Goku Notes
Anaerobes
Lecturer: Dr. Lim
ANAEROBES
They do not like oxygen.
They are killed in the presence of oxygen.
OBLIGATE ANAEROBES
Cannot grow in presence of oxygen
Strictly anaerobes
Oxygen is poisonous for them
Lack cytochrome systems for oxygen metabolism.
Lack either superoxide dismutase which detoxifies
superoxide ion into a nontoxic radical
Lack catalase which converts peroxidase into harmless
oxygen and water
They regard oxygen as toxic.
FACULTATIVE ANAEROBES
Able to grow in the presence or absence of oxygen
They do not have a total absence of the three enzyme
systems
They can survive with or without oxygen
In the presence of oxygen they generate ATP through
aerobic respiration but without oxygen they undergo
fermentation
AEROTOLERANT ANAEROBES
They can tolerate oxygen
They can grow poorly in the presence of oxygen
They multiply rapidly with lower oxygen tension
They do not use regard as hydrogen acceptor
MICROAEROPHILES
Need very little oxygen for aerobic respiration
They require 2-10% oxygen for aerobic respiration
REASONS FOR ANAEROBIASIS
Lack cytochrome which uses oxygen as terminal hydrogen
acceptor in energy yielding reactions
Lack catalase, peroxidase and superoxide dismutase.
Lack of there 3 enzymes in the presence of oxygen forms
superoxide and hydrogen peroxide which are toxic to the
bacteria.
Goku Notes
OXYGEN TOLERANCE
Strict anaerobes - tolerate oxygen saturation of less than
0.5%
Moderate anaerobes - tolerate oxygen less than 3%
GROWTH REQUIREMENTS
Carbon dioxide enriched anaerobic atmosphere - candle
jar
Enriched medium - yeast extract, blood, serum or ascites
fluid, vitamin K, fermentable carbohydrates, hemin
These medium lowers oxygen tension and allows bacteria
to grow
PATHOGENESIS
Any condition destroying blood supply to a tissue
Any condition impairing blood supply
Conditions such as these will promote anerobic bacterial
growth
Vascular diseases - infarcts
Trauma
Surgery
Foreign bodies
DM - elevated blood sugar impairs immune system and
blood supply
ANAEROBIC INFECTIONS
Caused by ENDOGENOUS opportunistic pathogens
meaning the bacteria came from the patient.
The anaerobes are actually mostly part of the normal flora
Occurs in immunocompromised individuals
Usually polymicrobial - combination of facultative and
obligate anaerobes. Facultative anaerobe will consume
the limited oxygen available and obligate anaerobe will
benefit from the loss of oxygen
Abscess formation due to virulence
Tissue necrosis due to virulence
Require broad spectrum antibiotics
Develop slowly and may become chronic
Produce a putrid odor
Gas may be present in the tissue
CLINICAL MANIFESTATIONS
INTRA-ABDOMINAL INFECTIONS
Derived from: spillage of fecal matter in the peritoneal
cavity (colon rupture)
Most common isolates:
Bacteroides fragilis - most common colonic flora
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Clostridium Specimens need to be transported properly without air

Fusobacterium exposure, because oxygen can kill bacteria present in the
OB-GYNE INFECTIONS samples.

Premature rupture of amniotic membrane ANAEROBIC CULTURE SYSTEM

Prolonged labor
Extensive manipulation Provides anaerobic environment for bacteria to grow.
Aseptic abortion
Intrauterine devices 2 tube system
Anaerobic transport device
Most common isolates: Bacteroides, pigmenting bacteroides,
anaerobic gram positive cocci GAS PAK - fiber glass jar with 3 components

PLEUROPULMONARY INFECTIONS Components of GAS PAK:

Associated with aspiration of mouth flora and dental Palladium coated aluminum pellets - catalyst
infections Gas pak envelope - generate CO2 and H gas
Bronchogenic CA Methylene blue strips - indicator of presence or absence of
pulmonary embolus oxygen; blue means oxygen is present in the gas pak jar.
Indicator should be white which means the inside of the jar
Most common isolates: contains no oxygen.

F. nucleatum NONE SPORE FORMERS

Pigmenting bacteroides
Bacteroides fragilis BACTEROIDES SPECIES
Gram positive cocci
B. fragilis
SEPTICEMIA
Most common clinical isolate from colon
Peritonitis Most commonly found in sepsis
Lung abscess Gram negative bacilli
Chorioamnionitis Intraabdominal, intrapelvic infections and sepsis
Bile resistant
UPPER RESPIRATORY TRACT INFECTIONS
Virulence factors:
Periodontal disease
Peritonsillar crypts Lipopolysaccharide - not as toxic as LPS of other gram
Otitis media negative bacteria; does not produce that much fever,
Mastoiditis hypotension of multiple organ failure; symptoms are more
Peritonsillar abscess because of the immune system response to the presence
of bacteria
Most common isolate: B. melanogenicus Capsule - renders bacterial resistance to phagocytosis,
important in the pathogenesis of bacteroides infections.
SOFT TISSUE INFECTIONS Due to this capsule the bacteria can produce abscess
formations on its own.
due to traumatic injuries
Prevotella melanogenica
SPECIMENS USED
Gram negative bacilli
Sterile tissue Present in gingival crevices
Bodily fluids Dental, pulmonary, ob gyne and soft tissue infections
Aspirates of wounds Normal flora
Abscess contents
Bronchoscopy aspirates

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P. bivia and P. disiens Metronidazole covers for anaerobic bacteria. It is good for
anaerobic infections below the diaphragm.
Occurs in the female genital tract Penicillin G is good for anaerobes but Prevotella and
Bacteroides can produce beta lactamase therefore
Porphyromonas deactivating Penicillin. It is a treatment of choice for
anaerobic infections except for Prevotella and Bacteroides
Normal oral flora caused infections.
Gram negative bacilli
Frequently isolated from gingival and periapical tooth
infections, breast and male genital infections

Fusobacteria

F. necrophorum and F. nucleatum

F. necrophorum is more virulent

Causes severe infection of head and neck
Lemierre’s disease - jugular vein septic thrombophlebitis
associated with F. necrophorum. It can lead to sepsis and
metastatic abscess to different sites such as lungs.
Lemierre’s disease is commonly found in patients with
infectious mononucleosis.
Necrosis in Lemierre’s disease is due to leukotoxin which
is also responsible for abscess formation.
F. necrophorum is long and has rounded ends.
F. nucleatum is also long but has pointed ends (spindle
shaped)
F. nucleatum is associated with Vincent’s
angina/stomatitis or trench mouth. It is a painful oral
infection with multiple ulcers in the mouth.

Veillonella

Mouth, nasopharynx and intestine

Can produce anaerobic infections
Opportunistic

Lactobacillus

Normal flora of vagina

Produces lactic acid from metabolism
Responsible for low vaginal pH
Rarely causes infections

Propionibacterium

Normal flora of the skin, oral cavity

Can produce pimples or surgical wound infections

TREATMENT

Clindamycin is effective against Staph. aureus and

anaerobic bacteria. It is a good choice of anaerobic
infections above the diaphragm.

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