Anaerobic infection is one of the types of wound infection and belongs to the most severe complications of injuries: compression syndrome, frostbite, wounds, burns, etc. The causative agents of anaerobic infection are gram-negative bacteria (anaerobic gram-negative bacilli, AGOB) that live in conditions of severely limited or completely absent oxygen access. The toxins released by anaerobic bacteria are very aggressive, highly penetrating and infect vital organs.
Regardless of the localization of the pathological process, anaerobic infection is initially considered as generalized. In addition to surgeons and traumatologists in clinical practice, doctors of various specialties face anaerobic infection: gynecologists, pediatricians, dentists, pulmonologists and many others. According to statistics, anaerobes are found in 30% of cases of the formation of purulent foci, however, the exact proportion of complications provoked by the development of anaerobes has not been determined.
Causes of anaerobic infection
Anaerobic bacteria are classified as conditionally pathogenic and are part of the normal microflora of the mucous membranes, digestive and genitourinary systems and skin. Under conditions that provoke their uncontrolled reproduction, endogenous anaerobic infection develops. Anaerobic bacteria that live in decaying organic debris and soil, when introduced into open wounds, cause exogenous anaerobic infection.
In relation to oxygen, anaerobic bacteria are divided into facultative, microaerophilic and obligate. Facultative anaerobes can develop both under normal conditions and in the absence of oxygen. This group includes staphylococci, Escherichia coli, streptococci, Shigella and a number of others. Microaerophilic bacteria are an intermediate link between aerobic and anaerobic bacteria, oxygen is needed for their vital activity, but in small quantities.
Among obligate anaerobes, clostridial and non-clostridial microorganisms are distinguished. Clostridial infections are exogenous (external). These are botulism, gas gangrene, tetanus, foodborne diseases. Representatives of non-clostridial anaerobes are causative agents of endogenous purulent-inflammatory processes, such as peritonitis, abscesses, sepsis, phlegmon, etc.
The development of anaerobic infection is facilitated by tissue damage, which creates the possibility of penetration of the pathogen into the body, a state of immunodeficiency, massive bleeding, necrotic processes, ischemia, and some chronic diseases. Potential danger is posed by invasive manipulations (tooth extraction, biopsy, etc.), surgical interventions. Anaerobic infections can develop as a result of contamination of wounds with earth or other foreign bodies entering the wound, against the background of traumatic and hypovolemic shock, irrational antibiotic therapy, which suppresses the development of normal microflora.
Characteristics (types), pathogens
Strictly speaking, anaerobic infections should include pathological processes caused by the vital activity of obligate anaerobes and microaerophilic organisms. The mechanisms of development of lesions caused by facultative anaerobes are somewhat different from the typical anaerobic, but both types of infectious processes are clinically very similar.
Among the most common causative agents of anaerobic infection;
- clostridia;
- propionibacteria;
- bifidobacteria;
- peptococci;
- peptostreptococci;
- sarcins;
- bacteroids;
- fusobacteria.
In the overwhelming majority, anaerobic infectious processes occur with the joint participation of anaerobic and aerobic bacteria, primarily enterobacteria, streptococci and staphylococci.
The most complete classification of anaerobic infections, which is optimally suitable for use in clinical practice, was developed by A.P. Kolesov.
According to microbial etiology, clostridial and non-clostridial infectious processes are distinguished. Non-clostridial, in turn, are subdivided into peptococcal, fusobacterial, bifidobacterial, etc.
According to the source of infection, anaerobic infections are divided into endogenous and exogenous.
According to the species composition of pathogens, infections are divided into monobacterial, polybacterial and mixed. Monobacterial infections are quite rare; in the overwhelming majority of cases, a polybacterial or mixed pathological process develops. Mixed refers to infections caused by the association of anaerobic and aerobic bacteria.
According to the localization of the lesions, infections of bones, soft tissues, serous cavities, bloodstream, internal organs are isolated.
Based on the prevalence of the process, there are:
- local (limited, local);
- regional (unlimited, prone to proliferation);
- generalized or systemic.
Depending on the origin, the infection can be community-acquired or nosocomial.
Due to the occurrence of anaerobic infections, a distinction is made between spontaneous, traumatic and iatrogenic infections.
Symptoms and Signs
Anaerobic infections of various origins have a number of common clinical features. They are characterized by an acute onset accompanied by an increase in local and general symptoms. Anaerobic infections can develop within a few hours, the average incubation period is 3 days.
With anaerobic infections, the prevalence of a symptom of general intoxication over the manifestations of the inflammatory process at the site of infection is characteristic. The deterioration of the patient's condition due to the developing endotoxicosis often occurs before the appearance of visible signs of a local inflammatory process. Among the symptoms of endotoxicosis:
- headache;
- general weakness;
- inhibition of reactions;
- nausea;
- tachycardia;
- fever;
- chills;
- rapid breathing;
- cyanosis of the limbs;
- hemolytic anemia.
Early local symptoms of anaerobic wound infection:
- bursting severe pain;
- crepitus of soft tissues;
- emphysema.
The pain accompanying the development of anaerobic infection is not relieved by analgesics, including narcotic ones. The patient's body temperature rises sharply, the pulse quickens to 100-120 beats per minute.
A liquid purulent or hemorrhagic exudate emerges from the wound, unevenly colored, with gas bubbles and fatty blotches. The smell is putrid, indicating the formation of methane, nitrogen and hydrogen. The wound contains gray-brown or gray-green tissue. As intoxication develops, disorders of the central nervous system occur, up to coma, blood pressure decreases. Against the background of anaerobic infection, severe sepsis, multiple organ failure, infectious-toxic shock, leading to death, may develop.
Non-clostridial pathological processes are indicated by the release of brown pus and diffuse tissue necrosis.
Clostridial and non-clostridial anaerobic infections can occur in a fulminant, acute or subacute form. Lightning-fast development is said if the infection develops within the first 24 hours after surgery or injury; an infectious process that develops within 4 days is called acute; the development of the subacute process is delayed for more than 4 days.
Diagnostics
The peculiarities of the development of anaerobic infections often leave doctors no choice but to diagnose pathology based on clinical data. The diagnosis is supported by a fetid odor, tissue necrosis, and localization of the infectious focus. It should be noted that with subacute development of infection, the smell does not appear immediately. Gas accumulates in the affected tissues. Indirectly confirms the diagnosis of the ineffectiveness of a number of antibiotics.
A sample for bacteriological research should be taken directly from the site of infection. In this case, it is important to exclude contact of the taken material with air.
Biological materials obtained by puncture (blood, urine, cerebrospinal fluid), tissue fragments obtained by puncture conicotomy are suitable for the detection of anaerobes. The material intended for research must be delivered to the laboratory as quickly as possible, since obligate anaerobes die when exposed to oxygen and are displaced by microaerophilic or facultative anaerobes.
Treatment of anaerobic infection
The treatment of anaerobic infection requires an integrated approach, including surgery and conservative treatment. Surgical intervention when an anaerobic pathological process is detected should be performed without delay, since the chances of saving the patient's life are rapidly decreasing. Surgical treatment is reduced to the disclosure of the infectious focus, excision of necrotic tissue, open drainage of the wound with rinsing with antiseptic solutions. Depending on the further course of the disease, the need for repeated surgical intervention is not excluded.
In the most severe cases, it is necessary to resort to disarticulation or amputation of the affected limbs. This is the most radical method of fighting anaerobic infection and is used in extreme cases.
Conservative general therapy is aimed at increasing the body's resistance, suppressing the vital activity of the infectious agent, and detoxifying the body. The patient is prescribed broad-spectrum antibiotics and intensive infusion therapy. If necessary, antigangrenous antitoxic serum is used. Extracorporeal hemocorrection, hyperbaric oxygenation, UFOK are performed.
Forecast
The prognosis is cautious, since the outcome of anaerobic infection depends on the timeliness of detection and initiation of treatment, as well as the clinical form of pathology. In some forms of anaerobic infection, death occurs in more than 20% of cases.
Prevention
Preventive measures include the removal of foreign bodies from the wound, strict adherence to antiseptic and aseptic measures during operations, timely PCO of the wound, corresponding to the patient's condition. With a high risk of anaerobic infection, the patient is prescribed antimicrobial and immune-strengthening treatment in the postoperative period.
Which doctor to contact
The main treatment for anaerobic pathologies is surgical. If an anaerobic infection is suspected, a surgeon should be consulted immediately.
Anaerobic infection is a rapidly developing pathogenic process that affects various organs and tissues in the body and is often fatal. It affects all people, regardless of gender or age. Timely diagnosis and treatment can save a person's life.
What it is?
Anaerobic infection is an infectious disease that occurs as a complication of various injuries. Its pathogens are spore-forming or non-spore-forming microorganisms that thrive in an oxygen-free environment or with a small amount of oxygen.Anaerobes are always present in the normal microflora, mucous membranes of the body, in the gastrointestinal tract and the genitourinary system. They are classified as conditionally pathogenic microorganisms, since they are natural inhabitants of biotopes of a living organism.
With a decrease in immunity or the influence of negative factors, bacteria begin to actively multiply uncontrollably, and microorganisms turn into pathogens and become sources of infection. Their waste products are hazardous, toxic and quite corrosive substances. They are capable of easily penetrating cells or other organs of the body and affecting them.
In the body, some enzymes (for example, hyaluronidase or heparinase) increase the pathogenicity of anaerobes, as a result, the latter begin to destroy the fibers of muscle and connective tissue, which leads to a violation of microcirculation. Vessels become fragile, erythrocytes are destroyed. All this provokes the development of immunopathological inflammation of blood vessels - arteries, veins, capillaries and microthrombosis.
The danger of the disease is associated with a large percentage of deaths, so it is extremely important to notice the onset of the infection in time and immediately start treating it.
Reasons for the development of infection
There are several main reasons for infection:- Creation of suitable conditions for the vital activity of pathogenic bacteria. This can happen:
- when an active internal microflora enters the sterile tissue;
- when using antibiotics that have no effect on anaerobic gram-negative bacteria;
- in case of circulatory disorders, for example, in the case of surgery, tumors, injuries, ingestion of a foreign body, vascular diseases, with tissue necrosis.
- Infection of tissue with aerobic bacteria. They, in turn, create the necessary conditions for the vital activity of anaerobic microorganisms.
- Chronic diseases.
- Some tumors that are localized in the intestine and head are often accompanied by this disease.
Types of anaerobic infections
It differs depending on which agents are provoked and in which area:Surgical infection or gas gangrene
Anaerobic surgical infection or gas gangrene is a complex complex response of the body to exposure to specific pathogens. It is one of the most difficult and often intractable wound complications. In this case, the patient is worried about the following symptoms:- increasing pain with a feeling of bursting, since the process of gas formation occurs in the wound;
- fetid odor;
- exit from the wound of a purulent heterogeneous mass with gas bubbles or blotches of fat.
Anaerobic surgical infection is rare, and its occurrence is directly related to the violation of antiseptic and sanitary standards during surgical operations.
Anaerobic Clostridial Infections
The causative agents of these infections are obligate bacteria that live and reproduce in an oxygen-free environment - spore-forming representatives of Clostridium (gram-positive bacteria). Another name for these infections is clostridiosis.In this case, the pathogen enters the human body from the external environment. For example, these are the following pathogens:
- tetanus;
- botulism;
- gas gangrene;
- toxic infections associated with the consumption of low-quality contaminated food.
Anaerobic non-clostridial infections
Unlike obligate bacteria, representatives of a facultative species are able to survive in the presence of an oxygen environment. The causative agents are:- (globular bacteria);
- shigella;
- escherichia;
- yersinia.
In gynecology
The microflora of the female genital tract is rich in various microorganisms and anaerobes as well. They are part of a complex microecological system that contributes to the normal functioning of a woman's genitals. Anaerobic microflora is directly related to the occurrence of severe pyoinflammatory gynecological diseases, for example, acute bartholinitis, acute salpingitis and pyosalpinx.The penetration of anaerobic infection into the female body is facilitated by:
- trauma to the soft tissues of the vagina and perineum, for example, during childbirth, during abortion or instrumental examinations;
- various vaginitis, cervicitis, erosion of the cervix, tumors of the genital tract;
- remnants of membranes, placenta, blood clots after childbirth in the uterus.
Qualification of anaerobic infections by localization of its focus
The following types of anaerobic infections are distinguished:
- Infection of soft tissues and skin... The disease is caused by anaerobic gram-negative bacteria. These are superficial diseases (cellulite, infected skin ulcers, consequences after major diseases - eczema, scabies and others), as well as subcutaneous or postoperative infections - subcutaneous abscesses, gas gangrene, bite wounds, burns, infected ulcers in diabetes, vascular diseases. With deep infection, soft tissue necrosis occurs, in which there is an accumulation of gas, gray pus with a foul odor.
- Bone infection... Septic arthritis is often a consequence of neglected Vincent, osteomyelitis - a purulent-necrotic disease that develops in the bone or bone marrow and surrounding tissues.
- Internal infections, including, women may experience bacterial vaginosis, septic abortion, abscesses in the genital apparatus, intrauterine and gynecological infections.
- Bloodstream infections- sepsis. It spreads through the bloodstream;
- Serous cavity infections- peritonitis, that is, inflammation of the peritoneum.
- Bacteremia- the presence of bacteria in the blood that enter there exogenous or endogenous.
Aerobic Surgical Infection
Unlike anaerobic infections, aerobic pathogens cannot exist without oxygen. Cause infection:- diplococci;
- sometimes ;
- intestinal and typhoid bacilli.
- furuncle;
- furunculosis;
- carbuncle;
- hydradenitis;
- erysipelas.
Diagnostics
For a timely diagnosis, it is necessary to correctly assess the clinical picture and provide the necessary medical assistance as soon as possible. Depending on the localization of the focus of the infection, various specialists are engaged in diagnostics - surgeons of different directions, otolaryngologists, gynecologists, traumatology.Only microbiological studies can confirm for sure the participation of anaerobic bacteria in the pathological process. However, a negative answer about the presence of anaerobes in the body does not reject their possible participation in the pathological process. According to experts, about 50% of the anaerobic representatives of the microbiological world today are uncultivated.
High-precision methods for indicating anaerobic infection include gas-liquid chromatography and mass spectrometric analysis, which determines the amount of volatile liquid acids and metabolites - substances that form in the process of metabolism. No less promising methods are the determination of bacteria or their antibodies in the patient's blood using enzyme-linked immunosorbent assay.
They also use express diagnostics. The biomaterial is studied in ultraviolet light. Carry out:
- bacteriological sowing of the contents of the abscess or the separated part of the wound into the nutrient medium;
- sowing blood for the presence of bacteria, both anaerobic and aerobic species;
- blood sampling for biochemical analysis.
X-ray examination reveals the accumulation of gases in the damaged tissue or body cavity.
When diagnosing, it is necessary to exclude the presence of erysipelas in the patient's body - a skin infectious disease, deep vein thrombosis, purulent-necrotic tissue lesions by another infection, pneumothorax, exudative erythema, frostbite stage 2–4.
Treatment of anaerobic infection
When treating, you can not do with such measures as:Surgical intervention
The wound is dissected, the dead tissue is drastically dried out, and the wound is treated with a solution of potassium permanganate, chlorhexidine or hydrogen peroxide. The procedure is usually performed under general anesthesia. With extensive tissue necrosis, limb amputation may be required.Drug therapy
It includes:- taking anesthetic components, vitamins and anticoagulants - substances that prevent clogging of blood vessels by blood clots;
- antibiotic therapy - taking antibiotics, and the appointment of a particular drug occurs after an analysis has been made for the sensitivity of pathogens to antibiotics;
- administration of anti-gangrenous serum to the patient;
- transfusion of plasma or immunoglobulin;
- the introduction of drugs that remove toxins from the body and eliminate their negative effects on the body, that is, they detoxify the body.
Physiotherapy
In physiotherapy, wounds are treated with ultrasound or laser. Ozone therapy or hyperbaric oxygenation is prescribed, that is, they act with oxygen under high pressure on the body for medicinal purposes.Prevention
To reduce the risk of developing the disease, high-quality primary treatment of the wound is carried out in time, a foreign body is removed from the soft tissues. When carrying out surgical operations, the rules of asepsis and antiseptics are strictly observed. For large areas of damage, antimicrobial prophylaxis and specific immunization are carried out - preventive vaccinations.What will be the result of the treatment? This largely depends on the type of pathogen, the location of the focus of infection, timely diagnosis and correctly selected treatment. Doctors usually give a careful but favorable prognosis for such diseases. With advanced stages of the disease, with a high degree of probability, we can talk about the death of the patient.
Next article.
ANAEROBIC INFECTION
The beginning of the study of anaerobes dates back to 1680, when Leeuwenhoek first described the existence of microbes without access to air. Almost two centuries later, in 1861-1863, L. Pasteur scientifically explained lactic acid fermentation in the absence of oxygen by the reproduction of microorganisms and called this process anaerobiosis. The discovery of L. Pasteur served as an impetus for numerous studies, which are associated, first of all, with the discovery of various types of anaerobic flora that are causative agents of botulism, tetanus, appendicitis, wound suppuration and many other diseases.
A new "heyday" of this problem falls on the 70s of the twentieth century and is associated with the use of more advanced methods of bacteriological research, allowing you to isolate and accurately identify anaerobic microorganisms.
Not so long ago, many doctors referred to anaerobic infection as purulent-septic inflammation caused by spore-forming microorganisms of the genus Clostridium, with an extremely severe clinical course, with extensive necrotic changes in tissues and gas formation. However, now there is no doubt that in most cases the causative agents of these diseases are non-clostridial anaerobes. Late diagnosis and incorrectly chosen treatment tactics determine a high, up to 60%, mortality rate in this pathology.
Epidemiology. Anaerobic flora occupies 11 out of 19 parts of the entire diversity of the microbial microcosm. This is due to the fact that microorganisms are among the most ancient creatures, the appearance of which on Earth dates back to the times when the atmosphere did not have oxygen. The microbiological characteristics of anaerobes, which are currently of the greatest clinical importance, are presented in the table.
Causative agents of anaerobic infection
Depending on the ability to sporulate, anaerobic microorganisms are classified into spore-forming (clostridial) and non-spore-forming (non-clostridial). The proportion of the former is 5% of the total number of anaerobes.
Anaerobic microorganisms are conditionally pathogenic saprophytes, which, under certain conditions, cause purulent diseases. The main habitat of anaerobes is the digestive tract, and their maximum number is in the large intestine.
Pathogenesis. For the occurrence of anaerobic infection, a prerequisite is necessary, which consists in the appearance of anaerobes in habitats unusual for them. This is facilitated by trauma, surgery, tumor decay and other circumstances.
Equally important is the set of conditions that create a favorable environment for the development of anaerobic microorganisms, including blood loss, shock, starvation, overwork, hypothermia, local circulatory disorders, weakening of immunity against the background of malignant and systemic diseases, diabetes mellitus and radiation therapy.
Anaerobes produce enzymes, including collagenase, hyaluronidase, deoxyribonuclease, which cause tissue destruction and thus increase the pain potential. The endotoxin present in the microbial cell determines antigenicity and toxigenicity. The capsule of the pathogen, in addition to antigenic properties, has a pronounced weakening of phagocytosis. Metabolic factors such as fatty acids, indole, hydrogen sulfide, ammonia, in addition to suppressing other microflora, have a toxic effect on the cells of the macroorganism.
Clostridial pathogens produce an exotoxin with a complex colloidal structure and its active fractions. Among them are: a-toxin (lecithinase), which has a necrotizing and hemolytic effect; b-toxin (hemolysin), which is considered a “lethal” factor due to its specific cardiotoxic effect; k-toxin (collagenase), which lyses protein structures; h-toxin (hyaluronidase), which potentiates the spread of wound infection and inflammation; m-toxin affecting the genetic apparatus of the cells of the macroorganism; fibrinolysin; neuraminidase, which destroys the immunoreceptor apparatus of erythrocytes; hemagglutinin, inactivating factor A on erythrocytes and inhibiting phagocytosis.
Classification. The most complete classification of surgical anaerobic infections is presented by A.P. Kolesov et al. (1989):
- by microbial etiology: fusobacterial, clostridial, peptostreptococcal, bacteroid, etc .;
- by the nature of microflora: monoinfection, polyinfection (several anaerobes), mixed (aerobic-anaerobic);
- on the affected part of the body: infection of soft tissues (fasciitis, myositis), infection of internal organs (liver abscess), infection of serous cavities (peritonitis), infection of the bloodstream (sepsis);
- by distribution: local (limited), unlimited - with a tendency to spread (regional), systemic or generalized;
- by source: exogenous, endogenous;
- by origin: community-acquired, nosocomial;
- for reasons of occurrence: traumatic, spontaneous; iatrogenic.
However, this classification is not very acceptable in the clinic, since on the one hand it is quite cumbersome, on the other hand, in some sections, for example, in the affected part of the body, in distribution, it tries to unequal and clinically incomparable pathological conditions.
From the point of view of a practicing physician, the most valuable classification is B.V. Petrovsky, G.I. Lyskin (1984), who proposed to single out two criteria that determine the tactics of therapeutic actions.
- by the rate of development - lightning-fast, acute and subacute forms of the course;
- by the depth of tissue damage - cellulitis, fasciitis, myositis and mixed infection.
This division of the labeling of anaerobic infection has clinical significance as in relation to Clostridial infection.
Identification of anaerobic microflora. A certain help in the diagnosis of anaerobic infection is provided by a rather simple technical implementation and, therefore, accessible to any doctor, a microscopic method of research.
Microscopy of the native material stained according to Gram within 40-60 minutes after its delivery to the laboratory by the presence of a number of morphological characteristics of cell types can be rejected or confirmed the presence of anaerobes in the smears under study. Here, a relative quantitative assessment of contamination is also possible. A significant disadvantage of this method is the inability to distinguish between aerobic and anaerobic cocci. Such a diagnosis of gram-negative anaerobes coincides with the results of bacteriological inoculation in 73% of cases [Kuzin MI. et al., 1987].
Another way of express diagnostics is to study the pathological material in ultraviolet light, while the color of the cotton swab soaked with exudate changes to red. This phenomenon is based on the discovery in the material of vitamins produced by bacteria of the Bacteroides melaninogenicus / assacchoroliticus group [Kuzin MI. et al., 1987].
Bacteriological analysis of wound exudate or wound tissue reveals more etiologically accurate data.
The method of paraphase (haed-spece) analysis, in which the chromatographic spectrum of substances contained over the object of study is studied, is also acceptable in the clinic. Isolation of propionic, valerian normal and isomeric-butyric, caproic acids makes it possible to identify the anaerobic pathogen.
Full verification of the pathogen is carried out using targeted microbiological research. However, the classical microbiological methods for the determination of anaerobes require a lot of time and strict adherence to special conditions for their conduct. Therefore, these methods are of little use for widespread use in surgical practice, the more they are unacceptable for fast infections, which include anaerobic inflammation.
Clinic of non-clostridial anaerobic infection. Non-clostridial anaerobic infection often develops in persons with secondary immune deficiency against the background of:
- 1. long-term and indiscriminate use of broad-spectrum antibiotics, as a result of which normal microbial biocenoses are disrupted;
- 2. the use of cytostatics;
- 3. the use of immunosuppressants;
- 4. long-term undiagnosed or uncompensated diabetes;
- 5. malignant tumors;
- 6. chronic atherosclerotic ischemia;
- 7. chronic cardiovascular diseases with severe decompensation of cardiac activity;
- 8. blood diseases.
Both gram-positive and gram-negative non-clostridial anaerobes cause a variety of diseases - from superficial phlegmon and extensive necrotic lesions of soft tissues to lung abscesses, peritonitis and sepsis.
At the same time, non-clostridial anaerobic infection combines a number of clinical signs that determine the specificity of symptomatic and syndromic disorders, on the basis of which the diagnosis is based.
One of the most permanent signs of anaerobic non-clostridial infection should be considered primarily the primary putrefactive nature of tissue damage, which acquire a dirty gray or gray-green tint. In some cases, foci of black or brown color are diagnosed. The boundaries of the lesion are usually without clear contours and are not visually traced. The rate of spread of such necrosis reaches 15-20 cm in diameter per day.
No less important diagnostic value is the appearance and smell of wound exudate. A putrid smell is usually due to the specificity of the substrates for the vital activity of microbes. At the same time, not all anaerobes produce such substances, and, therefore, the absence of a fetid odor is not a reason for absolute denial of the involvement of non-clostridial anaerobic infection in the development of the wound process.
Signs of non-clostridial anaerobic infection are also swelling of soft tissues along the periphery of the wound with signs of an inflammatory shaft up to 2-3 cm, disappearance of pain in the center of the focus and an increase in pain along the periphery of the wound.
A feature of the course of wounds with anaerobic lesion can be considered a sharp slowdown in the first phase of the course of the wound process.
In 65% of patients with anaerobic non-clostridial infection of soft tissues, the pathological focus can be characterized as necrotizing cellulitis, quite often involving the superficial fascia and loose connective tissue layers going to the fascia of the muscles. Anaerobic non-clostridial myositis with a predominant lesion of the intermuscular connective tissue layers or with the capture of muscle tissue in the pathological process (own myonecrosis).
Reliable signs of anaerobic abscesses in the lungs can be considered:
- 1. Putrid odor of the emitted air in the first days of the disease before it breaks into the bronchi.
- 2. Dirty gray color of the separated sputum and pus from the abscess cavity.
- 3. Progressive destruction of lung tissue and a tendency to become chronic.
- 4. Progressive anemia.
- 5. Progressive weight loss.
- 6. Localization of abscesses on radiographs in 2-6 pulmonary segments.
- 7. Single focus decay with an average cavity of 3 to 15 cm.
With peritonitis in adults, reliable signs of anaerobic non-clostridial infection are:
- 1. The presence of brown or gray exudate;
- 2. A sluggish course of peritonitis (4-5 days without a pronounced spread) and with an eventration that developed against this background;
- 3. Formation of intra-abdominal abscesses in the area of ischemic tissues (tied stumps of the mesentery, greater omentum, mesentery of the intestinal loops).
- 4. Organizing intraperitoneal abscesses that do not manifest themselves as pronounced clinical symptoms.
At the same time, in children, anaerobic non-clostridial peritonitis has a more violent and threatening course. As a rule, the following symptoms can serve as reliable signs of it:
- 1. Inhibited or soporic state alternating with euphoria;
- 2. Exudate from the abdominal cavity always has a fetid odor, and sometimes a brown tint;
- 3. Loops of the intestine are often fused into large conglomerates with multiple multicameral abscesses with a tendency to spread throughout the abdominal cavity;
- 4. The presence of abundant fibrinous overlays on the parietal and visceral peritoneum, often gray-black;
- 5. Severe intestinal paralysis.
As a classic sign of anaerobes, it should be noted gassing... It is mainly due to the fact that in the process of anaerobic metabolism, gaseous products, which are slightly soluble in water, are released, including nitrogen, hydrogen and methane. There are several clinical signs of gas formation. On palpation of the affected area, there is often a so-called "crepitus" or "crunching". During the operation, when dissecting the tissues, you can get a similar crunching sensation of the snow crust. Sometimes, during the opening of the purulent cavity, gas comes out with a noise, in some cases, gas is released in the form of small bubbles as inclusions in the wound exudate.
Symptoms of gas accumulation can be detected by x-ray. In abscesses, the level of liquid and gas above it is determined. When soft tissues are damaged with the involvement of cellulose in the process, the inclusion of gas is detected in the form of a "honeycomb" symptom. In the same cases, when muscles are affected, when the gas spreads, the muscle fibers are stratified, which causes the X-ray symptom of the “herringbone pattern”. It is these signs that make it possible to carry out the differential diagnosis of infectious emphysematous tissue changes from non-infectious emphysema, in which there is a uniform increased airiness. However, the symptoms of gas formation are more pronounced with clostridial lesions.
Since in the overwhelming majority of observations anaerobic infection is of endogenous origin, then among the characteristic signs it is legitimate to indicate the proximity of the focus of inflammation to the natural habitats of anaerobes. Often their localization is with the digestive tract, upper respiratory tract and genitals, which, as you know, are the areas where the largest amount of normal anaerobic microflora of humans lives.
Given the presence of these specific features, their knowledge makes it possible with a high degree of probability to diagnose anaerobic infection clinically. In order to have no doubts about the participation of anaerobic microorganisms in the infectious process, it is enough to detect two of the described signs [Kolesov A.P. et al., 1989].
Clinic of anaerobic clostridial infection. Among the first signs of an infectious process, one should focus on the general symptoms of intoxication: weakness, headache, inadequate behavior, agitation or lethargy of the patient, sleep disturbance. There is a rise in body temperature to 38-39 ° C with a swing between evening and morning indicators of 1 degree or more. There is anemia, leukocytosis with a neutrophilic shift of the leukocyte count to the left.
Intense pain is noted locally in the area of the wound or pathological focus. In this case, the patient may experience a sensation of distention or compression of the limb with a bandage. This symptomatology is explained by pronounced tissue edema. The presence of edema is evidenced by swelling of the muscles, traces of an impression of the bandage, incision of the seams, retraction of the skin in the area of the hair follicles. In some cases, the swelling is so pronounced that the skin becomes white and shiny. Somewhat later, due to hemolysis and tissue necrotization, it acquires a brownish color. Of great importance is the rate of increase in edema, the degree of which can be judged by the symptom of A.V. Melnikov. To detect it, proximal and distal to the inflammation focus, a thread is circularly applied around the limb. When observing the thread in dynamics, the speed of incising the ligature into soft tissues is determined.
On palpation, a symptom of crepitus is often determined. A number of X-ray signs help to confirm the presence of gas in the tissues - the symptom "honeycomb pattern" (gas spreading through the tissue) and the "herringbone pattern" symptom (gas fragmentation of muscle fibers).
The predominance in the clinic of signs of gas formation and edema traditionally characterize Clostridial anaerobic infection.
With cellulite, the subcutaneous fatty tissue is damaged. The skin is usually bluish-white in color. In some cases, there is slight hyperemia without clear boundaries. Edema in the area of the pathological focus is very dense. It is noteworthy that skin manifestations do not reflect the true extent of the spread of the inflammatory process. It goes far beyond these changes. During tissue dissection, the subcutaneous tissue has a gray or dirty gray color with areas of hemorrhage. It is saturated with serous fluid with an unpleasant fetid odor.
With the rapid spread of the process with a progressive increase in hyperemia, the appearance of areas of necrosis, as well as if necrosis of the subcutaneous tissue and the presenting fascia is detected during the operation, we can confidently talk about fasciitis.
With myositis, muscle tissue is damaged. The muscles take on the appearance of boiled meat, dull, saturated with serous-hemorrhagic exudate. Unlike fasciitis, in which only the superficial layers of muscles are involved in the pathological process, myositis is characterized by damage to the muscle mass throughout the entire thickness. Granulations are often visible on the wound surface, but their appearance does not correspond to the severity of anaerobic inflammation. In this regard, if myositis is suspected, muscle tissue is dissected and a biopsy is taken for an urgent histological examination, which makes it possible to determine the degree and depth of muscle damage.
With a combination of myositis and fasciitis during surgical treatment, areas of the fascia of a dark-dirty color with many perforations are found in the wound, through which a brownish-gray or serous-hemorrhagic exudate with a pungent unpleasant odor is released. Fiber in such cases suffers less, and necrotic changes in the skin, as a rule, are absent.
The most common combination of cellulite, fasciitis and myositis is a mixed lesion. In this case, local symptoms are observed, which are characterized by signs of all forms of anaerobic infection, and intoxication syndrome, which determines the severity of the patient's condition and the possible development of sepsis.
Thus, the vivid clinical picture of anaerobic inflammation of soft tissues makes it possible, with a fairly high degree of probability, to make a correct diagnosis even before laboratory express diagnostics.
Treating anaerobic infection. The variety of forms and clinical manifestations of anaerobic infection is one of the main reasons for the individual approach in the treatment of this category of patients. First of all, we note that the individuality of choice belongs to one of the decisive areas of complex therapy - sanitation therapy of the primary focus of infection.
In non-clostridial anaerobic infection, radical excision of all nonviable tissues with adequate drainage should be considered optimal. Repeated surgical treatments are aimed at preventing a possible expansion of the boundaries of destruction. From these positions, it is sometimes advisable (with necrotizing fasciitis) control incisions with a length of 1.5-2 cm along the periphery of the wound. If during the initial surgical treatment it is not possible to reliably excise all necrotic tissues, then subsequent treatments should be carried out daily until the desired effect is achieved. Of course, the most difficult are suppurative lung diseases and peritonitis with the participation of non-clostridial anaerobic flora. The stage-by-stage surgical sanitation of purulent foci in this case, and with peritonitis, sanitization relaparotomies are always justified.
In the case of anaerobic Clostridial infection, stripe cuts were previously widely declared. However, the school staff B.V. Petrovsky and, in particular, G.I. Lyskin (1984), who has experience in the treatment of gas infection, found that stripe cuts aggravate wound depletion, and therefore it is more expedient to use small cuts up to 7-8 cm along the periphery of the wound.
The surgical aid is only a part of the rehabilitation measures, the implementation of which is indisputably necessary at the first stage. Any surgical intervention can be supplemented with vacuum treatment, laser irradiation, ultrasonic cavitation, etc. Among medications, oxidizing agents (hydrogen peroxide, potassium permanganate, permur, etc.), adsorbents, ointments based on polyethylene glycol with high osmotic activity should be widely used.
Among the general biological, pathogenetically grounded, therapeutic measures, hyperbaric oxygenation should be widely used. HBO allows you to narrow the scope of tissue destruction, promotes the demarcation of necrosis in a shorter time, stimulates the growth of granulation tissue. The general biological orientation of HBO contributes to the stimulation of immunity and the reactivity of the organism as a whole.
Among the general drug therapy for anaerobic infection, derivatives of metranidazole should be used (metragil, flagil, up to 1.5 g per day i.v.; tinidazole - tricanix up to 1.5 g per day i.v. after 8 hours for 5-8 days), 1% dioxidine solution 120.0 i.v. These drugs have sufficient antiseptic properties against gram-negative bacilli and anaerobic cocci.
Mandatory components of the treatment of anaerobic infection are detoxification, antibacterial therapy, immunotherapy, correction of life support systems, energy supply of patients. We will cover these issues in more detail in the Sepsis section.
Control questions
- 1. What are the causative agents of anaerobic infection?
- 2. What are the features of anaerobic microflora?
- 3. How can anaerobic infection be classified?
- 4. What conditions are necessary for the development of anaerobic infection?
- 5. What are the factors of pathogenicity of anaerobic microorganisms?
- 6. What are the clinical features of anaerobic infection?
- 7. What additional methods are used in the diagnosis of anaerobic infection?
- 8. Classification of anaerobic soft tissue infection.
- 9. What is the clinic of anaerobic soft tissue infection?
10. What are the main directions of treatment for anaerobic infection?
11. What is the scope of surgical treatment for anaerobic soft tissue infection?
Situational tasks
1. A 28-year-old patient was admitted to the clinic with an extensive smashed wound of the right thigh, received 4 days ago in a road accident. The victim is inhibited, has difficulty answering questions, and is adequate. Locally, a 15x25 cm wound is noted, the edges are scalped, the presenting muscles are dull, the discharge is scanty, serous-purulent, palpation of the tissues of the near-wound area reveals a symptom of “crepitus”, tissue infiltration is expressed, the skin is tense, pale in color. What is your preliminary diagnosis? What additional survey methods need to be used in this situation? What is the treatment tactics?
2. A 38-year-old woman came to the emergency room with complaints of pain in the left thigh, where 2 weeks before that, injections of magnesium sulfate were performed for hypertensive crisis. Visually, there is a pronounced edema of the tissues of this zone, the skin is brown, tense, painfulness on palpation is moderate, the movements of the left leg are significantly limited. X-ray examination of the left thigh determines the symptom "herringbone pattern". What is your preliminary diagnosis? How to explain and how to interpret X-ray data? What is the treatment tactics?
3. During the operation of surgical treatment of a purulent focus for post-injection phlegmon of the right gluteal region during dissection of soft tissues, a symptom of crepitus was noted. Soft tissues are saturated with serous exudate of brownish color with a fetid odor, the fiber is dirty gray, dull. What is the nature of the inflammatory process in this case? What is your diagnosis? What research methods will clarify the diagnosis? What are the appropriate treatment measures in this situation?
Answers
1. The preliminary diagnosis is formulated as follows: purulent wound of the right thigh. The causative agent of wound infection is most likely anaerobic microorganisms. To clarify the nature of the bacterial flora and determine its sensitivity to antibiotics, a bacteriological examination of the wound is necessary. In this case, the operation is shown, the surgical treatment of a purulent focus (secondary surgical treatment of the wound) and the mandatory conduct of rational antibiotic therapy.
2. The patient has post-injection anaerobic phlegmon of the left thigh. The radiographically detected symptom "herringbone pattern" indicates that the causative agent of this surgical infection belongs to the group of anaerobes. As you know, in the process of life they are able to emit gas, which, spreading along the muscle fibers, stratifies them and thereby determines the X-ray symptomatology. The patient is shown surgical treatment, including the operation of the surgical treatment of the purulent focus.
3. In this case, it can be assumed that the causative agent of the surgical infection is anaerobic microorganisms. In this regard, the diagnosis can be formulated as follows: post-injection anaerobic phlegmon of the right gluteal region. To confirm the anaerobic etiology of the pathogen, it is advisable to conduct a microbiological study of the wound to determine the sensitivity of the flora to antibiotics. In the postoperative period, it is necessary to include local and general rational antibiotic therapy and symptomatic measures in the treatment complex.
LITERATURE
- 1. Anaerobic non-clostridial infection in surgery (guidelines). - M, 1987. - 28 p.
- 2. Grigoriev EG, Kogan AS Surgery of severe purulent processes. - Novosibirsk: Nauka, 2000 .-- 314 p.
- 3. Kolesov AP, Stolbovoy AV, Kocherovets VI Anaerobic infection in surgery. -L .: Medicine, 1989 .-- 160 p.
- 4. Larichev AB Anaerobic infections in purulent surgery (teaching aid) Yaroslavl, 1995. - 31 p.
- 5. Materials of the All-Union symposium "Anaerobic non-clostridial infection in purulent surgery: Ternopil, 1989. - 200 p.
- 6. Wounds and wound infection (Edited by MI Kuzin and BM Kostyuchenko). - M .: Medicine, 1990 .-- 592 p.
Anaerobic infection is triggered by anaerobic microorganisms, which do not require oxygen for energy and vital activity. Ailments caused by this type of bacteria include diseases such as botulism, tetanus, gas phlegmon, and gangrene. Aerobic infection, unlike anaerobic infection, is triggered by microorganisms that need oxygen to maintain life.
Brief classification of anaerobes
Microorganisms in this category are divided into clostridia (spore-forming) and non-clostridial types. There are also exogenous and endogenous anaerobes. The latter are considered a component of normal human microflora and are usually detected in the genitourinary system and intestines. They are also found on mucous membranes, skin, and are secreted from the respiratory tract. Exogenous microorganisms are found in soil and decaying organic matter.
This type of infection occurs quickly and is characterized by rapidly progressing necrotic tissue changes, as well as the formation of gases in them and severe intoxication. At the same time, there are no pronounced inflammatory phenomena. Anaerobic infection is considered one of the most severe. It leads to the development of endogenous intoxication and damage to important systems and organs. Anaerobic infection has a high mortality rate. Its development can be subacute (from 4 days), acute (3-4 days), lightning-fast (1 day from the moment pathogens enter the body). The likelihood and rate of development of anaerobic infection, as a rule, depend on the number of microorganisms trapped in the wound, the degree of their pathogenicity and the individual characteristics of the human body. The appearance of pathology is facilitated by a weakened immunity, the presence of tissue sites deprived of blood supply, and chronic intoxication. Anaerobic infection in surgery is one of the most severe postoperative complications.
Treatment
The main method of treating anaerobic wound infection is surgical, namely, a large-scale dissection of the affected area and the complete removal of necrotic tissue with good drainage and antiseptic treatment. The leading role in postoperative therapy is played by the use of antibacterial drugs.
As a rule, antibiotics of a wide spectrum are used: cephalosporins, semi-synthetic penicillins, aminoglycosides, etc. Antibacterial drugs are also used that selectively act on anaerobic microorganisms (Metronidazole, Clindamycin, Dioxidin, etc.). In difficult cases, patients are prescribed the maximum allowable dose of antibiotics every day. Infusion therapy is actively used: amino acid solutions, blood products, blood substitutes. Detoxification of the body and enhancing immunity are of great importance. Prevention of anaerobic infections consists in careful and timely treatment of wounds and compliance with antiseptic and aseptic measures during surgery.
The causative agents of anaerobic infections are frequent inhabitants of the skin, mucous membranes of the genitourinary and digestive systems. In addition, clostridia, the "inhabitants" of the soil, can cause similar pathologies.
Anaerobic infections cause a lot of trouble for the patient, since their manifestations are acute and aesthetically unpleasant. The provocateurs of this group of diseases are spore-forming or non-spore-forming microorganisms that have fallen into favorable conditions for life. Infections caused by anaerobic bacteria develop rapidly and can affect vital tissues and organs, so their treatment should be started immediately after diagnosis in order to avoid complications or death.
Anaerobic infectious diseases include pathologies caused by spore-forming, as well as non-spore-forming microbes that have entered an environment with a low oxygen content or without it at all. In this case, their metabolic processes are activated, they begin to multiply actively, and the patient develops symptoms of infection.
The difference between infectious processes caused by anaerobic microorganisms is that clinical manifestations are dominated by strong endogenous intoxication and the putrefactive nature of the exudate - the fluid released from small vessels in the area of inflammation.
Due to the resistance of anaerobes to many external factors, after entering a favorable environment, they begin to multiply very quickly. Because of this, gas-forming processes can appear in wounds - this is how the waste products of some bacteria are released. The rapid development of infection leads to the accumulation of a large amount of toxic metabolites of anaerobes in the patient's tissues, therefore, over time, extensive tissue necrosis begins - it is this factor that increases the lethality in such pathologies.
Pathogenic microorganisms
Most of the causative agents of acute anaerobic infections are part of the normal flora of the skin, mucous membranes of the mouth and nose, organs of the digestive, genitourinary systems. But the reproduction of these bacteria restrains several factors: firstly, there is too much oxygen in their habitual habitats, and secondly, the immune system suppresses the development of those who nevertheless were able to adapt to environmental conditions.
The causative agents of anaerobic infections can be divided into groups:
- obligate (clostridial and);
- optional (sticks, shigella, cocci, yersinia).
In the first case, pathogens of anaerobic infection more often fall into open wounds with soil or dirty water, their multiplication leads to extensive tissue necrosis, a large amount of purulent discharge. The second group of bacteria can actively multiply in completely anoxic conditions or in the presence of a small amount of it.
It is more difficult to fight obligate anaerobic bacteria, since this group includes Clostridia, which are capable of forming endospores, and with their help they easily survive any unpleasant conditions.
Additional classification
Depending on how the anaerobic infection was obtained, the classification of pathologies may be as follows:
- wounds (anaerobes penetrate tissues through wounds with earth or water);
- postoperative (bacteria enter the body under non-sterile conditions during the operation);
- physiological (bacteria penetrate tissues due to disruption of anatomical barriers due to ischemia, atherosclerosis or necrosis);
- post-therapeutic (occur after irrational use of antibiotics to suppress the growth of aerobic microorganisms).
Localization of infection
Depending on the selected localization in the body, anaerobes can cause various diseases, for which some of the symptoms described in the next section will be common. The most dangerous are bacterial lesions of the central nervous system and bone tissue. In these places, microorganisms cause irreversible tissue death, accompanied by severe pain and loss of functionality.
CNS infections
Acute anaerobic infection that develops in the tissues or fluid of the brain provokes brain abscess, meningitis, and subdural empyema. Diseases develop rapidly, contributing to the rapid death of nerve cells, while the patient most often falls into a coma due to dysregulation of the body's functioning.
Central nervous system infections are the most difficult to cure, they have a high mortality rate, and most of the surviving patients suffer from severe complications.
Bone and joint infection
It is quite difficult for bacteria to get into the bone and cartilaginous tissue, this happens most often with fractures, or the infection is added a second time to the already existing pathologies of bones and joints. Anaerobes in this part of the body provoke the development of purulent arthritis and osteomyelitis. These diseases cause severe pain, disrupt the body's motor activity and lead to rapid tissue degradation.
If the infection reaches the bone marrow, then the person's immunity will significantly decrease, as well as the production of red blood cells and platelets will decrease, which will lead to anemia and poor blood clotting.
It is almost impossible to "drive out" the infection from the bone and cartilage tissue, since these parts of the body are not directly washed with blood, the active substances of antibacterial drugs will not reach them.
In this case, the disease can be called "anaerobic surgical infection", since the patient can only be helped by an operation to remove the affected areas of the bone or joint and replace them with implants.
Head and neck infections
In the head and neck region, anaerobic microorganisms can cause the following pathologies:
- phlegmon of the neck;
- periodontal abscess;
- sinusitis;
- angina of Ludwig;
- otitis media.
Due to the fact that there are many lymphatic vessels in the neck area, anaerobes that cause infection in this area provoke swelling and enlargement of the lymph nodes. In addition, the transmission of nerve signals from the brain is disrupted, and the blood supply to the brain deteriorates, which causes headaches and nausea.
Reproductive system infections
Anaerobic microorganisms can settle in the reproductive system, causing the following diseases:
- bartholinitis;
- salpingitis;
- adnexitis;
- endometritis;
- pelvioperitonitis.
The danger of genital tract infections is that they give complications in the form of residual scar tissue, chronic infection or tissue necrosis, therefore, after them, patients often become infertile. Sometimes bacteria quickly get to the ovaries and testes, causing irreversible tissue destruction in them, for which they have to be removed.
Respiratory tract and pleural infections
Some of the favorite habitats of anaerobes are the respiratory tract and lungs, where they provoke the following pathological processes:
- aspiration pneumonia;
- lung abscess;
- empyema of the pleura;
- acute pneumonia;
- peritonitis;
- inflammation of the spleen;
- abscess of the abdominal cavity.
The putrefactive infection quickly spreads in the pleura and pleural fluid, producing a large amount of toxins, which cause an abscess and severe edema. If anaerobic microorganisms have settled in the tissues of the lungs, the patient has difficulty breathing, a large amount of discharge appears, and a high temperature is constantly kept.
Skin and soft tissue infections
Anaerobic wound infection is one of the most common, because a person almost every day damages the skin without noticing it. If dirty water or earth gets into a deep wound, then anaerobic microorganisms can be transferred with it, which will quickly begin to multiply and provoke such pathologies:
- gas gangrene;
- cellulite (bacteria disrupt the outflow of lymph in the skin, which causes local edema);
- abscesses of the dermis and muscles;
- necrotizing fasciitis.
Anaerobic bacteria cause acute inflammation of the skin or muscles, accumulating a large amount of toxic waste, causing the tissues to darken and die off. But this form of infection is the easiest to treat, since the bacterium does not hide inside the body; an external antiseptic can kill it.
Symptoms of anaerobic infection
The incubation period of diseases caused by anaerobes ranges from several hours to 3-4 days, depending on the type and localization of bacteria, after which the first signs of pathology appear. Anaerobic infection is characterized by acute symptoms that will help the doctor determine it:
- general intoxication of the body, due to which there is constant nausea, dizziness;
- if a putrefactive infection has settled inside the body, the patient quickly rises and maintains a high temperature;
- a fever appears with chills, bone aches and drowsiness;
- pressure decreases, especially this symptom is noticeable with infection of the central nervous system;
- due to pressure surges, tachycardia, tachypnea and swelling appear;
- hemolytic anemia (this symptom differs in bone infection, since it disrupts the synthesis of red blood cells);
- if a putrefactive infection affects the skin, then it darkens, large boils or wounds filled with pus appear;
- exudate accumulates in the affected tissues, which has a serous-hemorrhagic or purulent liquid consistency, as well as a terrible smell;
- the patient feels severe cutting or pulling pain in the area affected by the infection.
Diagnosis of anaerobic infection
Before starting treatment, it is important to determine exactly whether it is anaerobic or, and for this it is not enough just an external assessment of the symptoms. Methods for determining an infectious agent can be different:
- bacterial culture of pleural fluid, exudate, blood or purulent discharge;
- Gram staining of the taken smears;
- enzyme immunoassay (the efficiency and speed of this method is high, as is the price);
- X-ray (this method is most effective in diagnosing infections of bones and joints);
Treatment of anaerobic infection
If the patient develops an anaerobic infection, treatment should be urgent, as bacteria multiply rapidly and poison the tissues of the body. The technique of therapy depends on where the putrefactive infection is located. In case of damage to internal organs or bones and joints, surgery is required, since the affected areas must be removed and intensive disinfection must be carried out.
After surgery, the patient must undergo an intensive course of antibacterial drugs.
In case of external wound infection, the affected areas must be treated; the antiseptic must necessarily contain a broad spectrum antibiotic. Research practice has shown that most narrowly targeted antibacterial drugs are not effective against anaerobes. Wounds should not be wrapped tightly. It is important that oxygen gets to them and inhibits the growth of bacteria. Studies have shown that laser and ultraviolet light can also be used to disinfect pus pockets, which destroy bacterial cells.
Patients require intensive detoxification, as anaerobes produce a lot of toxic waste products. Together with this measure, hepatoprotectors can be used, because the liver neutralizes a large amount of toxins and needs support. The main difference between broad-spectrum antibiotics is the suppression of the growth of most bacteria in the body, because of this, the intestinal microflora suffers greatly. Accordingly, prebiotics must be taken when treating anaerobic infection.
Sometimes, after therapy, a small amount of pathogenic anaerobes may remain in the patient's body, such a "dormant" infection can flare up again with a weakened immune system, sudden weight loss and other stress factors, so a person will have to carefully monitor their well-being.
Anaerobic infections are dangerous to humans in that they cause severe intoxication and quickly destroy the affected tissue. The symptoms of pathology are difficult to miss, since they are acute. Treatment should be obtained only from a doctor, since often conventional medications are not able to eliminate the focus of infection, the intervention of a surgeon is required.
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