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This study guide provides a detailed overview of clostridioides difficile (c. Diff) infection, a common bacterial infection that can cause severe diarrhea and colitis. It covers the organism's characteristics, disease process, transmission, symptoms, diagnosis, and treatment. The guide includes numerous questions and answers, making it an excellent resource for students preparing for mbio 4823 exam 5.
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What is C. diff known as and what is its full name? - ansClostridioides (Clostridium) difficile. A new SUPERBUG of our times What are two diseases associated with C. diff? - ansClosridium difficile- Associated Disease (CDAD) and Pseudomembranous Colitis Who reclassified C. diff? - ansPaul Lawson, Diane Citron, Kerin Tyrell, Sydney Finegold What part of the GI tract does C. diff affect? - ansMainly found in Jejunum, where continued digestion and absorption of monosaccharides, amino acids, fatty acid, water pH 4-5. What is the gram reaction of all clostridial species? - ansAll clostridial species are Gram positive What kind of organism is C. diff? - ansObligate Anaerobe How many toxins does C. diff produce? - ansProduces 2 toxins:
After the sixth step involving hydrolytic enzymes, what occurs in C. diff progression? - ans6. Local production of hydrolytic enzymes: connective tissue degradation What occurs in the seventh (final step) of C. diff progression? - ans7. Colitis, pseudomembrane formation (dead tissue, fibrin, mucus phagocytes, DNA) and watery diarrhea Name a C. diff disease. - ansC. difficile- Associated Disease (CDAD) How is C. diff transmitted and by what route? - ansSpread from person to person contact. Fecal-oral route What conditions are the riskiest for C. difficile infection? - ansIn an environment where antibiotics cause a microbiota disruption and C. difficile that is resistant to that antibiotic has a selective advantage Describe how environments not containing antibiotics can create a risk for C. diff infection. - ansWhile a C. difficile that has antibiotic resistance has no advantage, if the microbiota is still disrupted, there is a risk for infection. What are three ways a patient that is negative for C. difficle can be be exposed to the organism and possible be infected? - ans- A nontoxigenic C. difficile can be asymptomically colonized in a host
What effect do both toxins A and B have on G protein? - ansBoth toxins glucosylate (addition of glucose) a threonine residue on G protein Where would a threonine be located in a protein in the GTP form? - ans-In the GTP form the threonine is buried in the protein and inaccessible to the toxin What is the result of toxin activity on GTPase? - ans-Result: action of toxins reduced GTPase activity of the protein and increases release of GTP from GTP-bond form (glucosylated-GTP bound form has a lower affinity for GTP) Where are TcdA/TCDb Toxin genes located? - ans-Tcda/TcdB toxin genes* are located on PaLoc pathogenicity island present in all toxogenic strains What type of regulatory control is tcdC under? - anstcdC (down) What type of regulatory control is tcdR under? - anstcdR (up) What characteristic of tcdR activity in leads to expression of A and B toxins? - ans- Transcription and expression of tcdR is highest in early exponential phase leading to expression of A and B toxins When is tcdC expressed? - ans-When toxins build up to highest level, tcdC is expressed which counters tcdR decreasing the expression of the toxin What causes severe reactions in C. diff cases? - ansVery powerful toxins and small amounts can cause severe reactions What do bacteria get in return for all this energy expenditure? - ansNutrients How much percentage increase occurred in England and Wales? - ansA rise of 28 percent in just one year What population demographic does C. diff infection affect? - ansThe infection which particularly affects elderly people increased four times over since 2001 (1804 deaths were linked to the superbug) What do resistant spores in C. diff affected individuals lead to? - ansFailure to clear C. difficile and resotre stable, nonpathogenic flora What practices need to be implemented in C. diff cases? - ansTreatment coupled with improved clean practices within hospitals What is an enema? - ansAn enema is the procedure of introducing liquids into the rectum and colon via the anus What are the effects of motility of intestinal contents in C. diff cases? - ansLeakage of water into lumen - diarrhea 35,000 - ansBetween 1990 and 2003 cases of C diff rocketed. The cases increased from 1, cases to how many cases over this span? routine monitoring in feces for A & B toxins - ansin order to diagnose early and prevent C diff what precautions must be taken when someone experiences antibiotic associated diarrhea? Cytoskeletal protein Slide - ansClass 30 Slide 21 45,000 - ansHow many cases of C diff appeared in 2004 in >65 year olds? glucosylate - ansthis term describes an addition of glucose G protein - ansThis is an important protein involved in many cell processes that controls the polymerization and depolymerization of actin (pseudopodia etc) and cycles between 2 states: binding with GDP or GTP
fecal bacteriotherapy (aka fecal microbiota transplantation FMT) - ansThis is a name for alternative therapy to replace resident flora using an enema containing dilute feces from a family member threonine residue - ansBoth C diff A-B toxins add glucose to this type of residue on G proteins. What is the residue called? vancomycin or metronidazole - answhat two antibiotics kill C diff but do not adversely affect normal flora? Where do Toxins A and B act (structurally)? - ans-A and B toxin act on GDP-bound form where the threonine residue is exposed that can by glucolyated (addition of glucose) What type of fecal bacteriotherapy has beens shown to improve C. diff symptoms? - ans- Fecal transplants that can induce solid bowel movements Name historical potential reasons for increased CDAD, incidence and severity. - ans-Changes in underlying host susceptibility
Name two similarities between Lyme disease and Syphilis. - ans-Both caused by spirochetes, although different genera
Where does infection occur in primary syphilis? - ansT. pallidum cannot pass through unbroken skin. Infection probably occurs via small tiny breaks in the epidermal layer caused during sexual activity Where does syphilis affect males? - ansMale: penis Where does syphilis affect females? - ansFemale: vagina, cervix, and surrounding regions If syphilis becomes extra genital, what areas does it affect? - ansUsually oral and anal regions What type of syphilis occurs when a fetus is infected? - ansCross placenta and infects fetus- Congenital syphilis What are the first symptoms of syphilis? - ansFirst symptoms: rhinitis (irritation and inflammation of the nose) and then rash Name symptoms of chronic syphilis infection. - ansTeeth and bone malformations, blindness, deafness, cardiovascular syphilis are common in untreated infants who survive. Where does T. pallidum multiply and what characteristic lesion is formed? - ansT. pallidum multiplies at the site of entry and a characteristic lesion (chancre) formed within 2 weeks to 2 months Name areas that T. pallidum can "hide". - ansMaybe hidden-on scalp under the hair, vagina, anus or mouth What are the spirochetes actively doing, relate it to pathogenicity? - ansSpirochetes actively multiplying, infectious What happens after a few weeks that provides a false sense of relief for patient? - ansChancre disappears after a few weeks and heals spontaneously (bacteria migrating away from the site) List the progression of Secondary syphilis (1-3 months) - ans-Bacteria penetrate mucosal membranes and enter bloodstream
Treponema pallidum subsp. pertenue - ans-a tropical (topical) infection of the skin, bones, and joints caused by the spirochete bacterium Map showing human migration routes beginning about 100,000 years ago of the globe - ansClass 32, Slide 44 Where was Yaws maintained? - ansWarm-moist areas of South America; as populations migrated to northern regions and wore more clothing, Treponemes mutated again Name modes of transmission for treponemes. - ans1. Migrated to mouth and throat via saliva on drinking vessels etc;
15th and 16th century saw urbanization and sexual liberties
Combined with more clothing in cold climates forcing pathogens to find new ways to transfer between individuals Many more chances for the organism to spread How did treponemes take advantage of more clothing? - ansMutated from a skin to a venereal disease What is gram reaction and morphology for C. difficile? - ansGram positive, rod How is C. diff transmitted? - ansFecal-oral What are C. diff virulence factors? - ansSpres, A&B toxins What are disease symptoms and treatments for C. diff? - ans-antibiotic associated diarrhea
In theory syphilis could be eradicated but what would impede this? - ansHuman behavior cannot be controlled but through safe sex practices may be able to reduce the incidence What is Mycobacterium tuberculosis known as? - ans-The People's Plague
Why are more people in developed world susceptible to contract TB? - ans-Immune systems are more likely to be compromised due to higher exposure to immunosupporessive drugs, substance abuse, or AIDS Is distribution of TB uniform across globe? - ansNo, more population in many Asian and African countries test positive for TB while less of US population test positive Over next decade ______ will _____________________ - ans-30 million will die worldwide (from TB) Name a multiple drug resistant TB. - ansMDR-TB Name an extremely drug resistant TB. - ansXDR-TB Why is drug resistance so high with TB? (Massive outbreaks in Russian prisons) - ans-Lack of new anti-TB drugs
What was introduced after streptomycin resistant TB strains developed? - ansRifampin an inhibitor of RNA What is an MDT and what drug cocktail was used in TB treatment next? - ans-MDT (Multiple drug therapy)
What are some possible future vaccines against TB? - ans-Introduce genes for effective antigens from a number of bacterial species for a multipurpose vaccine