18: The Genitourinary System Skin & Eyes Flashcards
Defense mechanism the urinary tract
-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.
UTI = inflammation of the urinary tract
Lower UTI occurs where and its known as
Upper UTI occurs where and known as
Inflammation of the Bladder = cystitis
Inflammation of the Kidneys = Pyelonephritis
How is community-acquired cystitis typically transmitted?
It is transmitted endogenously, meaning it arises from the individual’s own flora, especially from the GI tract.
How is healthcare-associated cystitis typically transmitted? And what bacterial species typically cause this type of cystitis?
It is transmitted exogenously, often due to obstructions or catheter use, and is caused by pathogens like Pseudomonas, Serratia, and Enterococcus species.
Which bacteria causes 80% of inflammation of the bladder?
Inflammation of the bladder = lower UTI
Uropathogenic Escherichia coli UPEC
Pathogenesis of cystitis via UPEC?
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
Clinical manifestations for Cystitis
Dysuria
Vesical tenesmus
Hematuria
Low fever
Pyelonephritis is caused by the same causative agents as cystitis, which include? What are the differences?
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
Pyelonephritis is caused by the same causative agents as cystitis, which include? What are the differences?
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
Reduction in the number of what bacteria could cause bacterial vaginosis? And why?
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
What is bacterial vaginosis?
is a condition where the normal Lactobacillus-dominated vaginal microbiota is replaced by an overgrowth of anaerobic bacteria, including Gardnerella vaginalis.
Gardnerella vaginalis virulence factors
Vaginolysin- adherence to vaginal epithelium
Biofilm formation
Symbiotic relationship with/ anaerobes
What is the typical pH range of the vagina during the reproductive years?
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)
Diagnosis of bacterial vaginosis
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)
How are clue cells identified? And in what condition are clue cells typically found?
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.
What is Trichomonas vaginalis?
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
Which bacteria causes serious complications during preterm labor?
Trichomonas vaginalis
Therapy treatment for Trichomonas vaginalis?
Metronidazole
Clinical symptoms in woman for Trichomonas vaginalis?
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
Syphilis is caused by what bacteria?
Treponema Pallidum
Which bacteria is similar to a gram (-) but does not have LPS in their outer membrane
Treponema Pallidum
What type of microscopy is used for the etiology of syphilis
Darkfield is used
During what stage of syphilis do you see the hallmark of clinical signs?
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
Rash, pink to brown macules involving palm/soles in 50% of cases are seen in what stage of syphilis?
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.
Primary Syphilis clinical manifestations
-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
In which phase of syphilis does the chancre heal spontaneously
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
Secondary syphilis clinical manifestations
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
Latent syphilis clinical manifestations
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.
Tertiary syphilis clinical manifestations
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.
Congenital syphilis clinical manifestations
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
Hutchinson’s teeth and mulberry molars are clinical manifestations of
Most common manifestations of Congenital syphilis (Treponema Pallidum)
Syphilis diagnosis
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)
Treatment of syphilis
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
What is Impetigo?
caused by what type of bacteria?
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
Blisters that become cloudy as they fill w/ bacteria, once the blisters burst they become yellow crusts which weep pus
Impetigo
Caused by
-S.aureus
-S.pyogenes
Superficial infection of the hair follicle, and the bacteria form pus.
Folliculitis
When it occurs in the eyelashes it is a stye!!!
Which bacteria causes folliculitis?
Staphylococcus aureus
When it occurs in the eyelashes it is a stye.
Superficial infection of the hair follicle. Bacteria form pus
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?
Furuncle (BOIL)
Caused by s.aureus
Infection usually resolves after draining the pus.
Infection has spread to subcutaneous tissue
A painful network of furuncles connected by sinus tracts beneath the surface of the skin. What is diagnosis? Caused by what bacteria?
Carbuncle
S.aureus
More frequent on the back of the neck
Can result in bacteremia
What is considered the best defense of the eye, besides being immuno privileged?
Tear film
-aq. Fluid, oil, and mucus
-lysozyme and lactoferrin
-flow of tears prevents microbe attachment (like urine)
Inflammation does not occur readily
Inflammation of the eye in newborns is caused by what bacteria?
Neisseria Gonorrhoeae
Chlamydia Trachomatis
Inflammation of the conjunctiva
Pink eye
Conjunctivitis
Inflammation of the cornea is known as?
Keratitis
Corneal ulcers that can lead to perforation
Which is the bacteria that is the most isolated pathogen in contact lens related keratitis?
Pseudomonas aeruginosa
Keratitis =inflammation of the cornea
Corneal ulcers that can lead to perforation
