botulium :red_flag:
        
        spore in fresh honey
        
        constipation --> flappy baby syndrome :fire:
        
        Botulinum IVIG :explode:
        
        less anaphylaxis, serum sickness
      - Neurotoxin
        
        :no_entry:SNARE in motor neuron,
        no Ach :star:
        
        Faccid paralysis
        
        cosmetic, muscle spasm
    - - Alpha-toxin
        
        Cellulitis / Myonecrosis
        
        Gas gangrene
        
        PCN + tissue debride + Hyperbaric
      - Enterotoxin
        
        food poison
    - - Toxin A (enterotoxin) / Toxin B (disrupt epithelium)
      - previous Clinda and Amp :star:
        
        Diarrhea
        
        oral Vanco or Metronidazole :explode:
        
        stool EIA
        
        toxic megacolon