exam 4 microbiology – Flashcards
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| septicemia |
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| - microbial infection of the blood - bacteremia or toxemia - septic shock= low blood pressure resulting from dilation of blood vessels, decrease in body temp, no urine, rapid breathing,anxiety, increased heart rate cause: different bacteria classic sign: low blood pressure, leads to shock, petechiae indicates toxin present, lymphangitis indicates infection of lymphatic system other: GI tract symptoms, fever, chills, nausea, vomiting, shortness of breath, confusion, anxiety, impending doom feeling *opportunistic and often gram negative 2 types |
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| bacteremia |
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| bacterial septicemia |
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| toxemia |
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| toxins in blood (septicemia) |
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| septic shock |
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| septic shock= low blood pressure resulting from dilation of blood vessels, decrease in body temp, no urine, rapid breathing,anxiety, increased heart rate cause: different bacteria classic sign: low blood pressure, leads to shock, petechiae indicates toxin present, lymphangitis indicates infection of lymphatic system other: GI tract symptoms, fever, chills, nausea, vomiting, shortness of breath, confusion, anxiety, impending doom feeling *opportunistic and often gram negative 2 types |
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| lymphangitis |
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| indicates infection of lymphatic system, red streaks |
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| petechiae |
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| indicate toxin present in septicemia |
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| endocarditis |
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inflammation of endocardium acute- not chronic (normal microbiota) chronic/ subacute- severe (streptococcus) cause: differs signs: splinter hemorrhages in nails, heart murmur, extreme fatigue, fever, malaise, heart murmurs, difficulty breathing, destruction of heart valves pathogens: 1. low virulence streptococci (chronic/ rheumatic fever) enters from previous heart valve damage 2. staphylococcus aureus, s epidermidis (acute)- people otherwise healthy, enters from infected tooth, skin lesion, catheter, or drug use 3 others: happens with trauma, surgery, infection, or drug users *vegetations= damage to valves
Normally, blood flows smoothly past these valves. If they have been damaged (from rheumatic fever, for example) the risk of bacteria attachment is increased.[2] |
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| splinter hemorrhages |
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| found in patients with endocarditis on nails |
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| lyme disease |
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| progressive disease leading to severe arthritis (not fatal) transmitted by a tick, bulls eye rash and severe fatigue cause: borrelia burgdorfei (bacteria) stage 1: expanding red rash (bulls eye) in 80%, malaise, headache, dizziness, stiff neck, fatigue, fever, chills stage 2: neurological symptoms and cardiac dysfunction (10%) stage 3: severe arthritis (80%) - antibiotics to treat |
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| bull's eye rash |
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| seen in lyme disease |
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| infectious mononucleosis |
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| caused by EBV (epstein barr virus), extreme fatigue, enlarged nodes and spleen, "THE KISSING DISEASE" signs: severe sore throat, fever, enlarged spleen and lymph nodes, extreme fatigue, nausea, loss of appetite, rash. transmitted: direct/indirect contact and droplets *B cells are infected !!! so Tc cells target and killthem - supportive treatment, no contact sports due to danger of enlarged spleen - nearly impossible to prevent pathogen: epstein barr virus (EBV or HHV-4) |
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| african viral hemorrhagic fevers |
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| - ebola virus -marburgvirus signs: FEVER, fatigue, dizziness, muscle pain, exhaustion, minor petechiae, severe INTERNAL HEMORRHAGING AND BLEEDING, death from shock, seizures, kidney failure cause: infected macrophages trigger localized blood clotting depleting serum of blood clotting proteins ebola virus: 90% fatal, marbugvirus= 25% fatal transmitted by bodily fluid contact, supportive treatment |
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| malaria |
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| plasmodium PROTOZOAN, caused by different species, transmitted through infected mosquito, SEVER AND RECURRENT FEVER AND CHILLS, JAUNDACE 1. liver cells infected, grow and rupture letting organisms in to blood stream 2. RBCs infected next through stages and eventually are ruptured and released again. RING SHAPED RBC TO DIAGNOSE 3. more RBCs infected after rupture symptoms: plasmodium in blood stream, HIGH FEVER, chills, shaking IN CYCLES (every 48-72 hrs) CAN BE FATAL cellular debris and RBC protein in blodo impacts how liver and kidneys function * jaundace and dark urine seen *strokes, heart attacks |
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| ring state/stage |
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| second stage of malaria in which rbis that are infected are ruptured (seen as ring shape) |
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| toxoplasmosis |
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| cause: toxoplasma gondii (PROTOZOAN) sign: BLINDNESS, 80% asymptomatic, with poor immunity however fever, malaise, inflammation of lungs, headache, confusion, blindness, myocarditis, encephalitis and death casued by:eating contaminated meats PORK AND BEEF or also from KITTY LITTER (pathogen of rodents) transplacental transfer may cause epilepsy, mental retardation, microcephaly , eye infection, still birth,jaundice, miscarriage ANTIPROTOZOAN TREATMENT avoid contact |
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| shistosomiasis |
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| WORM/ helminthic (shistosoma) classic sign: dermatitis where they have burrowed in skin cause: con tam water, spiny eggs seen in feces, known as swimmers itch or snail fever *antihelmithic treatment 1. larvae burrow into tissue and gain access to blood stream 2. spots of dermatitis seen (itching) 1st indication 3. leaves human in feces and urine where it is picked up by snail and formed there and is then re released |
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| dermatitis |
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| irritation of skin |
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| streptococcus species |
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| gram positive cause strep throughout |
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| borrelia burgdorferi |
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| causes lyme disease |
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| ebv |
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| epstein-barr virus |
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| ebola virus |
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| an african viral hemorrhagic fever |
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| marburgvirus |
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| an african viral hemorrhagic fever |
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| plasmodium |
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| causes malaria (PROTOZOAN) |
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| toxoplasma gondii |
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| causes toxoplasmosis (PROTOZOAN) |
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| schistosoma |
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| causes shistosomiasis (PARASITIC WORM) |
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| streptococcal pharyngitis |
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| -strep throat -bacterial upper disease cause: streptococcus pyrogenes (bacteria)(gram positive cocci) virulence factors: m protein, capsule, streptokinases, c4a peptidase, erthrogenic toxin, streptolysins transmitted: droplets classic sign: tonsil abscesses also: swollen lymph nodes, laryngitis, bronchitis, scarlet fever if erythrogenic toxin is made, rheumatic fever if untreated, |
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| scarlet fever |
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| cause: streptococcus pyrogenes (bacteria) classic sign: systemic rash other: follows strep throat, erythrogenic toxin, lysogenized |
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| rheumatic fever |
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| develops with pain in heart and joints from untreated step causing heart valve damage predisposes you to subacute endocarditis causes chronic endocarditis - predisposed - damages heart valve |
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| erythrogenic toxin |
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| toxin released by streptococcus pyrogenes during strep throat causing scarlet fever |
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| laryngitis |
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| irritation of larynx due to bacteria from strep spreading from pharynx to larynx |
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| bronchitis |
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| inflammation of bronchiole tubes |
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| diptheria |
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| pathogen: corynebacterium diptheriae, *THE DIPTHERIA TOXIN RELEASED MUST BE LYSOGENIZED signs: sore throat, PSEUDOMEMBRANE, localized pain and fever, pahryngitis, oozing fluid leading to pseudomembrane transmisison: droplet tratment: antitoxin and antibiotics prevention: VACCINE!!! Dtap |
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| pseudomembrane |
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| large pus patch on throat from diphtheria |
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| diptheria toxin |
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| bacterial upper disease, toxin that is released (corynebacterium diphtheria, must be lysogenized) causing sore throat, pain ,fever, oozing pseudomembranes |
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| rhinosinusitis |
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| bacterial upper disease sinus infection signs: pain, pressure in sinus area usually caused by normal microbiota of throat pathogenesis: pharynx to sinuses through connections with the throat canal antibiotics |
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| otitis media |
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| ear infection signs: severe pain in ears usually caused by normal microbiota of throat pathogenesis: pharynx to ears through connections bacterial upper disease with the ear canal antibiotics |
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| pharyngitis |
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| sore throat inflammation |
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| common cold |
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| >200 viruses upper viral disease dry cough**** sneeze, runny nose, congestion, sore throat, dry cough, maybe no caught, USUALLY NO FEVER kils nasal mucosal cells |
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| pneumonia |
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| - bacterial lower disease - inflammation of the lungs, alveoli, and bronchioles become filled with fluid - caused by streptococcus pneumonia (OPPORTUNISTIC!!! member of normal microbiota signs: fever, chills, congestion, PRODUCTIVE COUGH, chest pain, rapid breathing virulence: capsule, with pneumolysin pathogenesis: inhaled from pharynx to lungs, opportunistic antibiotics, vaccine against pneumococcus |
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| pneumococcal pneumonia |
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| pneumonia caused by bacteria streptococcus pneumoniae |
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| pneumolysins |
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| KILLS CILIATED EPITHELIAL CELLS Pneumolysin is a putative virulence factor of the gram-positive bacteria Streptococcus pneumoniae. It is a pore-forming toxin of 53 kDa composed of 471 amino acids. It has a range of biological activity, including the ability to lyse and interfere with the function of cells and soluble molecules of the immune system. |
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| tuberculosis skin test |
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| cause: mycobacterium tuberculosis asymptomatic!!!!!!! *macrophages infected, tubercule formation, dif stages primary-no signs, macrophages infected, tubercle formed, primary ends once its formed secondary- tuburcle ruptures possibly becomes disseminated, productive cough and blood and weight loss begin diseminated- (has left lungs causing infection and disease, macrophages left lungs) skin test: if the skin is red/swollen this means the immune system has memory cells and has been exposed before (so either you have been exposed OR have had the vaccine which is not usually given in US) - doctor will take chest X-ray to look for tubercle which will always be present in the case of tb |
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| primary/secondary/disseminated tuburculosis |
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| primary- no signs, ends when tubercle formes secondary- tubercule is there and ruptures, cough with blood and production and chest pain diseminated- macrophages leave lungs |
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| pertusis |
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| whooping coug, reemerging disease (children under 5 may be a fatal disease) cuase: bordetella pertusis bacteria, produced pertusis toxin (cytotoxin) creating excessive mucous production signs: prolonged cough followed by inhalation, begins with runny nose, mild fever, after 1-2 weeks vomitting, diarrhea, choking, cyanosis SUPPORTIVE treatment because antibiotics will release toxins possibly making it worse |
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| pertussis toxin |
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| also called cytotoxin, creates excessive mucous production in pertusis/whooping cough |
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| influenza virus HA and NA spikes |
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| - viral lower disease -dry cough, sudden high fever, myalgia - influenza virus A and B most common -8 RNA molecules make up the genome- genetic material tell it how to make spikes on surface called HA and NA spikes - hemagglutinin (HA) and neuraminidase(NA) spikes- on surface and important for virus attachment and is what immune system responds to GENETIC VARIABILITY antigenic drift- respiratory cells become infected by virus, as virus is going through synthesis there are mutations and changes to the genes, so what exits the cell is a slightly different virus (genetically different and spikes are different) (small change, minor) (account for minor outbreaks winter to winter) *BOTH A and B undergo shift antigenic shift- a major change to a very severe influenza, when pigs, birds, and people are living very closely together it creates a melting pot of influenza viruses. A cell becomes infected by virus 1 and virus 2, a third virus comes out of the respiratory cell (so they viruses are basically mixed) * 2 viruses enter>>> a 3rd is formed **ONLY INFLUENZA A UNDERGOES THE SHIFT (viruses are renames when they shift, named by their spikes changing) (more severe in under 2, over 65, or pregnant women (dangerous to pregnant lady, not baby) ) 1918-1919: 20-40% of people became ill, 40 million died ( we heard the bells) (young and healthy people died 20-50) CHEMICALS RELEASED FROM IMMUNE SYSTEM CAUSE SYMPTOMS RESPIRATORY EPITHELIAL CELLS ARE KKILLED VACCINE AVAILABLE |
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| antigenic drift |
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| antigenic drift- respiratory cells become infected by virus, as virus is going through synthesis there are mutations and changes to the genes, so what exits the cell is a slightly different virus (genetically different and spikes are different) (small change, minor) (account for minor outbreaks winter to winter) *BOTH A and B undergo shift |
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| antigenic shift |
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| antigenic shift- a major change to a very severe influenza, when pigs, birds, and people are living very closely together it creates a melting pot of influenza viruses. A cell becomes infected by virus 1 and virus 2, a third virus comes out of the respiratory cell (so they viruses are basically mixed) * 2 viruses enter>>> a 3rd is formed **ONLY INFLUENZA A UNDERGOES THE SHIFT (viruses are renames when they shift, named by their spikes changing) (more severe in under 2, over 65, or pregnant women (dangerous to pregnant lady, not baby) ) 1918-1919: 20-40% of people became ill, 40 million died ( we heard the bells) (young and healthy people died 20-50) |
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| RSV and tracheobronchtis (croup) |
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| respiratory synctial virus - most common childhood respiratory disease in newborns and young children - fever, runny nose, CYANOSIS, coughing, wheezing - most common cause of bronchiolitis or pneumonia and may cause CROUP- fever and distinct cough and wheezing only in children - pathogenesis: - causes giant, multinucleate cells to form (SYNCTIAL) - immune responses also damage the lungs treat: - antibodies would be given from treatment whichh neutralize the virus present - proper ascetic technique by HCW |
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| cyanosis |
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| turning blue |
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| streptococcus pyrogenes |
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| bacteria that causes strep throat, scarlet fever, and rheumatic fever |
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| corynebacterium diphtheria |
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| bacteria causes diphtheria |
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| streptococcus pneumoniae |
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| bacteria causes pneumonia |
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| mycobacterium tuberculosis |
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| bacteria causes tb |
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| bordetella pertusis |
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| bacteria causes whooping cough |
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| influenza virus |
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| virus causing flu, |
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| RSV |
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| (tracheobronchitis)- RSV virus causes this barking coug, wheezing, labored breathing in children--- leads to CROUP in newborns/young, cyanosis ANTIBODIES GIVEN |
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| histoplasma capsulatum (MYCOSES) |
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| fungal infection/mycoses - sever cough, blood tinged sputum - bird/bat droppings/vehicle transmission cause: histoplasmosis, a fingu that is dimorphic (found as yeast as well s mold depending on conditions MORE LIKELY YEST) - 95% asymptomatic infected macrophages carry pathogen outside of lungs |
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| normal microbiota are present where |
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| tongue, colon, teeth, jejenum, ileum, rectum NOT MANY in esophagus, stomach, duodenum (due to peristalsis and stomach acid) |
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| how do normal microbiota help |
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| - compete with pathogens for space and nutrients - help ward off IBS, Crohns disease - alleviate symptoms of gastroenteritis - may shorten the duration of colds by 36 hours - mediates whether a person is obese or lean |
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| Why does use of antibacterial drugs over an extended time increase the likelihood of oral candidiasis (thrush) and so-called C. diff diarrhea? |
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| - because it kills off normal microbiota allowing yeast to flourish |
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| caries |
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| Caries – holes or pits in teeth; initially painless but teeth become increasingly sensitive * biofilm formation and fermentation |
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| periodontal disease |
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| swollen and/or bleeding gums, tender and bright red gums *progresses from gingivitis |
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| dental pathogens are |
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| Streptococcus mutans and Lactobacillus- both normally present in mouth, but our lifestyle allows them to cause these diseases **** they use sucrose as a nutrient source… dextran is made as a byproduct allowing organisms to stick to teeth allowing microbes to form biofilm and then plaque |
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| strep mutans and lactobacillus are |
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| microbiota in mouth that use sucrose as nutrient source and make dextran which allows them to stick to teeth |
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| ______ and adhesion factors allow for biofilm formation; fermentation produces acid that destroys enamel |
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| dextran |
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| dental calculus |
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| dental calculus [calcified plaque] at gum line triggers gingivitis; if not corrected, further tissue destruction occurs along with bone loss |
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| Bacterial Gastroenteritis |
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| - inflammation of stomach or intestines caused by bacteria shigella- causes shigellosis- type of gastroenteritis ( transmitted by food or water that has fecal contamination) often opportunistic infection signs: fever, abdominal cramps, diarrhea, BLOODY STOOL!!!! -clostridum difficile- normal microbiota, severe diarrhea or PSEUDOMEMBRANES IN COLON (pseudomembrane colitis) * often noscomial infection due to antibiotics due to clostridium making endospores in poop, so cleaning rooms is important *fecal microbiota transplant *fluid and electrolyte replacement treatment *prevent by proper handling of food |
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| shigella |
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| (type of bacterial gastroenteritis) shigella- causes shigellosis- type of gastroenteritis ( transmitted by food or water that has fecal contamination) often opportunistic infection BLOODY STOOL! dysentery, cramps, fever |
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| clostridium difficile |
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| type of bacterial gastroenteritis -clostridum difficile- normal microbiota, severe diarrhea or PSEUDOMEMBRANES IN COLON (pseudomembrane colitis) ENDOSPORE FORMER, oportunistic !!!! * often noscomial infection due to antibiotics due to clostridium making endospores in poop, so cleaning rooms is important *fecal microbiota transplant *fluid and electrolyte replacement treatment *prevent by proper handling of food |
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| salmonella |
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| type of bacterial gastroenteritis - not normal microbiota, ingested from fecal matter from some animal chicken eggs, reptiles *fever, cramps, WATERY DIAREHEA |
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| bacterial food intoxications |
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| -food poisoning caused by toxins, microbe is either present or not present (ingesting toxin like food borne botulism) - signs: nausea VOMITING, diarreha, cramping, bloating, fever, FLUID LOSS AND DEHYDRATION pathogen= staphlococcus aureus that must produce enterotoxin processed meats, custard pies, potatoe salad, ice cream, higher sugar foods - contamination when it is at room temp or higher for several hours fluid and electrolyte replacement |
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| viral gastroenteritis |
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| -generally less severe than bacterial gastroenteritis symptoms: abdominal pain, cramping, diarrhea, nausea, vomiting, fver, chills clammy skin, weight loss noroviruses (a calicivirus)- in adults mostly (most common form) rotaviruses- much more severe and common in young children less than 5 (vaccine now) pathogenesis: infects cells lining the intestinal tract, as those cells die the normal function of intestinal tract is lost FLUID AND ELECTROLYTE REPLACEMENT |
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| viral hepatis |
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| - inflammation of liver by autoimmune disease, alcohol or drug abuse, genetic disorders, or microbial infections liver stops functioning from virus as well as immune response symptoms: jaundice, light colored stools, nausea, vommiting, fatigue, fever, weight loss typs: HAV- fecal/oral (food preperation) doesn't become chronic and doesn't lead to cancer *if exposed vaccine given because 15-45 day incubation HBV- needles, sex, blood, fluids * chronic and may cause hepatic cancer *NEWBORNS and children under 5 most likely to become chronic AGE RELATED!!! *vaccine HCV- needles, sex *chronic, hepatic cancer *NOT AGE RELATED, 80% chance of it being chronic and leading to liver cancer because the virus undergoes a lot of genetic mutations and defenses can't keep up. NO CURE treatment: antibodies, interferon, NO CURE vaccine fror HAV and HBV |
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| HAV |
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| hep a- fecal/oral transmission, not chronic, no cancer, vaccine may be given because incubation is 15-45 days treat: antibodies, interferon |
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| HBV |
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| hep b- needles, sex, blood, fluids *chronic and may cause hepatic cancer *newborns and children less than 5 most likely to become chronic , AGE RELATED, VACCINE AVAILABLE treat: antibodies, interferon, |
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| HCV |
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| hep c- needles, sex *chronic, hepatic cancer, NOT AGE RELATED, no cure, genetic changes and defenses can't keep up 80% chance of being chronic treat: antibodies,interferon, no cure |
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| giardias |
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| cause: giardia (protozoan) severe frothy, fatty diarrhea with rotten egg smell FROM backpacking, camping, contaminated fresh water, pets |
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| tapeworm infestations |
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| parasitic worm -taenia helminthic worm - usually asymptomatic, maybe cramps, nausea, weight loss, diarrhea BEEF AND PORK antihelminthic treatments COOK THOROUGHLY - beef and pork, ingest eggs or proglottids has hooks, suckers, necks, and segments called proglottid with eggs!!! |
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| proglottid |
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| part of tapeworm |
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| pinworm infestations |
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| enterobius (parasitic wormm) intense perianal itching, sleep disturbance, school aged children, dislodge eggs from scratching, female moves to anus (from colon) at night depositing eggs personally |
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| what is a dental calculus |
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| calcified plaque |
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| contrast gastroenteritis and food intoxication |
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| gastroenteritis is an infection of the GI tract while food intoxication is from ingesting a toxin on food. incubation for gastro may be a few days while food intoxication can be as quick as 30 mins |
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| HBV and HCV and role of immune |
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| when hbv infection occurs at a young age, the immune system is not developed enough to clear the virus. HCV undergoes genetic changes, changing the antigens which confuses the immune system and stops it from clearing |
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| bacterial UTI |
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| escherichia coli - frequent urgent need to urinate and painful - urethritis(ut inflammation), cystitis (bladder inflammation), pyelonephritis(bacteria in kidney), common HAI |
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| streptococcal acute glomerulonephritis |
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| -streptococcus pyrogenes -inflammation of the glomeruli and nephrons of kidneys -antigen- antibody complexes accumulate leading to inflammation SIGNS: high blood pressure, low urine output, blood and proteins in urine |
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| toxic shock syndrome |
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| -staphylococcus aureus causes! - toxic shock syndrome toxins (TSSTS) - sudden onset of fever, chills, vommiting, diarrhea, low BP, mental confusion, Severe rash 50% fatality rate if untreated -TSSTS cause activation of T cells resulting in an over abundance of cytokines -prolonged use of tampons, or surgery packing MEDICAL EMERGENY- remove, antibiotics, anti TSST IG |
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| bacterial vaginosis |
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| - gardnerella, mycoplasma - vaginal itching, white discharge with fishy odor - vaginal pH >4.5 (due to lactobacilli decreasing) - sometimes asymptomatic - oral or vaginal antibiotics |
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| vaginal candidiasis |
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| - candida fungus -white curd like discharge, sever itching and burning(worse on urination) -occurs when norm or microbiota are altered or ph>4.5 -topical or oral antifungal treatments - oportunistic |
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| gonorrhea |
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| neusseria gonorrhoeae (fimbriae, capsule, endotoxin, protease enzyme (destroys IgA) - infects cervix, can attach to sperm cells that carry Ng to uterine tubes ANTIBIOTICS- resistance is a problem - no long term immunity - sexual abstinance, monogamy, and use of condoms prevent men- painful urination, discharge women- painful urination, bloody discharge , but often asymptomatic *CAN LEAD TO PID |
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| syphilis |
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| treponema pallidum 1. chancre- painless hard lesion 2. rash, palms/soles- doesn't itch or hurt (may have sore throat or mild fever) 3. dementia, blindness, paralysis, heart failure, or syphilitic gummas (rubbery swollen lesions in bones, nervous tissue, or skin) LATENT- may have no symptoms PENICILLIN G progression, especially in absence of treatment |
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| genetial herpes |
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| signs/symptoms: numerous small blisters that break out and become painful ulcers -pathogens: HHV (85% caused by HHV-2) latent virus - blisters from when viral replication kills epithelial cells -latent viruses may trigger recurrent lesions - asymptomatic periods will still result in transmission of virus TREATMENT - acycovir, can relieve and lessen blister formation but no cure - C section necessary if blisters at birth |
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| genital warts |
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| various strains of HPV cause it - generally harmless growths of epithelial cells -small or large - may be itchy, bleed or increase vaginal discharge TreatmentL Tc cells eventually recognize and destroy infected cells, or surrey, freezing, burning, laser, or chemicals PREVENT -pap smear (linked to cervical cancer) - vaccine- protects from HPV |
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| trichomoniasis |
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| trichomonas vaginalis (protozoan) - women have malodorous yellow- green discharge, dysuria - men: urethritis BOTH MUST BE TREATED with ANTIPROTOZOAN |
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| what diseases have toxins |
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| - septicemia (if petichiae are present) -streptococcus pyrogenes releses erythrogenic toxin -diptheria (toxin must be lysogenizeD) |
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| endocarditis causes and whether they are acute or chronic |
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| streptococcus= chronic staphylococcus aureus, s epidermidis = acute |
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| lyme disease leads to |
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| 1. red bulls eye, malaise, stick neck, headache,dizziness,fever,chills 80% 2. neurological symptoms and cardiac disfunction 10% 3. severe arthritis 80% |
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| EBV causes what/ epstein barr virus |
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| infectious mononucleosis (kissing disease) signs: severe sore throat, fever, enlarged spleen and lymph nodes, extreme fatigue, nausea, loss of appetite, rash. |
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| plasmodium PROTOZOAN |
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| plasmodium protozoan causes malaria fever chills and shaking in CYCLES, jaundice, liver cells affected and ruptured, red blood cells affected and rupture to a RING SHAPE!!!!!, cellular debris and RBC protein in blodo impacts how liver and kidneys function * jaundace and dark urine seen *strokes, heart attacks |
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| which diseases are protozoans |
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| plasmodium, toxoplasmosis(kitty litter/pork n beef), giardia |
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| which disease is a parasitic worm |
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| shistosomiasis- dermatitis, spiny eggs in feces and urine |
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| what hurts when u get rheumatic fever |
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| joints, heart |
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| histoplasma capsulatum (MYCOSES) |
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| bird bat droppings |
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| which hepatitis is most common in kids |
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| hep B.... there is a vaccine thoo |
