Term
| examples of obligate anaerobies |
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Definition
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Term
| Mechanism of anaerobe discovery in culture and how it is preserved |
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Definition
- dependent on specimen handling and culture techniques
- exclude air from specimen
- anaerobic transport media can be utilized
- specimen should be promptly delivered to lab
- special jar, chamber to culture where oxygen can be excluded
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Term
| Where would we find anaerobic bacteria in normal body flora |
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Definition
- mucosal surfaces
- oral cavity
- GI tract (dominate in distal ileium and colon while aerobes found more in proximal GI tract)
- upper resp. tract
- femal GU tract
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Term
| medically important anaerobes in the flora |
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Definition
- gram neg. rods- bacteriods, fusbacterium, prevotella
- gram pos. rods- clostridia (spore forming), actinomyces (non spore forming)
- gram pos. cocci- peptococcus, peptostreptococcus
- gram neg. cocci- veillonella
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Term
| place in body with primarily aerobic flora |
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Definition
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Term
| predisposing conditions/clinical characteristics of anaerobic infections |
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Definition
- secondary invaders from normal flora
- predisposing conditions
- tissue destruction- tumor, trauma, vascular insufficiency (all lead to tissue anoxia and low oxygen tension)
- antecedent aerobic infection
- complex polymicrobial
- foul smell
- gas in tissue
- abscess formation
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Term
| cause of intraabdominal sepsis |
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Definition
| secondary to breach in colon |
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Term
| sources of intra-abdominal or pelvic infection |
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Definition
- perforated appendix or diverticulum
- perforated colon cancer
- gunshot to abdomen
- post-op infection
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Term
| pathophysiology of intraabdominal sepsis according to rat model and what can prevent the various stages from occuring |
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Definition
- breach in colon
- leads to fecal material being released into peritoneal cavity
- contains many anaerobic species
- usually Bacterioides fragilis and E coli
- two stages
- peritonitis stage- 40% mortality (dominated by E coli)
- prevent death via antibiotics
- abscess stage after 7-14 days (dominated by B. fragilis)
- must use antibiotics that will work against this bacteria to prevent abscess formation
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Term
| Ludwig's angina (cause, def., predisposing factors) |
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Definition
- definition- infection in submandibular space (sublingual, submylohyoid)
- predisposing factors
- odontogenic infection
- trauma
- mandibular fracture
- foreign bodies
- neoplasm
- causative agents
- mixed oral aerobes, anaerobes
- sometimes S. aureus
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Term
| Clinical features of Ludwig's angina |
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Definition
- mouth pain
- drooling
- dysphagia
- resp. distress
- hot potato voice
- edema on floor of mouth with swelling and displacement of tongue post. and sup.
- woody tender swelling of suprahyoid region of the neck
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Term
| predisposing conditions of anaerobic pneumonia/ lung abscess |
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Definition
- altered consciousness
- alcoholism
- general anesthesia
- drug overdose
- esophageal dysfunction
- tonsillectomy/tooth extraction
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Term
| lung abscess clinical features and tx |
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Definition
- present with cough, fever, coppious foul smelling sputum
- chest X ray with cavitation with air/fluid level
- sputum gram stain shows mixed gram negative and positive organisms
- increased incidence of penicillin R
- clindamycin most effect
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Term
| reliable diagnosis specimens in bacterial pulmonology infections |
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Definition
- blood cultures
- direct lung punctures
- thoracotomy aspirates
- empyema fluid
- percutaneous transtracheal aspiration
- bronchospcopy with protected brush
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Term
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Definition
- mix of anaerobes and aerobes
- shown that anaerboes were by far dominant
- common aerobes- Strep. pneumonia, S. aureus, E coli
- common anaerobes- Clostridium, Bacteriocides
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Term
| predisposing factors to brain abscess |
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Definition
- otitis media
- sinusitis
- dental infection
- pneumonia
- abdominal/pelvic infection
- endocarditis (S aureus, Strep.)
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Term
| etiology of brain abscess |
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Definition
- primarly caused by oral flora
- 85% anaerobe
- gram positive cocci
- Fusobacterium, Bacteroids
- in setting of endocarditis- S aureus, Viridans Strep
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|
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Term
| clinical presentation of brain abscess |
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Definition
- subacute symptoms
- fever, altered sensorium
- focal neurologic defects
- increase intracranial P, papilledema
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Term
| diagnosis of brain abscess |
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Definition
- imaging via CT, MRI
- aspiration and gram stain, culture
- blood culture
- CI: lumbar puncture due to risk of increased intracranial P
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Term
| examples of localized anaerobic soft tissue infections |
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Definition
- DM, vascular ulcures
- decubitus ulcers
- human bites
- hydradenitis suppurtiva
- Meleney synergistic gangrene
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Term
| examples of diffuse infections in soft tissue caused by anaerobes |
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Definition
- anaerobic cellulitis
- necrotizing faciitis
- synergistic necrotizing cellulitis
- myonecrosis syndromes
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Term
| risk factors of DM soft tissue infection |
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Definition
- neuropathy- loss of sensation
- vasculopathy- impaired blood flow
- immunopathy- impaired WBC function
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|
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Term
| compare and contrast the two types of necrotizing fasciitis |
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Definition
- mixed
- rapid progression, substantial mortality
- maybe subtle skin findings initially
- pain out of proportion to clinical findings
- group A strep
- more rapid progress, higher mortality
- may have no skin findings
- even more painful
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Term
| Epidemiology, char, toxicology of clostridia |
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Definition
- epidemiology- ubiquitous in soil, water, sewage (part of normal flora)
- char- gram positive spore forming bacilli
- produce multiple toxins
- cytotoxins
- enterotoxins
- neurotoxins
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Term
| Clostrium perfringes (toxins, what it causes) |
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Definition
- gas gangrene (Clostridial myonecrosis)
- 12 toxins/enzymes
- alpha toxin- via PLC, causes hemolysis (cytotoxic)
- food poisoning
- enterotoxin (heat labile toxin released during spore formation)
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Term
| clinical features of gas gangrene |
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Definition
- clincial syndrome char. by severe pain and marked toxicity
- patients alert with impending sense of doom
- usually with antecedent trauma
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Term
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Definition
| make dx clinically (never via microbiologic dx)
palpable if cause is C repitus
visualize via X ray, CT, MRI |
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Term
| causative agents of gas in tissues |
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Definition
- anaerobes- Bacteroids, Clostridia, anaerobic strept.
- aerobes if high glucose
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|
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Term
| danger signs of gas gangrene |
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Definition
- severe pain
- severe systemic toxicity
- hypoesthesia
- ecchymoses or bullae
- soft tissue gas
- rapid extension
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Term
| Char., toxins of C. tetani |
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Definition
- char.- anaerobic spore forming rod
- tetanospasmin- dimeric toxin
- neurotoxin (produced during stationary phase of growth)
- block inhibitory transmitter release at inhibitory synapse in spinal cord (ex: GABA, Gly)
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Term
| different types of tetanus and incubation period |
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Definition
- incubation- seven days usually (0-90 day range)
- localized- muscle spasms localized to area of primary infection
- generalized- lockjaw, persistent back spasm, autonomic dysfunction
- neonatal- associated with infection of umbilical stump (mortality 90%)
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Term
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Definition
- wound debriment
- antibiotics
- passive immunization (tetanus IG)
- active immunization (tetanus toxoid)
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Term
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Definition
- characteristics- spores heat resistent, present in soil
- VF- botulism toxin
- type A, B, E
- indiv. isolates prod. only one toxin
- type E with aquatic animals
- block ACh release at motor end plates leading to paralysis
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Term
| botulism (sources and what associated with) |
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Definition
- food born (preformed toxin)
- associated with ingestion of home and commercially canned foods
- infant toxin formed in vivo (MOST COMMON IN US)
- associated with honey ingestion
- wound toxin formed in vivo
- associated with IV drug use
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Term
| foodborn botulusm (clinical symptoms, incubation period) |
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Definition
- anticholinergic effects- vomitting, dry mouth, dilated pupils
- CN paralysis
- descending flacid motor paralysis
- incubation: 12-36 hrs
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|
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Term
|
Definition
- remove toxin (gastric lavage, wound debridment)
- resp. support
- polyvalent equine antitoxin
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Term
| Where are most of botulism cases in US? Why |
|
Definition
- Alaska
- traditional native foods ferment in conditions that favor spore forming bacteria
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Term
|
Definition
- Char- spore forming, gram positive anaerboic bacillus (asymp. in colonic floor of most people)
- spores persist for months in envir.
- VF- enterotoxin (A) and cytotoxin (B)
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Term
| C difile associated with what clinical syndrome |
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Definition
| antibiotic associated diarrhea |
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Term
| Antibiotic associated colitis (pathogenesis) |
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Definition
- antibiotic therapy
- up to six weeks after, alter colonic microflora
- germination of C dificile spores
- release toxin A and B from spore forming coat
- colonic mucosal injury and inflammation
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Term
| clinical manifestations of C difficile associated colitis |
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Definition
- symp.
- profuse watery diarrhea
- abdominal pain
- leukocytosis
- fever
- complication
- dehydration
- electrolyte disturbance
- shock
- toxic megacolon
- reactive arthritis
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Term
| dx of C difficile associated diarrhea |
|
Definition
- endoscopic appearance: pseudomembranes
- fetal leukocytes in 50%
- cytotoxic assay
- ELISA for toxin A or B
- NOT culture
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|
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Term
| clinical management of C difficile associated colitis |
|
Definition
- discontinue causative antibiotic
- initiate effective antibiotic
- metronidazole
- oral vancomycin
- rifaximin
- toxin bindin resins
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