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CMT-uno > Anaerobic Bacteria Infections > Flashcards

Anaerobic Bacteria Infections Flashcards

1
Q

Clostridia

are what kind of bacteria?

A

spore forming, anaerobic rods

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2
Q

Clostridia

what are clostridial disorders?

A

Botulism, tetanus, gas gangrene, c diff

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3
Q

Clostridia

what spp cause the most potent biological toxins for humans?

A

C botulinum & C tetani

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4
Q

Clostridium botulinum

What is botulism?

and what’s the pathophysiology?

A

a paralytic disease caused by the toxin from Clostridium botulinum

Toxin prevents release of acetylcholine at neuromuscular junctions and autonomic synapses

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5
Q

Clostridium botulinum

what are the three forms of botulism?

A
  1. Food-borne botulism
    Canned, smoked, or vacuum-packed food
  2. “wound botulism”
    Often seen with Injectable drug use
  3. Infant botulism
    Ingestion of honey
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6
Q

Clostridium botulinum

what are the signs and symptoms of infection?

A

Within 12-36 hours
Diplopia
Loss of accommodation
Ptosis
Impairment of extraocular muscles
Pupils are fixed and dilated

dry mouth
Dysphagia- cant swallow
dysphonia - vocal chord muscles don’t work
Descending symmetrical paralysis of voluntary muscles. Can progress to respiratory failure, death without mechanical assistance
Tendon reflexes are typically intact
normal sensory examination

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7
Q

what is the first sign of Infant Botulism, and why does this happen?

A

first sign can be constipation

incompletely-developed intestinal flora may be to blame

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8
Q

Botulism

How to be Dx?

A

Analysis of serum, stool, gastric contents or food for toxin
May consider electrophysiologic studies

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9
Q

Botulism

How do we treat infection?

A

Hospitilaztion
antitoxin given ASAP- avoid w horse serum allergy
Immunoglobulin for infants (BABYBIG)
resp failure managed with intubation/mechanical ventilation

Notify State health authorities/CDC at first suspicion

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10
Q

Clostridium tetani

produces what toxin and how does it work?

A

tetanospasmin which interferes with neurotransmission at spinal synapses of inhibitory neurons

minor stimuli=uncontrolled spasm
reflexes are exaggerated

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11
Q

Tetanus

how long is incubation?

A

8-12 days

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12
Q

Tetanus

What are the signs and symptoms of early infection?

A

Patient remains awake and alert throughout
Pain at wound site
Spasticity of regional muscles
Jaw muscle stiffness (“lock jaw”)
Stiffness of the neck and other muscles
Dysphagia
Irritability

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13
Q

Tetanus

what are LATER signs and symptoms of infection?

A

Hyperreflexia
Spasms of Jaw muscles (trismus) or facial muscles
Rigidity and spasms of abdomen, neck, and back
painful tonic convulsions precipitated by minimal stimuli
May have asphyxia if spasms of glottis/respiratory muscles

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14
Q

Tetanus

How do we Dx?

A

Dx is clinical, there are no labs.

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15
Q

Tetanus

how do we treat?

A

Human tetanus immune globulin 500 units IM within 24 hours of presentation
Wound debridement
Metronidazole(Flagyl) 7.5 mg/kg IV/PO every 6 hours for 7-10 days
bed rest and quietest conditions possible
Sedation, paralysis, and mechanical ventilation often needed

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16
Q

Tetanus

what is the prognosis?

A

high mortality with rapid onset and delayed care
spasm for 3-4 weeks
complete recovery may take months.

toxin binding is irreversible

17
Q

Tetanus

How can we prevent infection?

A

natural infection does not result in immunity

immunization

18
Q

what disease does Clostridial myonecrosis cause?

A

gas gangrene

19
Q

Clostridial myonecrosis

What is gas gangrene?

A

Commonly due to trauma or injection drug use
Toxins produced in affected tissue lead to shock, hemolysis, and tissue necrosis

20
Q

What spp cause clostridial myonecrosis?

A

Produced by multiple clostridia (C perfringens amongst many)

21
Q

gas gangrene

what are signs and symptoms of sudden onset infection?

A

Sudden onset
Rapidly worsening pain
Hypotension
Tachycardia
Fever but not proportionate to severe infection
delirium

22
Q

gas gangrene

what are the signs and symptoms of affected wounds?

A

Swelling
Pallor around wound
Foul smelling brown, blood-tinged serous drainage
almond smell

Later
Skin turns dusky then deeply discolored
Red fluid filled vesicles
Gas may be palpable in tissue

23
Q

Gas gangrene

How to we treat?

A

Surgical debridement
Penicillin 2 million units every 3 hours
AND
Clindamycin 600-900mg IV every 8 hours
Clindamycin may decrease bacterial toxin production.

benefit from O2 chamber therapy

24
Q

gas gangrene

How do we Dx?

A

Diagnosis is clinical
X-ray may show gas within soft tissue
Anaerobic culture confirms diagnosis

25
Q

C. Difficile colitis is associated with what populations?

A

antibiotic use, geriatric, immunocompromised

26
Q

C diff

how long after antibtiotics does infection arise?

A

up to 8 weeks after antibiotic use

27
Q

c Diff

what antibiotics are likely to cause infection?

A

fluoroquinolones
clindamycin
beta-lactams

28
Q

C diff

What are signs and symptoms?

A

Greenish, foul, watery diarrhea 5–15 x daily
Mild LLQ tenderness
Sever/fulminant disease

29
Q

C diff

Severe and sudden/fulminant disease Sx

A

profuse diarrhea (≥ 30 stools/day)
Fever
hemodynamic instability
abdominal distention/pain
Labs = WBC >30,000, albumin < 2.5 (due to protein-losing enteropathy), elevated serum lactate, rising Cr

30
Q

C diff

How do we Dx?

A

Stool toxin/antigen assay

non-contrast abd CT scan sever/fulminant to look for colonic dilation and wall thickening

31
Q

C diff

What are complications of infection?

A

Hemodynamic instability
Respiratory failure due to metabolic acidosis
Metabolic acidosis
Megacolon (>7cm)
Perforation
Death

32
Q

C diff

How do we treat?

A

Complex antibiotic decision tree
Prevention:
minimize antibiotic use
don’t suppress gastric acid
Contact precautions in facilities
Call infectious disease

33
Q

Corynebacterium diphtheriae

What is diptheria?

A

Acute infection caused by Corynebacterium diphtheriae
Nasal, laryngeal, pharyngeal, and cutaneous forms
Spread by respiratory secretions
Exotoxin responsible for myocarditis and neuropathy

34
Q

Diptheria

What are the complications of infection?

A

Myocarditis
Arrhythmia, heart block, heart failure
Neuropathy
Cranial nerves (diplopia, slurred speech, dysphagia)

35
Q

Diptheria

How do we Dx?

A

Clinical diagnosis
Can confirm with + culture for C. diphtheriae

36
Q

Diptheria

How do we treat?

A

Careful airway management
Removal of membrane by laryngoscopy or bronchoscopy
potential for dislodging pseudomembrane
Intubation may protect airway (airway edema and mucosal friability)
Respiratory droplet isolation until 3 consecutive negative cultures
Antitoxingiven with any suspicion

Erythromycin 500mg 4x a day 14 days

37
Q

Diptheria

How do we prevent infection?
after exposure?

A

childhood vaccine series
adults tdap
booster indicated with exposure

erythromycin 500mg 4x for 7 days if exposed to someone infected.

CMT-uno (54 decks)

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