GP anaerobes

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anaerobic GPRs

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63 Terms

1

anaerobic GPRs

  • found in GI/GU tracts, oral cavity, skin

  • differentiate by spore production

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2

aerotolerant clos (histolytica, tertium, canis)

  • pos: anaerobic spores

  • neg: cat, aerobic spores

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3

bacillus sp

  • pos: cat, aerobic spores

  • neg: anaerobic spores

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4

GNRs

vanc R, colistin S

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5

GPCs

vanc S, colistin R

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6

clostridium spp

  • large, GPR spore forming

  • ubiquitous (soil)

  • aerotolerant: histolyticum, tertium, carnis

  • fluoro: c. diff, innocuum = chartreuse; ramosum = red

  • exogenous infections: wounds, organism, toxin ingestion (except c.diff)

  • antibiotics can prevent growth on artificial media

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7

fluorescence

  • wood’s lamp

  • may need longer incubation or exposure to O2

  • a. odontolyticus red

  • veillonella brick red

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8

c. perfringens diseases

  • food poisoning

  • gas gangrene (clos myonecrosis)

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9

food poisoning - c. perfringens

  • ingestion of spores from contam food = enterotoxin made in GI

    • beef, poultry, gravies, dried/precooked foods

    • large amts of food made (hospitals, cafeterias, events)

  • watery diarrhea, adb cramps, 8-12 hrs, self resolving

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10

clostridial myonecrosis - c. perfringens

  • traumatic injury, entry of vegetative bacteria/spores in wound

    • vascular damage = improper perfusion = lack of O2 = anaerobic

  • sudden pain, skin pale = bronze = purple red

  • bullae develop (black bubbles)

  • tachy, fever, shock, organ failure, IV hemolysis, jaundice, renal failure, hypotension, liver necrosis

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11

c. perfringens toxins

  • alpha toxin: phospholipase C and sphingomyelinase

  • theta (perfringolysin O): pore forming

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12

morphology of c. perfringens

  • boxcar GPR with rare subterminal spores

  • double zone hemolysis (inner = theta) (outer = alpha)

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13

presumptive ID - c. perfringens

  • growth on anaBAP: large, irregular, double zone, boxcar, square rods; no indole

  • additional:

    • pos: gelatin, lecithinase, stormy litmus ferm, rvs CAMP

    • neg: motility, urease, lipase, proteolysis litmus

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14

which clostridium are lipase pos

c. botulinum, sporogenes, noyvi

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15

litmus milk

  • determine metabolic activity of microbes in milk (esp for clos)

  • skim milk substrate, azolitmin pH (pink acid; blue alk)

    • no change: no carb ferm

    • alk: proteolysis of lactalbumin (pos)

    • acid: ferm of lactose and/or dextrose (stormy - gas)

    • clot formation: coag of casein

    • clot dissolution: peptonization of milk protein

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16

spore induction - heat method

  • inoculate 2 tubes of starch broth and heat 1 for 10 min at 70C

  • incubate both 37C anaerobic

  • if growth in both = spores induced

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17

spore induction - ethanol test

  • mix week old TG broth with 95% EtOH

  • sit at RT 30 min and sub to anaBAP (incubate anaerobically 48 hrs)

  • growth = spores produced

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18

tetanus - c. tetani

  • spores enter tissue and vegetate, producing tetanospasmin

  • four types: generalized, local, cephalic, neonatal

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19

tetanospasmin

  • 2nd most toxic sub

  • carried thru to nerves, spinal cord, brain stem

  • binds to neuronal receptors irreversibly, blocks signals to inhibit motor responses (GABA) = spastic paralysis

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20

generalized tetanus

  • trismus (lockjaw) + irritability, restlessness, sweating, tachy

  • progresses with contraction of skeletal muscles + spasms

    • stiff neck, opisthotonus, risus sardonicus, rigid abd, dysphagia, apnea, airway obstruction from muscle contraction

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21

local tetanus

  • rare; muscle tonicity/spasms isolated to one region of body

  • progresses to generalized

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22

cephalic tetanus

  • in head/neck regions due to injury, progressing to generalized

  • dysphagia, trismus, focal cranial neuropathies can misDx as stroke

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23

neonatal tetanus

  • failure in aseptic techniques in delivery/umbilical stump management

    • cultural practices: ghee, juices, cow dung

    • unclean hands/environment

  • onset faster; begins with refusal to feed (trismus)

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24

c. tetani morph

  • GPR terminal spores; drumstick, tennis racket

  • swarming on anaBAP

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25

presumptive ID of c. tetani

  • smoothly swarming, slow growing, swollen terminal spores, indole pos

  • additional:

    • pos: motility, gelatin

    • neg: lecithinase, lipase, proteolysis, acid from lactose, urease

    • V: indole

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26

c. botulinum

  • botulism: spores enter body thru wounds, ingestion, inhalation which vegetate in tissue and make exotoxin

  • five types: infant, foodborne, wound, adult infectious, bioterrorism assoc

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27

botulism toxin

  • most potent toxin to man

  • carried to nerves, spinal cord, brain stem

  • moves across presynaptic nerve terminal membrane

  • breaks down neuronal SNARE proteins that are supposed to release Ach to stimulate motor responses = flaccid paralysis

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28

infant botulism - floppy baby syndrome

  • ingestion of clostridial spores move to GI tract and germinate and produce toxin

  • common form in US

  • constipation, weakness, feeding difficulties, hypotonia, drooling, anorexia, irritability, weak cry, dyspnea

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29

foodborne botulism

  • ingestion of preformed toxin in contam food (canned goods)

  • 2nd most common in US

  • nausea, vomiting, adb pain, diarrhea, dry mouth, sore throat

  • blurred vision, diplopia, nystagmus, dysphagia, muscle weakness, dyspnea

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30

wound botulism

  • bacteria/spores enter thru skin and tissue trauma

  • same symptoms as foodborne w/o prodromal

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31

adult infectious botulism

  • arises from enteric colonization by the bacteria

  • symptoms like infant form

  • botex used for cosmetics and migraines

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32

bioterrorism assoc botulism

  • theoretical delivery of botulinum toxin via aerosol or food

  • similar symptoms to generalized

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33

morphology of c. botulinum

  • GPR w subterminal or eccentric spores

  • large, rough appearing on anaBAP

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34

c. botulism lab dx

  • based on symptomology (cx done by ref lab)

  • sero or molecular methods

    • phenotypically similar to c. sporogenes, but makes a neurotoxin

    • ELISA, PCR, PGFE, GLS

  • lipase pos (so is c. noyvi)

  • dx from stool (organism or toxin)

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35

c. diff

  • no O&P after 3 days in hospital (CAP requirement)

  • after taking antimicrobials (clindamycin, fluoroquinolones)

  • advanced age and proton pump inhibitors also inc risk

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36

c. diff toxins

  • toxin A enterotoxin: causes inflammation leading to fluid secretion, mucosal injury

  • toxin B cytotoxin: induces cellular apoptosis, necrosis

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37

CDAD

  • watery diarrhea hallmark, lower abd pain, fever, nausea, anorexia, leukocytosis

  • pseudomembranous colitis: damage to colon leads to bloody stools, hypotension, bowel perforation, peritonitis

    • toxic megacolon: diffuse ulcerations, nodules, superficial plaques

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38

how to treat c. diff

  • new superbug R to metronidazole

  • oral vanc: not absorbed so it works, but expensive

  • fecal transplant

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39

c. diff morphology

  • thin GPR with rare subterminal spores

  • large, ground glass colony on ana BAP, horse stable odor

  • chartreuse fluro

  • grow on CCFA at 35C yellow colonies

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40

c. diff presumptive ID

  • large, flat, horse manure smell, chartreuse fluoro; thin rods rare spores; indole neg

  • additional:

    • pos: motility

    • neg: lecithinase, lipase, proteolysis, gelatin, acid from lactose, urease

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41

lab dx of c. diff

  • do not perform cx

  • old gold standard: cytotoxin neutralization test on human foreskin

  • current: PCR and EIA

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42

other clos species

  • septicum: cecum cancer, medusa head

  • sordelli: septic miscarriage

  • tertium: aerotolerant, terminal spores

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43

actinomycosis - actinomyces

  • normal flora in oral cavity and GI tract; bacteria enter thru trauma sites

  • form a mass in affected area, usually in mandible (misDx as cellulitis)

  • bluish/red swelling progressing to abscess, fistulae, draining sinus tracts

    • sulfur granules in yellow exudate

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44

a. israelii

most common isolate, slow grower, molar teeth

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45

a. odontolyticus

red pigment enhanced with air exposure

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46

a. naeslundii

colonies produce tan pigment with prolonged incubation

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47

a. visocosus

pos catalase

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48

a. meyeri

small GPR, strict anaerobic (QA organism)

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49

actinomyces ID

  • branching GPR, stain from exudate, sulfur granules

  • differentiation not done

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50

bifidobacterium

  • normal GI, vaginal, oral flora

  • rare resp, UTIs, dental caries

  • assoc w probiotics

  • bifurcated ends, Y shaped GPR

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51

eubacterium

rare infections (oral flora) teeth, human bite, polymicrobic vaginal infections

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52

lactobacillus

  • bacteremia, endocarditis, dental caries in IC

  • normal vaginal flora

  • some aerotolerant

  • long thin GPR in chains

  • cat neg

  • vanc R

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53

mobiluncus

  • polymicrobial BV

  • curved GPR (like vibrio)

  • motile

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54

proprionibacterium

  • skin flora in sebaceous glands = common contam in skin and blood cx

  • endocarditis, implanted prosthetic devices

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55

presumptive ID - p. acnes

  • small, opaque enamel white, circular colonies

  • cat pos w 15%

  • coryneform (diphtheroid like) spiders

  • indole pos

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56

anaerobic GPC

  • normal mouth, URT, GI, female GU, skin flora

  • opportunistic polymicrobial infections: skin, oral, brain, bacteremia, necrotizing pneumonia, septic abortion

  • anaerococcus, finegoldia, peptoniphilus, peptococcus, peptostreptococcus

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57

anaerococcus

  • a. prevotii: urease neg

  • a. tetradius: urease pos

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58

f. magna

greater than 0.6um

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59

peptoniphilus

  • p. asaccharolyticus: nitrate neg, indole pos

  • p. indolicus: nitrate pos, indole pos

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60

peptococcus

black colonies rarely isolated in cx

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61

peptostreptococcus

  • anaerobius most common: SPS sensitive so not recovered in blood cx

  • p. micros < 0.6um

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62

staphylococcus saccharolyticus

anaerobe

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63

v. parvula

nitrate pos

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