3/31/2019 Chapter 20 Homework

Chapter 20 Homework
Due: 1:59pm on Friday, April 5, 2019
You will receive no credit for items you complete after the assignment is due. Grading Policy

Clinical Case: A Protozoan Mystery

A Protozoan Mystery

A 20-year-old student was admitted to his college’s student health center with fever and headaches shortly after beginning the fall semester. He had spent his summer working with an
international aid organization in Nigeria and had returned to the United States only a week earlier. Gross examination revealed numerous insect bites and some swollen lymph nodes. The man
had spent most of his summer outdoors in rural areas and had spent some time on African game reserves working with the families of local guides. He could not specifically remember receiving
any of the bite wounds on his body, and he did not always use insect repellent in the field. The patient was admitted to the local hospital, where intermittent fever, headache, and swelling
continued. Initial blood smears proved negative for malaria.

Part A
Look carefully at the peripheral blood smear. What parasite is present in the blood?

Hint 1.
Review the life cycles and diagnostic tests for the protozoans in this unit.

ANSWER:

Toxoplasma gondii

Trypanosoma brucei

Entamoeba histolytica

Plasmodium vivax

Correct
These are mature trypomastigotes among erythrocytes.

Part B
What is the name of the disease this man is suffering from?

Hint 1.

Review the clinical signs/symptoms and diagnostic tests for protozoan diseases endemic in Africa.

ANSWER:

giardiasis

leishmaniasis

African sleeping sickness

malaria

Correct
The signs, symptoms, and blood smear point to African sleeping sickness.

Part C
What is the vector for African sleeping sickness?

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Hint 1.
Review the route of transmission for African sleeping sickness.

ANSWER:

kissing bugs

tsetse flies

Anopheles mosquitoes

sand flies

Correct
Tsetse flies are the vector for African sleeping sickness.

Part D
What medication should this man receive to treat this disease?

Hint 1.

Review the treatments recommended for African sleeping sickness.

ANSWER:

melarsoprol

paromomycin

tinidazole

chloroquine

Correct
Melarsoprol is used when the central nervous system is affected.

Part E
What is the mortality rate for untreated cases of African sleeping sickness?

Hint 1.
Review the clinical signs/symptoms and progression of African sleeping sickness.

ANSWER:

5%

25%

50%

100%

Correct
The mortality rate is 100% if not treated.

Clinical Case: A Very Sick Sophomore

A Very Sick Sophomore In December, a 19-year-old college student experiences a severe headache, nausea, vomiting, and fever. The student suspects a case of flu and goes to the health
center for a diagnosis. By the time he arrives he is feeling worse, with neck stiffness and disorientation. The doctor immediately prepares to perform a spinal tap.

Part A
Based on the symptoms stated, what is the most probable disease that this student has developed?

Hint 1.

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Which symptoms stand out as being significantly different from those of the flu or the common cold?

ANSWER:

influenza

polio

meningitis

sinusitis

Correct
The stiffened neck along with the other symptoms indicates a swelling of the meninges.

Part B
Analysis of the spinal tap shows the presence of Gram-negative bacteria cocci; for this age group which bacteria would be the probable cause of these symptoms?

Hint 1.
The description of the bacteria present indicates spherical bacteria with a thin layer of peptidoglycan that stains pinkish-red.

ANSWER:

Haemophilus influenzae

Streptococcus pneumoniae

Neisseria meningitidis

Streptococcus agalactiae

Correct
Also known as “meningococcus,” these Gram-negative cocci have been shown to cause bacterial meningitis.

Part C
Transmission of the causative bacterial agent is via this route.

Hint 1.
The transmission route may also lead to pneumonia, sinusitis, or bacteremia.

ANSWER:

inhalation of respiratory droplets

contaminated food

blood transfusions

physical contact

Correct
In most cases of bacterial meningitis, the bacteria spread to the meninges from infections of the lungs or sinuses (sinusitis) after inhalation of droplets from an infected individual.

Part D
To reduce the chances of bacterial meningitis, the CDC recommends what actions be taken for military recruits and college freshman?

Hint 1.
Chances are you had this done to you before entering college.

ANSWER:

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screening for meningococcus

vaccinations for meningococcus

prophylactic treatment for meningococcus

risk assessment for meningococcus

Correct
To reduce the chances of outbreaks of bacterial meningitis in the dorms or barracks, it is now expected that all incoming freshman and recruits receive this vaccination.

Part E
Why do symptoms persist after antibiotics have been used to treat and remove the bacterial infection?

Hint 1.
Is the mere presence of the bacteria all that is required to cause inflammation in a person?

ANSWER:

The bacteria are resistant to the antibiotics used and are still present.

The patient will still suffer from secondary infections because of the use of antibiotics.

The blebs containing lipid A are still present in the blood and in the tissues.

The toxins are still in the blood (toxemia) and will continue to damage cells.

Correct
The antibiotics may have killed the bacteria and allowed for their removal, but the LOS are still present in the tissues and will still induce inflammation.

Clinical Case: The Frowning Actor

The Frowning Actor A 55-year-old actor is concerned about maintaining his star status as a leading man and doesn’t like the “frown lines” on his forehead. He asks his dermatologist about a
cosmetic treatment to relax the facial lines. The dermatologist explains that Botox—purified type A botulism toxin—is approved for use on the glabella (forehead between the eyes) and
discusses with the actor the risks and benefits. The actor decides to have a treatment. Two weeks following the treatment, he calls the office reporting that his eyelids are sagging.

Part A
Botulism is generally associated with ingestion of the toxin produced by Clostridium botulinum. The activity of the toxin will result in __________.

Hint 1.
Toxins associated with Clostridium sp. affect neurological functions.

ANSWER:

loss of nerve sensations

impaired brain functions

spastic paralysis

flaccid paralysis

Correct
The toxin activity will inhibit the release of the neurotransmitter acetylcholine at the neuromuscular junction.

Part B
Why should the actor worry about the spread of the injected Botox from the forehead to other parts of the body or face?

Hint 1.

The activity of Clostridium toxins is to interfere with neuromuscular interactions.

ANSWER:

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The toxin’s activity will be irreversible, and the muscles of the forehead will be paralyzed permanently.

The toxin spreading to other areas of the body would inhibit muscle contractions required for normal daily activities.

The toxin may relax other muscles in the face and result in losing wrinkles that were meant to be kept to show age.

The toxin’s interfering with the muscle contractions required to focus the eye could result in blindness.

Correct
Talking, chewing, swallowing, and even your heart beat are based on muscle contractions due to a nerve impulse.

Part C
What would be the best course of action to treat someone who has been exposed to Clostridium boltulinum toxin or has had a Botox injection that is spreading?

Hint 1.
Toxins are not affected by antimicrobials or antiviral compounds.

ANSWER:

intravenous antibiotics

intravenous immunoglobulins

washing of the intestinal tract to remove bacteria

toxin immunization

Correct
BIG-IV is the administration of immunoglobulins against the toxin proteins to aid in clearing of the toxin by the patient’s own body.

Part D
The paralytic toxin from C. botulinum differs from the toxin from C. tetani in that __________.

Hint 1.

Clostridium toxins result in impaired neuromuscular functions.

ANSWER:

botulism results in flaccid paralysis and tetanus results in a spastic paralysis

botulism results in a deadly paralysis and tetanus results in a treatable paralysis

botulism and tetanus both result in paralysis but of different muscle groups

botulism results in spastic paralysis and tetanus results in a flaccid paralysis

Correct
C. botulinum toxin blocks the release of acetylcholine that would trigger the muscle contraction.

Part E
In the United States, most common exposure to Clostridium botulinum and its toxins occurs through __________.

Hint 1.

Clostridium species are endospore-forming soil bacteria.

ANSWER:

infection of surgical wounds

soil contaminating open wounds

inhalation of bacterial spores

ingestion of the spores or toxins in improperly canned foods

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Correct
Home canning saw an increase in the number of cases of botulism due to the spores not being destroyed during the canning process and germinating in the canned food. People
would then eat the food contaminated with botulism toxin and develop flaccid paralysis.

Connecting Concepts: Gram-negative Bacterial Pathogenicity

Part A - Bacterial Classification and Cell Characteristics

Bacteria are grouped into two categories reflecting structural features of their cells. Bacteria are classified as Gram-positive or Gram-negative based on whether or not they retain the crystal
violet dye used in the Gram stain procedure. Cell wall structure determines the ability to retain the dye, thus cell wall structure is the basis of categorization into Gram-positive (G+) and
Gram-negative (G-).

Which of the following occurs only in Gram-negative bacteria?

Hint 1. Peptidoglycan
Peptidoglycan is a structural feature composed of short amino acid chains and long polysaccharides.

Hint 2. Phospholipids
The cytoplasmic membranes of most organisms contains these molecules.

Hint 3. Lipoteichoic acid

Lipoteichoic acid functions to anchor the cell wall to the cytoplasmic membrane.

ANSWER:

Integral proteins

Lipoteichoic acid

Peptidoglycan

Phospholipids

Lipopolysaccharide

Correct
Lipopolysaccharide (LPS) is unique to G- bacteria, and is a factor in many of the characteristics of Gram-negative bacteria.

Part B - Gram-negative Structure and Pathogenicity

The outer membrane of Gram-negative bacteria contributes to their ability to cause disease (pathogenicity). One of the components of the outer membrane is called an “endotoxin”.
Match the following terms with their description as part of the Gram-negative bacterium.

Hint 1. Gram-negative cell wall structure

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Hint 2. Role of the outer membrane

The outer membrane separates and protects the bacteria from the external environment.

ANSWER:

Reset Help

Lipid A is released when the outer membrane disintegrates

The lack of a thick Cell wall causes Gram-negative bacteria to stain pink, in contrast with Gram-

positive bacteria staining purple.

Porin(s) allow monosaccharides to move across the membrane.

Periplasm contains water, nutrients, and enzymes necessary for bacterial survival.

Correct
The lipid portion (Lipid A) of lipopolysaccharide (LPS) is normally buried in the lipid bilayer of the outer leaflet of the outer membrane of Gram-negative bacteria. It is therefore not
exposed to the environment in intact bacteria. When the outer membrane is damaged, LPS is released and degraded, releasing Lipid A into the local environment.

Microbial pathogens possess a variety of features which contribute to their ability to cause disease. Some of those features include cellular structures which can prevent detection or be toxic in
some circumstances. The characteristics which contribute to pathogenicity are called virulence factors and will be explored further in coming chapters.

Part C - Acute Inflammatory Response to Bacterial Infection

Acute inflammation is an initial, nearly immediate response to microbial invasion. The acute inflammatory response can be beneficial and is frequently successful in containing and defeating
bacterial infection.

Scenario: an open cut is infected with Gram-negative bacteria. Place the events of acute inflammation in the most likely order from beginning of infection to fully developed
inflammation.

Hint 1. Vasodilation
The term “vasodilation” refers to changes in blood vessel walls.

Hint 2. Complement

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Complement factors are proteins found in the extracellular fluid which participate in a series of reactions.

Hint 3. Lectins

Lectins are complex carbohydrates that may be found on the surface of microbes.

Hint 4. Alternate pathway

The “alternate pathway” cascade is triggered by glycoproteins and endotoxins.

ANSWER:

Reset Help

Earliest event Latest event

Complement cascade Endotoxin triggers Vasodilation of Tissue around infection

MAC formation Phagocytes enter tissue
initiated by complement cascade nearby arterioles site becomes swollen,
damages bacteria. and attack bacteria.
lectin pathway. by alternate pathway. and capillaries. red, and warm to the touch.

Correct
When bacteria invade the body and cause damage, the acute inflammatory response is triggered. Damage can initiate the process, but in addition some bacterial structures can
also trigger events leading to inflammation.

Part D - Bacterial Cell Structures and Inflammation

Various types of damage can lead to acute inflammation, including cuts and abrasions, heat, and microbial damage. Some microbes have structures which can trigger the acute
inflammatory response when they invade tissues.
What structural characteristics common to Gram-negative bacteria may trigger the acute inflammatory response?

Hint 1. Mycolic acid

Mycolic acid is a waxy compound found in the cell walls of some Actinobacteria.

Hint 2. Teichoic acid

Teichoic acid is present in Gram-positive cell walls.

ANSWER:

Teichoic acid

Mycolic acid

Lipid A

External polysaccharides

Correct
Some bacterial cells structures including polysaccharides external to the cell wall, glycoproteins and surface proteins are recognized by complement factors, phagocytes, TLR and
NOD receptors as part of the innate response to infection. LPS released from dead cells degrades to Lipid A, an endotoxin with which one of the complement factors reacts.

Under normal circumstances the inflammatory response is beneficial, combating infection and beginning repair of tissue damage. When the inflammatory response is excessive or becomes
chronic it can instead cause tissue damage and death (necrosis).

Part E - Gram-negative Bacterial HAI’s

Gram-negative bacteria are responsible for the majority of Healthcare Associated Infections (HAI’s, also known as nosocomial infections). Serious disease may result when Gram-negative
bacteria establish opportunistic infection of nearly all body systems. These HAI’s have several signs in common.

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The signs of opportunistic HAI’s with Gram-negative bacteria typically include high fever, inflammation, tissue edema, low blood pressure and DIC. What common structural
characteristic of Gram-negative bacteria is directly or indirectly responsible for these signs?

Hint 1. Flagellin

Bacterial flagella are composed of proteins called flagellins.

Hint 2. Fimbriae

Fimbriae are small protein extensions cells use for attachment.

ANSWER:

Phospholipid

Flagellin

Peptidoglycan

Fimbriae

Lipid A

Correct
Lipid A from the LPS and LOS of Gram-negative bacteria is a potent toxin that causes severe inflammatory responses which can cause a wide range of serious problems. For
example, widespread vasodilation can result in sufficient fluid loss from the blood that blood pressure may become dangerously low. DIC can result in localized loss of function and
even tissue necrosis. So just when the body’s attack on the bacteria is successful (and/or the antibiotic is effective) new and dangerous damage may occur. As a consequence,
Gram-negative bacterial infections are often considered far more dangerous than infections with Gram-positive bacteria.

Score Summary:
Your score on this assignment is 98.0%.
You received 1.96 out of a possible total of 2 points.

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