{"id":5158,"date":"2011-07-14T20:24:00","date_gmt":"2011-07-14T20:24:00","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5158.htm\/"},"modified":"2014-04-26T15:45:06","modified_gmt":"2014-04-26T19:45:06","slug":"bacterial-toxin-infections","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/","title":{"rendered":"Bacterial and Toxin Infections"},"content":{"rendered":"

<\/span>See ICU Infections Chapter<\/a><\/span><\/h2>\n

 <\/p>\n

<\/span> Diphtheria<\/a><\/span><\/h2>\n

<\/span> Pertussis (whooping cough)<\/a><\/span><\/h2>\n

<\/h2>\n

<\/span>Tetanus<\/span><\/h2>\n

Pharmacological Management in Tetanus<\/a><\/p>\n

Toxin mediated (tetanospasmin)<\/p>\n

Gram + rod, spores are heat and cold resistant.\u00a0 3-14 day incubation<\/p>\n

Trismus progressing to risus sardonicus<\/p>\n

Opisthotonus-body bent concave forward, resting on head and heels<\/p>\n

Diff:\u00a0 strychnine poisoning, dystonia, hypocalcemic tetany, rabies<\/p>\n

Start c benzos, move to competitive NMJ blockade.\u00a0 Labetolol<\/p>\n

Tetanus immunoglobin (eliminates circulating toxin not yet bound to nerve fibers) and tetanus toxoid, debride any infected wounds then PCN or Flagyl<\/p>\n

 <\/p>\n

 <\/p>\n

Clean Minor Wounds<\/strong><\/p>\n

All Other Wounds<\/strong><\/p>\n

History of Tetanus Toxoid<\/strong> Td<\/strong> TIG<\/strong> Td<\/strong> TIG<\/strong> Unknown or <3 Doses<\/strong> Yes No Yes Yes 3 or More Doses<\/strong> No No No No<\/p>\n

<\/h3>\n

<\/span>Botulism<\/a><\/span><\/h2>\n

<\/h3>\n

<\/span>Meningococcemia<\/span><\/h3>\n

Gram \u0096 diplococci<\/p>\n

Rashes-petechial or maculopapular<\/p>\n

Rx Ceftriaxone, proph c rifampin<\/p>\n

<\/h3>\n

<\/span>Pneumococcemia<\/span><\/h3>\n

<\/h3>\n

<\/span>Typhoid (Enteric Fever)<\/span><\/h3>\n

Salmonella typhi<\/p>\n

Fever, HA, abd pn, possible organomegaly, later pea soup diarrhea.<\/p>\n

Usually from contaminated food<\/p>\n

Dx by blood, stool, or bone marrow cultures<\/p>\n

Mimicked by plague, intestinal anthrax, melioidosis, bartonellosis, leptosirosis, typhus, tularemia, brucellosis<\/p>\n

Mary Mallon=Typhoid Mary<\/p>\n

<\/span>Leptospirosis<\/span><\/h3>\n

From contaminated water (animal urine)<\/p>\n

Can enter through intact waterlogged skin<\/p>\n

5-30 days incubation<\/p>\n

flu-like illness c aseptic meningitis<\/p>\n

WBC 20-40<\/p>\n

Rx c Pcn or tetracycline<\/p>\n

<\/span>Brucellosis<\/span><\/h3>\n

From livestock exposure<\/p>\n

Treat c Abx<\/p>\n

<\/span>Enterobacter cloacae<\/em><\/span><\/h3>\n

think wooden foreign bodies<\/p>\n

<\/span>Sepsis<\/span><\/h2>\n

(2 or more):<\/p>\n

    \n
  1. T>38 or <36<\/li>\n
  2. HR>90<\/li>\n
  3. RR>20 or CO2 <32<\/li>\n
  4. WBC>12 or <4 or >10% bands<\/li>\n<\/ol>\n

    <\/span>Antibiotic Selection<\/span><\/h2>\n

    Cephalosporin use is contraindicated in penicillin-allergic patients only if an IgE-mediated reaction such as urticaria, angioedema, or anaphylaxis occurs. Estimates of cross-sensitivity of cephalosporins and penicillins vary widely, ranging between 2% and 16%.112 However, even in patients with a stated penicillin allergy, true anaphylaxis to cephalosporins is extremely rare (< 0.02%).113 In fact, cross-reactions appear limited to patients given first-generation cephalosporins. Studies of second- and third-generation cephalosporins show no increase in allergic reactions in patients who have a history of penicillin allergy\u00a0 (<\/em>Ann Allergy Asthma Immunol 1995;74(2))<\/p>\n","protected":false},"excerpt":{"rendered":"

    Array<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[23],"tags":[],"yoast_head":"\nBacterial and Toxin Infections - Crashing Patient<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"CrashMaster\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/\",\"url\":\"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/\",\"name\":\"Bacterial and Toxin Infections - Crashing Patient\",\"isPartOf\":{\"@id\":\"https:\/\/crashingpatient.com\/#website\"},\"datePublished\":\"2011-07-14T20:24:00+00:00\",\"dateModified\":\"2014-04-26T19:45:06+00:00\",\"author\":{\"@id\":\"https:\/\/crashingpatient.com\/#\/schema\/person\/68373c312014141023ba30948675be1d\"},\"breadcrumb\":{\"@id\":\"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/crashingpatient.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Bacterial and Toxin Infections\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/crashingpatient.com\/#website\",\"url\":\"https:\/\/crashingpatient.com\/\",\"name\":\"Crashing Patient\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/crashingpatient.com\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/crashingpatient.com\/#\/schema\/person\/68373c312014141023ba30948675be1d\",\"name\":\"CrashMaster\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/crashingpatient.com\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/df72275d57de87ddb0cfafc82b66d544?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/df72275d57de87ddb0cfafc82b66d544?s=96&d=mm&r=g\",\"caption\":\"CrashMaster\"},\"url\":\"https:\/\/crashingpatient.com\/author\/emcrit\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Bacterial and Toxin Infections - Crashing Patient","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/","twitter_misc":{"Written by":"CrashMaster","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/","url":"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/","name":"Bacterial and Toxin Infections - Crashing Patient","isPartOf":{"@id":"https:\/\/crashingpatient.com\/#website"},"datePublished":"2011-07-14T20:24:00+00:00","dateModified":"2014-04-26T19:45:06+00:00","author":{"@id":"https:\/\/crashingpatient.com\/#\/schema\/person\/68373c312014141023ba30948675be1d"},"breadcrumb":{"@id":"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/bacterial-toxin-infections.htm\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/crashingpatient.com\/"},{"@type":"ListItem","position":2,"name":"Bacterial and Toxin Infections"}]},{"@type":"WebSite","@id":"https:\/\/crashingpatient.com\/#website","url":"https:\/\/crashingpatient.com\/","name":"Crashing Patient","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/crashingpatient.com\/?s={search_term_string}"},"query-input":"required name=search_term_string"}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/crashingpatient.com\/#\/schema\/person\/68373c312014141023ba30948675be1d","name":"CrashMaster","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/crashingpatient.com\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/df72275d57de87ddb0cfafc82b66d544?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/df72275d57de87ddb0cfafc82b66d544?s=96&d=mm&r=g","caption":"CrashMaster"},"url":"https:\/\/crashingpatient.com\/author\/emcrit\/"}]}},"jetpack_featured_media_url":"","_links":{"self":[{"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/posts\/5158"}],"collection":[{"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/comments?post=5158"}],"version-history":[{"count":0,"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/posts\/5158\/revisions"}],"wp:attachment":[{"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/media?parent=5158"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/categories?post=5158"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/crashingpatient.com\/wp-json\/wp\/v2\/tags?post=5158"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}