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Microbiology Flashcards

1
Q

ANCA + asthma+ eosinophils

A

Churg-Strauss syndrome

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2
Q

cANCA+ respiratory necrotizing granulomatosis

A

Wegener’s granulomatosis

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3
Q

Anti-GBM autoantibodies+ lung hemorrhage

A

Goodpastures syndrome

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4
Q

To cause kidney immune disease an antigen must trigger this

A

a local immune inflammatory response

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5
Q

Nonrenal antigens mechanism for depositing in the kidney

A

usually bloodborne and attach to a specific antibody, forming immune complexes that circulate to the kidney

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6
Q

Berger disease

A
  • Focal glomerulonephritis
  • Presents with hematuria
  • Follows acute upper respiratory infection in young males
  • IgA deposits in the glomerular mesangium
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7
Q

Where do bacterial antigens complexed with IgG tend to localize?

A

within the GBM
or
on the epithelial side of the GBM because of their smaller sizes

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8
Q

An example of a systemic disease associated with Berger’s disease

A

Henoch-Schonlein purpura (HSP)

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9
Q

Where is the glomerular capillary bed situated?

A

Between two arterioles NOT between an arteriole and a venule as in other capillary beds

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10
Q

What is the high glomerular capillary pressure due to?

A

Resistance afforded by the efferent arterioles

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11
Q

Why is capillary pressure always greater than the pressure in Bowman space?

A

Only filtration occurs

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12
Q

Describe fluid flow through the glomerular capillary membrane

A

unidirectional with no associated reabsorption by the capillaries

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13
Q

Ag-Ab complexes establish immune inflammatory renal injury via:

A
  • Type I-IV hypersensitivities
  • direct complement activation
  • immunodeficiency disorders (AIDS)
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14
Q

IgE-mediated (type 1 hypersensitivity) immune response is triggered when..

A
  • Allergen sensitive T cells contact specific allergens
  • releasing pro-allergic interleukins IL-4 and IL-5
  • which enhance production of IgE by class switching and
  • activate mast cells and basophils
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15
Q

IgE coating of basophils and mast cells in the presence of allergen causes the release of…

A
  • vasoactive amines (histamine causing vasospasm)
  • chemokines (RANTES)
  • prostaglandin synthesis
  • platelet mediated coagulation, thrombosis and fibrin deposition
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16
Q

When allergen sensitive T cells contact specific allergens in Type I hypersensitivity this causes the release of

A

IL-4 and IL-5

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17
Q

IL-4 and IL-5 enhance the production of what?

A

IgE by class switching

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18
Q

Allergic tubulointerstitial renal disease due to penicillins is associated with…

A
  • penicillin or its metabolic products act as HAPTENS
  • IgE deposition on mast cells-activation
  • eosinophilia
  • eosinophilic infiltration in the kidney
  • responsiveness to corticosteroids
  • rapid improvement after discontinuation of the causative drug
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19
Q

What type of hypersensitivity is Goodpastures disease?

A

Ab mediated (type II) renal disease

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20
Q

What is renal damage caused by in Type II (Goodpastures) renal disease?

A

linear deposition of anti-collagen IV antibody

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21
Q

C5a

A

anaphylactic and chemotactic

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22
Q

Type II renal damage steps

A
  • Ag-Ab complex activates complement-MAC
  • Tissue injury: creating membrane channels (MAC) and attracting other inflammatory cells to participate in the immune response (C5a fragment attracts neutrophils)
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23
Q

What do C5a fragments attract

A

neutrophils

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24
Q

A specific antigen component of the neutrophil cytoplasm that ANCA recognizes

A

Myeloperoxidase (MPO)

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25
Q

Most common category of the rapidly progressive glomerulonephritides

A

Pauci-immune (type III) crescentic glomerulonephritis

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26
Q

Why is it termed Pauci-immune?

A

Because there is no detectable IgG or C3 immunofluorescence within the glomerular basement membrane

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27
Q

3 conditions associated with ANCA auto Abs:

A
  1. ) type III idiopathic crescentic glomerulonephritis
  2. ) Wegener granulomatosis
  3. ) microscopic polyangiitis
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28
Q

Wegener granulomatosis

A

c-ANCA

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29
Q

ANCA + cytoplasmic antigens activate:

A

neutrophils

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30
Q

Neutrophil beta2 integrins action

Wegener granulomatosis

A

attraction and rolling of neutrophils along vascular endothelium of the kidney (ADHESION)

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31
Q

What two endothelial surface interaction ligands are upregulated in Wegener granulomatosis?

A

ICAM-1 and ELAM-1

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32
Q

Histopathology of clinical Wegener features

A
  • necrotizing rapidly progressive crescentic glomerulonephritis
  • T-cell mediated granulomas in the kidney and respiratory tract
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33
Q

Renal biopsy pattern in immune complex-mediated (type III hypersensitivity)

A

Antibody and complement in these location in a lumby-bumpy pattern

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34
Q

Granular “lumpy-bumpy” pattern are deposits of…

A
  • IgG along the GBM of peripheral capillary loops

- components of the classical pathway of complement

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35
Q

Factors affecting localization of immune complex

A
  1. ) Release of vasoactive substances that enhance vascular permeability
  2. ) Presence of receptors:
    - CR1 receptor of C3b on glomerular epithelial cells
    - FcR for Fc fragment of IgG on mesangial and interstitial cells
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36
Q

Renal transplant acute rejection is mediated by

A

T cells (type IV) that are directed against MHC-1

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37
Q

During acute renal transplant rejection the release of this induces IL-2 syntesis

A

IL-1

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38
Q

TH cells stimulate these cells in the presence of IL-2 during acute rejection

A

Tc cells

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39
Q

What do activated Tc attack during acute rejection?

A

Foreign antigens of the graft resulting in cell-mediated immune inflammation

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40
Q

During acute rejection alloreactive antibodies contribute to this

A

vascular injury

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41
Q

During chronic rejection alloAgs T cells produce these that induce endothelial and intimal smooth muscle cell proliferation

A

cytokines

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42
Q

The production of cytokines during chronic rejection lead to…

A

luminal occlusion and graft arteriosclerosis

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43
Q

Poststreptococcal glomerulonephritis (PSGN) pathogenesis

A
  • T cells stimulate by streptococcal wall Ags may cross react with renal glomerular Ags resulting in:
  • progressive cell death
  • sclerosis of the renal parenchyma
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44
Q

Hyperacute refection in presensitized host, preformed antibodies react with…

A

alloantigens on the vascular endothelium of the transplanted kidney

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45
Q

Hyperacute rejection results in…

A

acute renal ischemia, infarction, and transplant loss

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46
Q

Where does C3b local immune inflammatory injury occur when C3b deposit?

A
  • In the phagocytic mesangium of the glomerulus
  • subendothelially
  • along C3b binding sites within the capillary wall
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47
Q

C3b

A

opsonin

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48
Q

Half of C3 deposition renal disease patients have this

A

C3 convertase

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49
Q

Type I of Membranoproliferative glomerulonephritis features distinguished on renal biopsy

A

Immune complex deposit C3 deposited primarily on subendithelial sites along capillary wall

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50
Q

Type II of Membranoproliferative glomerulonephritis features distinguished on renal biopsy

A

associated primarily with dense intramembranous deposits of C3 nephritic factor

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51
Q

Type III of Membranoproliferative glomerulonephritis features distinguished on renal biopsy

A

Mixture between types I and II

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52
Q

Pathway activated in MPGN Type I

A

classic pathway

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53
Q

Interposition of mesangial cell cytoplasm between the GBM and endothelial cell + glomerulosclerosis leads to…

A

renal failure

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54
Q

Pathway activated in MPGN Type II

A

alternative pathway

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55
Q

GBM appearance in MPGN Type I

A

double contours, rail track appearance

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56
Q

Basement membrane appearance in MPGN Type II

A

Appears thick and looks like a ribbon

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57
Q

RBC contain C3b/C4b receptor and regulate what?

A

C3bBb

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58
Q

How do RBCs that contain C3b/C4b receptor regulate C3bBb?

A

By binding C3b in immune complex, making it available for cleavage and inactivation by serum factor I

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59
Q

Male, urban, black IV drug users

A
  • proteinuria

- rapidly pregressive HIV-associated FSGS

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60
Q

White homosexual seropositive patients

A
  • Nonproteinuric

- more slowly progressive HIV nephropathy

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61
Q

HIV FSGS is characterized early by…

A

Focal deposition of IgM and C3 which leads to scarring of the glomeruli
** kidneys can fail

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62
Q

Immune complex type renal involvement in patients with HIV probably results from what?

A

circulation of bacterial, viral, or tumor associated immune complexes to the kidney

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63
Q

HLA-B12 (MCH I)

A

PSGN

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64
Q

HLA-B35 (MHC I) and HLA-DR4 (MHC II)

A

IgA neuropathy

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65
Q

HLA-DR2 (MHC II)

A

Anti-GBM or Goodpastures syndrome

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66
Q

Prevalence of asymptomatic bacteriuria in pregnant women

A

4-7%

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67
Q

Prevalence of asymptomatic bacteriuria in young men

68
Q

Prevalence of asymptomatic bacteriuria in elderly men

69
Q

Prevalence of asymptomatic bacteriuria in elderly females

70
Q

Most common routes ascending UTIs

A
  1. ) ascent of urethral organisms to bladder
  2. ) from bladder to ureter
  3. ) from ureter to renal pelvis
  4. ) from renal pelvis to kidneys
71
Q

Most common routes hematogenous spread

A
  1. ) bacteria reach blood- bacteremia
  2. ) from blood they reach renal parenchyma
  3. ) produce abscess
72
Q

Promotors of ascending infections

A
  1. )sexual intercourse: honeymoon cystitis
  2. ) bladder catheterization (insertion through urethra)
  3. ) fecal incontinence
73
Q

Host susceptibility local factors (UTIs): physiological obstructions

A
  1. ) infrequent voiding
  2. ) neurogenic or neuropathic bladder (impaired innervation)
  3. ) detrusor muscle instability
74
Q

Congenital or acquired anatomical abnormality (UTIs)

A

vesicoureteral reflux

75
Q

What is the vesicoureteral reflux?

A

condition in which the urine in the bladder flows back, or refluxes, into the ureter toward the kidney

76
Q

Systemic susceptibility factors of UTI

A
  1. ) HYPEROSMOLARITY (secondary to hyperglycemia in diabetics) of renal medulla–inhibits PMN migration to damaged tissue
  2. ) immunological cross reactions between bacterial and host Ags= TOLERANCE to bacteria or autoimmunity
77
Q

An example of susceptibility factor of UTIs in women

A

Pregnancy: dilation of ureter, pelvis, hormonal effect

78
Q

An example of susceptibility factors of UTIs in elderly

A

urinary obstruction and REFLUX

79
Q

An example of susceptibility factors of UTIs in children

A

poor toilet training

80
Q

An example of susceptibility factors of UTIs in immunosuppressed

A

fungal pyelonephritis

81
Q

Virulence factors of UT pathogens

A
  1. ) ADHERENCE to mucosal surfaces
  2. ) K antigens: specific capsular acidic polysaccharides (O1,O2,O4)
  3. ) P-fimbriae
  4. ) motility
  5. ) endotoxins
82
Q

Adherence properties of pathogen in UTIs

A
  1. ) pili

2. ) fimbriae

83
Q

Most important adhesin expressed by uropathogenic E. coli

A

P-fimbriae

84
Q

Virulence factor that facilitates ascending infections

85
Q

Virulence factor that decreases ureteral peristalsis

A

endotoxins

86
Q

K antigens MOA

A
  1. ) resistance to bactericidal action of normal serum via Igs and complement
  2. ) antiphagocytic
  3. ) specific K antigens of E coli in pyelonephritis
87
Q

Example of an organism who uses motility virulence factor

88
Q

Acute cystitis

A

-superficial inflammation/infection of lower UT: bladder

89
Q

Acute cystitis is most commonly a disorder of what population?

A

young women

90
Q

Predisposing factors of acute cystitis

A

residual urine in the bladder

91
Q

Symptoms of acute cystitis

A
  1. ) high frequency of urination
  2. ) burning pain on urination (dysuria)
  3. ) feeling of fullness following voiding
  4. ) sometimes hematuria
92
Q

What is affected in pyelonephritis?

A

tubules and interstitium

93
Q

Pyelonephritis

A

inflammation of kidney parenchyma and renal pelvis

94
Q

Manifestations of pyelonephritis

A

1.)small abscesses on kidney

95
Q

Acute pyelonephritis routes of infection

A

blood stream or ascent from the bladder

96
Q

Contributing factors to acute pyelonephritis

A
  • catheterization
  • vesicoureteral reflux
  • pregnancy
  • neurogenic bladder
97
Q

Clinical symptoms of acute pyelonephritis

A
  • abrupt onset
  • chills, fever, headache, back pain
  • tenderness costovertebral angle
  • dysuria, frequency and urgency
  • magnesium ammonium stones
98
Q

bacterial role in magnesium ammonium stones

A

proteus mirabilis

99
Q

Chronic pyelonephritis is a significant cause of this

A

renal failure

100
Q

Acute urethral syndrome has similar symptoms to these to infections

A

chlamydia and herpes

101
Q

UTI infections in pregnancy result from

A
  1. ) estrogen and progesterone induced dilation of uterus, bladder, pelvis
  2. ) decreased ureteral peristalsis
102
Q

Complicated UTIs primarily affect:

A

premenstrual girls and postmenopausal women

103
Q

Most male UTIs are complicated or uncomplicated?

A

complicated

104
Q

Are men or women at greater risk of acquiring catheter associated UTIs?

105
Q

Most common source of gram negative bacteremia?

106
Q

2 most common bacteria causing gram negative UTI

A
  1. ) E. coli

2. ) Proteus

107
Q

Gram positive, coagulase negative pathogen associated with UTI

A

Staphylococcus saprophyticus

108
Q

Enteroccoccus fecaelis

A

Pathogen associated with UTI, common in nursing homes, resistant to antibiotics

109
Q

Organism associated with >90% acute bacterial cystitis

110
Q

Most common organism involved in UTIs

111
Q

Organism responsible for 30-50% of nosocomial UTIs

112
Q

K antigens involved in E. coli UTIs

A

O1, O2, O4, O6, O7, O75

113
Q

K groups in children pyelonephritis

A

11, 24, 36, 37

114
Q

All strains of E coli posses this virulence factor that binds to mannose receptors

A

Type 1 pili

115
Q

Strains from cystitis have HIGHER affinity for these cells than fecal strains

A

uroepithelial cells

116
Q

Bacteria associated with Hemolytic Uremic Syndrome (HUS)

117
Q

How does EHEC involve with renal system?

A

Hemolytic Uremic Syndrome

118
Q

Hemolytic Uremic Syndrome

A
  1. ) acute renal failure
  2. ) thrombocytopenia
  3. ) microangiopathic hemolytic anemia
119
Q

What age group is HUS a complication for?

A

children under 10

120
Q

Epidemics of EHEC are often contributed to consumption of

A
  1. ) undercooked (ground) beef
    2) unpasteurized milk
  2. ) fruit juices (cider)
121
Q

Ingestion of what number of bacilli can produce EHEC diseases

A

fewer than 100 bacilli

122
Q

EHEC clinical & symptoms

A
  • mild, uncomplicated diarrhea
  • hemorrhagic colitis
  • severe abdominal pain
  • blood diarrhea
123
Q

Most common serotype of EHEC and what doesn’t it ferment?

A

Serotype: O157:H7

* does not ferment sorbitol

124
Q

E coli fimbriae have different specificities for what receptors?

A

Host cell carbohydrate receptors

125
Q

What is phase variation?

A

an individual bacterium will not express all fimbrial types at any given time

126
Q

Emphysematous pyelonephritis is associated with what populations?

A

diabetics and women

127
Q

Emphysematous pyelonephritis is characterized by…

A

gas formation and entrapment in the kidney

128
Q

What organism is commonly involved in Emphysematous pyelonephritis?

129
Q

Emphysematous pyelonephritis management

A

surgery: nephrectomy

and medical: antibacterials

130
Q

Proteus mirabilis is involved in which kind of UTI?

A

nosocomial UTIs

131
Q

Organism that produces urease which plays important role in pathogenesis

A

proteus mirabilis

132
Q

What type of pili does proteus mirabilis posses?

A

Type 1 pili

133
Q

This organism can alter its own surface composition and escape phagocytosis

A

proteus mirabilis

134
Q

Organism that displays a fog like swarming when inoculated on plate

A

proteus mirabilis

135
Q

organism is actively motile: swarming

A

proteus mirabilis

136
Q

Salmonella in UTIs can cause this

A

bacteriuria

137
Q

Bacteriuria from salmonella is associated with this

138
Q

Pseudomonas aeruginosa

A
  • involved in nosocomial UTIs
  • Oxidase positive
  • nonfermenter of glucose
  • cause of bacteremia
139
Q

May cause inflammatory infection in urethra leading to nongonococcal urethritis and recurrent urethritis

A

Mycoplasma genitalium

140
Q

Organism found in healthy male urethra

A

mycoplasma genitalium

141
Q

A cause of chorioamnionitis and premature delivery

A

Ureaplasma urealyticum

142
Q

A catalase positive, coagulase positive organism that should not be ignored because it can indicate or precede dangerous bacteremia

A

Staph aureus

143
Q

Second most common cause of honeymoon cystitis in young women thought to gain access to female urinary tract during sexual intercourse

A

Staph saprophyticus

144
Q

Coagulase negative, catalase positive, gram positive, nonmotile, opportunistic, found on skin as commensal

A

Staph epidermidis

145
Q

Gas bubbles in the lumen of bladder

A

Emphysematous cystitis

146
Q

Pneumaturia

A

-the passage of gas or air from the urethra during urination or after urination

147
Q

The passage of gas or air from the urethra during urination or after urination results from

A
  1. ) infected urine

2. ) intestinal fistulas (most common)

148
Q

Cause of pediatric hemorrhagic cystitis

A

Adenovirus

149
Q

varicella zoster can cause this type of cystitis

A

hemorrhagic cystitis

150
Q

Causes of chronic bacterial prostatitis

A

1.) E. coli (most common)
2.) enterococcus faecalis
3.) proteus mirabilis
4,) Klebsiella pneumoniae

151
Q

Causes first UTI lesion in kidney

A

Mycobacterium tuberculosis (urinary tuberculosis)

152
Q

Urinary tuberculosis can extend to:

A
  1. ) gall bladder
  2. ) prostate
  3. ) seminal vesicles
153
Q

How does urinary tuberculosis spread?

A

Hematogenous route

154
Q

Common symptoms of urinary tuberculosis

A

pyuria and hematuria

155
Q

How is urinary tuberculosis diagnosed?

A

Diagnosis based on 3 consecutive (3 mornings) early morning specimens

156
Q

Where does the adult worm reside in urinary schistosomiasis?

A

venous plexus of the bladder

157
Q

What to the worm eggs induce in urinary schistosomiasis?

A

granulomatous reaction

158
Q

Inflammation in urinary schistosomiasis leads to this

A

fibrous tissue and obstruction

159
Q

A cause of bladder carcinoma

A

urinary schistosomiasis

160
Q

Diagnostic tests for UTIs

A

urine culture

-100,000 CFU/ml

161
Q

Exception to urine culture diagnostic levels for UTIs

A

many women with acute cystitis
have bacteria at 100- 10,000/ml
-similar results with acute pyelonephritis

162
Q

Examples of rapid diagnostic tests in UTIs

A
  1. ) counts by hemocytometer using uncentrifuged urine

2. ) gram stain

163
Q

Where do IgA immune complexes deposit in Berger’s disease?

A

IN the mesangium because of the large size of IgA

164
Q

Where do bacterial antigens complexed with IgG tend to localize?

A

within the GBM or on the epithelial side of GBM because of their smaller size

165
Q

Acute rejection is which type of hypersensitivity?

A

Type IV (T cell mediated)

Renal (3 decks)

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