Anaerobes Flashcards by Duru Emmanuel

T/F
Anaerobic infections are not common in clinical practice

False
Anaerobic infections are common in clinical practice

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Anaerobic infections are common in clinical practice
Usually __________ in nature.

Polymicrobial

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Anaerobes
do not require ___________ for growth and metabolism
Obtain energy from ________ reactions.
Are normal flora of _____, _____, _____ and _____
Found in the soil (_________).
Infection results when bacteria ______ and _______ in ____________ sites of the body

molecular oxygen
fermentation
GIT, mouth, vagina and skin
Clostridia spores
contaminate and multiply
normally sterile

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PHYSIOLOGY OF ANAEROBIC BACTERIA
For optimal growth, they require (low/high?) pH and __ provided in areas of _______________ (________, ______, _______ & _______________).
.Lack ___________ system responsible for metabolism of _____________, ______________which catalyzes the reaction O2- + O2- + 2H+ ……………. 2H2O + O2, and _________ which catalyzes the reaction 2H2O2 ………….. 2H2O + O2.

Low pH and Eh
impaired blood supply (ischaemia, necrosis, infection & tissue devitalization)
cytochrome oxidase
oxygen radicals
superoxide dismutase (SOD)
catalase

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CLASSIFICATION OF ANAEROBIC BACTERIA
________ (______) ________ (Lack all the enzyme system)
__________ _________ (Possess low level of the enzyme system) - Most anaerobes of clinical importance)

_________ __________ – Possess adequate level of the enzyme system and so can grow well aerobically

Obligate (strict) anaerobes
Moderately obligate
Facultative anaerobes

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Obligate (strict) anaerobe (____________________)
Moderately obligate (_________________________) - Most anaerobes of clinical importance)

Facultative anaerobes – __________________________ and so can grow well ____________.

Lack all the enzyme system
Possess low level of the enzyme system
Possess adequate level of the enzyme system; aerobically

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Most anaerobes of clinical importance are ________________ anaerobes

Moderately obligate

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Obligate aerobe
Requirement: __%–__% O2 ( as found in a ___ ______ or ____)
Examples: __________, _______

15%-21%; CO2 incubator or air
mycobacteria, fungi

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Microaerophile
Requirement: __% O2
Examples: ___________, __________

5%
Campylobacter, Helicobacter

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Facultative anaerobe
Requirement: Multiplies equally well in the presence or absence of ________
Examples: _____________, most ____________

oxygen
Enterobacteriaceae, most Staphylococci

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Aerotolerant anaerobe
Requirement: Reduced concentrations of O2 (_________ system and ___________ environments)
Examples: Most strains of ________, _______________, ____________, some ___________

anaerobic; microaerophilic
Most strains of streptococci, propionibacterium, Lactobacillus, some clostridium

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Obligate anaerobe
Requirement: _____________ environment (__% O2)
Examples: Most ____________ spp, many ___________, __________, Fusobacterium, _________________, Porphyromonas

Strict anaerobic; 0%
Most Bacteroides spp, many clostridium, Eubacterium, Peptostreptococcus

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Canophile
Requirement: __% – __% ____
Examples: some anaerobes, __________

5% –10% CO2
Neisseria

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Endogenous anaerobes of the skin
_____________, ____________

Propionibacterium, peptostreptococci

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Endogenous anaerobes of the Upper Respiratory Tract;

_______________, ___________, ________________, ______________, _______________, prevotella, Veillonella

Peptostreptococci, Actinomyces, Propionibacterium, Campylobacter, Fusobacterium

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Endogenous anaerobes of the Oral Cavity

____________, ___________/ Eggerthella, _______________, _______________, ____________, Prevotella, Bifidobacterium, _______________, Veillonella

Actinomyces, Eubacterium, Peptostreptococci, Campylobacter, Fusobacterium, Porphorymonas

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Endogenous anaerobes of the Intestine

Bifidobacterium, ____________/ Eggerthella, ___________, ______________, Bacteroides fragilis group, Bilophila, ____________, _____________, ______________, Prevotella, Sutterella, Veillonella

Eubacterium, Clostridium, Peptostreptococci, Campylobacter, Fusobacterium, Porphorymonas

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Endogenous anaerobes of the Genitourinary tract

Peptostreptococci, ________________, Fusobacterium, ___________, _____________, ______________, _____________

Bifidobacterium, Lactobacillus, Mobiluncus, Prevotella, Veillonella

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List the gram negative anaerobic bacilli of clinical importance

___________ species
___________ species
______________spp
_____________
__________ _________

Bacteroides species
Prevotella species
Porphorymonas spp
Fusobacteria
Borrelia vincenti

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Gram negative anaerobic bacilli of clinical importance

Bacteroides species (B. _______, B. __________, B. __________) generally cause infections below the __________ (__________, ________________ gangrene, ______________ abscesses and __________________ (PID) )

fragilis; diastasonis; thetaiotamicron
diaphragm (peritonitis; synergistic abdominal gangrene; intra-abdominal abscess; Pelvic Inflammatory Disease )

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Gram negative anaerobic bacilli of clinical importance

Prevotella species (P. _____________) generally cause infections (above/ below ??) the _________ (URTI, ________ thoracis, ______________ and occasionally ______)

melaninogenicus
Above the diaphragm
empyema thoracis; lung abscess; PID (Pelvic Inflammatory Disease)

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Gram negative anaerobic bacilli of clinical importance

Porphyromonas spp - ___________
Fusobacteria (e.g. F. _________)- ____________ & ___________
Borrelia vincenti (in synergy with _________) – _________________

gingivitis
F. nucleatum (osteomyelitis & cancrum oris)
Fusobacteria; ulcerative gingivo-stomatitis

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Gram negative anaerobic cocci of clinical importance

_____________ spp - a normal commensal bacterium in the mouth and intestine and rarely causes infection
_________________ - may cause infectious endocarditis.

Veillonella
Acidominococcus

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Gram negative anaerobic cocci

Veillonella spp - a normal (pathogenic/ commensal??) bacterium in the _______ and ________ and (rarely/ always??) causes infection
Acidominococcus - may cause _______________.

Commensal; mouth and intestine; rarely
infectious endocarditis

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List the gram positive anaerobic bacilli of clinical importance _______________ _______________spp ________________spp _____________/__________/__________ _______________ spp

Actinomyces Lactobacilli spp Propionibacterium spp Eubacterium/ Bifidobacterium/ Arachnia Clostridium spp

Gram positive anaerobic bacilli of clinical importance __________ (________) -aerotolerant anaerobe, causes actinomycosis __________ spp - normal vaginal flora and found in milk - rarely cause disease __________ spp (______) - normal skin flora but can cause infection of plastic shunt and acne ________/ ________/ ________ - infections of endocardium

Actinomyces (A. israeli) Lactobacilli Propionibacterium (P. acne) Eubacterium/ Bifidobacterium/ Arachnia

Gram positive anaerobic bacilli of clinical importance Actinomyces (A. israeli) - ___________ anaerobe, causes ___________ Lactobacilli spp - normal ________ flora and found in _____ - (always/ rarely??) cause disease Propionibacterium spp (P. acne) - normal ____ flora but can cause infection of ______ and _____ Eubacterium/Bifidobacterium/Arachnia - infections of __________

aerotolerant; actinomycosis vaginal; milk; rarely skin; infection of plastic shunt and acne endocardium

Gram positive anaerobic bacilli of clinical importance (contd.) Clostridia – _____ forming anaerobic G+ve bacilli that are (highly/ mildly ??) pathogenic and cause significant human disease with (high / low??) fatality.

Spore; highly; high

Clostridia spp. C. ______ (Tetanus), C. ______/ ______ (Gas gangrene, Food poisoning, Pigbel disease), C. ______/_______ (Gas gangrene), Cl. _________ (Botulism) C. _______ (Pseudomembranous colitis).

tetani perfringes/welchii novyi/edematiens botulinum difficile

Clostridia spp. C. tetani (______), C. perfringes/welchii (___________, _______________, _____________) C. novyi/edematiens (_______________) Cl. botulinum (__________) C. difficile (__________________).

Tetanus Gas gangrene, Food poisoning, Pigbel disease Gas gangrene Botulism Pseudomembranous colitis

List the gram positive anaerobic cocci of clinical importance ______________ ______________

Peptococcus Peptostreptococcus

Gram positive anaerobic cocci of clinical importance Peptococcus and Peptostreptococcus are involved in __________, __________ infections and ___________.

abscesses, pulmonary infections and dental caries

List the gram variable anaerobic bacilli of clinical importance ________________ and ____________ spp

Gardnerella vaginalis and Mobiluncus spp

PATHOGENESIS OF ANEROBIC INFECTION Conditions favouring _____________ in tissues aid multiplication of bacteria (_________ infections, ________, ________, ______ and _______ devitalization) Pathogenic or virulent factors include ____________________ – ________ formation _____________ (_________) of the cell wall Enzymes (_________, _________ etc) - may contribute to tissue destruction (no specific role in pathogenesis) Potent exotoxins by ________

anaerobiosis; pyogenic infections, ischaemia, necrosis, burns and tissue devitalization capsular polysaccharide – abcess formation Lipopolysaccharide (endotoxin) heparinase, collagenase Clostridia

Enzymes (hsparinase, collagenase etc) - may contribute to tissue destruction and have specific role in pathogenesis)

F Enzymes (heparinase, collagenase etc) - may contribute to tissue destruction (**no specific role** in pathogenesis)

SOME ANAEROBIC INFECTIONS OF CLINICAL IMPORTANCE Tetanus – ________________ Botulism – a form of ______ poisoning caused by _________________ Gas gangrene – an anaerobic infections of soft tissue and muscle characterized by formation of gas in tissue as a result of individual or combined actions of such _________ as Cl. _____, Cl. ______, Cl. ________, Cl. _________ and Cl. ________.

Clostridium tetani Food poisoning; Clostridium botulinum Clostridia; perfringes, novyi, sporogens, histolyticum, sordelii

SOME ANAEROBIC INFECTIONS OF CLINICAL IMPORTANCE ctd Other skin and soft tissue infections (without gas formation) following ___________ or __________ of tissue caused by __________. (Prevotella) melaninogenicus, B. _______, ___________, Peptococcus and ___________________

traumatic wound or devitalization Bacteroides, fragilis; Fusobacteria; Borrelia vincenti.

SOME ORAL ANAEROBIC INFECTIONS OF CLINICAL IMPORTANCE ctd ___________ (B. melaninogenicus, Fusobacteria) and ________/ ________________infection of the mouth. Fusospirochaetal infections such as ____________________ (ANUG)/ __________ , ANUM and ________________

Periodontitis; rootcaries/ soft tissue Acute necrotizing ulcerative gingivitis (ANUG)/trench mouth gangrenous stomatitis (GS)

SOME ORAL ANAEROBIC INFECTIONS OF CLINICAL IMPORTANCE ctd Periodontitis (__________, _________) and rootcaries/soft tissue infection of the mouth. ____________ infections such as Acute necrotizing ulcerative gingivitis (ANUG)/trench mouth, ANUM and gangrenous stomatitis (GS)

B. melaninogenicus, Fusobacteria Fusospirochaetal

SOME ORAL ANAEROBIC INFECTIONS OF CLINICAL IMPORTANCE ctd Ludwig angina, a spreading infection affecting __________ and _________ salivary glands resulting in edema of the _____ that may cause ___________________ requiring emergency ___________ Actinomycosis of the mouth.

submaxillary and sublingual neck acute respiratory obstruction tracheostomy

SOME ANAEROBIC INFECTIONS OF CLINICAL IMPORTANCE ctd Brain infections. Abscesses may occur from spread of ______________ infection or ____________. Commonly implicated anaerobes in cerebral abscesses are __________, ___________, ____________

oral anaerobic; otitis media Peptococcus, B. fragilis and A. israeli.

Anaerobic pleuro-pulmonary infections such as lung abscess and empyema thoracic. . Predisposing factors include (i) __________ from ___________, general anaesthesia, tooth extraction, tonsillectomy and intestinal obstruction; (ii) ___________ infections such as periodontal infections, otitis media, infectious endocarditis; (iii) local conditions such as _________________, ___________, foreign body and (iv) systemic conditions such as _____________, malignancy, ________________ and previous _________ therapy.

aspiration from unconsciouness extrapulmonary bronchigenic carcinoma, bronchiectasis diabetes mellitus (DM); immunosuppresion Antibiotic

SOME ANAEROBIC INFECTIONS OF CLINICAL IMPORTANCE ctd Anaerobic abdominal infections such as __________, __________, _________________ gangrene and intraabdominal abscesses Bacteraemia and endocarditis by __________ and ___________ Anaerobic genital infections such as __________, ___________, _____________

liver abscess, peritonitis, synergistic abdominal gangrene B. fragilis and Fusobacteria Bactrrial Vaginosis , endometritis and pelvic abscesses

CLINICAL DIAGNOSIS OF ANAEROBIC INFECTIONS Anaerobic infections should be suspected when the following features are seen ● ___________________ from wound, _________ or discharge (short chain fatty acids products of anaerobic metabolism) . Infections in close proximity to _______________ where __________ are present as normal flora Presence of ____ in tissue which is detected as __________ on palpation (Positive/ Negative??) aerobic cultures in the presence of obvious clinical features of __________ infection.

Foul smelling discharge; exudates mucosal surfaces; anaerobes gas; crepitus Negative; anaerobic

LABORATORY DIAGNOSIS OF ANAEROBIC INFECTIONS Specimen to collect - ______, ______, _______, ________ etc. Collect properly & transport in a __________ medium or ____________ or ________________broth Culture media - _____________ agar, ___________ agar , ________ or ___________ Infusion supplemented with _______, ________ & blood & made selective by adding _________.

blood, exudates, pus, swabs PRAS (Prereduced Anaerobically Sterilized) medium or RCM (Robertson Cooked Meat) or anaerobic blood culture trypticase soy agar, Schaedler blood agar Brucella or Brain Heart Infusion; haemin, vitaminK; kanamycin

Sample collection ●Aspirate Disinfect skin with ___% alcohol and allow to dry Aspirate directly into the ______ and remove ____ Aseptically transfer into _____________________ ●Biospies Done aseptically by _________ and put in a sterile container without _______

70%; syringe; air; anaerobic transport medium surgeons; formalin

Specimen not recommended for anaerobic culture ●Specimen from site where anaerobes are _____________ ●________ or _______ urine ●_____ swabs and other swabs not put in __________ medium ●______

Normal flora Voided or catheter Skin; anaerobic transport Stool

ANAEROBIC INCUBATION Use of commercially produced _______ removing system such as _________ system (_______) which contain citric acid, Na2CO3 and iron powder as ________ agents, or __________(_______) which contain vitamin C as the _______ agent

oxygen Anaerocult system (Mercks); reducing Anaerogene system (Oxoid); reducing

ANAEROBIC INCUBATION Use of commercially produced oxygen removing system such as Anaerocult system (Mercks) which contain ________, __________ and _____________ as reducing agents, or Anaerogene system (Oxoid) which contain ____________ as the reducing agent

citric acid, Na2CO3 and iron powder vitamin C

ANAEROBIC INCUBATION ctd Use of ___________ with gas generating packs/satchets. The gas pack release __________ and _________ and the ________ removes oxygen by combining with it to form ________ after being catalyzed by ____________________ present in the jar Tartaric acid + Na2CO3 + H2O -------CO2 + H2 + Na tartrate ----------2H2O +CO2

anaerobic jar hydrogen and CO2 hydrogen water palladium pentoxide

ANAEROBIC INCUBATION ctd ●Use of _______________/ ______ for all processes of culture ●Use of ___________ coated steel wool to remove oxygen by plugging the mouth of tube with cotton wool or by putting cotton wool under the lid of petri dish ●Use of _______ agents in prepared culture media e. g. RCM and thioglycolate broth or by adding red hot iron nail to culture media such as __________ or __________to remove ________ and make them become anaerobic.

anaerobic cabinet/chamber copper (CuSO4) reducing litmus milk or peptone water Oxygen

INCUBATION CONDITION Culture media containing inoculated specimens are incubated in __________ environment containing ______ and at temperature between ___°C and __°C for ___ hours

anaerobic; CO2 35oC and 37oC ≥ 48 hours

What is the catalyst used in Mcintosh and Fildes anaerobic jar

Alumina pellets coated with palladium

MONITORING OF ANAEROBES .Chemical indicator such as _____________________ which appear blue in presence of oxygen but _________ in the absence of oxygen ●Biological indicator such as a strict aerobe (____________________) which will not grow in the absence of oxygen. ●Growth of ________________ on culture medium incubated in anaerobic cabinet or jar indicate failure of anaerobiosis.

Lucas semisolid thioglycollate methylene blue; colourless Pseudomonas aeruginosa P. areuginosa

Identification/isolation of anaerobes Conventional techniques such as _____________, _____ reaction, __________ reactions, ________ formation, ______________ detection & ____________________ of fatty acids

colony morphology; Gram; biochemical; pigment formation; β-lactamase detection & gas liquid chromatography

T/F Commercial rapid identification kits are also available for identification of anaerobic bacteria

INVITRO Susceptibility testing of anaerobes Not routinely recommended because susceptibility can be predicted as either sensitive to ________, ________ or __________. Limited to isolates from _____________, ______ and ______ infections, infections of _________________ materials or devices, and persistent or recurrent ___________.

penicillin, metronidazole or clindamycin brain abscesses; bone and joint; implanted prosthetic; bacteraemia

T/F INVITRO Susceptibility testing of anaerobes are routinely recommended

False

_________________ are currently the only reliable method of susceptibility testing.

Dilution techniques

T/F There are several reliable disk diffusion method available for susceptibility testing of anaerobes

False No reliable disk diffusion method is available because of the slow growing nature of anaerobes.

Problems of isolating anaerobes in lab Anaerobes are often derived from _________, hence it must be certain that what is being isolated is not a ___________ If ____ gets into sample during transportation to the laboratory, organism may become __________ (Fast/ slow ??) growth of the anaerobes due to __________________ (means of energy generataion) makes the isolation takes ______________.

normal flora; contaminant air; non-viable Slow; inefficiency of fermentation; several days

TREATMENT OF ANAEROBIC INFECTIONS ●General 1. ____________________ and _____________ 2. ____________________ therapy. 3. For peptococcus/peptostreptoccocus infections— ______________. 4. For Bacteroides infections-_____________. 5. For Prevotella-____________. Other drugs with significant anti-anaerobic activity include ________ generation cephalosporin (________ ) & _________penicillins (_________ and __________) ●Specific For _________ infection

Surgical drainage of abscesses and removal of dead tissues empirical antimicrobial PenicilllinG Metronidazole Clindamycin second; cefoxitin ureido; mezlocillin and piperacillin Individual