Download Mycobacterium tuberculosis

Infectious Disease
Clinical Image Review
Michael J. Tan, MD, FACP, FIDSA
Associate Professor of Internal Medicine
Northeastern Ohio Universities College of Medicine, Rootstown, OH
Summa Health System, Akron, OH
Session Objectives


Recognize and recite key words of specific infectious
diseases
Recognize images associated with specific infectious
diseases
Credits

John Sinnott MD, Todd Wills, MD
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University of South Florida College of Medicine
Division of Infectious Diseases and Tropical Medicine
Tampa, FL

Dockworker unloading
Persian goat-hair rugs
CDC

Bacillus anthracis

10 year old girl swimming
in freshwater lakes near
Walt Disney World
CDC

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Naegleria sp.: amoebic meningo-encephalitis
Primary amoebic encephalitis

60 year old male in DKA
with fever and proptosis
Mucormycosis
Preoperative external appearance of the patient. The necrotic tissue already reaches the periorbital region.
Mucormycosis of the head and neck
Metzen, Daniela, Journal of Cranio-Maxillo-Facial Surgery, Volume 40, Issue 8, e321-e327
Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery

Rose gardener
Sporotrichosis (Sporothrix schenckii)
Lymphocutaneous sporotrichosis with a papular lesion at the inoculation site that becomes nodular and often ulcerates. (From CID, Dr. Watanakunakorn, Universit
Press.)
Sporotrichosis
Kauffman, Carol A., Goldman's Cecil Medicine, 345, 1985-1986
Copyright © 2012 Copyright © 2012, 2008, 2004, 2000, 1996, 1991, 1988, 1982, 1979, 1975, 1971, 1963, 1959, 1955 by Saunders, an imprint of Elsevier Inc.
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University student from
Rhodesia with progressive
evidence of dementia
May have been bitten by a
tsetse fly

Trypanosoma brucei gambiense or rhodesiense

Geologist from Nevada
with fever and a painful
knot in his groin

Yersinia pestis

Exchange student from
India with anesthetic skin
lesion

Mycobacterium leprae

Hunter with skin ulcer,
lymphadenopathy, and
fever

Francisella tularensis

Turkish male with sudden
onset of fever, RUQ pain.
Cystic mass on liver CT.
Owns dogs.

Echinococcus granulosus

30 year old female back
from summer in west
Africa, alternating fever
and shaking chills
CDC

Plasmodium falciparum


7 year old from Brazil
with fever and unilateral
periorbital edema
Triamtomine bugs

Trypanosoma cruzi

35 year old female who
developed fever,
periorbital edema and
myalgias on July 10
CDC

Trichinella spiralis

26 year old Venezualan
with dyspnea and leg
edema

Trypanosoma cruzi

Traveler from St.
Petersburg (Russia) with
abdominal cramping and
loose stool
CDC

Giardia lamblia

Cornell students with
fever, LAD after all had
eaten hamburgers in the
dormitory cafeteria

Toxoplasma gondii

50 year old Greek
alcoholic with fever, RUQ
pain and raised right
hemidiaphragm

Entamoeba histolytica

21 year old Chinese male
with first-time seizure.
Numerous calcified
nodules in soft tissue

Neurocysticercosis: Taenia solium

Geophagic child with
rectal prolapse
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Whipworm: Trichuris trichurii

Hawaiian with eosinophilic
meningitis

Angiostrongyloides cantonensis


West African with
snowflake lesion of cornea
Black Fly
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River Blindness: Onchocerca volvulus
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Fever after eating Mexican
goat cheese milk
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Brucellosis

Meningitis after caring for
a pet hamster
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LCM: Lymphocytic choriomeningitis virus
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Pulmonary Abscess in a
Vietnam Veteran
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Melioidosis: Burkholderia pseudomallei

Caught it from a pet turtle
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Salmonella sp.

Anemia after walking
barefoot in the Southern
US
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Necator americanus, Ancylostoma duodenale

“Diphtheroid” meningitis
in a renal transplant
patient

Listeria monocytogenes

Nurse with inflamed finger
after tracheal suctioning

HSV: Herpetic whitlow

Continued urethral
discharge after ceftriaxone
treatment for verified
gonorrhea

Chlamydia trachomatis, Ureaplasma sp., Mycoplasma sp.

Broad Street Pump

John Snow – graphical representation of London Cholera
outbreak

28 year old female with
this:
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Bullous myringitis: Mycoplasma pneumoniae

Sickle Cell Anemia and
osteomyelitis
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Salmonella sp.

Calabar swelling (episodic
angioedema) of wrists and
a worm crawling across
the bulbae conjunctiva

Loa loa
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Diplopia five days after
eating canned fruit

Clostridium botulinum
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Severe vomiting and small
amounts of diarrhea 4
hours after a barbecue
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Staph aureus toxin
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Infected abdominal aortic
aneurysm
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Salmonella sp.

Californian with egg shell
calcifications on chest xray
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Coccidioides immitis
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Blister on the foot of a
Pakistani which ruptures
on cold water immersion
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Guinea worm: Dracunculus medinensus

Saber shins
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Congenital syphilis: Treponema pallidum

“Cancerous” mass in the
colon which reveals
organisms on biopsy
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Ameboma: Entamoeba histolytica

Hepatic fibrosis and
hematuria

Schistosoma mansoni
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Hypotension and plantar
desquamation in a
menstruating female
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Staphylococcal toxic shock syndrome
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Marijuana smoker in
Michigan
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Salmonella sp.
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Mesenteric lymphadenitis
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Yersinia enterocolitica
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“Retinoblastoma”
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Toxocara canis
Visceral larvae migrans
Ocular larvae migrans
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Diarrhea following
clindamycin
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Clostridium difficile

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Erosion of nasal septum in
a Brazilian 5 years after
spontaneous healing of a
skin ulcer
Sandfly
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Leishmania braziliensis
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Long white worm crawls
out of an actress’ nose as
she is about to deliver her
line

Ascaris lumbricoides
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Fever in a Caribbean
tourist with bony pain
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Dengue fever
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Polynesian girl with one
leg larger than the other
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Lymphatic filariais: Wucheria bancrofti
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Lumpy jaw
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Actinomyces
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Pruritis ani
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Pinworm: Enterobius vermicularis
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Pneumonia in a woman
who recently purchased a
parrot
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Psittacosis: Chlamydia psittaci
Chlamydophila
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Broad based budding
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Blastomyces dermatitidis
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Itching of hand following
prolonged hand holding
with a bar maid
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Syphilis
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Pneumonia in a man who
recently cleaned out his
attic inhabited by pigeons
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Psittacosis: Chlamydia psittaci
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Hutchinson’s teeth
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Congenital syphilis
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quellung
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Laboratory test for Streptococcus pneumoniae
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Asthma and eosinophilia
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Allergic bronchopulmonary aspergillosis (ABPA)
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Fever and bleeding
disorder in a Nigerian
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Ebola
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This rash
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Herpes Zoster:Varicella Zoster Virus
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Fever, shifting infiltrates
and eosinophilia in a renal
transplant patient
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Stongyloidiasis
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Pneumonia; this blood test
positive
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Cold agglutinins: Mycoplasma pneumoniae

Inguinal lymphadenopathy,
patient from India
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Groove sign: LGV – Lymphogranuloma venereum
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Neck lesion after fly bite
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Winterbottom’s sign: Trypanosoma brucei gambiense
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Child living in a mud hut
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Romana’s sign: Chaga’s disease – Trypanosoma cruzi
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Lymphadenopathy, AFB (+)
from Bangladesh
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Scrofula: Mycobacterium tuberculosis

Martha’s Vineyard
resident with fever

Babesia microti
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Gram stain of Ulcerative
genital lesion
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Donovan body: Calymmatobacterium granulomatis
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Hepatic disease in a
traveler recently returned
from a white water rafting
trip
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Leptospirosis with subconjunctival hemorrhage
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Gram stain of painful
penile lesion
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“School of Fish” – Chancroid
Hemophilus ducreyi
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Lung biopsy of patient
with glioblastoma
multiforme and
pneumonia
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Gomori methamine silver stain
Pneumocystis jiroveci pneumonia (PCP)
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Pneumonia, diarrhea,
hyponatremia - growth on
this agar
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BCYE agar: Legionella pneumoniae
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Swimming pool granuloma
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Mycobacterium marinum
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Relapsing fever
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Borrelia recurrentis
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Elevated transaminases;
these lesions on liver
biopsy

Councilman bodies: Associated with Yellow fever – seen
with any viral hepatitis
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River Blindness
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Onchocerca volvulus
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Woolsorter’s disease
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Bacillus anthracis
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Fever, lympadenopathy
OR
Violaceous skin lesions
OR
Cystic liver lesions

Bartonella henselae
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This cell on CBC in a fish
eater
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Fish tapeworm: Diphyllobothrium latum
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Teichoic Acid Antibodies

Staphylococcus aureus
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Sexually active female with
this seen on laparoscopy
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Fitz-Hugh Curtis: Neisseria gonorrhea

Pakistani with this
anesthetic skin lesion
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Hansen’s disease: Mycobacterium leprae

Fever, truncal rash as
shown
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Rose spots: Typhoid fever – Salmonella typhi

3 year old with difficulty
breathing, x-ray shown
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Epiglottitis: Hemophilus influenzae type B

Undulant fever, chronic
back pain
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Sacroiliitis from Brucellosis

Related to these vectors


Yersinia pestis
Vectors: Rattus rattus and Xenopsylla cheopsis

Fever and sore throat –
exam as shown

Corynebacterium diphtheriae

Cough, Coryza,
conjunctivitis and physical
exam as shown

Koplik spots: Measles

Peruvian with this skin
rash
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
Carrion’s Disease, Oroya Fever – Bartonella bacilliformis
Vector: sandfly

Weight Loss, chronic fever

Pott’s disease: Mycobacterium tuberculosis

Buruli ulcer

Mycobacterium ulcerans

The Great Pox

Syphilis, Treponema pallidum

Leading cause of blindness
in the world

Chlamydia trachomatis

10 year old from South
Carolina with fever,
headache, and this rash
after a camping trip

Rickettsia rickettsii, Rocky Mountain Spotted Fever
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Lockjaw

Clostridium tetani

Fever, facial rash

Fifth disease, Parvovirus B19

Recurrence of petechial
rash, fever and headache
10 years after similar
symptoms in a southeast
Asian refugee camp

Brill-Zinsser disease: Rickettsia prowazwkii

Sign associated with
Staphylococcal scalded
skin syndrome

Nikolsky’s sign

8 month old Japanese
child with conjunctivitis,
strawberry tongue,
fissured lips, truncal rash,
lymphadenopathy and
desquamation

Kawasaki’s syndrome

Connecticut resident with
this rash and arthritis
following a camping trip

Lyme disease: Borrelia burgdorferi

Persistent facial tingling
and numbness in a 21 year
old female honeymooning
in Florida

Ciguatera fish poisoning; consumption of fish which
consume dinoflagellates with ciguatera toxin

Hypogammaglobulinemia and
diarrhea

Giardiasis: Giardia lamblia

Headache, facial flushing,
conjunctival injection,
diarrhea and nausea one
hour after eating at a
seafood restaurant

Scombroid poisoning

Coughed up this egg

Paragonimus westermani

Fever and myalgias in
arctic explorers

Trichinella spiralis

This appearance on
Mueller-Hinton agar

Pseudomonas Aeruginosa - from production of pyoverdin
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Al Capone
Ivan the Terrible
Henry VIII
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Syphilis,Treponema pallidum


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Laennec
Chopin
Goethe
Brontë Sisters

Mycobacterium tuberculosis

9 month old boy with recurrent
otitis and pneumonia, normal
lymph nodes, no plasma cells,
normal cell mediated immunity,
hypogammaglobulinemia

Bruton’s (X-linked) agammaglobulinemia; deficit of btk
(Bruton tyrosine kinase)

PMN dysfunction,
increased IgE, recurrent
staph abscesses,
bronchiectesis, eczema,
red hair

Job’s syndrome

Recurrent sinopulmonary
infections, decreased IgA,
anergy and progressive
ataxia

Ataxia-Telangectasia

Neonatal tetany,
lymphopenia, normal
immunoglobulins, absent
thymus, infections with
Herpes, Candida

DiGeorge’s Syndrome

Recurrent staphylococcal
abscesses, normal PMN
phagocytosis, abnormal
nitroblue tetrazolium test

Chronic Granulomatous Disease

Recurrent infections,
thrombocytopenia,
eczema, decreased
lymphocytes, decreased
IgM, increased IgA

Wiscott-Aldrich Syndrome – often recognized as poorly
controlled bleeding after circumcision

PMNs with giant granules

Chediak-Hegashi Syndrome

New Guinea child
trembling with fear

Kuru – spongiform encephalopathy (prion disease)

35 year old male with 6th
episode of sterile
lymphocytic meningitis in
one year

Mollaret’s meningitis: HSV

60 year old male with
pulmonary infection,
arthritis, fever,
malabsorption, dementia
and this finding on jejunal
biopsy

Trephorema whippeli: Whipple’s disease

Cause of this finding

HSV dendritic corneal ulcer

Female from India with
this finding on soft tissue
x-ray

Guinea worm: Dracunculus medinensis

Biliary carcinoma in a
Vietnamese male

Clonorchis sinensis

Recurrent UTIs and
hematuria in an Egyptian
male

Schistosoma hematobium

Infection following a rat
bite

Rat bite fever: caused by Streptobacillus moniliformis or
Spirulina minus

Cause of this clinical sign

Clostridium tetani

Dishwater pus

Meleney’s synergistic gangrene

Right upper quadrant pain
in a Libyan male

Amoebic liver abscess: Entamoeba histolytica

Fevers occurring every 21
days

Cyclic neutropenia – associated with aphthous ulcers

Most commonly
transmitted infectious
agent in blood
transfusions

CMV - cytomegalovirus

Fish handler with this
infection of a finger

Erysipeloid: Erysipelothrix rhusiopathiae

This finding on
microscopy of a draining
wound

Sulfur granules: Actinomyces

Sore throat, cervical
lymphadenopathy, this
finding on peripheral
blood smear

Atypical lymphocyte: Epstein-Barr Virus

Sabin-Feldman test

Toxoplasma gondii serology test

Weil-Felix test

Serologic test for rickettsial diseases; cross reacts with
OX strains of Proteus species which may confound test

Organism leading to this
finding

Purpura fulminans: Neisseria meningitidis

Cause of this finding on
pupil exam

Argyll-Robertson pupils; seen in Neurosyphilis – pupils
accommodate but do not react to light



Hydrophobia
Aerophobia
Dysphagia

Rabies: Negri body

Prozone phenomenon

False negative non-treponemal antibody test seen in
setting of profound antigen excess (especially secondary
syphilis)

1 month old infant with
decreased ability to suck,
weak cry, progressing to
floppy condition

Clostridium botulinum