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Bugs & Drugs > Anaerobic Infections > Flashcards

Anaerobic Infections Flashcards

1
Q

Anaerobes primarily reside where?

A

Mucosa (surfaces/membranes) oral cavity, GI, female genital

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2
Q

3 important roles of anaerobes

A

Colonization (depletion of nutrients)
Vitamin K production
Bile production

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3
Q

High likelihood of anaerobe infection

A 
Intra-abdominal abscess (GI perf)
Brain abscess
Liver abscess
Diabetic foot infection
Suspect them even if they don't grow on culture
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4
Q

Cranial neuropathies and descending flaccid paralysis ddx

A

botulism

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5
Q

Peptostreptococcus is found where?

A

oral cavity

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6
Q

Sterile pus (no growth on culture) a clue for what?

A

Anaerobes

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7
Q

Good specimens for anaerobes

A

purulent material
debrided tissue
process in an anaerobic environment

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8
Q

Good abx for anaerobes

A 
Metronidazole
Clindamycin (above diaphragm)
Carbapenems
Cephamycins
Tigecycline
Moxifloxacin
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9
Q

B. fragilis resistance via?

A

Increased B-Lase production

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10
Q

Anaerobic toxin-mediated disease

A

*Clostridia –> pseudo colitis

Also tetanus, botulism

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11
Q

Risk factors for anaerobic infections

A 
Malignancy
Airway/vessel occlusion (ischemic tissue)
Vascular disease
Diabetes
Trauma
Immunocompromise
Foreign bodies
Antibiotic pressure
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12
Q

Important G- rod anaerobes (BFP2)

A

Bacteroides spp
Prevotella
Fusobacterium
Porphyromonas

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13
Q

Important GPC anaerobes

A

Peptostreptococcus

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14
Q

Important GPR anaerobes (spores)

A

Clostridia

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15
Q

Important G- rod anaerobes (no spores)

A

Actinomyces

Propionibacterium

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16
Q

Abscess formation, increasing drug resistance

A

B. fragilis (clinda/BL)

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17
Q

Long, thin, (pointed ends) found in mouth and gingiva and produce endotoxin

A

Fusobacterium (pointed=fusiform)

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18
Q

Nearly always found in mixed infections

A

Peptostreptococci

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19
Q

Organisms in the oral cavity

A

High #’s in saliva, gingival scrapings

Pepto/Prevo/Fuso/B.spp/Actino

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20
Q

Common oral cavity anaerobe infections

A

CNS, mouth, H/N, lungs, pleural space

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21
Q

bug causing brain abscess via hematogenous spread

A

s. aureus

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22
Q

Vincent’s angina/trench mouth

A

Necrotizing gingivitis
ulcerations/bleeding
common in AIDS/chemo

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23
Q

Ludwig’s angina

A

SSTI of submandibular/sublingual spaces

Respiratory compromise by forcing tongue into airway

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24
Q

Lemierre’s syndrome (assoc. w/which bug?)

A

SSTI of lateral pharyngeal space
Suppurative thrombophlebitis of JUGULAR VEIN
–> septic PE and bacteremia w/ Fuso. necrophorum

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25
Q

Sinusitis or OM >3 months

A

most likely due to anaerobes

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26
Q

Conditions predisposing to aspiration

A

Neuro disorders
Alcohol, drugs
GI reflux
Thick sputum

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27
Q

Commonly develops after aspiration pneumonia

A

Lung abscess

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28
Q

FETID, foul sputum with weight loss, low fever

A

Lung abscess

Tx: weeks of abx, no resection/drainage

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29
Q

Infection of pleural space requiring drainage thru chest tubes or decortications (S3a)

A

Empyema - 2ndary to pneumonia
S. aureus, S. pyogenes, S. pneumo + anaerobes
Tx: weeks of abx

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30
Q

Common infections of GI anaerobes

A

peritonitis
intra-abd abscess
liver abscess
biliary tract infections

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31
Q

Common GI anaerobes –> peritonitis, intra-abd abcess, liver abscess, biliary

A

B. fragilis
Peptostrepto
Fuso
Clostridia

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32
Q

Infection of ascitic fluid seen in end stage liver disease

Results from a mono microbial, aerobic bacteremia

A

Primary peritonitis

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33
Q

Severe abd pain, rebound tenderness (irritation of peritoneum), requiring surgery and broad-spec abx

A 
Secondary peritonitis (large anaerobe role)
B. fragilis, E.coli, enterococci most common bugs
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34
Q

Predisposing conditions to 2ndary peritonitis

A

Ruptured viscus (appendix, bowel perf)
Abd surgery
Trauma

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35
Q

Contained infection 2ndary to incompletely treated peritonitis, w/PERSISTENT abd pain, non-resolving LEUKOCYTOSIS

A

Intra-abd abscess

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36
Q

Most common visceral abd abscess

A

Liver abscess

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37
Q

Common female GU anaerobes

A

Prevotella
Peptostrepto
B. fragilis group
Clostridia

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38
Q

infection of the uterine lining, may follow incomplete abortions - caused by what bug

A

endometritis

C. perfringens

39
Q

mixed aerobic/anaerobic infection can lead to need for drainage, scarring of repo sys, infertility

A

tuboovarian abscesses and PID

40
Q

Decline of acid-producing lactobacilli normal flora and increase in anaerobic bacteria leading to vaginal discharge

A

Bacterial vaginosis

41
Q

bug assoc w/acne and orthopedic/neurosurgical fixation device/shunt infections

A

propionibacterium

42
Q

common SSTI anaerobes (BPC)

A

bacteroides
peptostrepto
clostridia

43
Q

plantar ulceration –> polymicrobial mixed infection

A

diabetic foot infection

prolonged antibiotics and debridement

44
Q

on sacrum, mixed infection of bugs from GI tract

A

pressure ulcers

prolonged abx

45
Q

deep SSTI mixed infection

A

necrotizing faciitis e.g. Fournier’s

46
Q

resulting from contamination of an open fracture

A

contiguous osteomyelitis

47
Q

most frequent isolated anaerobe from blood cultures (bacteremia)

A

B. fragilis (from GI/GU/lung/soft tissue)

48
Q

large “boxy” gram positive rods

A

clostridia

produce spores which survive in soil, decaying vegetation, marine environments)

49
Q

sustained muscle contraction first manifest as a “lock jaw” and painful spasms that are triggered by sensory stimuli, potentially leading to airway obstruction and autonomic dysfunction (mimics strychnine poisoning) up temp, BP, pulse, sweating

A

Tetanus (C. tetani)

tetanospasmin aka tetanus toxin prevents release of INHIBITORY NT’s from presynaptic cells

50
Q

treatment of tetanus

A 
ICU supportive care
Benzos for spasm control
Immunization with HTIG(globulin)
Metronidazole
Dx CLINICALLY, not based on lab ID
Takes weeks to months for toxin to clear
51
Q

tetanus vaccine

A

DTaP during childhood

Routine Td/Tdap boosters for adults

52
Q

pt is alert and afebrile; weakness and flaccid paralysis due to bilateral cranial nerve abnormalities (blurred vision, dysphagia) and descending motor weakness leading to respiratory failure and autonomic dysfunction

A

Botulism (C. botulinum)

Neurotoxin prevents ACh release

53
Q

ingestion of preformed botulinum toxin (sx w/in 36 hr)

A

foodborne botulism

54
Q

“floppy baby syndrome” what is ingested?

A

infant botulism
spores (honey…ok after 1st year of life)
colonic normal flora is not yet established

55
Q

longest botulinum form to develop due to infection of a wound and release of toxin (sx in 4-14d)

A

wound botulism (penicillin)

56
Q

inhalation botulism

A

biowarfare

57
Q

how to dx botulism? (4 things)

A

clinical
stool, blood, soft tissue, food source
anaerobic culture and toxin typing

58
Q

botulism tx?

A

supportive
trivalent antitoxin (hypersensitivity)
infant –> HBIG
wound –> penicillin

prevention via food handling and prep

59
Q

gram + rod with “boxcar appearance”

A

C. perfringens

60
Q

GI illnesses
food poisoning
enteritis necroticans
clostridial myonecrosis

A

C. perfringens

61
Q

C. perfringens toxins

A

lethicinase (a-toxin)

hemolysin

62
Q

risk groups for gas gangrene

A

trauma wounds (miliatry, motor vehicle, agricultural) or surgery (colon, septic abortion)

63
Q

nontraumatic (spontaneous) gas gangrene assoc w/?

A

C. septicum

originating via diseased / cancerous colon

64
Q

bug causing: severe pain out of proportion than what is seen, followed by rapid evolution of gas in soft tissues (crepitus) with MAGENA/BRONZE then followed by hemorrhagic bullae and DIRTY BROWN discharge; systemic illness

A

C. septicum

65
Q

dx C. septicum?

A

culture and gram stain

66
Q

C. septicum tx?

A

debridement
PEN + clinda (decrease toxin production)
hyperbaric oxygen

67
Q

mucosal damage and diarrheal illness due to VEGETATIVE forms proliferating and producing exotoxins A&B

A

C. diff –> pseudomembranous colitis

68
Q

RF’s of pseudo-colitis

A

age
severity of illness
antibiotic use (80% of the time)
20% 4 weeks after abx are stopped

69
Q

most common cause of unexplained leukocytosis in hospitalized pts

A

C. difficile

70
Q

C. diff dx?

A

PCR of STOOL for toxin A or B gene

endoscopy to find pseudomembranes

71
Q

C. diff tx? (mild v. moderate/severe)

A 
stop antibiotics
no antiperistaltics
Mild --> METRONIDAZOLE
Mod/severe --> oral VANCO
IVIG
colectomy to save life
72
Q

Recurrent C. diff tx?

A

lacking of IgG to toxins
avoid unnecessary abx
oral vanco, probiotics, rifaximin, fidaxomicin
FECAL TRANSPLANT

73
Q

cramps, diarrhea 8-16 hours after ingestion and end within 24 hours. RARE VOMITING

A

C. perfringens food poisoning
meats, poultry, gravy temperature control
toxin production in-vivo (not-preformed such as S. aureus)

74
Q

outstanding drug for Gram negative anaerobe infections i.e. abscess, peritonitis, GI, GU

A

Metronidazole

75
Q

outstanding drug for gram positive anaerobes above diaphragm (i.e. come from mouth)

A

clindamycin

e.g. good for aspiration pneuma, not peritonitis

76
Q

abx for G+ not G-

A

Vanco and Pen

77
Q

how do chemo drugs allow anaerobes to cause disease?

A

via mucositis (e.g. of the mouth) or enterocolitis

78
Q

Gram positive anaerobes

A

Peptostrepto
Clostridia
Actinomyces

79
Q

hallmarks: abcess formation

A

Bacteroides (up resistance to clinda/BL)
fragillis –> GI
other –> mouth/GU

80
Q

purple G+ cocci

A

peptostrep (mouth, GI, GU)

81
Q

why do abx work so well for lung abscesses?

A

wonderful blood supply

82
Q

pleural fluid analysis:
positive culture/gram stain
Low pH (60)

A

empyema

83
Q

removal of pleural lining

A

decortication

84
Q

tennis racket terminal spore

A

tetanus

85
Q

spores enter via wound, incubate for 3-21d (avg 8) under low O2 conditions –> germinate and produce toxin at wound site which spreads via blood and lymphatics

A

C. tetani

86
Q

Tetanospasmin route of entry

A

via retrograde axonal transport to CNS, diffuses to terminals of inhibitory cells

87
Q 
trismus
neck stiffness
trouble swallowing
abdominal muscle rigidity
spasms
autonomic: inc temp, pulse, BP, sweating
A

lock jaw

tetanus

88
Q

Wound comparison: tetanus or no?

A

age of wound: >6 = tetanus
configuration: stellate, avulsion (T); linear (non)
depth: >1cm = tetanus
mechanism: missile/crush/burn/frostbite (T); sharp surface, glass/knife (non)
contaminants: yes (T)
devitalized tissue: yes (T)

89
Q

GNR anaerobes

A 
B. fragilis
Bacteroides spp
Prevotella
Fusobacterium
Porphyromonas
90
Q

GPR anaerobes

A

clostridia
actinomyces
propionibacterium

91
Q

brain abscess via direct extension: mono/polymicrobial?

A

poly

92
Q

brain abscess via hematogenous spread: mono/polymicrobial?

A

mono

93
Q

thick, fetid sputum

A

aspiration pneumonia

94
Q

tx of aspiration pneumonia

A

clindamycin

ampicillin-sulbactam

Bugs & Drugs (15 decks)

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