18: The Genitourinary System Skin & Eyes

Question 1

Defense mechanism the urinary tract

Answer 1

-desquamation of epithelial cells lining the urinary tract: this shedding prevents bacteria from establishing a permanent attachment to the bladder or urethral lining. As epithelial cells naturally slough off, they take any adhered pathogens with them, helping to reduce the bacterial load and minimize the chances of infection.
-IN MALES= desquamation along urethra provides protection
-IN FEMALES= the vaginal canal is lined with/ mucosal tissue and mucus Low pH during the reproductive years
-flushing action of urine
-lysozyme: Lysozyme functions by breaking down the peptidoglycan in bacterial cell walls, particularly in Gram-positive bacteria, leading to bacterial cell lysis and death. -lactoferrin: By sequestering iron, lactoferrin limits its availability to bacteria, thereby inhibiting their growth.

Question 2

UTI = inflammation of the urinary tract
Lower UTI occurs where and its known as
Upper UTI occurs where and known as

Answer 2

Inflammation of the Bladder = cystitis
Inflammation of the Kidneys = Pyelonephritis

Question 3

How is community-acquired cystitis typically transmitted?

Answer 3

It is transmitted endogenously, meaning it arises from the individual’s own flora, especially from the GI tract.

Question 4

How is healthcare-associated cystitis typically transmitted? And what bacterial species typically cause this type of cystitis?

Answer 4

It is transmitted exogenously, often due to obstructions or catheter use, and is caused by pathogens like Pseudomonas, Serratia, and Enterococcus species.

Question 5

Which bacteria causes 80% of inflammation of the bladder?

Answer 5

Inflammation of the bladder = lower UTI
Uropathogenic Escherichia coli UPEC

Question 6

Pathogenesis of cystitis via UPEC?

Answer 6

Ureopathogenic E.coli = UPEC

UPEC uses fimbriae to attach to the mucosa of the urethra
Cells multiply
LPS induces an inflammatory rxn
Sometimes… bacteria can ascend the ureter to the kidneys

Question 7

Clinical manifestations for Cystitis

Answer 7

Dysuria
Vesical tenesmus
Hematuria
Low fever

Question 8

Pyelonephritis is caused by the same causative agents as cystitis, which include? What are the differences?

Answer 8

Uropathogenic Escherichia coli (UPEC
Other causative agents include
Klebsiella,
Proteus species,
Staphylococcus saprophyticus

-high fever and back pain (duhhhhhh I know this)
Can progress to septicemia

Question 9

Pyelonephritis is caused by the same causative agents as cystitis, which include? What are the differences?

Answer 9

Uropathogenic Escherichia coli (UPEC
Other causative agents include
Klebsiella,
Proteus species,
Staphylococcus saprophyticus

-high fever and back pain (duhhhhhh I know this)
Can progress to septicemia

Question 10

Reduction in the number of what bacteria could cause bacterial vaginosis? And why?

Answer 10

The metabolism of glycogen by Lactobacillus species into lactic acid maintains a low pH.

H2O2 is produced by some strains of Lactobacillus
Most anaerobes lack catalase and peroxidase and cannot eliminate H2O

Question 11

What is bacterial vaginosis?

Answer 11

is a condition where the normal Lactobacillus-dominated vaginal microbiota is replaced by an overgrowth of anaerobic bacteria, including Gardnerella vaginalis.

Question 12

Gardnerella vaginalis virulence factors

Answer 12

Vaginolysin- adherence to vaginal epithelium
Biofilm formation
Symbiotic relationship with/ anaerobes

Question 13

What is the typical pH range of the vagina during the reproductive years?

Answer 13

The vaginal pH typically ranges >4.5

Lactic acid production by Lactobacillus spp. keep a low pH (<4.5) in the vagina and inhibits anaerobic species
Decreased lactic acid production rises the vaginal pH (>4.5)

Question 14

Diagnosis of bacterial vaginosis

Answer 14

Clinically done by at least 3 signs:
Vaginal fluid w/ pH >4.5
Fishy odor
Homogenous adherent discharge
Clue cells on a saline wet mount (epithelial cells w/ great amount of adhered bacteria)

Question 15

How are clue cells identified? And in what condition are clue cells typically found?

Answer 15

Clue cells are identified by examining a saline wet mount of vaginal discharge under a microscope, where the epithelial cells have a lot of bacteria adhered to it.

Clue cells are found in bacterial vaginosis (BV), especially in infections caused by Gardnerella vaginalis.

Question 16

What is Trichomonas vaginalis?

Answer 16

Trichomonas vaginalis is a Pathogenic protozoan parasite that causes the sexually transmitted infection trichomoniasis.

It has four flagella highly MOTILE
This can be found both in men and women
Men = prostate and urethras
Women = vagina and urethras

Question 17

Which bacteria causes serious complications during preterm labor?

Answer 17

Trichomonas vaginalis

Question 18

Therapy treatment for Trichomonas vaginalis?

Answer 18

Metronidazole

Question 19

Clinical symptoms in woman for Trichomonas vaginalis?

Answer 19

Vaginitis caused by Trichomonas vaginalis is usually ass. W/ a greenish discharge and a ”strawberry cervix”

This is how we can deduct vaginitis caused by monilial which is a yeast infection because that one is white rather than green

Question 20

Syphilis is caused by what bacteria?

Answer 20

Treponema Pallidum

Question 21

Which bacteria is similar to a gram (-) but does not have LPS in their outer membrane

Answer 21

Treponema Pallidum

Question 22

What type of microscopy is used for the etiology of syphilis

Answer 22

Darkfield is used

Question 23

During what stage of syphilis do you see the hallmark of clinical signs?

Answer 23

The Chancre lesion are seen in the primary stage of syphilis
May appear 10-90 days after exposure.
Common sites are penis and labia.
W/o treatments chancre disappears in 2-8 weeks

Question 24

Rash, pink to brown macules involving palm/soles in 50% of cases are seen in what stage of syphilis?

Answer 24

The secondary stage
May also see:
-oral lesions called “mucous patches” resembling snail tracks
-genito-inguinal rashes, including tinea-mimicker or wart-like lesion called condylomata lata.

Question 25

Primary Syphilis clinical manifestations

Answer 25

-painless chancre at site of inoculation (filled with/ spirochetes)
-clean-based, well-demarcated lesion w/ firm, indurated margins
-heals spontaneously in 3-6 weeks w/ or w/o treatment but the spirochetes move into blood circulation

Question 26

In which phase of syphilis does the chancre heal spontaneously

Answer 26

During primary syphilis in 3-6 weeks w/ or w/o treatment but the spirochetes move into blood circulation = bacteremia and this would be secondary syphilis

Question 27

Secondary syphilis clinical manifestations

Answer 27

Untreated patients w/ bacteremia after the primary chancre has healed.
-rash commonly on palms and soles
-mucous patches on mucosa
-fever and malaise
-lymphadenopathy
ALL THESE LESIONS OF SECONDARY SYPHILIS AFE INFECTIOUS

Question 28

Latent syphilis clinical manifestations

Answer 28

Secondary syphilis has resolved in patients are asymptomatic after 4 years and are generally considered non-infectious at this stage.
If still untreated <40% develop tertiary syphilis.

Question 29

Tertiary syphilis clinical manifestations

Answer 29

Develops over 6-40 years
-gummatous syphilis: firm, necrotic center found on skin,liver, and bones
-cardiovascular syphili: necrosis of aorta
-neurosyphilis:
paresis - disease of the nerve cells in the brain
Muscle weakness, progressive dementia and paralysis
Tabes dorsalis: causes posture instability w/ a staggering wide base gait.

Question 30

Congenital syphilis clinical manifestations

Answer 30

Treponema Pallidum can pass from mom’s circulation into the placenta and through to fetal tissue resulting in
-miscarriage/stillbirth or disease
-inhibits normal fetal growth
most common manifestations
-Hutchinson’s teeth
-mulberry molars
-bone deformation
-8th nerve deafness

Question 31

Hutchinson’s teeth and mulberry molars are clinical manifestations of

Answer 31

Most common manifestations of Congenital syphilis (Treponema Pallidum)

Question 32

Syphilis diagnosis

Answer 32

Serologic screening tests
-non-treponemal test: measure IgG and IgM
-treponemal test: detects specific anti- treponema Pallidum antibodies from serum
-direct visualization under darkfield microscopy of specimen from primary chancre or rash (only effective during the active stages or primary and secondary syphilis)

Question 33

Treatment of syphilis

Answer 33

Early syphilis = primary, secondary and latent
= pen G

Late syphilis = tertiary
=pen G for Gummatous and cardiovascular
=pen G (IV) for Neurosyphilis

Prevention of secondary and tertiary stages depends upon early diagnosis and treatment

Question 34

What is Impetigo?
caused by what type of bacteria?

Answer 34

Superficial bacterial infection that causes the skin to flake or peel off.

-staphylococcus aureus
-streptococcus pyogenes

Common in children. Bacteria enter through a break in the skin. It is not that serious but is HIGHLY contagious

Question 35

Blisters that become cloudy as they fill w/ bacteria, once the blisters burst they become yellow crusts which weep pus

Answer 35

Impetigo
Caused by
-S.aureus
-S.pyogenes

Question 36

Superficial infection of the hair follicle, and the bacteria form pus.

Answer 36

Folliculitis
When it occurs in the eyelashes it is a stye!!!

Question 37

Which bacteria causes folliculitis?

Answer 37

Staphylococcus aureus

When it occurs in the eyelashes it is a stye.
Superficial infection of the hair follicle. Bacteria form pus

Question 38

A folliculitis which has deeper into the tissues… May occur in the sebaceous glands or sweat glands. What is the diagnosis and the bacteria caused?

Answer 38

Furuncle (BOIL)
Caused by s.aureus
Infection usually resolves after draining the pus.
Infection has spread to subcutaneous tissue

Question 39

A painful network of furuncles connected by sinus tracts beneath the surface of the skin. What is diagnosis? Caused by what bacteria?

Answer 39

Carbuncle
S.aureus

More frequent on the back of the neck
Can result in bacteremia

Question 40

What is considered the best defense of the eye, besides being immuno privileged?

Answer 40

Tear film
-aq. Fluid, oil, and mucus
-lysozyme and lactoferrin
-flow of tears prevents microbe attachment (like urine)
Inflammation does not occur readily

Question 41

Inflammation of the eye in newborns is caused by what bacteria?

Answer 41

Neisseria Gonorrhoeae
Chlamydia Trachomatis

Inflammation of the conjunctiva
Pink eye
Conjunctivitis

Question 42

Inflammation of the cornea is known as?

Answer 42

Keratitis

Corneal ulcers that can lead to perforation

Question 43

Which is the bacteria that is the most isolated pathogen in contact lens related keratitis?

Answer 43

Pseudomonas aeruginosa

Keratitis =inflammation of the cornea
Corneal ulcers that can lead to perforation