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Antinuclear antibody (ANA) is a non-specific screening test to evaluate for the presence of rheumatic diseases. ANA screening often yields positive results in many connective tissue disorders and other autoimmune diseases, and may also be positive among normal individuals. Subtypes of antinuclear antibodies include anti-Smith (targets RNA) and anti-double stranded DNA (targets dsDNA) antibodies, both of which are associated with the diagnosis of systemic lupus erythematosus (SLE), and anti-histone antibodies (targets histones), which are associated with the diagnosis of drug-induced lupus.<br/>
'''Educational Objective:''' Subtypes of antinuclear antibodies include anti-Smith (targets RNA) and anti-double stranded DNA (targets dsDNA) antibodies, both of which are associated with the diagnosis of systemic lupus erythematosus (SLE), and anti-histone antibodies (targets histones), which are associated with the diagnosis of drug-induced lupus.<br/>
'''References:''' Migliorini P, Baldini C, Rocchi V, et al. Anti-Sm and anti-RNP antibodies. Autoimmunity. 2005;38(1):47-54.<br>
First Aid 2015 page 213, 433. +
Systemic sclerosis is usually classified by the extent of cutaneous manifestations and may be either limited (70%, less severe - positive anti-centromere antibodies) or diffuse (30%, more severe with visceral manifestations - positive anti-Scl-70 antibody). The limited cutaneous form of systemic sclerosis (lcSSc) may include characteristic vascular manifestations and is then termed CREST syndrome which is an acronym for the five main features: Calcinosis, Raynaud's syndrome, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. The patient is most likely diagnosed with CREST syndrome, whereby she complains of hardened skin patches (calcinosis), tight pale fingers (Raynaud's phenomenon), difficulty swallowing (esophageal dysmotility), and has positive anti-centromere antibodies. The majority of patients with CREST syndrome do not have all 5 characteristic features of the disease, but often have variable manifestations. The association between CREST syndrome and vascular abnormalities predisposes to the development of pulmonary hypertension when the pulmonary vasculature is affected. While limited sclerosis is associated with pulmonary hypertension, the diffuse form is typically associated with pulmonary fibrosis.<br/>
'''Educational Objective:''' Systemic sclerosis is usually classified by the extent of cutaneous manifestations and may be either limited (70%, less severe - positive anti-centromere antibodies) or diffuse (30%, more severe with visceral manifestations - positive anti-Scl-70 antibody). Vascular involvement in limited forms of scleroderms is referred to as CREST syndrome (Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia). CREST syndrome may be associated with pulmonary hypertension.<br/>
'''References:''' Lonzetti LS, Joyal F, Raynauld JP, et al. Updating the American College
of Rheumatology preliminary classification criteria for systemic
sclerosis: addition of severe nailfold capillaroscopy adbnormalities
markedly increase the sensitivity of limited scleroderma. Arthritis
Rheum. 2001;44(3):735.<br>
Silman AJ. Scleroderma. Bailleres Clin Rheumatol. 1995;9(3):471-82.<br>
First Aid 2015 page 436.
Mitral valve prolapse (aka primary form of myxomatous degeneration of the mitral valve aka floppy mitral valve syndrome) is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. Upon auscultation of an individual with mitral valve prolapse, a mid-systolic click, followed by a late systolic murmur heard best at the apex is common. Echocardiography is the most useful method of diagnosing a prolapsed mitral valve. Two- and three-dimensional echocardiography are particularly valuable as they allow visualization of the mitral leaflets relative to the mitral annulus. This allows measurement of the leaflet thickness and their displacement relative to the annulus. Thickening of the mitral leaflets >5 mm and leaflet displacement >2 mm indicates classic mitral valve prolapse.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
A spinal epidural abscess threatens the spinal cord or cauda equina by compression and also by vascular compromise (see images below). If untreated, an expanding suppurative infection in the spinal epidural space impinges on the spinal cord, producing sensory symptoms and signs, motor dysfunction, and, ultimately, paralysis and death. This patient is having cauda equina signs and immediate surgical consultation and operative decompression is the first step in management. All other answers are appropriate in the meantime, but after steps towards surgical release are taken.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
This patient displays criteria for bipolar disorder, manic with psychotic features. Individuals intoxicated with cocaine classically show signs similar to mania. Frank psychotic symptoms can occur in up to 50% of individuals.
Cocaine is a powerful nervous system stimulant. Its effects can last from 15–30 minutes to an hour, depending on dosage and the route of administration.
Cocaine increases alertness, feelings of well-being and euphoria, energy and motor activity, feelings of competence and sexuality. Athletic performance may be enhanced in sports where sustained attention and endurance is required. Anxiety, paranoia and restlessness can also occur, especially during the comedown. With excessive dosage, tremors, convulsions and increased body temperature are observed.With excessive or prolonged use, the drug can cause itching, tachycardia, hallucinations, and paranoid delusions. Overdoses cause hyperthermia and a marked elevation of blood pressure, which can be life-threatening.
Educational objective: Individuals intoxicated with cocaine classically show signs similar to mania. Frank psychotic symptoms can occur in up to 50% of individuals.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
Fetal alcohol syndrome is a leading cause of congenital malformation and intellectual disability in the United States. Newborns of mothers who consumed significant quantities of alcohol during pregnancy have an increased incidence of congenital abnormalities. These abnormalities include:
* pre-and postnatal developmental retardation
* microcephaly
* holopresencephaly
* facial abnormalities
* limb dislocation
* heart and lung fistulas.
The child exhibits microcephaly, facial abnormalities, both of which are tissue malformations. The patient's heart murmur is likely also caused by tissue malformation, but echocardiography would be required for confirmation.
Malformation refers to the intrinsic disruption of tissue structure, and it typically occurs during the embryonic period of development (3rd -8th week). Alcohol, a teratogen, exerts its effect during this stage of fetal development. Defective cell migration is thought to mediate a substantial fraction of alcohol's teratogenicity.<br/>
'''Educational Objective:''' Fetal alcohol syndrome is caused by the teratogen alcohol which causes congenital malformations, an error in organ morphogenesis during the embryonic period (3rd – 8th weeks).<br/>
'''References:''' Riley, Edward P., M. Alejandra Infante, and Kenneth R. Warren. "Fetal alcohol spectrum disorders: an overview." Neuropsychology review 21.2 (2011): 73-80.<br>
First Aid 2015 page 561 +
The patient is most likely diagnosed with Rubella virus infection (German measles). The primary symptom of rubella virus infection is the appearance of a rash (exanthem) on the face which spreads to the trunk and limbs and usually fades after three days. Other symptoms include low grade fever, swollen glands (typically post-cervical/post-auricular lymphadenopathy), joint pains, headache, and conjunctivitis. The swollen glands or lymph nodes can persist for up to a week, and the fever rarely rises above 38 <sup>o</sup>C (100.4 <sup>o</sup>F). The rash disappears after a few days with no staining or peeling of the skin.<br/>
'''Educational Objective:''' Rubella virus causes German measles with the clinical presentation of post-auricular lymphadenopathy and rash.<br/>
'''References:''' First Aid 2015 page 163 <br> +
This patient displays criteria for bipolar disorder, manic with psychotic features. Individuals intoxicated with cocaine classically show signs similar to mania. Frank psychotic symptoms can occur in up to 50% of individuals.
Cocaine is a powerful nervous system stimulant. Its effects can last from 15–30 minutes to an hour, depending on dosage and the route of administration.
Cocaine increases alertness, feelings of well-being and euphoria, energy and motor activity, feelings of competence and sexuality. Athletic performance may be enhanced in sports where sustained attention and endurance is required. Anxiety, paranoia and restlessness can also occur, especially during the comedown. With excessive dosage, tremors, convulsions and increased body temperature are observed.With excessive or prolonged use, the drug can cause itching, tachycardia, hallucinations, and paranoid delusions. Overdoses cause hyperthermia and a marked elevation of blood pressure, which can be life-threatening.
Educational Objective: Lorazepam is used to treat manic symptoms associated with cocaine intoxication and it has relatively rapid course of action.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
The patient is diagnosed with patent ductus arteriosus (PDA), which is characterized by significant postnatal left to right shunt. Pneumonia is a typical early manifestation of PDA, and PDA should be ruled out when infants are diagnosed with recurrent pneumonias shortly after birth. The ductus arteriosus (DA) is derived from the embryonic left sixth aortic arch. It connects the pulmonary artery to the aorta and it serves to shunt blood away from the lungs into the umbilical placental circulation, where gas exchange takes place. At birth, the closure of the DA is essential for postnatal adaptation. Its closure is initiated by an increase in oxygen and changes in both the pulmonary and systemic blood pressures. In full-term neonates, the DA typically closes within the first 5 days post-delivery. In preterm infants, however, failure of DA closure following birth is associated with an increased incidence of neonatal morbidity. The patency of the ductus arteriosus is primarily controlled by low fetal oxygen tension and the prostanoids in the blood produced from arachidonic acid metabolism.
Oxygen-induced constriction of the ductus arteriosus fails in preterm infants potentially due to immaturity of oxygen-sensing receptors. Smooth muscle relaxation of the ductus arteriosus results from the activation of the G-coupled prostaglandin receptor EP4 by PGE2. Within 1 – 5 days after a full-term birth, the ductus arteriosus closes as a result of increased oxygen tension and decreased circulating PGE2 and prostacyclins (PGI2).
Using either indomethacin or ibuprofen to trigger prostaglandin inhibition has been the standard of care to close the PDA in predisposed infants, who are particularly preterm. Surgical closure of the patent DA is often reserved to patients whose PDA fails to close following pharmacologic therapy.<br/>
'''Educational Objective:''' Oxygen-induced constriction of the ductus arteriosus fails in preterm infants potentially due to immaturity of oxygen-sensing receptors. Smooth muscle relaxation of the ductus arteriosus results from the activation of the G-coupled prostaglandin receptor EP4 by PGE2. Within 1– 5 days after a full-term birth, the ductus arteriosus closes as a result of increased oxygen tension and decreased circulating PGE2 and prostacyclin (PGI2).<br/>
'''References:''' Thebaud B, Lacaze-Mazmonteil T. Patent ductus arteriosus in premature infants: A never-closing act. Paediatr Child Health. 2010;15(5):267-70.<br>
The seventh report of the Joint National Committee on the prevention, detection, evaluation, and treatment of high blood pressure (JNC 7) key recommendations classify this patient in hypertension stage 1, as most of her BP readings are systolic blood pressure (SBP) in the 140–159 range and diastolic blood pressure (DBP) between 90 and 99.
*Category: SBP and/or DBP
*Normal: <120 and <80
*Prehypertension: 120–139 or 80–90
*Hypertension stage 1: 140–159 or 90–99
*Hypertension stage 2: >160 or >100
The primary purpose of the initial physical examination is to look for causes of secondary hypertension and for early organ damage due to untreated hypertension. In physical examination for a newly diagnosed patient with hypertension, there are recommendations to include BP measurement in both arms, examination of the optic fundi, BMI calculation, auscultation for carotid, abdominal and femoral bruits, palpation of the thyroid gland, examination of the heart and lungs, and examination of the abdomen for enlarged kidneys, masses, and abnormal aortic pulsation.
Educational objective: The primary aim of the initial physical examination is to look for causes of secondary hypertension and for early organ damage due to untreated hypertension.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
Inclusion cell disease (I-cell disease) is an inherited lysosomal storage disorder characterized by failure of addition of mannose -6- phosphate to lysosome proteins. It usually manifests with coarse facial features, clouded corneas, restricted joint movement, and in the majority of cases, it is fatal in childhood. The disease is caused by defective phosphotransferase enzyme that is located on the Golgi apparatus (involved cellular organelle). The Golgi apparatus is a distribution center of proteins and lipids from the endoplasmic reticulum (ER) to the plasma membrane, lysosomes, and secretory vesicles. It modifies N-oligosaccharides on asparagine and adds O-oligosaccharides to serine and threonine residues.<br/>
'''Educational Objective:''' The cellular organelle involved in I-cell disease disease is the Golgi apparatus. It is a distribution center of proteins and lipids from the endoplasmic reticulum (ER) to the plasma membrane, lysosomes, and secretory vesicles. It modifies N-oligosaccharides on asparagine and adds O-oligosaccharides to serine and threonine residues.<br/>
'''References:''' Leroy JG, DeMars RI, Opitz JM. I-cell disease; Birth Defects Orig Art Ser. 1969;4:174-85.<br>
First Aid 2015 page 73. +
HUS (Hemolytic Uraemic Syndrome) is the combination of a microangiopathic hemolytic anemia and acute renal failure. It is commonly associated with E. coli O157/H7 gastroenteritis. HUS is one of the most common causes of acquired renal failure in children.
EDUCATIONAL OBJECTIVE: HUS is triad of gastroenteritis, microangiopathic hemolytic anemia and acute renal failure.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
EXPLANATION: The most common finding in a newborn with Down syndrome is hypotonia. Other common findings include single palmar crease, flat facial profile, macroglossia, and wide space between the first and second toes. Hypotonia in the newborn period should prompt close evaluation and follow-up.
EDUCATIONAL OBJECTIVE: The most common finding in a newborn with Down syndrome is hypotonia which should prompt close evaluation and follow-up.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
EXPLANATION: Aortic stenosis is one of the most common valvular abnormalities found in adults. It can be congenital—such as a unicuspid or bicuspid valve—or acquired. In young adults, acquired aortic stenosis is often seen as a consequence of rheumatic fever. This is becoming less common in developed nations. In adults over the age of 65, the most common cause of aortic stenosis is age-related degenerative, calcific aortic stenosis. The valvular cusps are immobilized and the stenosis caused by calcium deposits along the flexion lines of the valves. Acquired aortic stenosis typically has a prolonged asymptomatic period. During this time the stenosis may be found incidentally by auscultation of the characteristic harsh, holosystolic murmur in the aortic valve area that radiates to the carotid arteries. There may also be a slow, small, and sustained arterial pulsation (pulsus parvus and tardus) due to the relative outflow obstruction.
When considering the diagnosis of aortic stenosis, the initial diagnostic test of choice would be echocardiography. It would provide information on both the structure (bicuspid, tricuspid, and the like) and the function (valve area, pressures) of the valve. The size and function of the left ventricle can also be determined.
EDUCATIONAL OBJECTIVE: Aortic stenosis is one of the most common valvular abnormalities found in adults. The initial diagnostic test of choice would be echocardiography.<br/>
'''Educational Objective:''' <br/>
'''References:''' +
Pasteurella multocida is a non-motile, penicillin-sensitive, Gram-negative coccobacillus that causes zoonotic infections in humans following bites or scratches from pets (such as cats and dogs). Many mammals and fowl harbor it as part of their normal respiratory flora. Inflammatory signs of pasteurellosis are very rapid to develop. Classical presenting signs include severe pain, fever, swelling and exudation hours to a few days following a cat or a dog bite. Patients with more severe disease and bacteremia can present with vomiting, headache and diarrhea. Lymphangitis is common among infected patients. Untreated, the disease could lead to septic shock, septic arthritis, meningitis, endocarditis, or osteomyelitis. Depending on the stage of the infection, diagnosis is made by tissue or blood culture. Most cases of pasteurellosis can be prevented with a short-course of oral antibiotics following a cat or dog bite. Severe or progressing infections may require IV antibiotics, or surgical intervention. Pasteurella is generally susceptible to oral amoxicillin, amoxicillin/clavulanate, fluoroquinolones, trimethoprim-sulfamethoxazole, and tetracyclines. Most isolates are resistant to second generation cephalosporins, dicloxacillin, macrolides and clindamycin.<br/>
'''Educational Objective:''' Pasteurella multocida is sensitive to amoxicillin, amoxicillin-clavulanate, fluoroquinolones, and tetracycline. Most strains are resistant to second generation cephalosporins, dicloxacillin, macrolides and clindamycin.<br/>
'''References:''' Oehler RL, Velez AP, Mizrachi M, Lamarche J, Gompf S. Bite-related and septic syndromes caused by cats and dogs. Lancet Infect Dis. 2009;9(7):439-47.<br>
Weber DJ, Wolfson JS, Swartz MN, Hooper DC. Pasteurella multocida infections. Report of 34 cases and review of the literature. Medicine (Baltimore). 1984;63(3):133-54. +
Human bite wounds can be divided into 2 different types: occlusive injuries, defined as a wound from a direct bite, or clenched-fist injuries, defined as a wound from a fist striking teeth. Bacteria associated with human bite injuries are usually part of the oral flora and include viridans ''Streptococci'', ''Staphylococci'', anaerobic organisms (''Fusobacterium nucleatum'', ''Prevotella'', ''Peptostreptococci''), and ''Eikenella corrodens''. ''E. corrodens'' is a facultatively anaerobic, pleomorphic bacillus that requires ample carbon dioxide concentrations to thrive. ''E. corrodens'' is part of the normal flora of the oral cavity and the upper respiratory tract. ''E. corrodens'' infections are common in untreated human bite wounds, especially clenched fist injuries. ''E. corrodens'' infections typically progress slowly and can manifest clinically one to two weeks after inoculation. Complications include osteomyelitis, loss of joint function, and bacteremia with endocarditis. General treatment of human bite wounds includes irrigation and topical wound cleansing, however, unlike animal bites, prophylactic antimicrobials should be administered to all patients regardless of the wound appearance. Antibiotic regimens should cover: ''E. corrodens'', ''S. aureus'', ''Haemophilus'' species, and anaerobes. Notably, ''E. corrodens'' is resistant to first-generation cephalosporins, macrolides, clindamycin, and aminoglycosides. Adequate agents include amoxicillin-clavulanate, ampicillin-sulbactam, carbapenems, and doxycyline. Intravenous antibiotics are preferred in clenched-fist injuries.<br/>
'''Educational Objective:''' Prophylactic antimicrobials should be administered to all patients with human bite injuries. Antibiotic regimens should cover: ''E. corrodens'', ''S. aureus'', ''Haemophilus'' species, and anaerobes. Adequate agents include amoxicillin-clavulanate, ampicillin-sulbactam, carbapenems, and doxycyline.<br/>
'''References:''' Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. 2005;41(10):1373-406.<br>
Decker MD. Eikenella corrodens. Infect Control. 1986;7(1):36-41.
Familial hypertrophic cardiomyopathy (HCM) is an autosomal dominant disorder due to one or more of 11 identified missense mutations in genes that encode the thick and thin contractile myofilament protein components of the sarcomere (specifically the beta-myosin heavy chain and myosin-binding protein C) which are exclusive to the heart. Phenotypically, not all patients with the mutation manifest the disease, although phenotypic conversion is possible at any point in the disease. Diagnosis requires phenotypic confirmation with imaging, which demonstrates unexplained LV wall thickness >15 mm. Patients generally have a normal life expectancy-, but have a higher risk of sudden death, progressive heart failure, and paroxysmal or chronic atrial fibrillation. The typical murmur of HCM is a systolic ejection murmur that is intensified with conditions of decreased preload or after long cardiac cycles and softened with conditions of increased afterload. The hypertrophied interventricular septum with systolic anterior motion of the mitral valve among patients with phenotypically manifest disease may result in subaortic obstruction of the left ventricular outflow tract that produces a "double-tap" apical impulse as well as pulsus bisferiens (biphasic or beating twice). Treatment of HCM depends on the extent of symptoms. Beta-blockers are the first-line for outflow tract obstruction to decrease the flow gradient (same mechanism as decreased murmurs). Patients with siginificant obstruction may benefit from surgical septal myectomy. Implantable cardioverter-defibrillators are the only strategy shown to reduce the risk of sudden death.<br/>
'''Educational Objective:''' Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disorder due to one or more of 11 identified missense mutations in genes that encode the thick and thin contractile myofilament protein components of the sarcomere.<br/>
'''References:''' Maron BJ, Ommen SR, Semsarian C, Spirito P, Olivotto I, Maron MS. Hypertrophic cardiomyopathy: present and future, with translation into contemporary cardiovascular medicine. J Am Coll Cardiol. 2014;64(1):83-99.
Persistent pulmonary hypertension in the newborn may be either idiopathic or associated with prematurity, pulmonary hypoplasia, or premature closure of the ductus arteriosus. In hypoxemic newborns with pulmonary hypertension, inhaled nitric oxide reduces pulmonary vascular resistance and decreases the need for extracorporeal membrane oxygenation therapy. However, nitric oxide inhalation may result in elevations in methemoglobin leading to methemoglobinemia. In infants with PPH receiving nitric oxide, methemoglobin levels should be monitored every 4 hours and maintained below 5%. Infants with methemoglobinemia have signifcant cyanosis. Methemoglobin interferes with the regular pulse oximetry often giving a reading higher than the true available oxygen, and not in proportion to the level of cyanosis. A co-oximeter, able to differentiate oxyhemoglobin, methemoglobin, and deoxyhemoglobin, is the best way to monitor methemoglobin levels. Treatment should be initiated promptly in patients with elevated methemoglobin with or without clinical manifestations. Methylene blue is the optimal initial agent. Exchange transfusions are recommended when methylene blue is contraindicated (E.g.: G6PD deficiency). Methylene blue increases the rate of reduction of methemoglobin into hemoglobin by converting the iron moeity from a ferric ion (Fe<sup>3+</sup>) into a ferrous ion (Fe<sup>2+</sup>).<br/>
'''Educational Objective:''' Methylene blue is the treatment of choice in methemoglobinemia. It increases the rate of reduction of methemoglobin into hemoglobin by converting the iron moeity from a ferric ion (Fe<sup>3+</sup>) into a ferrous ion (Fe<sup>2+</sup>).<br/>
'''References:''' Jaffe ER, Neurmann G. A comparision of the effect of menadione, methylene blue and ascorbic acid on the reduction of methemoglobin in vivo. Nature. 1964;202:607-8.<br>
Bizzarro M, Gross I, Barbosa FT. Inhaled nitric oxide for the postoperative management of pulmonary hypertension in infants and children with congenital heart disease. Cochrane Database Syst Rev. 2014;7:CD005055.<br>
Hamon I, Gauthier-moulinier H, Grelet-dessioux E, Storme L, Fresson J, Hascoet JM. Methaemoglobinaemia risk factors with inhaled nitric oxide therapy in newborn infants. Acta Paediatr. 2010;99(10):1467-73.
The patient is most likely diagnosed with Down syndrome (trisomy 21), as evidenced by the phenotypic profile, Down syndrome is associated with duodenal atresia, which is characterized by the congenital underdevelopment of parts of the duodenum and is suggested by the vomiting and the double bubble sign on imaging. Down syndrome is strongly associated with an increased risk of congenital cardiovascular disease, especially endocardial cushion defects (AV canal). Down syndrome is also associated with other congenital heart diseases (less commonly than with endocardial cushion defects), namely ventricular septal defects (VSD) and atrial septal defects (ASD).<br/>
'''Educational Objective:''' Down syndrome is strongly associated with endocardial cushion defects (formation of AV canal), which is characterized by failure of migration of neural crest cells to the endocardial cushion.<br/>
'''References:''' FIrst Aid 2015 page 290. +
''Campylobacter jejuni'' is a curved, helical-shaped, non-spore forming, non-glucose-fermenting, microaerophilic, gram-negative bacteria. It is one of the most common causes of human gastroenteritis worldwide. Infection with ''C. jejuni'' occurs following invasion of the microorganism of the colonic mucosa with disruption of epithelial cells. ''C. jejuni'' has also been associated with subsequent development of Guillain-Barré syndrome, which usually develops two to three weeks after the initial illness. ''C. jejuni'' is commonly associated with ingestion of poultry as it naturally colonizes the digestive tract of many bird species. ''C. jejuni'' is grown on specially selective agar plates at 42°C, the normal avian body temperature, rather than at 37°C, the temperature at which the majority of other pathogenic bacteria are grown. Since the colonies are oxidase positive, they will usually only grow in scanty amounts on the plates. Microaerophilic conditions are required for abundant growth. A selective blood agar medium (Skirrow's medium) may also be used.
The following include the mportant oxidase-positive pathogens:<br>
*''Campylobacter''
*''Helicobacter''
*''Legionella''
*''Neisseria''
*''Pseudomonas''
*''Vibrio''<br/>
'''Educational Objective:''' ''Campylobacter jejuni'' is a curved, helical-shaped, non-spore forming, non-glucose-fermenting, microaerophilic, gram-negative bacteria. It is one of the most common causes of human gastroenteritis worldwide.<br/>
'''References:''' First Aid 2014 page 138. +