Several children and adults who recently fled a detention camp come to the ED with sore throats and a low grade fever. Physical examination of the buccal and nasal mucosa in these patients shows adherent pseudomembrane. 1. What is your diagnosis and why? 2. What is the MOA of the toxins of the causal organism?

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1. Several children and adults who recently fled a detention camp come to the ED with sore throats and a low grade fever. Physical examination of the buccal and nasal mucosa in these patients shows adherent pseudomembrane. 1. What is your diagnosis and why? 2. What is the MOA of the toxins of the causal organism?

1. Hydroxocobalamin should be given. In a fire a person is likely to get CO poisoning. This is why we give 100 % O2. This is to create a gradient and bump CO off of HB. But in addition to CO poisoning cyanide poisoning is also possible. Cyanide is produced from household items that burn. Cyanide stops oxidative phosphorylation (inhibits cytochrome C oxidase) and thus stops aerobic respiration. SOoo the O2 you give for the CO poisoning doesnt even help. Now tissues are generating lactate through anerobic respiration causing lactic acidosis. so we give hydroxocobalamin which binds to intracellular cyanide to produce cyanocobalamin which is water soluble and can be excreted in the urine. Common features of cyanide toxicity are: Unstable vitals Headache seizures Bright red skin
Vitamin C: Needed for hydroxylatin of proline residues on collagen. This man has scurvy. As suggested by perifollicular hemorrhages, ecchymoses.
1. Corynebacterium diptheriae infeciton - Unvaccinated child with thick pseudomembrane in throate. 2. Diptheria toxin stops translation elongation: inactivates eukaryotic elongation factor 2
1. Streptococcus pneumonai 2. Polysaccharide capsule = phagocytosis prevention

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