GP anaerobes

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63 Terms

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anaerobic GPRs
* found in GI/GU tracts, oral cavity, skin
* differentiate by spore production
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aerotolerant clos (histolytica, tertium, canis)
* pos: anaerobic spores


* neg: cat, aerobic spores
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bacillus sp
* pos: cat, aerobic spores
* neg: anaerobic spores
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GNRs
vanc R, colistin S
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GPCs
vanc S, colistin R
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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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fluorescence
* wood’s lamp
* may need longer incubation or exposure to O2
* a. odontolyticus red
* veillonella brick red
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c. perfringens diseases
* food poisoning
* gas gangrene (clos myonecrosis)
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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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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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c. perfringens toxins
* alpha toxin: phospholipase C and sphingomyelinase
* theta (perfringolysin O): pore forming
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morphology of c. perfringens
* boxcar GPR with rare subterminal spores
* double zone hemolysis (inner = theta) (outer = alpha)
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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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which clostridium are lipase pos
c. botulinum, sporogenes, noyvi
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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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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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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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tetanus - c. tetani
* spores enter tissue and vegetate, producing tetanospasmin
* four types: generalized, local, cephalic, neonatal
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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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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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local tetanus
* rare; muscle tonicity/spasms isolated to one region of body
* progresses to generalized
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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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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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c. tetani morph
* GPR terminal spores; drumstick, tennis racket
* swarming on anaBAP
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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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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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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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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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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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wound botulism
* bacteria/spores enter thru skin and tissue trauma
* same symptoms as foodborne w/o prodromal
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adult infectious botulism
* arises from enteric colonization by the bacteria
* symptoms like infant form
* botex used for cosmetics and migraines
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bioterrorism assoc botulism
* theoretical delivery of botulinum toxin via aerosol or food
* similar symptoms to generalized
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morphology of c. botulinum
* GPR w subterminal or eccentric spores
* large, rough appearing on anaBAP
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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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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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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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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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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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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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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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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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other clos species
* septicum: cecum cancer, medusa head
* sordelli: septic miscarriage
* tertium: aerotolerant, terminal spores
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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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a. israelii
most common isolate, slow grower, molar teeth
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a. odontolyticus
red pigment enhanced with air exposure
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a. naeslundii
colonies produce tan pigment with prolonged incubation
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a. visocosus
pos catalase
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a. meyeri
small GPR, strict anaerobic (QA organism)
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actinomyces ID
* branching GPR, stain from exudate, sulfur granules
* differentiation not done
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bifidobacterium
* normal GI, vaginal, oral flora
* rare resp, UTIs, dental caries
* assoc w probiotics
* bifurcated ends, Y shaped GPR
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eubacterium
rare infections (oral flora) teeth, human bite, polymicrobic vaginal infections
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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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mobiluncus
* polymicrobial BV
* curved GPR (like vibrio)
* motile
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proprionibacterium
* skin flora in sebaceous glands = common contam in skin and blood cx
* endocarditis, implanted prosthetic devices
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presumptive ID - p. acnes
* small, opaque enamel white, circular colonies
* cat pos w 15%
* coryneform (diphtheroid like) spiders
* indole pos
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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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anaerococcus
* a. prevotii: urease neg
* a. tetradius: urease pos
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f. magna
greater than 0.6um
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peptoniphilus
* p. asaccharolyticus: nitrate neg, indole pos
* p. indolicus: nitrate pos, indole pos
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peptococcus
black colonies rarely isolated in cx
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peptostreptococcus
* anaerobius most common: SPS sensitive so not recovered in blood cx
* p. micros < 0.6um
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staphylococcus saccharolyticus
anaerobe
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v. parvula
nitrate pos