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MHD Block 3: Gram Negative Gram Positive ANAEROBES > Gram Positive Anaerobes > Flashcards

Gram Positive Anaerobes Flashcards

1
Q

Which gram positive anaerobes form spores?

A

Clostridium Species (Perfringens, Tetani, Botulinum, Difficile)

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2
Q

What diseases can C.Perfringens cause?

A

Gas Gangrene
Intraabdominal infections
Food poisoning

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3
Q

Describe the structural features of C.Perfringens

A 
Gram Positive
Non Motile
Encapsulated
Spore Forming
Double zone hemolysis
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4
Q

How does gas gangrene arise?

A

Requires injury/trauma -> spores and C.Perfringens get int and germinate -> effects via toxins

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5
Q

What are the toxins of C.Perfringens?/

A

a-toxin: lecithinase ; PLC; lyses inflammatory cells and tissues

B-toxin: enteritis necroticans
i toxin: necrosis and vascular permeability
e-toxin: systemic vascular permeability

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6
Q

What characteristic lesions are found in gas gangrene?

A

Bullae -> full of liquid -> will find gram positive box-car organisms but NO WBCs

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7
Q

What is the clinical presentation of gas gangrene?

A 
Rapid onset 
Necrosis of skin and muscle
Tense edema
Bullae
Gas formation => CREPITUS

Can lead to shock

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8
Q

How is gas gangrene diagnosed?

A

Clinical setting and history

Gram stain/culture

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9
Q

How is gas gangrene treated?

A

DEBRIDEMENT + Abx (Penicillin, B-lactam inhibitor)

Can also add Clindamycin to shut down toxin production while treatment given

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10
Q

What causes C.Perfringens food poisoning?

A

Heat resistant spores survive -> produce enterotoxin after germination -> nausea, abd pain, diarrhea within 24 hours after ingestion

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11
Q

How is C.Perfringens associated food poisoning treated?

A

Diagnosed clinically, no culture needed

Tx: Self limiting, just supportive therapy

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12
Q

How are C.Tetani and C.Perfringens different?

A

C.Tetani:NO Gas gangrene

local germination without necroses

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13
Q

What is the main toxin produced by C.Tetani and what does it do?

A

Tetanospamin- neurotoxin

Blocks post synpatic inhibition of spinal motor reflexes leading to uninhibited spasmotic contractions

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14
Q

What do C.Tetani look like in culture and stain?

A

they LOOK gram neg but are GRAM POSITIVE

Look like mini tennis raquets

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15
Q

What is the general clinical presentation of C.Tetani infection?

A

Trismus- lockjaw
Risus Sardonicus- inc tone of orbicularis oris
Opisthotonus: arm/leg flexion/extension
Respiratory- obstructioin due to diaphragm spasms

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16
Q

How do we take care of pts with spastic contractions in C.Tetani infecitons?

A

Support with respiratory help and monitoring until synapses reform (it is a permanent inhibition) -> takes weeks to months

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17
Q

How is tetanus diagnosed?

A

Clinical presentation

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18
Q

How is tetanus treated?

A

Human tetanus Ig
Control spasms
Supportive airway

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19
Q

How can tetanus be prevented?

A

3 doses of DPT for prophylaxis every 10 years

Passive immunity for people without previous vaccination

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20
Q

Where is C.Botulinum commonly found?

A

Home canned foods

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21
Q

How is botulism different from tetanus?

A

Botulism: we have paralysis (flaccid) rather than overstimulation/spasm

22
Q

What causes botulinum in adults?

A

Preformed toxin in contaminated foods

23
Q

What causes botulinum in children/infants?

A

Spores in honey that germinate once inside the baby

24
Q

What are the characteristics of the C.Boutlinum toxin?

A

Bacteriophage born
Blocks release of Ach at synapse - permanent damage!
Descending Paralysis
Heat labile

25
Q

How is the paralysis seen in botulinum different from that in Guillen Barre?

A

Botulinum: descending paralysis

Guillen Barre: Ascending paralysis

26
Q

What is the clinical presentaiton of botulism?

A

GI: nausea, dry mouth, diarrhea
Flaccid Descending paralysis
Wound Botulism: local paralysis

27
Q

How is botulism diagnosed?

A

Clinical history and presentation

Toxin Assay from serum, stool, food

28
Q

What is in the DDx of botulism?

A 
Botulism
Myasthenia Gravis
Eaton Lambert
Tick PAralysis
Guillen Barre
29
Q

How can botulism be prevented./treated?

A

Avoid contaminated food
Adequate heating of food
Antitoxin
Supportive

30
Q

Where is C.Diff infections mostly found?

A

Spores are acquierd in hospital

31
Q

What precedes C.Diff infections usually?

A

Antibiotic therapy

Just ingestion is not enough-> abx kills off normal flora-> C.Diff proliferates then

32
Q

What does Toxin A of C.Diff cause?

A

Enterotoxin: inflammatory response -> diarrhea

33
Q

What does Toxin B of C.Diff cause?

A

Cytotoxic effects

34
Q

What else can C.Diff cause besides diarrhea?

A

Diffuse hemorrhagic colitis

Pseudomembrane formation

35
Q

How is C.Diff clinically presented?

A 
Diarrhea
Pseudomembrane colitis
Abd Pain
Leukocytosis
Fever
Toxic Megacolon
36
Q

Why do we see leukocytosis with C.Diff?

A

Inflmmatory reaction in gut -> high white count

37
Q

What can happen with C.diff associated toxic megaocolon?

A

Dilation-> can lead to perforation and pt can die without intervention

38
Q

Which strain of C.Diff is associated with higher mortality and increased Toxin A production?

A

BI/NAP1 Strain: dominant strian in US

39
Q

How is C.Diff diagnosed?

A

ELISA: Detect toxin A in stool
PCR: standard
Sigmoidoscopy/Colonoscopy

40
Q

How is C.Diff treated?

A

Mild: Oral Metroinidazole, oral vancomycin

Relapsing C.Diff: Fidaxemicin

Fecal Transplat?
Colon resection

41
Q

What are 2 other pathogenic clostridium species besides perfringens, tetani, botulinum, and difficile?

A

C.Septicum

C.Sordelli

42
Q

Describe Actinomyces

A 
Non spore forming
Gram positive rod
Filamentous hyphae
Forms sulfur granules
Neg Acid Fast
Slow growing
43
Q

How are actinomyces and nocardia different?

A

Nocardia: Acid fast positive, aerobic
Actinomyces: Acid fast negative, anaerobic

44
Q

How are actinomyces presented clinically?

A 
Orally associated (LOCK JAW)
Cervicofacial
45
Q

How is actinomyces treated?

A

Penicllin: Clindamycin or Erythromycin

46
Q

What is propionobacterium acnes?

A

Slow growing anaerobe
Opportunistic infections
Found on prosthetic device or hardware
Commonly contaminant in blood cultures

47
Q

What is the treatment for Propionobacterium acnes?

A

Penicillin

NO METRONIDAZOLE

48
Q

Which species of bacteria are anaerobic gram positive cocci?

A

Peptostreptococcus

49
Q

Where is peptostreptococcus found?

A

Normal flora of mouth, GI, pelvis

50
Q

What can peptostreptococcal infections cause?

A

Brain abscess

51
Q

How is peptostreptococcal infections treated?

A

Debridement and penicillin

MHD Block 3: Gram Negative Gram Positive ANAEROBES (3 decks)

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