FACULTAS MEDICINAE ET CHIRURGIAE

Oh Lord Our God,

May the inpouring of the Holy Spirit
Purify our hearts and
make them fruitful by the
sprinkling with the dew of His grace.
We ask this through
Our Lord Jesus Christ, Your Son,
Who lives and reigns with You
and the Holy Spirit,
PRAYER BEFORE
One God forever and ever.
CLASS Amen.
INFECTION CAUSED BY
ANAEROBIC BACTERIA
Physiology and Growth
Condition for Anaerobes
 Anaerobic Bacteria
 Organisms that do not need or use oxygen
for growth and metabolism. They obtain
their energy thru fermentation
 Organisms will not grow in the presence of
oxygen and are killed by oxygen or toxic
oxygen
 pH and oxidation – reduction potential (EH)
are important factors in the determinant of
growth of anaerobes
 Superoxide radicals
- - +
O2 + O2 + 2H H2O2 +O2
superoxide
dismutase
(SOD)

2H2O2 catalase
2H2O + O2
(hydrogen peroxide)
Characteristics that
make organism to be an
anaerobic
 Lack cytochrome systems for the
metabolism of O2
 Lack superoxide dismutase or catalase
 Growth at low or negative EH (oxidative
reduction potential)
 Anaerobic bacteria are widespread in
nature and are predominant part of our
normal flora
 Most anaerobic infections are caused by
moderately obligate anaerobes
 Obligate anaerobes usually lack
superoxide dismutase and catalase and
are infrequently isolated from human
infection
 Anaerobes with small amount of SOD and
catalase can tolerate toxic effects of
oxygen radicals and H2O2
 Facultative anaerobes are often termed as
aerobes (Bacteria that can grow either
oxidatively using oxygen as terminal
electron acceptor as anaerobically using
fermentation reactions)
 Facultative anaerobe at a site of infection
can rapidly consume available oxygen and
change to anaerobic metabolsim
 Anaerobic infections are often
polymicrobic
 The most important anaerobic
pathogens belong to the Bacteroides
fragilis group
 Anaerobic Bacteria of
Clinical Importance

GENERA ANATOMIC SITE

BACILLI (rods)

Gram negative
Bacteroides fragilis group Colon
Prevotella melaninogenica Mouth
Fusobacterium Mouth, colon
 Anaerobic Bacteria of
Clinical Importance
GENERA ANATOMIC SITE

BACILLI (rods)
Gram-positive
Actinomyces Mouth
Lactobacillus Vagina
Propionibacterium Skin
Eubacterium,
bifidobacterium, and
arachnia Mouth, colon
Clostridium Colon
 Anaerobic Bacteria of
Clinical Importance

GENERA ANATOMIC SITE

COCCI(spheres)

Gram-positive
Peptostreptococus Colon
Gram-negative
Veilonella Mouth, colon
Gram Negative
Anaerobes
 Bacteroides
 Prevotella
 Porphyromonas
 Fusobacteria
Bacteroides
 Gram (-) bacilli
 Non spore forming slender rods
appearing as coccobacilli, bile resistant
 Normal habitat of bowel
 Species
 B. fragilis
 B. ovatus
 B. distasanis
 B. vulgatus
 VIRULENCE FACTOR
○ Capsule – antiphagocytic, promotes abscess
formation
 glycolipid little or no endotoxin
activity
• Enzymes – hyaluronidase, neuraminidase,
collagenase, etc.
 Infections are often polymicrobial
 Associated clinical syndromes
 Pleuropulmonary infections
 Intraabdominal infections
 Genital infection
 Infections are often mixed with
peptostreptococcus, clostridium and
eubacterium
Prevotella
 Species
 P. melaninogenica
 P. bivia
 P. disiens
 Associated clinical syndromes
 P. melaninogenica – URTI
 P. bivia and P. disiens – female genital tract
infections
 All species can cause brain, lung abscesses
and empyema
 Mixed with peptostreptococcus and
Fusobacterium
Porphyromonas
 Gram (-) bacilli
 Normal flora
 Clinical associated syndromes
 Gingival and periapical tooth infection
 Breast and axillary infection
 Perianal and male genital infection
Fusobacteria
 2 species
 Fusobacterium necrophorum
 Fusobacterium nucleatum
Fusobacteria

 F. necrophorum
 Pleomorphic, long rod with rounded end
 Not a component of healthy oral cavity
 Virulent causing Lemierre’s disease
(characterized by acute jugular vein septic
thrombophlebitis that progresses to sepsis
with metastatic abscess to the lungs,
mediastinum, pleural space and liver)
Fusobacteria
 F. nucleatum
 Thin rod with tapered ends (needle shaped)
 Clinical associated infections
○ Pleuropulmonary infection
○ Obstetric infection
○ Brain abscesses
Veillonella
 Normal flora of the mouth, nasopharynx
and intestine
 rarely associated with infection
Gram Positive Anaerobes
 A Gram positive bacilli
 Actinomyces
 Lactobacillus
 Propionibacterium
 Eubacterium, bifidobacterium
 Arachnia
Actinomyces
 Species
 A. israelii
 A. gerenseriae
Actinomyces
 Variably short or club-shaped with long
thin or beaded filaments
 Aerotolerant, slow growers
 Colonies resembles molar teeth, maybe
mistaken with diphtheroids
 Causes chronic suppurative and
granulomatous infection with pyogenic
lesion interconnecting sinus tract
 Contain sulfur granules in lesions
Diagnosis
 It is made by presence of sulfur granules
(hard, lobulated) in the tissues
 Lactobacillus
 Major member of normal vaginal flora;
lactic acid product helps maintain vaginal
pH
Bacterial vaginosis
 Non-inflammatory overgrowth of
anaerobic species in the vagina
(Peptostreptococcus, Gardnerella,
Mobilincus)
 106 org – vs – 109 org/gm of vag.fluid
 No pus cells noted
 Normal

Wet smear
Vaginal fluid

Bacterial
Vaginosis
Propionebacterium
 Normal flora of skin associated with
shunts in contact with skin. May
contaminate sterile specimen like blood
and CSF
 Associated with acne
Clostridium
 Gram positive, spore forming bacilli –
diseases associated with exotoxins
 Clostridium tetani – tetanus
 Clostridium botulinum – botulism
 Clostridium perfringens – gas gangrene
 Clostridium difficile – pseudomembranous
colitis
Gram stain of Clostridium spp.: gram variable, long, thin, parallel sided,
some with swollen ends indicative of spore formation
Gram – positive cocci
 Peptostreptococcus – from skin and
part of normal flora of mucous
membrane; infections of the breast;
brain or pulmonary; occasionally, they
are the sole causative agent

Peptostreptococcus anaerobius
Pathogenesis of
Anaerobic Infections
 Disturbance in balance between tissue
resistance and endogenous flora is basic to
pathogenesis of anaerobic infections
 Most often they are due to several species
of anaerobes acting together (5-6 species)
 Bacteroides fragilis is the single most
important pathogen; utilized in the rat
model study
 given Gentamicin abscess

B. fragilis
+ E. coli
No antibiotics sepsis
(injected
intraperitoneal

given both No sepsis

Clindamycin and No abscess
Gentamycin
 Capsular polysaccharide is responsible
for the abscess formation, but the
mechanism is not well understood
 The polymicrobic nature allows the
enzymes present in various species to
likewise contribute to the tissue damage
 25% due to anaerobes alone
 25% due to facultative anaerobes
 50% due to both anaerobes and
facultative anaerobes
 Aerobic bacteria may also be present
but obligate aerobes are much less
common
Immunity to
Anaerobic Infections
 Antibodies against Bacteroides antigen
is protective against bacteremia but not
against abscess formation
 Prevention against abscess formation is
a T-cell dependent response
Anaerobic bacteria and
associated representative
infections

 Brain abscesses
 Peptostreptococci and others
 Oropharyngeal infections
 Oropharyngeal anaerobes; Actinomyces,
Prevotella melaninogenica, Fusobacterium
species
 Pleuropulmonary infections
 Peptostreptococci; Fusobacterium species;
P. melaninogenica, B. fragilis in 20-25%
others
Anaerobic bacteria and
associated representaive
infections
 Intra-abdominal infection
 Liver abscess: Mixed anaerobes in 40-90%;
facultative anaerobes
 Abdominal abscesses: B. fragilis; other
gastrointestinal flora
 Female genital tract infections
 Vulvar abscesses: Peptostreptococci and
others
 Tubo-ovarian and pelvic abscesses: P. bivia
and P. disiens; Peptostreptococci; others
DIAGNOSIS
 CLINICAL SIGNS OF ANAEROBIC
INFECTIONS
 Foul smelling discharge due to short chain
fatty acids
 Proximity to a mucosal surface
 Gas in tissue (CO2 and H2)
 Negative aerobic cultures
DIAGNOSIS
 ANAEROBIC CULTURE
Schaedler blood agar
Brucella agar
Trypticase Soy Broth
Brain heart infusion agar
Selective complex medium with Kanamycin
(Inhibits facultative anaerobes but not
obligate anaerobe
Incubation at 35-37ºC in anaerobic
atmosphere containing CO2
Anaerobes:
Laboratory Diagnosis

- specimen collection: aspirated or

tissue specimen preferred
than swab

- sensitivity testing: should be

done in life threatening
infections
Treatment
 Surgical drainage
 Antimicrobial therapy
Most Active Drugs
 Clindamycin
 Metronidazole
 Cephalosporins – Cefoxitin, Cefotetan
 Pen G – indicated for organisms not
producing B-lactamase
 Piperacillin
 FACULTAS MEDICINAE ET CHIRURGIAE

Oh god, Who teaches

the hearts of the faithful
by the light of the Holy Spirit:
Grant, by the same Spirit,
That we may relish what is right,
And ever rejoice in His consolation.
We ask this through
Our Lord Jesus Christ, Your Son,
Who lives and reigns with You
and the Holy Spirit,
PRAYER AFTER One God forever and ever.
CLASS
Amen.