Pathophysiology, clinical clues, and recovery of organisms in anaerobic infections
- John G Bartlett, MD
John G Bartlett, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — HIV; Pulmonary Infections
- Professor Emeritus
- Johns Hopkins University School of Medicine
Anaerobic bacteria are the major constituents of normal human flora and have been recovered from a wide array of different infections. Isolating the organisms from specimens required discovery of specialized methods in the microbiology laboratory, but it has been more problematic to determine when these bacteria represent true pathogens or merely commensals.
The pathophysiology of anaerobic infections, clinical clues to suspect anaerobes, and methods for recovering the organisms will be reviewed here. Clinical syndromes, history, and the composition of the normal flora are discussed separately. (See "Anaerobic bacterial infections" and "Anaerobic bacteria: History and role in normal human flora".)
PATHOPHYSIOLOGY OF ANAEROBIC INFECTIONS
Anaerobic infections nearly always arise from leakage of endogenous bacteria into contiguous or other sites. Important exceptions are some of the clostridial syndromes, including botulism, Clostridium perfringens food poisoning, enteritis necroticans, tetanus, some cases of gas gangrene, and Clostridium difficile–associated diarrhea. (See related topics.)
The usual pathophysiologic mechanism for anaerobic infection is a breach in the mucocutaneous barrier resulting in displacement of the normal flora. Host defense mechanisms are presumably important, but the compromised host is not unusually susceptible. Exceptions are infections associated with defects of mucocutaneous barriers, such as carcinoma with obstruction, mucositis, perirectal lesions, or compromised consciousness with aspiration.
Three major issues arise in the pathogenesis of anaerobic infections:
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- PATHOPHYSIOLOGY OF ANAEROBIC INFECTIONS
- Virulence factors
- - Toxins
- - Capsular polysaccharides
- - Lipopolysaccharides
- - Volatile fatty acids
- - Ability to tolerate oxygen
- Formation of and host defense to abscesses
- - Intraabdominal sepsis model
- - Role of anaerobes
- - Role of T cells in abscesses
- Bacterial synergy
- CLUES TO ANAEROBIC INFECTIONS
- METHODS FOR RECOVERING ANAEROBES
- Specimen selection
- Specimen transport
- Laboratory processing
- Susceptibility testing