Tags: Tetanus


Nematodes (roundworms) are nonsegmented, tapered, bilaterally symmetrical, cylindrical organisms that have complete digestive tracts and reproduce sexually. Although > 500,000 species of nematodes have been described, only a small number are commonly encountered as human parasites. Most nematodes have complex life cycles, sometimes involving several larval forms and intermediate hosts or free-living stages. The pathogenic nematodes may be categorized as primarily intestinal or extraintestinal tissue parasites (Box 1).


Pasteurella multocida has been recovered from cultures of specimens from the nasopharynx and the gastrointestinal tract of a large number of asymptomatic wild and domestic animals. The highest carriage rates occur in cats (50%-90%), dogs or swine (50%), and rats (15%). Infections are usually preceded by a cat or dog bite or scratch on an extremity.

Important Anaerobes

Anaerobic bacteria are the predominant component of the normal microbial flora of the human body. The following sites harbor the vast majority of them:

Toxin-Mediated Infections

Tetanus is a disease of global incidence produced by the toxin of Clostridium tetani. The risk of acquiring it increases in people > 60 years of age and in neonates, especially in Third World countries where poor sanitary conditions predispose to umbilical stump contamination. Immunization campaigns have played a crucial role in bringing about the observed decreasing incidence in the United States. The pathogenesis of tetanus involves the absorption of preformed toxin, or, less commonly, invasion of toxin-producing organisms from contaminated wounds; it may complicate surgical wounds colonized with C tetani.

Haemophilus, Bordetella, & Branhamella Species

Before 1990, strains of Haemophilus influenzae type b were found in the upper respiratory tract of 3-5% of children and a small percentage of adults. Colonization rates with type-b strains are even lower now, reflecting routine immunization of infants against H influenzae type b. Non-type-b encapsulated H influenzae are present in the nasopharynx of < 2% of individuals, whereas nonencapsulated (nontypable [see below]) strains colonize the respiratory tract of 40-80% of children and adults.

Bordetella Species: Clinical Syndrome

The catarrhal stage is characterized by nonspecific upper respiratory symptoms, including rhinorrhea, mild cough, and low-grade fever. During this stage, which typically lasts 1-2 weeks, the disease is highly communicable. The paroxysmal stage is marked by sudden attacks or paroxysms of severe, repetitive coughing, often culminating with the characteristic whoop and frequently followed by vomiting.

Haemophilus Influenzae: Clinical Syndromes

H influenzae was first isolated during the 1892 influenza pandemic and was originally believed to be the causative agent of influenza. Although subsequent studies revealed the fallacy of this idea, H influenzae has proved to be a common cause of localized respiratory tract and systemic disease, including meningitis, epiglottitis, pneumonia, pyogenic arthritis, cellulitis, otitis media, and sinusitis, among others (Box 1). Meningitis is the most common and serious form of invasive H influenzae type-b disease. In the mid-1980s, before the introduction of effective vaccines, ~ 10,000-12,000 cases of H influenzae type-b meningitis occurred in the United States each year, and 95% of cases involved children < 5 years old.

Order Chloroquine\Hydroxychloroquine (Aralen) No Prescription 250/500mg

Syncope occurred in a hypertensive 48-year-old man who took oral chloroquine sulfate (total 600 mg base) while also taking amlodipine 5 mg/day. Chloroquine and amlodipine both cause vasodilatation, perhaps by release of nitric oxide, and the syncope in this case was probably due to a synergistic mechanism. Malaria itself can also provoke orthostatic reactions, which may be why syncope is not a reported adverse effect of chloroquine.

Anaerobic & Necrotizing Infections

Gangrene is local death of soft tissues due to disease or injury and is associated with loss of blood supply. Anaerobic and necrotizing infections may be associated with gas.

Vaccines, Toxoids, and other Immunobiologics

Vaccine and toxoid recommendations. Diphtheria toxoid adsorbed (DTA) and Diphtheria antitoxin (DA). Haemophilus influenzae type (HIB) vaccines. Influenza virus vaccine. Measles vaccine. Meningococcal polysaccharide vaccine. Mumps vaccine. Pertussis vaccine. Poliovirus vaccines. Rubella vaccine. Varicella vaccine. Varicella-zoster immune globulin. Immune globulin.