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Unexplained Fever In Infectious Diseases: Section 2: Commonly Encountered Aerobic, Facultative Anaerobic, And Strict Anaerobic Bacteria, Spirochetes, And Parasites
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Anaerobic infections may generate problems of unexplained fever and are responsible for 8 to 10% of general hospital bacteremias and 85% of suppurative brain infections.47 They are often polymicrobial in nature: the anaerobes may be associated with aerobes, especially E. coli, or with Actinomyces. Anaerobes can be allocated to one of two classes, according to their origin: (1) exogenous species — generally found in soil, but also residing in man (skin, buccal cavity, gastrointestinal tract, female genital tract). They are spore-bearing rods, virulent, extremely toxic, their principal representative being Clostridium; (2) endogenous species — nonsporing, a normal part of the body flora, and found particularly in the intestines and pelvis. Their main representative is Bacteroides fragilis. Most exogenous anaerobes cause nonfebrile diseases; a small proportion cause febrile infections: bacteremia, pulmonary, biliary, intra-abdominal and post-abortion genital infections. Clostridium bacteremia may develop in the setting of a septic surgical operation, a puerperal or post-abortum infection, an underlying neoplastic disease, or decubitus ulcers, and may have a fulminant evolution. The clinical features are high fever with chills, abdominal pain, intravascular hemolysis with oliguria or anuria, jaundice and shock. Aggressive treatment with high doses of intravenous aqueous penicillin or, in penicillin-allergic patients, clindamycin, a cephalosporin or chloramfenicol, may sometimes be life-saving.
Peritonitis (General Considerations)
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Donald E. Fry, Susan Galandiuk
Culturing the peritoneal cavity in acute peritonitis of colonic origin remains controversial. With an acute perforation of the colon with gross faecal contamination in a community-acquired infection, is it not reasonable to assume that normal colonic bacteria are the pathogens to target with antibiotic therapy? Culturing practices in most hospitals do not perform well in recovering anaerobic species from clinical specimens obtained from faecal peritonitis. Clinicians do not discontinue anaerobic antibiotics when they are confronted with faecal peritonitis and the culture does not identify anaerobes.3 Furthermore, it is the rare hospital that uniformly performs sensitivity testing of those anaerobes that may be isolated. Recommendations have been made for routine culturing of community-acquired peritonitis for epidemiologic reasons to monitor changing sensitivity patterns of cultured isolates.70 It is true that the occasional culture of peritonitis may identify Pseudomonas aeruginosa or Candida albicans, but peritoneal cultures are not quantitative cultures and a very low inoculum of unusual organisms in the usual clinical case becomes a distraction. No evidence supports the coverage of resistant gram-negative bacteria or fungi in the empirical antibiotic treatment of community-acquired peritonitis.
Microorganisms
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Ursula Altmeyer, Penelope Redding, Nitish Khanna
The anaerobes are a phyllogenetically heterogeneous group of organisms that are united by two characteristics – they grow in culture under strict anaerobic conditions and are sensitive to metronidazole (Table 19.12).
Bacterial effluxome as a barrier against antimicrobial agents: structural biology aspects and drug targeting
Published in Tissue Barriers, 2022
Pownraj Brindangnanam, Ajit Ramesh Sawant, K. Prashanth, Mohane Selvaraj Coumar
In the beginning, single cells were the only living being on earth. By the process of natural selection, from a single cell to anaerobes, anaerobes to aerobes, aerobes to multicellular organisms emerged slowly.27–30 Between anaerobes to aerobes era, various races, for instance, aerotolerant, facultative, obligate bacteria, and so on have emerged.30,31 In the race for “survival of the fittest” or in the “war of defence”, microbes start competing with each other including multicellular organisms (animals including humans). Microbes use various armaments in their defense for survival. To propagate within the host, microbes first use only a few knacks like colonization, adherence and drug-metabolizing enzymes. Later on, they use other tricks such as lenience, frameshift mutations, rapid reproduction to attain the power of “resistance”, leading to better survival.
Micromonas micros: A rare anaerobic cause of late implant failure following spinal surgery
Published in The Journal of Spinal Cord Medicine, 2022
Garret L. Sobol, John I. Shin, Michael J. Vives, Lisa L. Dever, Colin B. Harris
Our patient’s case highlights an unusual etiology of a delayed postoperative spinal infection causing implant failure and necessitating anterior and posterior revision surgery. There is a high prevalence of chronic back pain in patients undergoing spinal surgery, specifically instrumented spinal fusion,24,25 and fentanyl lozenges may be used as adjunct opioid analgesia in these patients. This case provides further evidence for periodontal disease as a potential source for postoperative spinal infection. Clinicians should therefore inquire about recent dental work as well as oral hygiene in patients presenting with delayed postoperative infections and consider anaerobic pathogens as potential causes. Anaerobic coverage should be included when treating these infections empirically. Chronic pain patients who are being considered for instrumented spinal fusion should be queried about use of fentanyl lozenges. Referral for dental evaluation may be a prudent component of the preoperative assessment in selected cases.
Diagnosis of pleural empyema/parapneumonic effusion by next-generation sequencing
Published in Infectious Diseases, 2021
Yoshiki Shiraishi, Kirill Kryukov, Katsuyoshi Tomomatsu, Fumio Sakamaki, Shigeaki Inoue, So Nakagawa, Tadashi Imanishi, Koichiro Asano
To overcome these problems, Kawanami and colleagues applied clonal microflora analysis in which the 16S ribosomal RNA (rRNA) gene was amplified, and 100 randomly selected clones were sequenced using the Sanger method [16]. This strategy identified anaerobes more efficiently and comprehensively than in vitro culture, but it is time and labour-intensive and thus, impractical for clinical applications. Other researchers have applied next-generation sequencing (NGS) technology for the diagnosis of infectious respiratory diseases such as pneumonia and pleural empyema [17–20], however, it is often difficult to differentiate pathogenic bacteria from contaminated species with NGS analysis alone. Therefore, we combined 16S rRNA gene-specific PCR with NGS to identify pathogenic bacteria in pleural empyema/parapneumonic effusions.