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Microbiology Exam IV > Other Genitourinary Tract Infections > Flashcards

Other Genitourinary Tract Infections Flashcards

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1
Q

Normal Vaginal Microbiota

A 
***Lactobacillus*** (Predominantly composed of this during child-bearing years)
Gardnerella
Mobiluncus
Mycoplasma
Prevotella
Staphylococcus
Ureaplamsa

Fungi: Candida

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2
Q

Lactobacillus (Characteristics)

A
  • Gram-positive, microaerophilic, or anaerobic rods
  • Do not cause UTI because they CANNOT grow in urine
  • Glycogen is metabolized to LACTIC ACID by lactobacilli resulting in a vaginal pH of 4 to 5
  • Optimal for growth and survival of lactobacilli and inhibits growth of many other organisms*
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3
Q

Alterations in Normal Microbiota of Vagina

A

1) Age (lower prevalence of Lactobacillus as you move away from reproductive age (both younger and older))
2) Menstruation (Transient changes)

3) Hysterectomy with removal of the cervix
- Increases Bacteroides fragilis and, of the aerobes, increases E. coli and Enterococcus species

These 3 species are frequently found in cultures obtained from women who develop pelvic infections following hysterectomy

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4
Q

Bacterial Vaginosis (BV) (Characteristics)

A

Common, complex, and poorly understood clinical syndrome that reflects ABNORMAL VAGINAL MICROBIOTA (Dysbiosis)

Overgrowth of ANAEROBIC species including Garderella vaginalis, Ureaplasma urealyticum, Mobiluncus species, Mycoplasma hominis, and Prevotella species

Reduction of Lactobacillus

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5
Q

Bacterial Vaginosis (BV) (Symptoms)

A 
Can be asymptomatic
Discharge
Odor
Pain
Itching
Burning
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6
Q

Bacterial Vaginosis (BV) (Risk Factors)

A 
Oral sex
Douching
Smoking
Sex during menses
IUD
Early age of sexual intercourse
New or multiple sex partners
Sexual activity with other women (WSW)

NOT considered an STD, although is associated with sexual activity

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7
Q

Bacterial Vaginosis (BV) (Diagnosis: Amsel Criteria)

A

Amsel Criteria (3 of 4 of these must be met)

1) Discharge, usually WHITE or GREY and MILKY
2) Microscopic evaluation of a vaginal secretion saline preparation reveals CLUE CELLS
3) Release of volatile amines produced by anaerobic metabolism (foul, fishy odor)- WHIFF TEST
- Several drops of a potassium hydroxide (KOH) solution are added to a sample of vaginal discharge to see whether a STRONG FISHY ODOR is produced
4) Determination of the vaginal pH (pH > 4.5 is associated with BV)

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8
Q

Bacterial Vaginosis (BV) (Diagnosis: Nugent Score)

A

Numerical score based on semi-quantization of:

1) Large gram-positive rods (Lactobacillus spp.)
2) Small gram-variable rods (G. vaginalis or Bacteroides spp.)
3) Curved gram-variable rods (Mobiluncus spp.)

0-3: normal; lactobacillus dominant
4-6: intermediate; mixed morphotypes
7-10: BV; absences of lactobacilli; predominance of 2 other morphotypes

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9
Q

Bacterial Vaginosis (BV) (Complications)

A

Having BV…

1) Can increase a woman’s SUSCEPTIBILITY TO HIV INFECTION
2) Increases the chances that an HIV-infected woman can PASS HIV TO HER SEX PARTNER
3) Has been associated with an increase in the DEVELOPMENT OF AN INFECTION FOLLOWING SURGICAL PROCEDURES such as hysterectomy or an abortion
4) While pregnant may put a woman at increased risk for some complications of pregnancy, such as PRETERM DELIVERY, MISCARRIAGE, AND INFECTION AFTER DELIVERY
5) Can increase a woman’s SUSCEPTIBILITY TO OTHER STDs, such as HSV, chlamydia, and gonorrhea

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10
Q

Bacterial Vaginosis (BV) (Treatment)

A

1) Oral Metronidazole (Anaerobes and parasites; inhibits nucleic acid synthesis)
2) Clindamycin (Gram positive cocci and anaerobes)

***Recurrence is common

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11
Q

Vulvovaginal Candidiasis (Yeast Infection) (Characteristics)

A

Common FUNGAL infection in women of child-bearing age

Pruritis with THICKE, ODORLESS, WHITE VAGINAL DISCHARGE Cottage-cheese like

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12
Q

Vulvovaginal Candidiasis (Yeast Infection) (Complicated vs Uncomplicated)

A

Complicated: Recurrent (4 or more episodes per year) or SEVERE VVC, non-albicans candidiasis, or the patient has uncontrolled diabetes, debilitation, or immunosuppression

Uncomplicated: Sporadic or infrequent mild-to-moderate symptoms in otherwise healthy patient

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13
Q

Candida Species (Appearance)

A

Oval yeast-like forms that produce BUDS, PSEUDOHYPHAE, and HYPHAE

Candida albicans —> Germ Tubes

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14
Q

Candida Albicans (Characteristics)

A

NORMAL FLORA of the GI tract, vagina, and urethra, skin, and finger/toe nails

Found in air, water, and soil

Most episodes of candidiasis represent endogenous infection by normally commensal host flora (i.e. an OVERGROWTH of NORMAL FLORA)

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15
Q

Candida Albicans (Pathology)

A

Vaginitis: 20 million cases/year in US
More frequent after taking ANTIBIOTICS

Diaper Rash, Oral thrush

Immunocompromised –> Esophagitis, Disseminated

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16
Q

Candida Albicans (Pathogenesis)

A

Seen in individuals with local or generalized IMMUNOSUPPRESSION or in settings which FAVOR OVERGROWTH:

  • Oral contraceptives
  • Pregnancy
  • Diabetes
  • Systemic corticosteroids
  • HIV infection
  • Antibiotic use
17
Q

Candida Albicans (Diagnosis and Treatment)

A

Diagnosis: Microscopic examination 10% potassium hydroxide (KOH) reveals HYPHAE and BUDDING YEAST
-Cultures with Nickerson medium may be used if Candida is suspected but not demonstrated

Treatment:

  • 1-3 day regimen of topical AZOLE for uncomplicated VVC
  • 7-14 days of a topical regimen or two doses of oral FLUCONAZOLE 3 days apart for complicated VVC
18
Q

Trichomoniasis (Characteristics)

A

Most common, curable sexually transmitted disease

Most women are ASYMPTOMATIC or have scant, watery, vaginal discharge

SYMPTOMS CAN RANGE FROM MILD TO SEVERE VAGINITIS with INFLAMMATION associated with ITCHING, BURNING, and DYSURIA
Yellow-green, froty, foul-smelling discharge

Men serve as ASYMPTOMATIC CARRIERS/RESERVOIRS for infection (occasional urethritis, prostatitis, or other urinary tract problems)

19
Q

Trichomonas vaginalis (Characteristics)

A
  • Small, pear-shaped PROTOZOA
  • 4 anterior flagella and an UNDULATING MEMBRANE are responsible for MOTILITY (key for diagnosis)
  • Rigid axostyle involved in attachment
  • Anaerobic
  • Exist ONLY IN TROPHOZOITE form (strict parasite, cannot survive long outside of host; reservoir is human urogenital tract)

Trophozoite = replicating, metabolically active form of a protozoa

20
Q

Trichomonas vaginalis (Pathogenesis)

A
  • Destruction of epithelial cells, neutrophil influx, and PETEHCIAL HEMORRHAGE
  • Strawberry Cervix*

-No clinically significant immunity (Can be reinfected over and over)

21
Q

Trichomonas vaginalis (Diagnosis and Treatment)

A

Diagnosis:

  • Detecting swimming T. vaginalis in exudate (Discharge)
  • Asymptomatic infection often detected by Pap smear

Treatment:
-Metronidazole, treat BOTH partners

22
Q

Menstrual Toxic Shock Syndrome (TSS)

A

TSST-1 producing strains of Staphylococcus aureus could multiply rapidly in HYPERABSORBANT TAMPONS and release toxin

TSS is usually seen from S. aureus infecting a wound nowadays

23
Q

Staphylococcus aureus

A

Catalase Positive, Coagulase Positive, Gram Positive cocci arranged in clusters

Normal flora on human skin and mucosal surfaces

Person to person spread through direct contact or exposure to contaminated fomites (e.g. bed linenes, clothing)

Facultative INTRACELLULAR

24
Q

S. Aureus (Clinical Manifestations)

A

Toxin-Mediated:

  • Scalded skin syndrome
  • Food poisoning
  • Toxic shock
25
Q

TSST-1

A
  • 22 kDa heat and proteolysis resistant EXOTOXIN
  • Can penetrate the mucosal barrier and is responsible for systemic effects
  • SUPERANTIGEN*
  • Stimulates T-cell activation and release of cytokines
26
Q

TSST-1 (Pathology)

A

Macrophages release IL-1B and TNFa

T cells release IL-2, IFNy, and TNFB

IL-1B release results in fever

TNFa and TNFB release is associated with HYPOTENSION and SHOCK

27
Q

Menstrual Toxic Shock Syndrome (TSS) (Symptoms)

A

Diarrhea, General ill-feeling, High fever (accompanied by chills), Nausea and Vomiting

Confusion, headaches, hypotension, myalgias, organ failure, redness of eye mouth and throat, seizures, widespread sunburn-like red rash

28
Q

Menstrual Toxic Shock Syndrome (TSS) (Diagnosis)

A

Major Criteria:

  • Hypotension
  • Orthostatic syncope
  • Systolic BP < 90 mm Hg for adults
  • Diffuse macular erythroderma
  • Temperautre >= 38.8 C
  • Late skin desquamation, particularly on the hands, palms, and sole of feet (1 to 2 weeks later)

Minor Criteria:

  • Gastrointestinal - diarrhea or vomiting
  • Mucous membranes - oral, pharyngeal, conjunctival, and/or vaginal erythema
  • Muscular - myalgia or creatinine phosphokinase level greater than TWICE normal

To meet strict criteria, a woman must have ALL MAJOR and at least THREE MINOR criteria

29
Q

Menstrual Toxic Shock Syndrome (TSS) (Pathogenesis)

A

Exotoxin is released into the blood, so will not detect S. aureus in the blood, but rather in the vagina

30
Q

Menstrual Toxic Shock Syndrome (TSS) (Treatment)

A

5% fatality rate
Remove tampon
Send sample for culture
Provide supportive measures (e.g. fluids)
Administer B-lactamase-resistant Penicillin or Vancomycin

Considerable risk for reinfection in women due to 50% of TSS patients failing to mount an antibody response to TSST

31
Q

Menstrual Toxic Shock Syndrome (TSS) (Case Presentation)

A

Girl with 2-day history of pharyngitis and vaginitis with vomiting and watery diarrhea

Febrile and hypotensive with diffuse erythematous rash over ENTIRE BODY

Lab tests: acidosis, oliguria, and disseminated intravascular coagulation with severe thrombocytopenia

Improved gradually for 17-day period

Progressed to peeling of palms and soles by 14th day

Microbiology Exam IV (6 decks)

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