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CMT > Anaerobic Bacterial Infections > Flashcards

Anaerobic Bacterial Infections Flashcards

1
Q

Clostridia

what type of anaerobic rods are these?

A

spore forming

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2
Q

Clostridia

which two Clostridia are the two most potent biological toxins known to humans?

A
  1. botulinum
  2. tetani
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3
Q

Clostridia

4 different disorders

A
  1. botulism
  2. tetanus
  3. gas gangrene
  4. c. diff
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4
Q

Clostridium botulinum

3 types

A
  1. foodborne
  2. wound (not as common as the others)
  3. infant
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5
Q

Clostridium botulinum

what is associated w/ foodborne bot?

A

canning, smoking, vaccuum packing food

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6
Q

Clostridium botulinum

what is associated with wound bot?

A

IV drug use

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7
Q

Clostridium botulinum

what is seen with infant bot?

A

honey ingestion

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8
Q

Clostridium botulinum

what does bot toxin do?

A

paralysis

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9
Q

Clostridium botulinum

how does bot toxin cause paralysis?

A

prevents release of ACH at neuromuscular junctions and autonomic synapses

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10
Q

Clostridium botulinum

signs and sx

8 components

A
  1. development of sudden, fluctuating, severe weakness w/ intact sensation
  2. diplopia, loss of accomodation, ptosis, impairment of extraocular muscles, pupils fixed/dilated
  3. dry mouth
  4. dysphagia
  5. dysphonia
  6. symmetrical paralysis that is descending
  7. tendon reflexes in tact
  8. normal sensory exam
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11
Q

Clostridium botulinum

why are infants more susceptible to spores that wouldn’t typically make adults ill?

Infant Bot

A

incompletely developed intestinal flora

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12
Q

Clostridium botulinum

first sign of infant bot? followed by?

A
  1. constipation
  2. lethargy, poor feeding
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13
Q

Clostridium botulinum

Dx

A
  1. notify PH/CDC at first suspicion
  2. analysis of serum, stool, gastric contents
  3. consider electrophysiologic studies
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14
Q

Clostridium botulinum

Tx

5 things

A
  1. anti-toxin
  2. give before confirmation if suspicions are high enough
  3. must be released by PH
  4. hospitalize pt ASAP
  5. intubation/mech vent if respiratory failure occured
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15
Q

Clostridium botulinum

Antitoxin contraindication

A

horse serum allergy

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16
Q

Clostridium botulinum

what do you give for infant bot?

A

babybig (bot immunoglobin)

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17
Q

Clostridium tetani

pathophys

A
  • produces neurotoxin tetanospasmin
  • interferes with neurotransmission at spinal synapses of inhibitory neurons
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18
Q

Clostridium tetani

incubation period

A

8-12 days

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19
Q

Clostridium tetani

at risk population

A

unvax people

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20
Q

Clostridium tetani

initial signs & sx

A
  • pt remains awake/alert
  • pain at wound site
  • spasticity of regional muscles
  • jaw muscle stiffness
  • stiffness of neck/other muscles
  • dysphagia
  • irritability
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21
Q

Clostridium tetani

later signs & sx

A
  • hyperreflexia
  • spasm of jaw or facial muscles
  • rigidity and spasms of abdomen/neck/back
  • painful tonic convulsions precipitated by minimal stimuli
  • asphyxia if pumlp spasms
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22
Q

Clostridium tetani

dx

A

clinical observation

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23
Q

Clostridium tetani

tx

A
  • human tetanus immuneglobin 500 units, IM
  • wound debridement
  • Metrondiazole, 7.5 mg/kg IV/PO, Q6 hrs, 7-10 days
  • bed rest
  • sedation, paralysis, mech vent often needed
  • g-tube nutrition
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24
Q

Clostridium tetani

when must human tetanus immune globin be given by?

A

w/in 24 hrs of sx onset

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25
Q

Clostridium tetani

prognosis

A
  • high mortality rate with rapid onset & delayed care
  • spasms for 3-4 wks
  • complete recovery may take weeks
  • toxin binding is irreversible, so pt must regenerate new axonal terminals
26
Q

Clostridium tetani

prevention

natural infection, passive immunization, active immunization

A
  • natural infection does not result in immunity
  • passive immunization if unsure of vax status with at risk wound (give immune globin)
  • active immunization for adults
27
Q

Clostridium tetani

Immunization schedule

general series, boosters, pregnancy

A
  • primary immunization: 2 doses 4-6wks apart, 3rd dose 6-12 mo later
  • boosters: every 10 yrs or at time of major injury if occurs > 5 yrs after dose
  • TDAP with each pregnancy (27-36 wks, but ab concentrations best for baby 27-30 wks)
28
Q

Clostridial myonecrosis

AKA

A

gas gangrene

29
Q

Clostridial myonecrosis

commonly due to?

A

trauma or IV drug use

30
Q

Clostridial myonecrosis

where are toxins produced? what do the toxins lead to?

A
  1. affected tissue
  2. shock, hemolysis, tissue necrosis
31
Q

Clostridial myonecrosis

Signs & sx

A
  1. sudden onset
  2. rapidly worsening pain
  3. hypotension
  4. tachycardia
  5. fever
  6. delirium
  7. wound- swelling, pallor, foul smelling drainage
32
Q

Clostridial myonecrosis

Later changes to wound

A
  1. skin turns dusky then deeply discolored
  2. red fluid filling vesicles
  3. gas may be palpable in tissue
33
Q

Clostridial myonecrosis

Dx

A
  • x-ray
  • anaerobic culture
34
Q

Clostridial myonecrosis

tx

A
  • surgical debridement
  • PCN, 2 mil units, Q3 hrs
  • Clindamycin, 600-900mg IV, Q8 hrs
35
Q

C. diff

associated with?

A

recent abx use (as long as 8 wks prior to sx)

36
Q

C. diff

mode of transmission

A

fecal oral

37
Q

C. diff

MOA of infection

A

disrupts normal bacterial flora in bowel, colonizes the colon and releases 2 toxins

38
Q

C. diff

most common abx that lead to C. diff?

A
  • fluoroquinolones
  • clindamycin
  • PCN
  • Cephalosporins (2-4th gens)
  • Carbapenems
39
Q

C. diff

signs & sx

A
  • green, foul, watery diarrhea (5-15x daily)
  • mucus in stool, rarely bloody
  • mild LLQ tenderness
40
Q

C. diff

signs & sx in severe disease

4 sx, 4 test results

A
  • profuse diarrhea (> 30 per day)
  • fever
  • hemodynamic instability from hypovolemia
  • abd pain/distension

Labs
* WBC: > 30,000
* Albumin: < 2.5
* Elevated serum lactate
* Rising CR

41
Q

C. diff

why is albumin low with C. diff?

A

protein losing enteropathy

42
Q

C. diff

Dx

A

stool toxin/antigen assay available
* immunoassay for glutamate dehydrogenase (GDH) protein
* PCR for C. diff toxin gene
* Rapid enzyme immunoassy for presence of 2 C. diff toxins
* non-contrast abd CT

43
Q

C. diff

which test can differentiate colonization vs infection?

A

rapid enzyme immunoassay

44
Q

C. diff

what will non-contrast abdominal ct show? when to get one?

A
  1. colonic dilation and wall thickening
  2. with severe/fulminant infections
45
Q

C. diff

complications

6 things

A
  • hemodynamic instability
  • resp failure
  • metabolic acidosis
  • megacolon (> 7 cm)
  • perforation
  • death
46
Q

C. diff

when to consider surgical consult?

10 things

A
  1. hypotension
  2. fever greater than 38.5degC
  3. ileus or severe abd distension
  4. peritonitis or severe abd tenderness
  5. mental status changes
  6. WBC > 20,000
  7. serum lactate levels > 2.2
  8. admission to ICU
  9. end organ failure
  10. no improvement after 3-5 of therapy
47
Q

C. diff

Tx

A
  • complex abx decision tree
48
Q

C. diff

prevention

A
  • minimize abx use
  • don’t suppress gastric acid
  • contact precautions in facilities
49
Q

Corynebacterium diphtheriae

AKA

A

diphtheria

50
Q

Corynebacterium diphtheriae

4 forms

A
  1. nasal
  2. laryngeal
  3. pharyngeal
  4. cutaneous
51
Q

Corynebacterium diphtheriae

mode of transmission

A

respiratory secretions

52
Q

Corynebacterium diphtheriae

exotoxin causes what 2 things?

A
  1. myocarditis
  2. neuropathy
53
Q

Corynebacterium diphtheriae

clinical diagnosis

A

consider diphtheria if relevant clinical sx and incomplete vax

54
Q

Corynebacterium diphtheriae

incubation period

A

2-5 days

55
Q

Corynebacterium diphtheriae

signs & sx

A
  • sore throat
  • malaise
  • cervial lymphadenopathy
  • low-grade fever
  • early on: mild erythema/isolated spots of gray and white exudate on pharynx
56
Q

Corynebacterium diphtheriae

complications

A
  • myocarditis (arrhythmia, heart block, heart failure)
  • neuropathy (diplopia, slurring, dysphagia)
57
Q

Corynebacterium diphtheriae

dx

A
  • clinical dx
  • can confirm with pos culture
58
Q

Corynebacterium diphtheriae

important to detect what not what?

A
  1. toxigenic
  2. non-toxigenic strains
59
Q

Corynebacterium diphtheriae

tx

A
  • administer antitoxin upon clinical suspicion
  • involve PH/CDC in diagnostic/treating if strongly suspected
  • erythromycin: 500mg, Q8 hrs, 14 days
60
Q

Corynebacterium diphtheriae

considerations for antitoxin

A
  • have epi ready, 10% risk of hypersensitivity
  • must be obtained from CDC
  • dose varies based on severity
61
Q

Corynebacterium diphtheriae

prevention

A
  • childhood vax series
  • TDAP
  • booster indicated with exposure
62
Q

Corynebacterium diphtheriae

prophylactic abx

A

Erythromycin: 500mg PO, Q8 hrs, 7 days

CMT (72 decks)

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