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GIHEP > 7. Anaerobes and Peritonitis > Flashcards

7. Anaerobes and Peritonitis Flashcards

1
Q

What infection is associated with intrauterine devices?

A

Actinomycosis

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2
Q

What features of an infection suggest that it may be caused by anaerobes?

A 
Adjacent to mucosa
Free gas
Foul smell
Not responding to gram positive antibiotics
CNS manifestations
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3
Q

Why is particularly important to bring gram negative samples to the lab promptly?

A

They have been exposed to oxygen so will begin to die quickly

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4
Q

How do anaerobes inhibit phagocytosis?

A

Produce short chain fatty acids

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5
Q

What host factors can increase the risk of a gram negative infection?

A

Impaired gag or cough
Trauma and tissue ischaemia (so lack oxygen)
GI surgery
Amputation in a patient with peripheral vascular disease
Antibiotics

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6
Q

What are the symptoms of a clostridia tetani infection?

A

Muscle rigidity and spasms that last minutes, ongoing for 3-4 weeks
Exacerbated by noise, light and touch

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7
Q

What is the name of the neurotoxin produced by clostridia tetani?

A

Tetanospasm

Blocks inhibitory neurons

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8
Q

What type of vaccine is the tetanus vaccine?

A

Toxoid

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9
Q

What ways does clostridia tetani commonly enter the body?

A

Spores are introduced via skin trauma or on umbilical stump and germinate in the local anaerobic environment
May also contaminate heroin

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10
Q

How long is the incubation period for tetanus?

A

14 days

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11
Q

What does the muscle spasm appear like in tetanus?

A

Arm flexion
Leg extension
Back arch
Lockjaw
‘Risus sardonicus’ due to increased tone of orbicularis oris
May also cause laryngospasm and autonomic dysfunction

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12
Q

What can autonomic dysfunction cause in tetanus?

A

Arrhythmias

Sweating

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13
Q

What is the management for tetanus?

A

Early recognition essential, ABCs as may need to intubate
Treat infected source; debridement and metronidazole
Neutralise toxin with tetanus immunoglobulin

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14
Q

What effect does the botulinum toxin have?

A

Flaccid paralysis

Inhibits release of ACh at the neuromuscular junction

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15
Q

What are the types of botulinism?

A

Foodborne
Infant
Wound associated (including IVDU)

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16
Q

What is the typical cause of foodborne botulinism?

A

Homemade canned foods
Spores germinate in the anaerobic environment and produce toxins
Onset of symptoms after 12-36 hours

17
Q

What is the common source of infant botulinism?

A

Raw honey

Spores are ingested and germinate in the underdeveloped GIT

18
Q

What are the symptoms of infant botulinism?

A

Constipation

Muscle weakness: ‘Floppy baby’

19
Q

What are the symptoms of botulinism?

A

Symmetrical descending flaccid paralysis
Bilateral cranial nerve palsy
Resp failure
No fever and no loss of consciousness

20
Q

What lab test can be used to diagnose botulinism?

A

Toxin in stool, vomit or wound site

21
Q

What is the management of botulinism?

A

ABCs as resp failure possible
Botulism Ig or babyBIg
Wound debridement and metronidazole

22
Q

What is the range of disease associated with c. difficile?

A

Anything from diarrhoea to life threatening inflammation of colon (pseudomembrane colitis)
Children are commonly colonised but rarely infected
High risk of recurrence within 8 weeks

23
Q

What antibiotics increase the risk of c.diff infection?

A

Fluoroquinolones
B-lactams
Clindamycin

24
Q

What toxins are associated with c. diff?

A

A and B toxins

25
Q

What is the management for a c. diff infection?

A

Isolate with contact precautions
Hand washing as spores survive alcohol
PCR stool for toxin gene: Toxin EIA

26
Q

What antibiotics are used to treat c.diff infection?

A

Vancomycin or fidaxomicin

Given PO so that it acts locally in the gut

27
Q

What toxin does c. perfringens produce?

A

Lecithinane

Perforates cell membrane

28
Q

What infections are caused by c. perfringens?

A

Gas gangrene
Emphysematous cholecystitis
Food poisoning

29
Q

What is the management for gas gangrene?

A

Surgical debridement

High dose penicillin or clindamycin

30
Q

What is peritonitis?

A

Inflammation of the peritoneum, exudate becomes purulent

31
Q

What are the types of peritonitis?

A

Spontaneous Bacterial Peritonitis
Secondary
Peritonitis complicating peritoneal dialysis

32
Q

What are the signs of peritonitis complicating peritoneal dialysis?

A

Cloudy dialysis fluid

Less likely to be caused by anerobes: think skin flora

33
Q

What are the symptoms of peritonitis?

A

Acute abdomen: pain, tenderness, rigidity

34
Q

What anaerobes are associated with SBP?

A 
E.coli
Klebsiella
Strep pneumo
Group A strep
Entercocci
35
Q

What is secondary peritonitis?

A

Spillage of GI or GU into the peritoneal cavity

36
Q

What is the empiric treatment for secondary peritonitis?

A

B-lactam with a B-lactamase inhibitor

and gentamicin

GIHEP (30 decks)

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