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Clinical and lab aspect of anaerobic infection

Learn about classification, antimicrobial sensitivity, anaerobiosis, habitats, clinical aspects, features of anaerobic infections, infections caused by anaerobic organisms, laboratory diagnosis, treatment, oral and dental implications, infections in the head and neck, and more.

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Clinical and lab aspect of anaerobic infection

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  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 (Bacteroides) • Anaerobic streptococci (Peptostreptococcus) • Anaerobic staphylococcus (Peptococcus) • Gram negative diplococci (Veillonella) • Gram positive bacilli (Actinomyces)

  3. Propionibacterium

  4. Bacteroidesfragilis

  5. Fusobacteriumnucleatum

  6. AntimicrobiolialSensitivity • All of them resistant to aminoglycosides • Gentamicine • Tobramycin • Amikacin • Almost all are sensitive to metranidazole (flagyl)

  7. 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 fumarate reductase must be reduced form to work

  8. Anaerobic chamber

  9. NONSPORINGANAEROBES

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

  11. 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)

  12. CLINICAL ASPECTS • ANAEROBES ARE INDIGENOUS FLORA OF SKIN & MUCOUS MEMBRANES • NORMALLY CONTAINED AWAY FROM INTERNAL STERILE BODY SITES • HIGH MORBIDITY & MORTALITY

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

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

  15. 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

  16. 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

  17. 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

  18. 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.

  19. 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.

  20. 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

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

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

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

  24. 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

  25. Ludwig’s Angina

  26. Lemierre Syndrome

  27. Expansion of the retropharyngeal soft tissues

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

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

  30. THORACIC ACTINOMYCOSIS

  31. THORACIC ACTINOMYCOSIS

  32. ACTINOMYCOSIS

  33. Molar tooth appearance of Actinomyces israeIii

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

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

  36. CLENCHED FIST INJURIES

  37. DIABETIC FOOT

  38. HUMAN BITE

  39. NECROTIZING CELLULITIS

  40. FEMALE UROGENITAL • CHORIOAMNIOTIC INFECTIONS • ENDOMETRITIS • PID – ABDOMINAL INFECTIONS • BACTERIAL VAGINOSIS WITH GARDNERELLA & BACTEROIDES SP.

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

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

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

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

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

  46. 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)

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

  48. Bacteroides fragilis

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

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