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Case Study: A male brought to the emergency room experiences severe face…

- - - - Toxin seems to be generalized & cephalic
        
        Immediate effects on nervous system
        
        He can hardly speak
        
        Patient may be experiencing symptoms of
        
        Lock jaw
        
        Swallowing issues
        
        Consequences if patient can't swallow food
        
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        Extreme face & arm muscle spasms
        
        The neurotoxin may spread all throughout the body
        
        Symptoms are not localized around shoulder area
        
        Average time toxin spreads
        
        7-21 days
        
        Patients occurred on second day
        
        This could mean the patient has a more severe case of clostridium tetani
      - Attacks on CNS
        
        Causing convulsive spasms of muscles throughout rest of the body
        
        Effects on organ systems
        
        Skeletal system
        
        Can lead to death
        
        by causing
        
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        Dislocating joints & bones
        
        Creating bone fractures
        
        Tendon ruptures
        
        Cardiovascular system
        
        Rapid heart rate
        
        High blood pressure
        
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        Lymphatic system
        
        Secondary infections
        
        Due to prolonged hospital stay
        
        Primary infection
        
        Due to the body trying to fight the foreign invader
        
        Nervous system
        
        Possible seizures could occur
        
        Respiratory system
        
        Breathing issues due to
        
        This can lead to death if
        
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        Other possibly resulting symptoms
        
        Excessive sweating
        
        Fever
        
        Stiff muscles in the
        
        Neck
        
        back
        
        Shoulders
- - - - Penicillin
    - - To help calm contractions
    - - Tetanus Immune Globulin (TIG)
        
        This neutralizes toxins
        
        Downside effects
        
        Has been shown to only work on nerves that have not already been affected by the toxin
        
        Helps to prevent further release of tetanospasmin
    - - To get rid of source of bacteria
    - - Due to laryngospasm
- - - - Symptoms
        
        Extreme face & arm muscle spasms
        
        He can hardly speak
      - A bacterium that is activated in anaerobic environments
        
        Patient is not vaccinated against this bacterium
    - - The bacteria released the neurotoxin
        
        This affects the muscles by
        
        Producing involuntary contractions
        
        As the frequency get higher & higher
        
        1) Individual twitches -> Temoral summation
        
        Produce smooth muscle contractions
        
        This begins a new twitch before relaxation
        
        2) Unfused tetanus occurs
        
        Quivery contractions
        
        a) Tetanospasmin
        
        d) With increased frequency, muscles contract more & more
        
        Creating spasms
        
        b) This prevents the release of inhibitory neurotransmitters from entering interneurons
        
        c) Due to lack of inhibitory signals, motor neuron fires constantly
      - Why patient is experiencing spasms
        
        Muscle stimulation & hyperactivity of nerves are occurring at the SAME time
        
        Example
        
        The patient is going to experience spasms first
        
        Reason
        
        1) Due to the tetanus acting first on the nervous system
        
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        2) Tetany will occur later on
        
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  - - - Upon the patient receiving a new tattoo on shoulder yesterday
        
        He may have contacted it from the tattoo shop
        
        Being that the shop seemed to practice in unsanitary conditions w/unsanitary practices
        
        This bacterium could have been transmitted by use of unhygienic needles
- - - - Function
        
        Allows manipulation of environment
        
        Locomotion
        
        Facial expression
        
        Maintains posture
        
        Produces heat
      - Includes
        
        Skeletal muscles
      - Components involved in muscular contractions
        
        Summation
        
        Frequency picks up & twitches add on each other
        
        When enough frequency is increasing at a faster rate
        
        4) Fused tetanus
        
        As frequency continues to increase muscle tension increases
        
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        3) Unfused tetanus (incomplete tetanus)
        
        Wave of summation becomes greater & greater
        
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        2) Temporal summation
        
        Additional stimuli is added before relaxation is complete
        
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        1) Individual twitches
        
        Tetany
        
        Consists of
        
        Intermittent spasms can occur
        
        Involuntary, prolonged muscle contractions
        
        Usually occurs from
        
        Hyperexcitability of CNS & PNS
        
        Resulting from a reduction in electrolyte imbalance
        
        [Mg2+]
        
        [H+]
        
        [Ca2+]
        
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        Can be additionally triggered by
        
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        Characterized by
        
        Spasm of the larynx (voice box)
        
        Spasms of feet & hands
        
        Overactive neurological reflexes
        
        Twitch
        
        Occurs when a muscle fiber or motor unit contracts due to 1 stimulus
        
        Ex: One neuron sending a signal across synaptic cleft
        
        Phases of a twich
        
        Period of contraction
        
        Cross bridges are active
        
        Lasts 10-100ms
        
        Period of relaxation
        
        Due to pumping of Ca2+ back into SR
        
        Muscle tension decreases to zero
        
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        Latent period
        
        First few ms following stimulation (during excitation contraction coupling)
        
        Cross bridges begin to cycle
        
        But muscle tension is not yet measurable
        
        Characteristics
        
        Muscles can contract w/out shortening
        
        Tetanus
        
        Primary cause
        
        A neurotoxin -> tetanospasmin
        
        Produced by gram positive anaerobic clostridium tetani
        
        The workings of clostridium tetani
        
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      - Events at neuromuscular junction (NMJ)
        
        Neurotransmitters involved in the neuromuscular junction
        
        acetylcholine (ACh)
        
        Acts at 2 classes of receptor
        
        Nicotinic
        
        Muscarinic
        
        Functional classes
        
        Excitatory or inhibitory depending on receptor
        
        Direct or indirect at muscarinic receptors
        
        Sites where secreted
        
        CNS
        
        Throughout
        
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        PNS
        
        All neuromuscular junctions w/skeletal muscle
        
        Some autonomic endings
        
        Characteristics
        
        Effects prolonged
        
        When
        
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        Process
        
        3) Ach diffuses acros cleft & binds to Ach receptors
        
        This allows chemically gated ion channels to let Na+ into cell
        
        Depolarization occurs due to the lesser (-) inside cell
        
        4) Channels close
        
        Na+ gets pumped out by Na+ K+ pump
        
        K+ slowly gets pumped out
        
        2) Voltage-gated Ca2+ channels open
        
        Ca2+ entry triggers Ach to be exocytosed from neuron into synaptic cleft
        
        5) This causes change in charge
        
        Which causes voltage gated ion channels to open down the length of sarcolemma letting in Na+
        
        Na+ gets pumped out, K+ slowly diffuses out
        
        Causing an action potential
        
        1) Neuron brings signal (action potential) -> muscle cell at NMJ
        
        Action potential arrives where acetylcholine (ACh) resides in axon terminal
        
        6) Excitation-contraction coupling (E-C)
        
        a) The AP travels down the length of the T-tubules in a wave like ripple
        
        Signal reaches each myfibril
        
        b) T-tubules -> terminal cisternae (which are at the ends of the sarcoplasmic reticulum at the ends of the sarcomere)
        
        Voltage gated Ca2+ channels on the cisternae let Ca2+ due to change in charge
        
        c) This triggers Ca2+ into the sarcomere of myofibril
        
        Ca2+ binds to troponine which moves tropomyosine
        
        Exposing active sites on actin
        
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        d) The sarcomere shortens, making the H zone disappear
        
        Myofibril shortens
        
        Shortening the fascicles
        
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    - - Function
        
        Responds rapidly to internal & external changes
        
        By activating glands & muscles
      - Includes
        
        Spinal cord
        
        Nerves
        
        Anatomy of nerves
        
        Epineurium
        
        Nerve
        
        Perineurium
        
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        Brain
    - - Function
        
        Forms bodies external covering
        
        Protects tissues
        
        Houses cutaneous receptors such as pain & pressure
      - Includes
        
        Skin
        
        Nails
        
        Hair
    - - Function
        
        Picks up fluid leaked from blood vessels & returns it to blood
        
        disposes of debris in lymphatic stream
        
        houses white blood cells (lymphocytes)
        
        the immune response attack against foreign substances in body
      - Includes
        
        Lymph nodes
        
        Spleen
        
        Thoracic duct
        
        Lymphatic vessels
        
        Thymus
        
        Red bone marrow
    - - Includes
        
        Adrenal gland
        
        Pancreas
        
        Testis
        
        Ovary
        
        Thymus
        
        Thyroid gland
        
        Pituitary gland
        
        Pineal gland
      - Function
        
        Glands secrete hormones -> Regulate
        
        Reproduction
        
        Nutrient use by cells
        
        Growth
    - - Function
        
        Blood vessels transport blood (carrying O2, CO2, wastes, nutrients)
        
        Circulates extracellular fluid
        
        Heart pumps the blood
      - Includes
        
        Heart
        
        Blood vessels
  - - - 3) Vesicle & membrane fuse & pore opens
      - 1) Vesicle migrate -> plasma membrane
      - 4) Vesicle contents are released to cell exterior
      - 2) Proteins at vesicle surface (v-SNAREs) bind w/plasma membrane proteins (t-SNAREs)
    - - Typical stimulation
        
        Cell surface signal
        
        Such as
        
        Binding of a hormone to a membrane receptor
        
        Change in membrane voltage
      - Accounts for
        
        Hormone secretion
        
        Neurotransmitter release
        
        Mucus secretion
        
        Ejaculation of wastes