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Because death from cholera is a consequence of dehydration, the disease is treated using oral rehydration therapy (ORT), which consists of large volumes of water mixed with a blend of sugar and salts.
Antibiotics. While antibiotics are not a necessary part of cholera treatment, some of these drugs may reduce both the amount and duration of cholera-related diarrhea. A single dose of doxycycline (Adoxa, Monodox) or azithromycin (Zithromax, Zmax) may be effective.
Toxin Producing Bacteria
Tetanus – lockjaw ( risus sardonicus)
Diphtheria – upper respiratory & cardiac problems
Tetanus is an acute, often fatal, disease caused by an exotoxin produced by Clostridium tetani.
Spores found in soil, dust, animal feces; may persist for months to years
Multiple toxins produced with growth of bacteria
Tetanospasmin estimated lethal dose = 150ng
Grown in hamburger!
Peptone based medium.
Generalized tetanus in newborn infant
Infant born without protective passive immunity
High fatality rate without therapy
Estimated 500,000 deaths worldwide in 2004
Tetanus cases reported worldwide 1990-2004. Ranging from strongly prevalent (dark red) to very few cases (in light yellow) (grey data).
Laryngospasm – spasms of vocal cords and respiratory muscles
Fractures – spine and long bones due to muscle spasms and seizures
Formalin-inactivated tetanus toxin
Schedule: 3 or 4 doses + booster, booster every 10 years
Efficacy: approximately 100%
Duration: approximately 10 years
Antibiotics help kill the bacteria. Penicillin G is the most commonly used antibiotic for tetanus infection. You might receive it orally or intravenously.
Diphtheria is an acute, toxin mediated disease caused by Corynebacterium diphtheriae. Diphthera – Greek for leather hide.
Antitoxin developed in 1891.
Toxoid developed in the 1920’s.
Cultures are grown in a modified Mueller and Miller medium.
Purified by serial ammonium sulfate fractionation and diafiltration.
Aerobic gram-positive bacilli
Toxin production occurs only when the bacillus is itself infected (lysogenized) by a specific virus carrying the genetic information for the toxin (tox gene). Only toxigenic strains can cause severe disease.
Treatment is with erythromycin orally or by injection (40 mg/kg/day; maximum, 2 gm/day) for 14 days, or procaine penicillin G daily, intramuscularly (300,000 U/day for those weighing 10 kg or less and 600,000 U/day for those weighing more than 10 kg) for 14 days.
The disease is usually not contagious 48 hours after antibiotics are instituted. Elimination of the organism should be documented by two consecutive negative cultures after therapy is completed.
Bacteria with capsules
Haemophilus influenzae, type b
Bacteria with capsules
Evade APCs – no T-cells activated
children & older adults make few or no antibodies, or short-lived antibodies
No memory cell production
Antibodies working with APCs are important for bacterial disease protection
Bacterial Strains: A/B/C/Y/W-135
Signs and Symptoms
Discomfort around bright light
Seizures (as the disease progresses)
Commonly used meningitis treatments include cephalosporins, especially Claforan (cefotaxime) and Rocephin (ceftriaxone). Various penicillin-type antibiotics, aminoglycoside drugs such as gentamicin, and others, are also used
Do not inject ID, IM or IV
Capsule bonded to a protein.
Stimulate a more vigorous immune response. More antibody is produced along with memory.
Conjugate vaccines work much better in young children whose immune systems are immature.
Haemophilus influenzae type b infections – ActHIB
Streptococcus pneumoniae – Prevnar
Neisseria meningitidis - Menactra
This vaccine provides protection against bacterial strains A, C, W135, and Y but not against B
This is the new meningococcal conjugate vaccine from Sanofi-Pasteur licensed in January 2005. It is licensed for 2 to 55 year olds.
Haemophilus influenzae B
Act-HIB Haemophilus influenzae type b (Hib) Act-HIB ® (Haemophilus b conjugate vaccine, tetanus protein - conjugate) 01959034 5 x 0.5 mL
Haemophilus influenzae produces beta-lactamases, and it is also able to modify iHaemophilus influenzae produces beta-lactamases, and it is also able to modify its penicillin-binding proteins, so it has gained resistance to the penicillin family of antibiotics.
In severe cases, cefotaxime and ceftriaxone delivered directly into the bloodstream are the elected antibiotics, and, for the less severe cases, an association of ampicillin and sulbactam, cephalosporins of the second and thirdgeneration, or fluoroquinolones are preferred. (Fluoroquinolone-resistant Haemophilus influenzae has been observed.)
Macrolide antibiotics (e.g., clarithromycin) may be used in patients with a history of allergy to beta-lactam antibiotics. [ citation needed ] Macrolide resistance has also been observed
Combination Vaccines – should be
stable for 18 to 24 months
Recommended at same age - age appropriate vaccine cocktail