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Path. Microbio > Student with dysuria > Flashcards

Student with dysuria Flashcards

1
Q

What is dysuria?

A

Burning on urination

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2
Q

How common are UTIs in women?

A

50%

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3
Q

What differential diagnoses should be considered for dysuria?

A

Cystisis: pain on urination, urgency to void with blood in urine (hematuria)

Vulvovaginitis: caused by trichomonas vaginalis or candida; malodorous discharge and dysuria but no void urgency

Urethritis via STD, e.g. gonorrhoeae or chlamydia trachomatis; usually gradual onset, no discharge, associated with new sexual partner

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4
Q

What distinguishes complicated and uncomplicated UTI?

A

Uncomplicated = no signs of pyelonephritis

= fever and flank pain from infection involving upper urinary tract / kidney

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5
Q

What are the risk factors for UTIs?

A

Female
Sexually active
Previous UTIs
Use of spermicidal diaphragm

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6
Q

What fecal bacteria typically infect the urethra/blaffer?

A

Gram-negative rods: E coli (common), Klebsiella and pseudomonas aeruginosa (hospital UTIs), proteus mirabilis

Gram-positive cocci: enterococci (usually nosocomial); staph. saprophyticus (common in young women), strep. agalactiae (group B strep; mostly found in pregnant women)

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7
Q

What non-bacterial fecal flora infect the urethra/bladder?

A

Virus: Adenovirus (children)

Fungi: candida spp (usually diabetics, immunocompromised; catheters)

Parasites: schistosoma haemotobium - with a travel history

Mycobacterium tuberculosis - but not common!

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8
Q

What is a urine dipstick test?

A

Compared against color key to determine levels of various chemicals, proteins, cells

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9
Q

What does the presence of glucose in urine indicate? (Glycosuria)

A

Uncontrolled diabetes; excessive carb intake

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10
Q

What does the presence of proteins in urine indicate? (proteinuria)

A

suggests increased permeability of glomerular membrane =>

indicates hypertension, glomerulonephritis; poisons; kidney trauma; pregnancy

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11
Q

What does the presence of ketone bodies in urine indicate? (ketonuria)

A

Excessive production of fat intermediates

Suggests uncontrolled diabetes; starvation; low carb diets

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12
Q

What does the presence of RBCs in urine indicate? (hematuria)

A

Bleeding in tract; kidney stones; tumors; trauma; glumerulonephritis

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13
Q

What does the presence of hemoglobin in urine indicate? (hemoglobinuria)

A

hemolytic anemia, transfusion reactions, severe burns

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14
Q

What does the presence of nitrates in urine indicate? (nitrituria)

A

Produced by gram negative bacteria; suggests E Coli

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15
Q

What does the presence of bile pigments in urine indicate? (bilirubinuria)

A

Hepatitis, cirrhosis, gallstones

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16
Q

What does the presence of WBCs in urine indicate? (pyuria)?

A

UTIs, gonorrhea

17
Q

What is the threshold for significant bacteruria?

A

10^5 cfu/ml with three or less microorganisms

18
Q

What is the threshold for urine sample contamination?

A

10^5 cfu/ml with more than three microorganisms

19
Q

What is a MacConkey Agar?

A

Contains bile salts – interferes with gram positive bacteria growth and favors gram negative, esp. enterobacteriaceae

Contains lactose and PH test for lactic acid

In sum: tests for gram negative lactose fermenters

20
Q

What is an EMB agar?

A

Digested meat proteins for nutrients
Two indicator dyes - eosin and methylene blue

Lactose fermenters = metallic green/purple

Non lactose fermenters - colorless colonies

21
Q

What are characeristic patterns on EMB agar for:
Klebsiella
Enterobacter
E Coli?

A

Klebsiella - mucoid colonies, lactose-fermenting

Enterobacter - moderately mucoid, lactose-fermenting

E Coli - lactose fermenting with green sheen

All are gram negative rods

22
Q

What is the spot indole test?

A

Positive result with blue/green indole = E coli

Negative - red

23
Q

How does ampicillin work?

A

interacts directly with PBPs, inhibits transpeptidase activity. A penicillin. Some gram negatives

24
Q

How does ciprofloxacin work?

A

Inhibits activity of DNA gyrase, bloaks DNA replication. Broad spectrum against gram negative and gram positive bacteria – very commonly prescribed

25
Q

How does nitrofurantoin work?

A

Inhibits bacterial citric acid cycle and RNA/DNA synthesis. Common UTI treatment

26
Q

How do Trimethoprim and Sulfamethoxazole work?

A

Inhibits bacterial folic acid synthesis.
Trimethoprim = dibydrofolic acid
sulfamethoxazole = tetrahydrofolic acid

Broad spectrum +/-

27
Q

How does cefazolin work?

A

A caphalosporin, inhibits bacterial cell wall synthesis

28
Q

How is a disk diffusion test carried out?

A

Various disks
Grown on Mueller-Hinton agar overnight
Diameter of zone of inhibition measured and compared to sample

29
Q

What is a hematogenous UTI?

A

Comes from blood - usually staph or strep

30
Q

What types of bacteria usually cause ascending UTIs?

A

Gram negative rods

31
Q

What virulence factors are common in uropathic bacterial strains?

A
  • Fimbriae: Fimbriae types I, P, S, F1C bind to specific receptors on UT epithelium
    Cranberry juice may help
  • Flagella: E coli and other enterobacteriaceae have good flagella
  • Iron chelation: uropathogenic e coli contain aerobactrin - aids survivial where iron levels low
  • K-Antigens / capsular antigens
    K-2a / K-2c seen 3-5x more often in pyelonephritis
  • Specific ‘pathogenicity islands’
    = twenty percent larger genomes
32
Q

How long is antibacterial treatment for uncomplicated cystitis? And in complicated

A

Uncomplicated - One to three days

Complicated - one to two weeks

33
Q

Name some anaerobic causes of pyuria

A

Chlamydia trachomatis, neiserria gonorrhoeae. Co-infection common

34
Q

What are some complications of E Coli UTIs?

A

Neonatal meningitis
Sepsis
Diarhea

Path. Microbio (6 decks)

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