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Reproductive > Micro > Flashcards

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
Q

STDs causing warts

A

HPV (esp 6 + 11), 2 Syphilis, Molluscum Contagiosum (pox),

26
Q

HSV 1 + 2 charact.

A
  • 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
Q

Tx for HSV

A

ACV - not curative

28
Q

DDx of HSV

A

Blood PCR, fab assays, Tzanck smear

29
Q

what does Tzanck smear show for HSV?

A

multinucleated giant cells w/ inclusion bodies from viral replication

30
Q

S+S HSV

A
  • 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
Q

neonatal HSV

A
  • 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
Q

immune rxn to HSV

A
  • 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
Q

causative agent of syphilis

A

Treponema pallidum - a spirochete

34
Q

tests for syphilis

A

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
Q

presentation of 1,2,3 syph

A 
1 = PAINLESS chancre @ site of infection
2 = maculopapular rash (incl hands and feet last) 
3 = granulomas (gummas), CNS dementia, aortic aneurysm
36
Q

tx for syph

A

penicillan (benzothene preparation for IM XR), if allergy - desens. then tx

37
Q

what strain of C. trachomatis causes lymphogranulosum venarium (LGV)

A

L1-3

38
Q

S+S of LGV

A

swollen inguinal lymph glands that may ulcerate, rare

39
Q

s+s of chancroid

A

single or multiple ulcers that may look v. similar syphilis but v. painful, rare

40
Q

charact. of Neisseria gonorrhoeae (GC)

A
  • 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
Q

tests for GC (gonococcus)

A
  • 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
Q

S+S of GC

A
  • 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
Q

tx for GC

A

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
Q

S+S of PID

A
  • dull to sev. abdm pain
  • adnexal tenderness and cervical motion tenderness
  • fever
  • poss. cervicitis
  • may result in sterility, abcesses, hospitalizations, chronic pain
45
Q

what strains of C. trachomatis causes urethritis, cervicitis, PID?

A

Ct D-K

46
Q

charact. of Ct

A
  • 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
Q

dx of Ct

A

urine NAAT, not detectable w/ gram stain, cell culture v. diff, rapid antigen test is not as sensitive

48
Q

tx of Ct

A

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
Q

S+S of Ct

A

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
Q

infant pn. from Ct

A

afebrile, staccato cough w/ tachypnea (like pertussis but w/o whoop), wheezing rare, may be concurrent w/ conjunctivitis

51
Q

T/F Ct/GC infections are often inapparent/subclinical

A

T

52
Q

Bacterial Vaginosis charact. and S+S

A
  • 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
Q

agents of BV

A

Gardnerella vaginalis, Mobiluncus, oth. anaerobes

54
Q

tx of BV

A

Metronidazole, or clindamycin cream

Reproductive (5 decks)

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