Infectious diseases. Infection caused by anaerobic microorganisms. Clinic. Diagnostics. Treatment (most important)

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Infectious diseases. Infection caused by anaerobic microorganisms. Clinic. Diagnostics. Treatment (most important)

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25. Infection caused by anaerobic microorganisms. Clinic. Diagnostics. Treatment

Clinical manifestations. Anaerobic bacteria are commonly found in chronic sinusitis, otitis media, mastoiditis, peritonsillar and pharyngeal abscesses, mumps, and cervical lymphadenitis.

Fusobacteria play an important role in the development of Vincent's angina, characterized by ulceration of the tonsils and the appearance of a brown or gray fetid coating on them. Rapidly developing necrosis and fusion of surrounding tissues can lead to perforation of the carotid artery.

Ludwig's angina is an acute inflammation of the tissue in the sublingual and submandibular regions. The infection spreads rapidly, without involvement of the lymph nodes and the formation of abscesses. Airway obstruction may occur, requiring urgent tracheostomy.

Anaerobic infection of the lower respiratory tract usually takes the form of necrotizing pneumonia, lung abscess, or purulent empyema.

Anaerobic infection of the CNS is manifested by a brain abscess, subdural empyema, or septic thrombophlebitis of the veins of the cortex or venous sinuses. A brain abscess is manifested by headaches, impaired consciousness, stupor, convulsions, focal loss of function of the motor and sensory nerves, and impaired speech.

The penetration of intestinal contents, which is very rich in anaerobic flora, into the abdominal cavity often leads to the development of anaerobic peritonitis.

Infection with anaerobic microorganisms can cause osteomyelitis, septic arthritis, urinary tract disease, subdiaphragmatic and hepatic abscesses, lymphadenitis, skin and soft tissue diseases, orbital and perinephric, periorbital and peritonsillar abscesses.

Diagnosis. The objects of bacteriological examination are the blood of patients, bile, exudate from the pleural, abdominal cavities or from the pericardial cavity, CSF, the contents of abscesses, aspirate from deep layers of wounds, trachea and biopsy of organs obtained under aseptic conditions.

Treatment. Penicillin G is effective in almost all infections caused by gram-positive and gram-negative anaerobic bacteria. The exception is B. fragilis, which is resistant to penicillin, ampicillin, and cephalosporin. Combined treatment with penicillin and levomycetin should be carried out with anaerobic bacteremia and localization of infection in other organs. Most anaerobic pathogens are sensitive to chloramphenicol, clindamycin, carbenicillin.

Erythromycin has an effect on anaerobic cocci. Aminoglycosides do not affect anaerobic bacteria. Cefoxitin has a bacteriostatic effect on B. fragilis (in 80% of cases) and C. perfringes, but does not affect other types of clostridia.

With a mixed aerobic and anaerobic infection, especially when it is localized in the abdominal cavity, gastrointestinal tract, retroperitoneal space or organs of the genitourinary system, treatment with chloramphenicol or clindamycin in combination with gentamicin or kanamycin is recommended.

Author: Pavlova N.V.

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