Professional Documents
Culture Documents
Dr. Molina
July 23, 2013 GASTROINTESTINAL TRACT AND RECTUM
Group 2
Enterobacteriaceae except: Salmonella, Shigella, Yersinia,
Vibrio and Campylobacter species
Anaerobes are members of the normal microbiota of
Glucose non-fermenting gram (-) rods
different areas of the human body.
Enterococci
Alpha and non-hemolytic streptococci
SKIN Staphylococcus aureus in small numbers
Yeast in small amount
Staphylococcus epidermidis Anaerobes in large numbers
Staphylococcus aureus (small numbers)
Micrococcus species GENITALIA
Nonpathogenic neisseria species
Alpha-hemolytic (S. viridans), non-hemolytic streptococci
Any amount of the following:
Corynebacterium species
Corynebacterium species
Propionibacterium species
Lactobacillus species
Peptostreptococcus species
Alpha and non-hemolytic streptococci
Acinetobacter species
Small numbers of other organisms (Candida species, P.
Mixed and not predominant:
aeruginosa)
Enterococci
XXX: Diphtheroids, nonpathogenic Neisseria species
Enterobacteriaceae
Other gram (-) rods
NASOPHARYNX (Mouth & Upper Respiratory Tract) Staphylococcus epidermidis
Candida albicans and other yeasts
Any amount of the following:
Diphtheroids Anaerobes when in pure growth or clearly predominant
Non-[pathogenic neisseria species Prevotella, Clostridium and Peptostreptococcus species
Alpha-hemolytic and non-hemolytic streptococci
Staphylococcus epidermidis VAGINA
Anaerobes (many types)
Lesser amounts of the following:
Soon after birth: lactobacilli as long as pH is acidic
Yeasts
Hemophilus species
Until puberty: neutral PH
Pneumococci
Cocci and bacilli
Staphylococcus aureus
Gram negative rods
Puberty onwards: acidic pH through production of acid
Neisseria meningitides
from carbohydrates especially glycogen
Nose Corynebacterium staphylococci, streptococci
After menopause: neutral pH lactobacilli diminish;
mixed flora returns
Mouth and pharynx sterile at birth
S. viridans
Anaerobic spirochetes when teeth erupt
HELPFUL TERMS
Actinomyces in tonsillar tissue
Yeasts
Anaerobic bacteria - do not require oxygen for growth
Small bronchi and alveoli sterile and metabolism but obtain their energy from
Infectious agents of the mouth and respiratory tract fermentation reactions; require reduced oxygen
Usually include anaerobes tension and fail to grow on the surface of solid medium
in 10% carbon dioxide in ambient air
Mouth and respiratory tract Examples: Bacteroides, clostridium
Mixed oronasal flora including anaerobes:
P. Melaninnogenica Facultative anaerobes - grow either oxidatively using
Fusobacterium oxygen or anaerobically using fermentation reaction for
energy needs; are often called aerobes; versatile Lemierres disease
organisms Porphyromonas- Mouth Oropharyngeal,
Examples: Streptococcus species, E. coli *members before pleuropulmonary,
of the Bacteroides breast, axillary, perianal,
Aerobic bacteria - require oxygen for growth group male genitalia
Obligate aerobes: Micrococcus, Nocardia
Microaerophilic bacteria - require oxygen but fail to 1. Bacteroides bile resistant, nonspore forming, slender
grow on the surface of solid medium in air and exhibit gram (-) rods that may appear as coccobacilli
minimal growth under aerobic conditions - most often implicated under circumstances of disruption
of the intestinal wall (surgery, trauma, appendicitis,
diverticulitis)
Capnophilic bacteria - require carbon dioxide for
growth
2. Prevotella may appear as slender rods or coccobacilli
- in infections, may often be associated with other
**Anaerobes grow in areas with low or negative oxidation-
anaerobic organisms that are part of the normal flora
reduction potential**
(peptostreptococci, anaerobic gram (+) rods,
Ex. Necrotic tissues, gangrenous tissues
fusobacteria)
AEROBES VS. ANAEROBES
3. Porphyromonas part of the normal mouth flora
Aerobes Anaerobes
4. Fusobacteria
+ Cytochrome Systems -
F. necrophorum very pleomorphic, long rod with
+ Superoxide Dismutase round ends and tends to make bizarre forms
+ Catalase - It is not a component of the healthy oral cavity.
- depending if microorganism is obligate or facultative anaerobe
F. nucleatum thin rod with tapered ends (needle
shaped morphology)
Cytochrome systems for the metabolism of O 2
- Quite virulent and can cause severe infections of the
Superoxide dismutase or catalase able to negate the head and neck leading to Lemierres disease.
toxic effects of oxygen radicals and hydrogen peroxide
and thus tolerate oxygen
Catalase system- related with hydrogen peroxide Lemierres Disease
- Very severe infection associated w/ F.necrophorum
ANAEROBES OF CLINICAL IMPORTANCE - Characterized by acute jugular vein septic
thrombophlebitis (involves head & neck) that
progresses to sepsis with metastatic abscesses of the
A. Gram Negative Bacilli
lungs, mediastinum, pleural cavity, and liver
GENERA ANATOMIC INFECTIONS
- Most common among older children and young adults
SITE
- Often occurs in association with infectious
Bacteroides Mouth Pleuropulmonary
mononucleosis
fragilis Colon infections
Endocarditis
Intra-abdominal
abscesses (*usually
after colonic
perforations)
Pelvic inflammatory
disease (PID)
Bacteremia
Prevotella Mouth Oropharyngeal,
melaninogenica Colon pleuropulmonary
(reclassified from GUT Lung and brain abscess
bacteroides) PID, tubo-ovarian and
pelvic abscesses
Fusobacterium Mouth Oropharyngeal, Prevotella intermedia
(F. nucleatum, F. Colon pleuropulmonary, skin, Black pigment on sheep blood agar (left) vs. rabbit blood agar
necrophorum) soft tissue, bone
Bacteria that cause Bacterial Vaginosis B. Gram (-) Cocci
Actinomycosis
3 Forms of Actinomycosis
Genital Actinomycosis
Rare
Associated with Intrauterine device colonization &
subsequent invasion
Diagnosis
Specimen:
o Pus from draining sinus
o Sputum Fig 3. Actinomyces israelii: Sulfur granule demonstrating
o Tissue gram positive branching bacilli
Appropriate media, anaerobic environment
Granules:
o Hard, lobulated tissue elements
o Bacterial filaments
Fig 5. Eubacterium sp. Some species appear gram variable Fig 6. Clostridium perfringens: Boxcar-shaped cells
or gram negative
This is a BOXCAR
CLOSTRIDIUM
CLOSTRIDIUM TETANI
- Spores germinate in devitalized tissue
- Tetanospamin-potent neurotoxin
CLOSTRIDIUM DIFFICILE Principal Clostridia involved in gas gangrene related to
- Cytopathic and enterotoxin bowel cancer:
- Pseudomembranous colitis C. perfringens
o Diarrhea C. septicum
o Necrosis of the mucosa with the C. tertium
accumulation of inflammatory cells and
fibrin Other causes of intra-abdominal anaerobic infections:
o Tx: Metronidazole, Vancomycin Vascular sources
Pathogenesis of Anaerobic Infections Obstructions
1. Polymicrobial nature Inflammatory reactions
2. Synergistic pathogenicity Other bowel lesions
Biliary tract infection usually caused by C.
*Bacteroides fragilis experiments (rat model of
perfringens, B. fragilis
intraabdominal infection; gentamicin, clindamycin)
Carcinoma of the bowel may initially manifest as an II. SPECIMEN COLLECTION AND TRANSPORT
anaerobic abdominal infection or gas gangrene due to the
Good anaerobic bacteriology starts with proper specimen
low redox potential of the area; be sure to evaluate
collection
patient further.
Aspirate
Tissue Biopsy
Lavage
Oxygen-free transport at room temperature
Gram stain
Anaerobic cultures - supplemented with hemin, Vit. K,
blood
Trypticase soy agar base
Schaedler blood agar
Brucella agar
Brain heart infusion agar Actinomyces species
Principles:
Large broad gram (+) rods mixed with gram (-) rods and
WBCs distorted by C. perfringens toxins
V. TREATMENT
Blood transfusion
Fluids and electrolytes
Immobilization of infected injury
Treatment of shock
Pain relief
Management of renal failure
B. Medical
1. Antimicrobials
*Metronidazole
*Clindamycin
Chloramphenicol
Cefoxitin, Cefotetan
Penicillins
Newer Quinolones
Carbapenems
Tigecycline
2. Antitoxins
C. Surgical
Debridement
Drainage
References: