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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
Infection control measures include isolation or cohorting of suspected cases, barrier nursing with gown and gloves, and hand washing with soap and water as alcohol gels do not adequately destroy Clostridium spores.
Bacteria
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
Gas gangrene is an infection caused by the growth of Clostridium perfringens or closely related Clostridium species. For clostridial infections to develop, wound contamination with endospores and anaerobic conditions for germination and growth are required. The toxins produced by the Clostridia are a group of exotoxins and enzymes with a proteolytic activity that literally digest the tissue. If damaged tissue in a wound is removed, anaerobic conditions are unlikely to occur. The predominant gases produced in gas gangrene are due to carbohydrate fermentation and are carbon dioxide and hydrogen.
Meeting personal needs: elimination
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
When someone has diarrhoea that could be infective, cross-infection measures needed are prompt and careful disposal of the faeces, use of non-sterile gloves and aprons, scrupulous hand washing and source isolation (see Chapter 12). When caring for people with diarrhoea caused by Clostridium difficile, alcohol hand rub is ineffective against the spores produced, so wearing non-sterile gloves, with hand washing following glove removal, is essential.
Suspected tetanus in an unvaccinated pediatric patient
Published in Baylor University Medical Center Proceedings, 2023
Kimberly Walter, Renita Thomas, Swasti Gyawali, Sowmya Kallur
Tetanus is a life-threatening vaccine-preventable illness. It is caused by tetanospasmin, a potent exotoxin of Clostridium tetani. Tetanospasmin causes neuromuscular dysfunction by inhibiting presynaptic GABA and glycine release. This leads to tonic spasms and paroxysmal contractions of skeletal muscles.1 Spores of Clostridium tetani are present throughout the environment in soil, dust, and manure and are often transmitted to humans via contaminated wounds. Tetanus is extremely rare in the United States due to vaccination efforts, with only 20 cases reported in 2018 and 26 cases in 2019.2,3 Here, we describe a suspected case of tetanus in a 10-year-old unvaccinated child in central Texas resulting in a 1-month stay in the pediatric intensive care unit and ultimately requiring a tracheostomy tube.
Botulinum neurotoxin for head and neck disorders
Published in Neuro-Ophthalmology, 2021
Botulinum neurotoxin is a product of clostridial species bacteria that has been studied extensively. As the book describes, it interferes with the release of various neurotransmitters and perhaps neuropeptides, which is believed to be the mechanism of action of this agent in a wide variety of medical conditions. The basis of muscle weakening and decreased glandular output induced by this neuromodulator seems to be more straightforward than its impact on pain syndromes, as the effect of botulinum toxin on nociceptive pathways has proven to be a bit more elusive, although many theories have been proposed. One disadvantage of this treatment modality is that periodic repeated injections are usually necessary. Nevertheless, the wide range of disparate conditions that are effectively treatable with botulinum toxin injection is vast and ever-growing, providing an excellent, minimally invasive therapeutic alternative.
Hidradenitis suppurativa for the nondermatology clinician
Published in Baylor University Medical Center Proceedings, 2020
Kavina Patel, Lucy Liu, Benjamin Ahn, Annika S. Silfvast-Kaiser, So Yeon Paek
Systemic combination therapy with oral clindamycin and rifampin is the best studied antibiotic regimen and is used first line for Hurley stage II or III disease. Several case series have shown combination twice-daily clindamycin 300 mg and rifampin 300 mg for up to 10 weeks to be effective. In one study, 47% of patients treated for 10 weeks reported total remission and 35% had at least some improvement in their HS.23 Nearly 70% of 116 patients in one survey reported significant improvement after 10 weeks of treatment.24 Common side effects of clindamycin include Clostridium difficile–associated diarrhea, rash, and hepatotoxicity.25 Rifampin causes orange-tinged bodily fluids and CYP450 interactions. The use of clindamycin and rifampin up to 12 weeks is supported by all HS guidelines.