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Micro Flashcards

1
Q

define significant bacteriuria

A

> 10^5 cfu/ml, used in research and smwhat in the clinical def. of UTI

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2
Q

lower UTI includes?

A

bladder and urethra, upper is kidney and upper urinary tract

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3
Q

most common causes of dysuria

A

cystitis most comm, also vaginitis, chlamydia, bacterial causes below the clinical def, and unknown causes

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4
Q

most comm culprit of UTI

A

E. coli, 95% from GI tract, also Staph saprophyticus in sex. active young F

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5
Q

age distrib. of UTI and gender

A
  • Infants = males > F
  • 3-50 y/o = F&raquo_space;» M
  • elders = incr. incid in both, but still more comm in F
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6
Q

what effect does birth control choice have on UTI incidence

A
  • highest incid. in those using diaphragms and spermicidal gel b/c of alterations in the flora/pH of vagina as well as anatomical alterations,
  • lower incid in oral contraception
  • note from nun studies that intercourse itself puts women at 4xs higher risk of UTI
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7
Q

Pregnancy and UTI

A

10% of all pregnant women will have bacteriuria (2xs higher than expected) and of those, if untreated, 25% will prog. to pyelonephritis
-can increase risk of fetal loss

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8
Q

symp. of pyelonephritis

A

fever/chills
flank pain (cvat)
asymptomatic

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9
Q

symp and ddx of UTI

A 
\+/- fever
frequency
dysuria
turbid urine
hematuria
suprapubic discomfort
asymptomatic cystitis
-ddx = microscopic urinanalysis, gram stain, urine culture, blood culture (prn)
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10
Q

route of infection in UTI

A

us. ascending from urethral trauma, intercourse, instrumentation, diaphragm use. less than 5% hematogenous seeding from signif. bacteremia.

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11
Q

steps in pathogenesis of UTI

A

adhesion, colonization, invasion, phase variation

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12
Q

describe the phase variation of UTI bacteria

A

they display antigenic variation through switching which pilus gene is expressed so that immune system surveillance is disrupted

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13
Q

types of pili (fimbriae) employed by uropathogenic e. coli

A

type 1 - mannose sens (how they attach to uroepith - but mannose also express. on PMNs)
P-fimbriae - think pyelonephritis b/c the bact switches to this and this cause p.n. preferentially

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14
Q

what do the siderophores and exotoxin hemolysin provide for the bacterium

A

these virulence factors liberate iron from RBCs thru their lysis necc for bact. growth

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15
Q

host defense mech from UTI

A
  • environ = high salt and urea content
  • uroepith sloughing = slough colonies too
  • flushing = urine washes colonies out
  • antib. = secreted IgA
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16
Q

factors predisposing to UTI

A
  • chronic infections (lumenal narrowing)
  • tumors - blockage
  • kinking, abnml vessels - anat. anomaly
  • calculi - obstruct flow
  • scar tiss
  • vesicoureteral reflux
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17
Q

prevention of UTI

A

good hygiene
remove catheters ASAP
correct anatomic abnmlties
-rarely- prophylactic antibiotics

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18
Q

Tx of UTI

A

IF SYMPTOMATIC : tx M 1 wk, F 3 days w/ flouroquinolone, cephalosporin, trimeth/sulfa, aminoglycoside

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19
Q

Tx of pyelonephritis

A

aminogylcosides best, then flouroquinolones, then trimeth/sulfa, and others don’t do as well

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20
Q

incid of which STD is highest in US

A

chlamydia, HPV has similar incid. but is not reportable so numbers not certain

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21
Q

second highest incidence STD

A

GC and also HSV has similar incid but not reportable

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22
Q

_______has twice the incid of HBV and HAV but half that of TB

A

syphilis, higher in TN and memphis esp.

23
Q

STDs causing ulcers

A

1 syphilis, HSV, Chancroid, LGV (c.trachomatis L1-3),

24
Q

STDs causing drips

A

GC, Chlamydia (C. trach D-K), Trichomoniasis, Bacterial vaginosis, Candidiasis, ureaplasma

25
STDs causing warts
HPV (esp 6 + 11), 2 Syphilis, Molluscum Contagiosum (pox),
26
HSV 1 + 2 charact.
- lg, ds DNA virus, enveloped - neurotropic latency - 2 prefers below the belt, 1 above, but both can cross over - route of infection is determinant - 10% can cause meningitis
27
Tx for HSV
ACV - not curative
28
DDx of HSV
Blood PCR, fab assays, Tzanck smear
29
what does Tzanck smear show for HSV?
multinucleated giant cells w/ inclusion bodies from viral replication
30
S+S HSV
- can be preceded by flu-like prodrome - group PAINFUL vesicular lesions on erythematous base recurring in a dermatomal distrib. 2 wks after initial infection, second. usu. not as bad b/c of preformed antib. - 1+2 look similar in genital infection - active infection can be transmitted to baby during birth - meningitis us. resolves on its own unlike bacterial (look for cytopathic effect in csf culture for virus)
31
neonatal HSV
- tx mostly at parturition - C-section if active dz - zosterform rash on skin w/ eye mouth involvmt - CNS or disseminated - bad - encephalitis, organ failure, 75% die
32
immune rxn to HSV
- controlled by cell-mediated immunity so defects in this (neonates w/o fully dvlped immune system, AIDS) can lead to massive problems. Also, secondary infection us. not as bad b/c of preformed antib.
33
causative agent of syphilis
Treponema pallidum - a spirochete
34
tests for syphilis
non-specific : RPR and VDRL specific: FTA-abs not vis. by gram stain, but darkfield microscopy can reveal if done well mandatory report to health dept
35
presentation of 1,2,3 syph
``` 1 = PAINLESS chancre @ site of infection 2 = maculopapular rash (incl hands and feet last) 3 = granulomas (gummas), CNS dementia, aortic aneurysm ```
36
tx for syph
penicillan (benzothene preparation for IM XR), if allergy - desens. then tx
37
what strain of C. trachomatis causes lymphogranulosum venarium (LGV)
L1-3
38
S+S of LGV
swollen inguinal lymph glands that may ulcerate, rare
39
s+s of chancroid
single or multiple ulcers that may look v. similar syphilis but v. painful, rare
40
charact. of Neisseria gonorrhoeae (GC)
- oxidase + (aerobic), gram -, no capsule, extracellular "parasite" - sheds LPS which causes inflamm. - displays antigenic variation thru multiple genes for pili so no perm. immunity
41
tests for GC (gonococcus)
- NAAT (nucleic acid amplific. tests) - grow on Thayer-Martin (choc. agar w/ antib. for nml flora) - gram stain of smear (look for gram- cocci and PMNS) if polys but no cocci then presume Ct
42
S+S of GC
- cervicitis, urethritis, PID, rectal infections, pharyngitis, conjunctivitis in newborn, (all same for Ct), but disseminated infection to endocard, meningitis, arthritis w/ rash is unique to GC - mucopurulent exudate - PAINFUL urination
43
tx for GC
ceftriaxone (or cefixime), PLUS azithromycin or doxycycline (for coverage of Ct which is presumed present until proven otherwise) *flouroquinolones no longer rec. bc of resistance tx sexual contacts **silver nitrate in eyes of newborn for GC doesn't work for Ct
44
S+S of PID
- dull to sev. abdm pain - adnexal tenderness and cervical motion tenderness - fever - poss. cervicitis - may result in sterility, abcesses, hospitalizations, chronic pain
45
what strains of C. trachomatis causes urethritis, cervicitis, PID?
Ct D-K
46
charact. of Ct
- obligate intracell. bact w/o peptidoglycan cell wall (no beta lactams, doesn't gram stain) - two phase replication cycle (Elementary body - the extracellular infecting phase, Reticulate body - the replicating form intracell - form CYTOPLASMIC inclusion bodies)
47
dx of Ct
urine NAAT, not detectable w/ gram stain, cell culture v. diff, rapid antigen test is not as sensitive
48
tx of Ct
azithromycin or doxycycline AND ceftriaxone for presumed concurrent GC, tx sexual contacts **silver nitrate in eyes of newborn will not help w/ Ct or infant pn.
49
S+S of Ct
cervicitis, urethritis, PID, rectal infections, pharyngitis, conjunctivitis in newborn, infant pn, (all same for GC), infant pneumonia is unique to Ct -less purulent than GC, milky discharge, dysuria
50
infant pn. from Ct
afebrile, staccato cough w/ tachypnea (like pertussis but w/o whoop), wheezing rare, may be concurrent w/ conjunctivitis
51
T/F Ct/GC infections are often inapparent/subclinical
T
52
Bacterial Vaginosis charact. and S+S
- represents an imbalance of nml flora (loss of lactobacilli) - us. not painful, no dysuria - anaerobes - smells bad - 10% KOH releases amines (fishy) = whiff test - look for "clue cells" = epith. cells w/ dots indicating bacteria (us. gardnerella, mobiluncus and a combination of others) - mod. white or gray, adherent, homogenous discharge that coats vagina, pH > 4.5tx
53
agents of BV
Gardnerella vaginalis, Mobiluncus, oth. anaerobes
54
tx of BV
Metronidazole, or clindamycin cream

Reproductive (5 decks)

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