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GIHEP > L7: Anaerobes & Peritonitis > Flashcards

L7: Anaerobes & Peritonitis Flashcards

1
Q

What is an example of a strict/obligate aerobe?

A

Pseudomonas aeruginosa

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2
Q

What is an example of a facultative aerobe?

A

E. coli

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3
Q

What is a microaerophilic organism? Give an example

A

grow poorly aerobically but distinctly better under 10% CO2 - e.g. Neisseria meningitidis

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4
Q

What is an example of a strict/obligate anaerobe?

A

Bacteroides fragilis

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5
Q

Which anaerobe(s) are present on the skin?

A

Propionibacterium acnes

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6
Q

Which anaerobe(s) are present in the colon?

A

bacteroides spp.
clostridium spp.
prevotella spp.
peptostreptococcus spp.

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7
Q

Which anaerobe(s) are present in the oral cavity + upper respiratory tract?

A

fusobacterium

peptostreptococcus spp.

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8
Q

Which anaerobe(s) are present in the female genital tract?

A

lactobacillus spp.

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9
Q

If someone was bitten by a dog, which anaerobe will most likely be present?

A

Capnocytophaga canimorsus

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10
Q

What must be collected to make a diagnosis of an anaerobic infection?

A
  1. Pus
  2. Tissue Sample

both for culture

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11
Q

What are host factors that may predispose a patient to anaerobic infections?

A
  • impaired gag reflex + cough reflex
  • trauma + tissue ischaemia
  • gastrointestinal surgery
  • amputation of lower limb in patient with peripheral vascular disease
  • antibiotics
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12
Q

Antibiotics alter the composition of the normal colonic flora, predisposing it to the overgrowth of…?

A

Clostridium difficile

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13
Q

List some of the characteristics of the Clostridium spp.

A
  • gram positive bacilli
  • form spores
  • produce exotoxin
  • most are strict anaerobes

e.g. C. tetani, C. botulinum, C. difficile, C. perfringens

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14
Q

What is the name of the toxin a/w Clostridium Tetani? What is its function/MOA?

A

Neurotoxin - Tetanospasmin

  • blocks transmission at inhibitory synapse resulting in “inhibition of the inhibitory neurons”
  • leads to sustained muscle contractions/spasms
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15
Q

Briefly explain the pathogenesis of C. tetani

A
  • skin trauma occurs (e.g. puncture wound, burns…)
  • spores inroduced via skin trauma
  • spores in wound germinate when there is a localized anaerobic environment
  • they will then produce toxin
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16
Q

Which organism was known to contaminate heroin?

A

Clostridium tetani

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17
Q

What is the clinical presentation/symptoms of C. tetani?

A

muscle spasms - spontaneously or after minor stimuli
flexion of muscles e.g. arching of back
trismus - “lock jaw”
sardonic appearance

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18
Q

What is another name for trismus?

A

Lock Jaw

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19
Q

What pathogen is known for causing a sardonic appearance?

A

C. tetani

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20
Q

What are some complication of a C. tetani infection?

A 
laryngospasm
ANS dysfunction (labile BP, arrhythmias, sweating)
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21
Q

What is the treatment/management plan for treating a patient with a C. tetani infection?

A
  1. ABCs
  2. Wound Debridement + Metronidazole
  3. Tetanus Immunoglobulin
  4. Manage Spasms
  5. Avoid Touch, Light or Other Stimuli
22
Q

Which antibiotic is used when treating C. tetani?

A

Metronidazole

23
Q

What is the main prevention strategy for preventing a C. tetani infection?

A

Vaccination!

Toxoid Vaccine/Inactivated Tetanus Toxin Vaccine

24
Q

Why might a C. tetani booster immunization be required?

A

the vaccine may not provide protection after 10 years - so the patient will need a booster

25
Q

What is the name of the toxin a/w Clostridium Botulinum? What is its function/MOA?

A

“Botox”

- inhibits the release of ACh at NMJ resulting in weakness/acute flaccid paralysis

26
Q

How does foodborne botulism occur? (pathogenesis)

A

from poorly canned foods - foods that were not cooked thoroughly and then put in an anaerobic environment

  • spores germinate and toxin is produce
  • person ingests contaminated food
  • fast onset
27
Q

What is infant botulism? (pathogenesis)

A
  • ingestion of spores that germinate in the GIT

- toxin then released in the GIT and absorbed

28
Q

What is the presentation/clinical features of botulism?

A
  • symmetrical descending flaccid paralysis
  • bilateral cranial nerve palsies
  • double vision
  • difficulty swallowing
  • muscle weakness
29
Q

How does infant botulism appear?

A
  • constipation
  • muscle weakness
  • lethargy
  • poor feeding
  • “floppy” baby
30
Q

What tests/investigation can be done to diagnose foodborne botulism?

A

detection of toxin in stool/vomitus

31
Q

What test/investigation can be done to diagnose infant botulism?

A

organism or toxin in stool

32
Q

What test/investigation can be done to diagnose wound botulism?

A

culture of organism from wound site

33
Q

What is the treatment/management for botulism?

A
  1. ABCs
  2. Antitoxin - Botulism Immunoglobulin
  3. Wound Debridement + Metronidazole (only in wound botulism)
34
Q

C. difficile infections often occur in which population group?

A

in people who have had contact with healthcare or have been on antibiotics

35
Q

Antibiotics are known to knock out both good and bad bacteria in the gut - this can lead to a C. difficile infection. Which antibiotics have been most implicated with C. diff infections?

A
  • Fluoroquinolones
  • Beta-Lactam Antibiotics (esp. ampicillin and 3rd generation cephalosporins)
  • Clindamycin
36
Q

What are some 3rd generation cephalosporins?

A

Cefotaxime, Ceftriaxone

37
Q

How may a C. diff infection be diagnosed?

A

PCR of stool for toxin gene (TCDB gene)

38
Q

What is the treatment/management plan for C. difficile infection?

A
  1. Isolation + Contact Precautions
  2. Review Antibiotics
  3. Supportive Therapy
  4. Antibiotics ( Oral Vancomycin OR Fidaxomicin)
39
Q

Which antibiotic is used to treat botulism?

A

Metronidazole

40
Q

Which antibiotics may be used to treat C. difficile infections?

A

Oral Vancomycin or Fidaxomicin

41
Q

What is clostridial myonecrosis another name for?

A

gas gangrene

42
Q

What toxin causes c. perfringens food poisoning?

A

C. perfingens enterotoxin

43
Q

What toxin causes c. perfringens gas gangrene?

A

Lecithinase toxin

44
Q

How can gas gangrene be diagnosed? What tests/investigations can be done?

A
  • CT or XRAY (looking for gas in tissues)
  • Wound Swab or Blister Fluid for Culture
  • Blood Culture
45
Q

What is the treatment for gas gangrene?

A
  • surgical debridement**

- high dose penicillin/clindamycin

46
Q

What is a risk factor for SBP?

A

cirrhosis of the liver (ascites)

47
Q

What organisms usually cause SBP?

A

Aerobic Bacteria (E. coli, K. pneumoniae, S. pneumoniae, GAS, enterococci)

48
Q

What organisms usually cause peritonitis complicating peritoneal dialysis?

A

Skin Flora - S. aureus, coag neg staph

GI Flora - E. coli, pseudomonas

49
Q

What are the symptoms/clinical features of peritonitis complicating peritoneal dialysis?

A
  • cloudy dialysis fluid

- white flecks, strands or clumps (fibrin) in the dialysis fluid

50
Q

What is the treatment of secondary peritonitis?

A
  1. Empiric Antibiotics: Co-Amoxiclav/Piperacillin-Tazobactam + Gentamicin
  2. Source Control: drainage of abscesses, appendicectomy, bowel resection, repair perforated ulcer etc.

GIHEP (24 decks)

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