1 / 106

Clinical and lab aspect of anaerobic infection

Clinical and lab aspect of anaerobic infection. Ali Somily MD, FRCPC,ABMM. Classification. Anaerobic spore forming bacilli (Clostridia) Gram negative bacilli non- sporing forming ( Bacteroides ) Anaerobic streptococci ( Peptostreptococcus ) Anaerobic staphylococcus ( Peptococcus )

Download Presentation

Clinical and lab aspect of anaerobic infection

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Clinical and lab aspect of anaerobic infection Ali Somily MD, FRCPC,ABMM

  2. Classification • Anaerobic spore forming bacilli (Clostridia) • Gram negative bacilli non-sporing forming (Bacteroides) • Anaerobic streptococci (Peptostreptococcus) • Anaerobic staphylococcus (Peptococcus) • Gram negative diplococci (Veillonella) • Gram positive bacilli (Actinomyces)

  3. Anaerobiosis • Lack cytochrome-cannot use oxygen as hydrogen acceptor • Most Lack • Catalase • Peroxidase • Contain flavoproteinso in the presence of oxygen produce H2O2 which is toxic • Some lack enzyme superoxide dismutase so many killed , peroxide and toxic radicales enzyme like fumaratereductase must be in reduced form to work

  4. HABITATI : • These organism are normal flora in: • A. Oropharynx • eg. 1. Bacteroides melaninogenicus • Now called provetella melaninogenicus • 2. Fusobacteria • 3. Veillonella

  5. HABITAT II: • B. Gastrointestinal tract • Found mainly in the large colon in large numbers • Total number of anaerobes = 10 11 • While all aerobes (including E. coli) = 10 4 • examples are • (1) B acteroides fragilis • (2) Bifidobacterium species • C. Female genital tract (mainly in the vagina)

  6. INFECTIONS CAUSED BY ,NONSPORING ANAEROBES • A. The head, neck and respiratory tract • B. The lower abdomen and the pelvis

  7. FEATURES OF ANAEROBIC INFECTIONS Characterized by • Infections are always near to the site of the body which are habitat. • Infection from animal bites. • Deep abscesses • The infections are also polymicrobial foul smell • Gas formation • Detection of "Sulphur granules"' due to actinomycosis • Failure to grow organism from pus if not culture anaerobically. • Failure to respond to usual antibiotics.

  8. INFECTIONS BEGIN • DISRUPTION OF BARRIERS • TRAUMA • OPERATIONS • CANCEROUS INVASION OF TISSUES • DISRUPTION OF BLOOD SUPPLY • DROPS OXYGEN CONTENT OF TISSUE • DECREASE IN Eh POTENTIAL • TISSUE NECROSIS

  9. WHAT ARE THE INFECTION CAUSED BY THESE ANAEROBIC ORGANISMS I • Post operative wound infection • Brain abscess • Dental abscesses • Lung abscess • Intra abdominal abscess, appendicitis, diverculitis • All these infection can cause bacteriaemia

  10. WHAT ARE THE INFECTION CAUSED BY THESE ANAEROBIC ORGANISMS II • Infection of the female genital tract • Septic abortion • Puerperalinfection or sepsis • Endometritis • Pelvic abscess • 12. Other infections • a)Breast abscess in puerperal sepsis • b) Infection of diabetic patients (diabetic foot infections). • c) Infection of pilonidal sinus

  11. ORAL & DENTAL • > 400 SPECIES OF ANO2 IN MOUTH • MOST INFECTIONS = POLYMICROBIC • MIXED ORGANISMS • ENTER AS A GROUP • ANO2 NOT INITIAL INVADER • USUALLY SECONDARY • 1ST ORGANISM DECREASES [O2] & Eh

  12. ORAL & DENTAL • COMMONLY ASSOCIATED WITH • DENTAL ABSCESSES • ROOT CANALS • JUVENILE PERIODONTITIS • ADULT PERIODONTITIS • CLENCHED FIST INJURIES

  13. ENT – HEAD & NECK • CHRONIC OTITIS MEDIA • CO-PATHOGENS WITH CHRONIC STREP TONSILLITIS • ACUTE SINUSITIS • POST-DENTAL EXTRACTIONS OR TRAUMA • 2o INVADER

  14. ENT – HEAD & NECK • VINCENT’S ANGINA • COMBINATION OF FUSOBACTERIUM & SPIROCHETE SPECIES OVERGROWTH • ANAEROBIC PHARYNGITIS • GRAY MEMBRANE • FOUL ODOR

  15. Vincent’s disease • Trench mouth • Sudden onset of pain in the gingiva (mastication) • Necrosis of the gingiva • interdental papilla • a marginated, punched-out, and eroded appearance • A superficial grayish pseudomembrane • altered taste sensation is present • Fever, malaise, and regional lymphadenopathy

  16. Ludwig’s Angina

  17. Lemierre Syndrome

  18. Expansion of the retropharyngeal soft tissues

  19. PLELRO PULMONARY I FECTION • ASPIRATION LUNG ABSCESS • ASPIRATION PNEUMONIA • M ETASTATIC LUNG ABSCESS • BRONCHIACTSIS • ALL OF ABOVE CAN CAUSE EMPYEMA

  20. LUNG & PLEURAL • ASPIRATION PNEUMONIA • EMPHYSEMA • LUNG ABSCESSES • MALIGNANCIES • LEUKOPENIA

  21. THORACIC ACTINOMYCOSIS

  22. THORACIC ACTINOMYCOSIS

  23. ACTINOMYCOSIS

  24. Molar tooth appearance of Actinomyces israeIii

  25. Macroscopic colony (left) Gram stain (right) of Actinomyces

  26. SKIN & SOFT TISSUE • TRAUMATIZED & DEVITALIZED TISSUE • TRAUMATIC WOUNDS • HUMAN/ANIMAL BITES • ISCHEMIA OF EXTREMITIES • DIABETES • ATHEROSCLEROSIS

  27. CLENCHED FIST INJURIES

  28. DIABETIC FOOT

  29. HUMAN BITE

  30. NECROTIZING CELLULITIS

  31. PUERPERAL INFECTION SEPTIC ABORTION • PUERPERAL ABSCESS • SEPTIC ABORTION • BACTERAEMIA • PELVIC ABSCESS • ADENXAL ABSCESS • PERITONITIS • ENDOMETRITIS

  32. ABDOMINAL INFECTIONS • MANIPULATION, INVASION OR TRAUMA TO GI TRACT • TRAUMA • SURGERY • APPENDICITIS • MALIGNANCIES • COLON CANCER

  33. CNS • HEAD TRAUMA • HEMATOGENOUS SPREAD • FROM ANY INFECTED BODY SITE • GEOGRAPHIC SPREAD • SINUS INFECTIONS • DENTAL ABSCESSES

  34. BONE & JOINT • HEMATOGENOUS SPREAD • TRAUMA • PERIVASCULAR DISEASE • JUVENILE PERIODONTITIS

  35. OTHERINFECTIONS • GRAM NEGATIVE BACTREMIA • BREAST ABSCESS • AXILLARY ABSCESS • INFECTION OF DIABETIS EG.DIABETIC ULCERS • INFECTION OF PILONIDAL SINUS • PARONYCHIA

  36. LABORATORY DIAGNOSIS: • When anaerobic infection is suspected; • a) Specimens have to be collected from the site containing necrotic tissue. • b) Pus is better than swabs. • c) Specimens has to be send to the laboratory within 1/2 hour why? • d) Fluid media like cooked meat broth are the best culture media. • e) Specimens have to incubated anaerobically for 48 hours.

  37. Anaerobic chamber

  38. TREATMENT: • Bacteroides fragilis is always resistant to penicillin. • But penicillin can he used for other anaerobes • Flagyl (metronidazole) is the drug of choice. • Clindamycin can also be used.

  39. CLASSIFICATION • Anaerobic spore forming bacilli (Clostridia) • Gram negative bacilli nonsporing (Bacteroides) • Anaerobic streptococci (Peptostreptococcus) • Anaerobic staphylococcus (Peptococcus) • Gram negative diplococci (Veillonella) • Gram positive bacilli (Actinomyces)

  40. ORGANISM GROUPS • GRAM NEGATIVE RODS • BACTEROIDES • PREVOTELLA • PORPHYROMONAS • FUSOBACTERIUM • BUTYRIVIBRIO • SUCCINOMONAS

  41. Bacteroides fragilis

  42. Propionibacterium

  43. Fusobacteriumnucleatum

  44. BACTEROIDES • STRICT ANAEROBE • PLEOMORPHIC • GRAM NEGATIVE BACILLI (COCCO BACILLI) • NORMAL FLORA IN • OROPHARYNX • GASTROINTESTINAL TRACT • VAGINA

  45. BACTEROIDES FRAGILIS GP • GROUP = B. FRAGILIS, B. VULGARIS, B.THETAIOTAMICRON, B. UNIFORMIS • ACCOUNT FOR 1/3 OF ALL ISOLATES • RESISTANT TO 20% BILE • RESISTANT TO MANY ANTIBIOTICS • PENICILLIN, KANAMYCIN, VANCOMYCIN, COLISTIN – AND MANY MORE

  46. BACTEROIDES FRAGILIS GP • GLC = MAJOR ACETIC & SUCCINIC, LACTIC & PROPIONIC ACIDS • NO PIGMENTATION OF COLONIES OR FLUORESCENCE

  47. BACTEROIDES OTHER SP • BACTEROIDES SPECIES OTHER THAN B. FRAGILIS GROUP • GLC = MAJOR ACETIC & SUCCINIC ONLY • BILE SENSITIVE • RESISTANT TO KANAMYCIN ONLY • SOME PIGMENTED

  48. BACTEROIDES • B. FRAGILIS IN THE GUT AND VAGINA • B.MELANINOGESUS AND B.ORALIS IN THE MOUTH AND OROPHARYNX • B. FRAGILIS PENICILLIN RESISTANT, • OTHER ARE SENSITIVE, • IT IS THE COMMONEST ORGANISM IN THE GUT 10 12 ORGANISM /GRAM OF FAECES

  49. Bacteroides and other anaerobic bacilli

  50. BACTEROIDES AND FUSOBCTERIUM

More Related