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Quiz 4 > Session 10: Genitourinary infections > Flashcards

Session 10: Genitourinary infections Flashcards

0
Q

Urine

A
  • kidney: removes waste from blood ( filtration)
  • valves control backwards flow of urine from bladder (storage) to ureters
  • urine: lower pH, has antimicrobial properties, sterile
  • flushing of urine is physical
  • analysis of cell content, osmolarity, protein, glucose content, “casts” important for diagnosis of complicated infection
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1
Q

UTI

A
  • most common site of bacterial infection
  • most common in females
  • majority of infections are acute and uncomplicated (cystitis, urethritis)
  • most common type of nosocomial infection ( catheter)
  • severe infection affect kidney function (pyelonephritis)
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2
Q

common cause of UTIs

A
  • outpatients: E. Coli 80%, S. aureus, CNS, Enterococci, Streptococcus Group. B
  • inpatients: E. Coli 40%, other enteric bacteria (25%), gram positive, proteus mirabilis, candida species
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3
Q

symptoms

A

lower UTI:

  • painful urination (dysuria)
  • urgency and frequency of micturation
  • catheter related infections are asymptomatic
  • cloudy urine WBC (pyuria) and bacteria ( bacteriuria)

Upper UTI: Kidney

  • fever, some same symptoms
  • may have lower back pain
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4
Q

cystitis and pyelonephritis

A

infection of urinary bladder and kidney

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5
Q

Asymptomatic UTIs:

A
  • presence of significant #s of bacteria ( bacteriuria) in absence of symptoms
  • can cause complications, such as scarring in young children and pregnant women
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6
Q

problems with catheter usage

A

significant bacteriuria: if urine held in bladder for less than 4 hours, there is an infection with S. Saphrophyticus
-contaminated urine means species are growing

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7
Q

UTI in children

A
  • Reflux found in 30-50% of children with asymptomatic bacteria
  • high risk for renal scarring
  • difficult to get good specimen, especially from infants, often require SUPRA-PUBIC ASPIRATION for adequate sample
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8
Q

E. Coli

A
  • gram negative bacilli, motile, can and not have a capsule
  • has O (somatic), H ( flagella), K (capsule), F (fimbrial) antigens
  • adhesion is by P fimbriae
  • susceptible to a variety of antibiotics
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9
Q

Staphylococcus Saphrophyticus

A
  • gram positive cocci, coagulase negative
  • novobiocin resistant
  • infections in young healthy women
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10
Q

Streptococcus agalactiae (Group B)

A
  • gram positive cocci in chains
  • beta hemolytic on blood agar, very small zones
  • important if patient is pregnant
  • neonatal meningitis, sepsis, respiratory failure
  • think B=BABIES
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11
Q

Enterococcus faecalis/faecium

A
  • gram positive cocci, short chains or pairs
  • may produce alpha, beta, or no (gamma) hemolysis on BAP
  • common in UTI
  • bile and salt resistant
  • VRE=PROBLEM
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12
Q

proper collection of UTI specimens- important due to quantitative nature of cultures

A

-Mid-stream sample (MSU) in sterile container
-incubate in bladder 4 hours best, note other
babies: bag urine often contaminated
SUPRAPUBIC Aspiration recommended
-catheterized patients: withdraw from tube with syringe
-urine esterase: measured by dip-stick, pos means presence of WBC (infection)

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13
Q

STD/STI

A
  • no vaccine available
  • produce negligible symptoms initially
  • symptoms may persist and reoccur
  • may allow for reinfection because agents are poor antigenic
  • fastidious, spread from mucous membrane to another
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14
Q

PID: Pelvic inflammatory disease

A
  • extensive infection in female
  • cervix, uterus, Fallopian tubes, ovaries
  • spread to peritoneal cavity and cause liver damage ( hepatitis)
  • over 50% of women with PID asymptomatic but have sequalae

Symptoms:

  • lower abdominal pain, radiating to back
  • discharge from vagina
  • C. trachomatis and N. gonorrhoeae most common causative agents
  • MORE CHLAMYDIA THAN Gonorrhea in canada
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15
Q

Gonorrhea

A

-Gram negative diplococci

pathogenesis:

  • mucous membrane of vagina, cervix, urethra, rectum, throat
  • pilli attaches to human mucosal epithelium, inactive complete and inactivate T cells
  • spread up reproductive tract
  • bacterial cell walls contain LPS ( virulence factor)
  • produce IgA protease
  • Opa proteins on cell surface vary and prevent immune recognition by antibodies
  • damage to tissues results from the inflammation that the gonococcus elicits ( no exotoxin)
  • infection usually localized but some strains which are resistant to bactericidal effects of serum, can spread systemically.

Symptoms: incubation period 2-7 days

  • male: urethral discharge (pus) and dysuria
  • female: vaginal discharge
16
Q

Systemic disease in both males and females

A
  • results in endocarditis, meningitis, monoarticular arthritis with tendonitis and skin lesions
  • pharyngeal gonorrhoea: sore throat
  • rectal gonorrhoea: itching, painful inflammation

laboratory diagnosis:

  • finding of gram negative diplococci in WBC urethral discharge (men)
  • culture, DNA probes, PCR
  • antibiotic susceptibility tests as there is increase resistance to many antibiotics

treatment: no vaccines available! partner tracing and treatment important

17
Q

Chlamydia trachomatis

A
  • most common bacterial STD
  • Gram negative (LPS in cell wall)
  • unique development cycle with infectious form (RB), obligate intracellular parasites

3 species of chlamydia infect humans:

  1. C. trachomatis serotypes A to C cause trachoma, serotypes D-K cause genital infections, serotypes L1,2,3 cause LGV
  2. C. psittaci: zoonosis from birds, respiratory infection
  3. C. pneumoniae: respiratory infection, associated with cardiovascular disease
18
Q

pathogenesis of C. trachomatis

A

-elementary bodies enter mucosal membrane
-bind host cell receptors, internalized in a vacuole
-chlamydia vacuole is not fused with host lysosome
-site of infection determines disease
-disease effects due to inflammation
serotypes D-K infects only columnar and transitional epithelial cells, including neonates eyes ( inclusion conjunctivitis)
-LGV are invasive and cause systemic disease

19
Q

Genital infection with C. trachomatis D-K

A
  • endemic
  • highest frequency in 15-25 year olds
  • 50% asymptomatic in women
  • PID: asymptomatic in women, results in ectopic pregnancy, scarring of Fallopian tubes, infertility, peritonitis
  • causes NGU (non-gonococcal urethritis in men)

Laboratory diagnosis:

  • culture, DNA probes, PCR (urine and secretions)
  • serology not helpful in uncomplicated genital infections

treatment:

  • tetracycline or macrolides
  • partner tracing
  • NO VACCINE
20
Q

LGV (Lymphogranuloma venereum)

A
  • C. trachomatis (L1,L2,L3)
  • characterized by supperative inguinal adenitis
  • most common in tropics
  • lesions formed on genitals, infects nearby lymph glands
  • untreated results in tissue damage, fibrosis, elephantiasis

Lab diagnosis:

  • culture, DNA probes, PCR (urine and secretions)
  • serology not helpful in uncomplicated genital infections

treatment:
-tetracycline or macrolides, partner tracing, NO VACCINE

21
Q

syphillis

A
  • spirochaete, gram negative helix ( not visible in gram stain)
  • can’t be cultured in vitro
  • low prevalence
  • risk population are drug users and homosexuals
  • closely related to other treponema species causing tropical diseases (T. pertenue: yaws and T. carateum: pinta)
22
Q

3 stages of disease for syphilis

A

incubation period is 3 weeks

primary: initial sign is chancre (painless), highly infectious (HARD chancre). bacteria enters blood and lymph
secondary: occurs weeks after the chancre disappears. Characterized by rash on skin and mucous membranes, very infectious
latent: may last months to years

tertiary stage: 50% of patients, chronic stage

23
Q

pathogenesis of syphilis

A
  • portal of entry is breaks in skin or mucous membranes
  • local lesion leads to inflammation, recruitment of macrophages
  • poorly antigenic due to lipid layer, only dead “treponema” can activate immune system and induce antibody formation

Diagnosis: serology and wet mount direct microscopy

Complications: aortic aneurysm, CNS damage (paresis), blindness,
seizures, dementia, congenital syphilis

Treatment: penicillin: drug of choice (no resistance), no immunity, no vaccine

24
Q

Haemophilus ducreyi

A
  • Gram negative bacillus
  • causes CHANOCROID
  • soft chancre, painful
  • no permanent immunity
  • treated with ceftriaxone
25
Q

Vaginosis

A
  • most common bacterial infection of fertile women
  • no inflammation involved, multiple types of bacteria are involved, many anaerobic
  • characterized a thin, frothy vaginal discharge, FISHY
  • often asymptomatic
  • diagnosed by smear and finding of clue cells or epithelia cells with bacteria attached
26
Q

HSV 1/2

A

incubation is 1 week

  • primary lesions are vesicles
  • break down to form shallow ulcers (pain)
  • chronic infection, latent infections
  • most infectious when vesicles are apparent
  • complication: encephalitis or disseminated herpes in fetus

treatment: acyclovir
- primary infection with HSV 2: cause aseptic meningitis
- pregnant women may pass virus to fetus
- many with chronic infections and reoccurrences self-medicate
- both HSV 1 and HSV 2 can cause genital herpes, but most common with HSV 2

Quiz 4 (2 decks)

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