Test #5 Microbiology Test Flashcards by Yonni Huggins

3 best defenses for the body:

skin
GI
resp tract

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Most common way for infectious agents to gain access, has to be well defended.

*respiratory tract

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Upper-nose–>larynx

- Lower-trachea–>lungs

*respiratory tract

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nasal hair(filter things out)
ciliatory escalator
mucus(moist membrane)
coughing/sneezing(protects by expelling things)
IgA(primarily in mucus secretion)
normal biota

Are defenses of the ____.

*upper respiratory tract

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Lining from pharynx to larynx.

*ciliatory escalator

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common cold
droplet or indirect contact(fomite)
2-5 day incubation

*rhinitis

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caused by many viruses
- rhinovirus=most common
- coronaviruses and adenoviruses
avoid with good hygiene
treat the symptoms

*rhinitis

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sinus infection
allergic, infectious or structural(septum)
not contagious

*sinusitissta

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If sinusitis is ____:

opportunistic(have something else first)
endogenous
clinical or x-ray dx
bacterial(more common) or fungal

*infectious

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Treatment for sinusitis:

____ broad spectrum antibiotic (z-pac)
____ scrape out sinuses

bacterial

* fungal

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cause: acute-bacteria S. pneumoniae from upper respiratory tract working with a virus
eustachian tubes(equalize pressure)=pathogenic highway
chornic-biofilm? bacteria are colonized in middle ear

*otitis media (middle ear infection)

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prevnar vaccine
tx: antibiotics (amoxicillin)
tubes
symptoms: fever, ear hurts

*otitis media

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6 months to a year to keep bacteria from draining.

*tubes

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sore throat
viral or bacterial
incubation usually 2-5 days

*pharyngitis

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redness of mucosa
swollen tonsils
white patches
swelling

Are clinical signs of ___.

*pharyngitis

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cause: fusobacterium necrophorum, ____.streptococcus pyogenes (bacteria)
may be mechanical irritation
viral

Are causes of

*pharyngitis

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severe sore throat
emerging cause of pharyngitis
opportunistic infection in young adults

fusobacterium necrophorum

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can lead to Lemierre’s Syndrome
possibly due to reduced use of antibiotics
sensitive to penicillin
no rapid test
prevent by good hygiene
gram negative rod

fusobacterium necrophorum

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When bacteria get into bloodstream.

*Lemierre’s Syndrome

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chains of gram positive cocci
facultative anaerobe: grows anywhere
pharyngitis + fever
lots of virulence factors

*streptococcus pyogenes

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lipoteichoic acid (LTA) and spiky M proteins: help strep hold on, sticky
peroxidase: breaks down hydrogen peroxide
streptolysins(O and S): hemolysins
hyaluronic acid capsule: avoid immune system
erythrogenic toxin: responsible for scarlet fever
superantigens: cause the body to over react

These are virulence factors of ____.

*streptococcus pyogenes

80 different ways to get strep

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Transmission:
-direct contact with mucus secretions/droplets
-fomite(rarely)
Diagnosis:
-rapid test(swab)
-culture
Tx: penicillin and cephalexin

*strep

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scarlet fever: has to have toxins
rheumatic fever: if strep is left untreated, joint pain, a systemic disease, attacks heart valves
glomerulonephritis: cells die and clogs and effect kidneys
only happen if superantigens on the particular strand of
toxic shock syndrome
necrotizing fascitis

Complications of ___.

*streptococcus pyogenes

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if we rule out the other causes
avoid with good hygiene
palliative care
hoarseness is common

*viral pharyngitis

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- cause: corynebacterium diphtheriae (club shape, gram positive) - diphtheria toxin: has effects on nerves and heart system - symptoms: sore throat, swollen glands, nasal discharge - droplet, direct, indirect, fomite

*diphtheria

- white/gray pseudomembrane at back of throat, most distinctive feature, can see mild parlysis - DTaP vaccine - tx: antitoxin plus penicillin - pt has to be isolated - reported disease

*diphtheria

Microbial diseases of upper and lower respiratory tract: (3)

* influenza * pertussis * resp syncytial virus

- cause: orthomyxoviridae A(nasteir), B(everyday flu), C (feels like a cold) - 1-4 day incubation - symptoms: headache, chills, dry cough, myalgia, fever, stuffy nose, sore throat, fatigue

*influenza

- Virulence factors: neuraminidase- hydrolizes mucus in trachea - continuous change: * antigens drift: proteins on the outside of virus change and the body doesnt recognize it * antigens shift: RNA swapping, major changes to genetic virus

*influenza

- aerosois and droplets - complicated by dry air - rapid PCR or ELISA tests from nasal swab - vaccine - tx: reienza and tamiflu (antivirals)

*tx, dx, and transmission for the flu

- cause: bordatella pertussis (gram negative, coccobacillus) - whooping cough - toxins - spread by droplet contact - 3 to 21 day incubation

*pertussis

- stages: catarrhal and paroxysmal - DtaP vaccine - tx: erythromycin

*pertussis

- ___ looks like a cold for 1 to 2 weeks | - ___ horrible cough, lasts up to 3 months

* catarrhal | * paroxysmal

- produces syncytia in resp tract - very contagious via droplet contact or fomite - high risk:

*resp syncytial virus (RSV)

Enourmous multinucleus non functional cells.

*syncytia

- mucus - alveolar macrophages - IgA - no normal biota Defenses of the ____.

*lower resp tract

- ancient disease - worldwide problem - usually affects the lungs - infection does not mean illness(latency) - spread by droplet contact, particles can survive up to 8 months - can be dormant for years

*TB

- cause: mycobacterium tuberculosis(bacillus) - strict aerobe - virulence factor: waxy surface, holds in moisture, allows them to survive in macrophages - acid fast rods

*TB

- long generation time (slow growing), 15 to 20 hours to generate - dormancy - 3 types: * primary * secondary * extrapulmonary

*TB

- low infectious dose, takes about 10 organisms - Symptoms: can be low grade, low fever, coughing, fatigue, weight loss, night sweats or can be asymptomatic - 3 to 4 weeks--> HUGE cell mediated immunity (CMI)

*primary TB

-Tubercles have 2 layers an outer wall and a core: *good-->prevent spread *bad-->caseous lesions tubercles break down and calcify

*primary TB

In a tubercle the fibroblasts, lymphocytes, and macrophages is the ____.

*outer wall

In a tubercle, the TB bacteria inside enlarged macrophages is called the ___.

*core

- reactivation in weeks, months, or years after primary | - usually a result of weakened immunity

*secondary TB

- tubercles expand--> cavities in lungs drain into bronchial tubes - severe: same symptoms of primary but also bloody mucus, green and red, anorexia: not wanting to eat - consumption - very high mortality if untreated

*secondary TB

- infection outside the lungs - immunocompromised and young children - attack: lymph nodes, kidney, genital tract, bones, meninges - paralysis if it gets to meninges - kidney failure - 50% mortality rate

*extrapulmonary TB

- tuberculin test (mantoux test) - x-ray - acid fast staining - culture These are ____.

*culture and diagnosis of TB

- forearm intradermal injection - bleb-->48-72 hrs-->induration (looking for a red spot) - 5, 10, or 15mm spot size

*tuberculin test (mantoux test)

- primary: show up as infiltration (cloudy) - secondary: expanded tubercles - scars: if you had it before

*x-ray

- detect AFB | - sputum (sample)

*acid fast staining

- long incubation - treat for contaminants - use selective media (lowenstein-jensen) - antibiotic sensitivities

*culture

- BCG vaccine, given in other countries - TX: * isoniazid and rifampin for 9 mos, plus pyraziamide for 2 months * extension of tx to 12 months * biggest issue, compliance getting people to take the drug

*prevention and tx of TB

- anatomical diagnosis - viral (secondary to another infection) vs, bacterial (more severe) - microorganisms must survive alveolar macrophages to get it - community vs hospital acquired

*pneumonia

In the US: - 2.3 million cases per year - 45,000 deaths per year

*pneumonia

- streptococcus pneumoniae - legionella - mycoplasma pneumoniae - hantavirus - histoplasma capsulatum - pneumocystis jiroveci These are causative agents of ____.

*community acquired pneumonia

- very severe - 67% of CAP is responsible for most deaths - spread by droplet or endogenous - gram positive diplococci, pneumococcus - virulence factor: capsule - alpha hemolytic on algar

*streptococcus pneumoniae

- risk factors: immuno compromised and elderly - vaccine: 2 prevor for kids and pneumovax for adults - tx: antibiotics - common secondary infection - may be resistant to antibiotics

*streptococcus pneumoniae

- cause: most common L. pneumophila - weakly gram negative, pleomorphic(variety of shapes) - severe in elderly(hospitalized or death), milder in healthy adults - spread by aerosolized fresh water (water fountains, air conditioners) - chlorine resistant, reason why it can spread in hot tubs - very hard to dx - prevention? - tx: antibiotics

*legionella

- atypical, very mild - walking pneumonia - aerosol droplets in close quarters( teens, college campus) - virulence factor: adhesins - dx: by ruling out - no vaccine - tx: doxycycline (maybe)

*mycoplasma pneumoniae

- 1993 - airborne dust from urine, feces or saliva of infected rodents - no specific risk group - 38% mortality rate, dont know much about it - fast moving, get very sick soon after symptoms - dx: serology/PCR test for Ag - supoortive care - fall 2012 last case

*hantavirus

- cause: fungal - virulence factor: lives inside of phagocyte - endemic everywhere EXCEPT Australia - inhalation of contaminated soil(high nitrogen) by bird or bat drippings - dx: Ab titer test, tuberculin-like test - tx: amphotericin B (maybe), hardcore antiviral - often asymptomatic

*histoplasma capsulatum

- cause: fungus - opportunistic infection (HIV/AIDS), not much in general public - low grade or sub-acute in healthy adults - dx: PCR or microscope, sputum sample - no vaccine - tx: TMP-SMX

*pneumocystis jiroveci

- cause: S.pneumoniae, K.pneumoniae, polymicrobial - about 1% of hospitalized/institutionalized pts 2nd - mortality rate of 30 to 50% b/c pt is already sick - Causes: * assisted ventilation * aspiration

*healthcare associated pneumonia

- starts at the mouth and ends at the anus - digestive or enteric - 8 part tube plus accessories - needs to be VERY well defended

*gastrointestinal tract (GI)

- mucus - secretory IgA - muscle movement - fluids(saliva, stomach acid) - GALT Important defenses pf the ____.

*GI tract

The small intestine or both is called ____.

*entero

Collection of lymphatic tissue through out the GI tract.

*pyers patches

____ of the GI tract: - has so many microbes - everywhere in the tube - highest concentration: large intestine

*normal biota

-protective -digestion -produce nutrients Are the functions of ____ in GI tract.

*normal biota

Very broad term, irritation of stomach and intestines, can cause: - vomiting - diarrhea - mucosal irritation(pain)

*gastroenteritis

- usually 3+ loose stools in 24hrs - often self-limiting - in the US: * 1.2 to 1.9 cases/person/year * more in children * 1/3 from contaminated food or water - long term implication of multiple bouts of diarrhea in childhood - prevent by good hygiene

*acute diarrhea

-salmonella -shigella -e-coli -campylobacter -yersinia -clostridium difficile -vibrio cholerae These are bacterial causes of ____.

*acute diarrhea

- cause: salmonellosis - gram neg rod - motile (flagellated) bacteria - virulence: adherence - resistant to cold, fresh water, freezing and bile - ENDOTOXIN GRAM NEG ROD

*salmonella enterica

- may be mild gastroenteritis - may be severe, symptoms: - gastroenteritis - fever - blood in stool, but doesnt have to be - septicemia - resolves in 2-5 days - not usually fatal

*salmonella enterica

- transmission: food, beverage, fecal-oral (poultry, eggs, reptile) - high infectious dose - Tx: fluids and electrolytes - antibiotics only in special cases, immuno compromised

*salmonella enterica

- cause: shigellosis aka dysentery - non-motile - enters mucosa of LARGE intestine via pyers patches - ENDOTOXIN GRAM NEG RODS - enterotoxin - sometimes shiga toxin

*shigella

Can mean blood in stool or shigella

*dysentery

Ripping up intestine from the inside, result is bloody mucusy diarrhea.

*enterotoxin

Disrupts protein synthesis and nerves, leads to systemic disease.

*shiga toxin

- frequent, watery stool - fever - intense abdominal pain - dysentery: obvious(hidden) or occult(blood in stool) - nausea/vomiting

*shigella

- transmission: fecal-oral, direct contact - small infectious dose, 10 to 20 microbes - epidemic spreading in crowded areas - chronic human carriers for months after recovery - TX: rehydration and TMP-SMZ

*shigella

- most virulent form of e-coli - gram neg rod - shiga toxin from phage - destroy enterocytes-->effacement(lesions) in large intestine * *bloody diarrhea**

*E.coli 0157:H7 (EHEC) enterohemorrhagic E.-coli

- may be mild gastroenteritis - possibly fever and bloody diarrhea - hemolytic uremic syndrome, 10% of cases, WORSE CASE

*E.coli 0157:H7 (EHEC) enterohemorrhagic E.-coli

- result of shiga toxin - severe hemolytic anemia - kidney damage/failure - neurologic complication - common in kids under 5 and elderly * *requires hospitalization

*hemolytic uremic syndrome (HUS)

- transmission: fecal-oral, food (undercooked meat HAMBEGER, petty zoo) - low infectious dose, handful of cells to cause illness - looking for a vaccine for cows - NO antibiotics EVER, will make person sicker - tx: supportive therapy - fluids - plasma infusion to dilute toxin (HUS)

*E.coli 0157:H7 (EHEC) enterohemorrhagic E.-coli

- less serious illness - otherwise similar - enterotoxigenic (ETEC) - enteroinvasive (EIEC) - enteropathogenic (EPEC)

*other e-coli

- cause: campylobacterosis - gram neg, slendar, curved or spiral - virulence: motile (flagella) 2 - most common bacterial cause of diarrhea, 2 cases per year

*campylobacter

- Usually C.jejuni (common species) - burrow into mucosa of ileum - enterotoxin: stimulates intestines and pushes them into overdrive

*campylobacter

- fever - frequent watery diarrhea (no blood) - vomiting sometimes - headaches - severe abdominal pain - gullian-barre syndrome

*campylobacter

- autoimmune reaction - paralysis, usually temporary - 1 in 1000 infection in campylobacter

*gullian-barre syndrome (GBS)

- transmission: food, water, fecal-oral - tx: rehydration - erythromycin if severe, resistance developing if last for more than a week

*campylobacter

- gram neg rods | - Y.enterocolitica and Y.pseudotuberculosis

*yersinia

- intense abdominal pain - high fever - rarely blood in stool - loose stool - gets mistaken for appendicitis

*yersinia

- transmission: food, water, fecal-oral, indirect contact - tx: hydration - antibiotics IF bacteremia (genetimyacin)

*yersinia

- gram positive endospore forming rod - major cause of diarrhea in hospitals - predisposition due to use of reflux meds? - pseudomembranous colitis: makes passages way - enterotoxins A and B is responsible for pseudomembranous colitis

*clostridium difficile

``` Mild: -diarrhea with mucus Severe: -pseudomembrane sloughing: can rip off pieces of intestine -abdominal cramps -fever -leukocytosis -perforation of the cecum-->death ```

*clostridium difficile

- transmission: superinfection of the LARGE intestine by endogenous biota - some community acquired cases

*clostridium difficile

Treatment: - withdraw antibiotics - replace fluids/eletrolytes - vancomycin or dificid for several weeks, heavy antibiotics - replace biota directly with probiotics or fecal transplant

*clostridium difficile

- cause: cholera, classic and El Tor - gram negative curved, flagellated rod - virulence: flagella penetrate between duodenum and jejunum - cholera toxin (enterotoxin), puts intestines in overdrive

*vibrio cholerae

- quick, abrupt onset - vomiting - secretory diarrhea, very intense and frequent, clear with mucus - severe dehydration - shock possible in 18-24 hours - untreated: death in less than 48 hours

*vibrio cholerae

Loss of blood volume, acidosis, electrolyte imbalance, muscle cramps, hypotension, tachycardia

*severe dehydration

- transmission: fecal-oral, water (fresh warm) - favors warm, saline, alkaline conditions - endemic to parts of ASIA, AFRICA, AND LATIN AMERICA - high ID - tx: - replace fluids and electrolytes ASAP - severe cases tetracycline

*vibrio cholerae

-cryptosporidum -rotavirus -other viruses These are ____.

*non bacterial causes of acute diarrhea

- cause: cryptosporidosis - protozoan - infects many species - lives intracellularly in intestinal mucosa - survives chlorination - often associated with swimming pools - dx: stool sample

*cryptosporidum

- headache - fever/chills - sweating - severe abdominal cramps - diarrhea (not bloody)

*cryptosporidum

- transmission: food, water, fecal-oral - Tx: - fluid replacement - maybe paromycin - NO antibiotic

*cryptosporidum

- primary viral cause of diarrhea - dsRNA - spread by food, water, fomite, or fecal-oral - may present with fever - usually mild and self limiting in adults - serious in infants - oral live vaccine, given early on - tx: replacement fluid

*rotavirus

- so many viruses - adenovirus - norwalk virus (noro virus) - transmitted: food, water, fecal-oral - 3-5 days of profuse water diarrhea, no blood - vomiting - mild fever - Tx: fluid and electrolyte replacement

*other viruses

Signs and symptoms: - severe nausea - frequent vomiting - diarrhea (usually no blood) - no fever - bonus: companions that shared a meal

*food poisoning

- cause: S.aureus, B.cereus, C. perfringes - cause: EXOTOXINS, thats why no fever - avoid with proper food handling - tx: supportive

*food poisoning

- heat stable exotoxin up to 30 min at 100C - custards, sauces, creams, processed meats, contaminated (by human carrier) and left unrefridgerated - stimulates nerves of GI epithelium - self limiting: recovery 24 hrs

*staphylococcus aureus

- sporulating gram positive bacteria - bacteria present in soil - typically vegetables - 2 exotoxins: emetic (vomiting) and diarrhea - emetic toxin: heat stable, fried rice - diarrheal toxin: heat labile, cooked meat and veggies - self limiting: last about 24 hrs

*bacillus cereus

- sporulating gram positive bacteria - most frequently in undercooked meats and veggies - spores germinate on cooling after cooking - attacks SMALL intestine in 8-16 hours - self limiting: very rapid recovery

*clostridium perfringes

- diarrhea for 14+ days - often seen associated with other diseases - 4 main causes in healthy adults: - cyclospora - giardia - entamoeba

*chronic diarrhea

- spread by food, water, fecal-oral - adheres as aggregates rather than single cells - clumps up and makes colonies in intestines - more common in children - stimulates large amounts of mucus-->diarrhea - may see blood in stool, mucusy diarrhea

*EAEC

- cause: cyclosporosis - protozoan - transmission: fecal-oral, food(produce), water - may be ingested as cyst(protective stage) or trophozoite(active stage, feeding) - invade mucosa of SMALL intestine - Symptoms: watery diarrhea, stomach cramps, bloating, fever, muscle aches - tx: TMP-SMZ

*cyclospora cyatanensis

- cause: giardiasis - protozoan (flagellate) - transmission: water, close contact, contaminated objects, pets, wild game - cyst survive a long time in the environment - symptoms: abdominal pain, flatulence, greasy foul smelling diarrhea

*giardia lamblia

- intestinal amoebiasis - attacks cecum, appendix, colon, and rectum - enzymes dissolve tissue-->ulcerations and dysentery-->new info trogocytosis - complications: hemorrhage, perforation, appendicitis, amoebomas(lumps of amoeba in body), extraintestinal amoebosis

*entamoeba histolytica

Eat the cells alive then using enzymes to digest

*trogocytosis

- spread by food, water, fecal-oral from asymptomatic carriers - more prominent in tropical regions b/c they use night soil - prevention: purification water, chlorine does NOT work - tx: - replace fluids/electrolytes - metronidazole for feces and prevent the spread - iodoquinol for tissue, removes amoeba from body

*entamoeba histolytica

- cause: Streptococcus mutans, Scardovia wiggsiae - virulence: fimbria and slime layers - tooth decay - most common infectious disease in humans - degrees: 1(enamel), 2(down to dentin), 3(down to pulp) - secrete acid in presence of dietary carbs - prevent with oral hygiene and fluoride - Tx: removal of tooth or fill

*dental caries

- cause: polymicrobial community - 97-100% of population affected by age 45 - periodontitis: gum disease - gingivitis is first stage, tender gums and bleeding - prevent with oral hygiene - Tx: removal, antibiotics, reconstructive surgery

*periodontal disease

- cause: paramyxovirus - spike induced syncytium - 2-3 week incubation - symptoms: runny nose, muscle pain, malaise - inflammation of salivary glands (parotids especially) - other organs invaded - complication: 20-30% of males develop orchitis and epididymitis (usually unilateral)

*mumps

- droplet contact through saliva and resp secretions - usually under 15 - as many as 40% are subclinical - immunity is long lasting, no carriers - MMR vaccine - supportive care

*mumps

- cause: Heliobacter pylori, gram neg rod - symptoms: sharp burning pain radiating from abdomen - lesion in mucosa: gastric, duodenal, peptic ulcers - increased risk of stomach cancer - bores through outermost mucosa in stomach - transmission: - 25% of middle age adults - 60% of adults over 60

*gastritis and gastric ulcers

- asypmtomatic util aggravated by conditions - no prevention - tx: acid suppressors + antibiotics

*gastritis and gastric ulcers

- inflammatory disease of the liver - necrosis of hepatocytes - swelling - accumulation of bilirubin-->jaundice (main sign) - long incubation periods - viruses A-E

*hepatitis

- relatively minor and self limiting - 2-7 weeks incubation - symptoms: vaguely flu-like symptoms, dark urine/light stools - severe cases: jaundice, swollen liver - transmission: fecal-oral, food, occasionally close contact - Havrax vaccine (A only) - tx: IgG - complications on pregnant women

*Hep A (and E)

- D is a co-infection of B - symptoms: fever,chills, malaise, anorexia, abdominal discomfort, diarrhea, nausea - potential complications: - chronic infection (carrier state), exposed before 5 - necrosis and/or cirrhosis - liver cancer. Hep B leading cause of cancer in US

*Hep B (and D)

Co-infects with hep B and causes D, makes it more severe.

*delta agent

- 1-6 month incubation - transmission: blood contact, direct contact (primarily sexual), vertical - survives when dried, refrigerated or frozen - HBV vaccine or passive immunity with HBIG - tx: supportive care or interferon (block replication)

*Hep B (and D)

- very likely to become chronic - may lead to liver failure - may have severe symptoms with no liver damage - more likely to have damage without symptoms - may lead to liver cancer - transmission: blood contact or vertical - drugs ease liver damage, not cure

*Hep C

The urinary tract consist of: (4)

* kidneys * ureters * bladder * urethra

- flushing of urine - desquamation: shedding of lining of uretha - inappropriate attachment sites - composition of urine These are the ____.

*defenses of the urinary tract

- acidic - IgA - lysozyme lactoferrin: starves bacteria of iron

*composition of urine

- outer region of the urethra | - everything else should be STERILE

*normal biota of urinary tract

-non-hemolytic Sterptococcus -Staphylococcus -Cornebacterium -Lactobacllis ____ of the urethra.

*outer region

Diseases of the urinary tract: (2)

* urinary tract infections (UTI) | * Leptospirosis

- urine can be hospitable to certain microbes - transmission: endogenous, normal biota from tract get carried from anus to vagina - more common women, shorter urethra - recurrent infections - urethritis(infection urethra)-->cystitis(infection of bladder)-->pyelonephritis(inflammation of kidneys)

*urinary tract infection

Sings and Symptoms: - pain - frequent urges to urinate - dysuria(painful urination) - hematuria(blood in urine) - low grade fever - nausea - back pain-danger!!

*urinary tract infection

- 95% caused by normal biota of GI tract - Escherilibchia coli - Staphylococcus saprophyticus: lives on skin works way to urethra - Proteus mirabilispy

*causative agents of UTI's

``` Prevention: -urination -hygiene -cranberry juice Tx: -antibiotics -pyridium/Azo ```

*urinary tract infection

- cause: Leptospira interrogans - zoonosis affecting kidneys, liver, brain, eyes - non-communicable - spread by contaminated soil/water or contact with infected urine - 2 phases: - Leptospiremic - immune - must be treated earlt on with amoxicillin or doxycycline

*Leptospirosis

Spriochete in blood and spinal fluid, vomiting, conjunctivitis

*Leptospiremic

Have effect on kidneys, liver, brain, eyes, lesions

*-immune

The male reproductive systems defenses are the same as ___. The urethra is the pathway for urine and semen.

*urinary tract

- urethra: same as urinary tract - surface of penis: pseudomonas and Staphylococcus - uncircumcized penis : anaerobic gram negatives This is the ____ of the male reproductive system.

*normal biota

- inflammation of the prostate - acute of chronic - tx: antibiotics and pain meds - very hard to pinpoint cause

*prostatis

Diagnosis: - digital rectal exam - culture urine or semen

*prostatis

Sign and Symptoms: - pain in the low back and genital region - difficult/painful urination and ejaculation - frequent urge to urinate - blood in urine

*prostatis

Defenses and normal biota vary throughout lifetime, vagina located behind urethra.

*female reproductive system

``` Defenses: -mucus -IgA Biota: -same as urinary tract ```

*childhood and post-menopause

``` Defenses: -mucus -IgA -acidic pH: drops from 7 to 4 1/2 Biota: -mostly Lactobacillis (bacteria) -Candida albicans (yeast) ```

*childbearing years

- inflammation of the vagina - ititching, burning sensation - discharge sometimes

*vaginitis/vaginosis | (vaginitis is more extreme)

Causative agents of ____. - candida albicans - garnerella - trichomons vaginalis (STI)

*vaginitis/vaginosis

- cause: fungus - most common case of vaginitis - vulvovaginal candidiasis or yeast infection - white curd-like discharge - opportunistic infection: takes advantage of another infection

*candida albicans

- transmission between sexual partners? - may occur more in diabetics, pregnant women, and menstruation - dx: smear or gram stain - tx: topical, and oral drugs, many OTC

*candida albicans

-bacterial vaginosis (BV) -itching with fishy smelling discharge or asymptomatic -common in sexually active women during child bearing years -really an opportunistic mixed infection from a "shift" look for "clue cells" epithelial cell that has a higher # of bacteria -Complications: PID or low birthweight -Tx: metronidazole or clindamycin

*gardnerella

- protozoan - spread through sexual contact - Complications: increased susceptability to HIV, premature labor, low birth weight - TX: metronidazole or tinidazole

*trichomonas vaginalis

Asypmtomatic in 50% of people - men almost never show symtoms - women: vaginitis with green/white frothy discharge

*trichomonas vaginalis

-discharge diseases -ulcer diseases -wart diseases Are microbial diseases associated with ____ sexes.

*both

- spread through direct sexual contact - some are reportable, some are not - often silent - Prevention: - limit sexual partners - barrier method such as condoms - Common complications: PID

*sexually transmitted infections (STI)

- scar that forms around fallopian tubes and ovaries - bacteria to fallopian tubes and ovaries - LEADING CAUSE OF INFERTILITY - LEADING CAUSE OF CHLAMYDIA - ectopic pregnancies - Acute: pain, discharge, nausea, fever, hurts to walk - Chronic: asyptomatic or subacute - Tx: antibiotics

*pelvic inflammatory disease

2 discharge diseases:

* gonorrhea | * chlamydia

- cause: neisseria gonorrhoeae - one of the most common STI's - gram neg diplococci (kidney bean shaped) - direct contact or vertical transmission

*gonorrhea

- finbriae adhere to mucosal epithelium, in women vagina, in males urethra - antigenic changes, so the body doesnt fight back - IgA protease gets dissolved - membrane blebs with endotoxin - gram neg bacteria

*gonorrhea

-Aypmtomatic: 10% of males, 50% of females Males: -painful urination -yellow discharge -may spread to prostate or epididymis, infertility Females: -painful urination -mucupurulent or blood discharge -may spread to upper tract and cause salpingitis inflammation of fallopian tubes or PID

*gonorrhea

Complications of bacteremia: -joint pain -painful papular rash -rare: meningitis or endocarditis Children: -neonates: ophthalmia neonatorum, resp infection -other children: concern about sexual abuse

*gonorrhea

Diagnosis: - men: easy, gram stain urethral discharge - women: ELISA or PCR - Prevention: limit partners and barriers - Tx: used to be penicillin, GISP

*gonorrhea

- cause: Chlamydia trachomatis - MOST COMMOM REPORTABLE INFECTIOUS DISEASE IN US - gran neg and tiny - direct contact or vertical transmission

*chlamydia

- escapes host immune response by living intracellularly - locks ability to make atp - cell wall prevents phagocytosis - tissue damage from intense immune response - utimate result: scar tissue formation (PID)

*chlamydia

- up to 75% asymptomatic, most women are asymptomatic - symptoms mimic gonorrhea - higher rate of complications: PID or epididymitis - some strains: lymphogranuloma venereum- lymph nodes around brain get infected, causes swelling in genital area - Neonates: from vertical transmission - conjunctivitis - pneumonia

*chlamydia

``` Diagnosis: -PCR or ELISA rapid test -urine test, slightly better for males than females Prevention: limit partners and condoms Treatment: -azithromycin or doxycycline -recheck, rate of infection is high ```

*chlamydia

- syphillis - chancriod - herpes - Note: open lesions mean more susceptible to HIV

*genital ulcer diseases

- cause: treponema pallidum, spirochete, gram neg - used to be very common in 1800's - virulence: hooks on and drills into epithellium - will infect any tissue - aviod immune system - extremely delicate and fastidious, outside host it dies quiclky - 3 stages - only 1/3 exposed will get it

*syphillis

- chancre at site entry, hard painless lesion - spirochete escapes into circulation and secrete enzyme to help it drill deeper - healing with no scar in 3-6 weeks - while chancre is there it is loaded with spirochetes and very infectious

*primary syphillis

- 3 weeks to 6 months after chancre - pathogen enters and multiples in blood - initially: fever, headache, sore throat - later: lympadenopathy, red/brown rash on palms and soles and is contagious, hair loss - months to years, rash may go away - about 30% enter latency phase

*secondary syphillis

- rare, but very damaging - aortic weakening, rupture and valve damage - gummas: lesions that open up, painful and damaging - neurosyphillis: - headaches - convulsions - optic nerve atrophy - mental issues

*tertiary syphilis

- usually passed in 2nd or 3rd trimester - disrupts fetal growth, interferes with cell division - miscarriage or stillbirth - infants diagnosed at 3-8 weeks - profuse nasal discharge - skin eruptions - bone deformations - Hutchinson's teeth: barrel notch shape teeth

*congenital syphilis

Diagnose: -look for bacteria directly -Ab blood tests (antibodies) Tx: penicillin

*syphilis

- cause: haemophilus ducreyi bacteria - soft papule becomes soft chancre, painful in mean but not painful than women - swollen inguinal lymph nodes - can be carried asyptomatically

*chancroid

- transmission by direct contact ONLY - causes disease by hemolysis, destroys RBC's - more common in: - subtropic regions - uncircumcised men

*chancroid

- diagnosed with culture from lesion | - tx: antibiotics azithromycin

*chancroid

- Cause: herpes sinplex viruses (HSV-1 or HSV-2) - spread by direct contact or vertically - maybe asypmtomatic

*herpes

``` Initial outbreak: -painful vesicles on genitalia and surrounding areas -malaise, fever, anorexia Following outbreaks: -usually less severe -may be constant, may be very spread out -average 4-5x/yr ```

*herpes

``` Complications are rare: -encephalitis -meningitis Newborns: -usually contact with lesions during birth -blindness -if mouth, skin and/or eyes 30% mortality -CNS 50-80% mortality ```

*herpes

``` Diagnosis: -usually clinical -PCR test from lesions -Ab test from blood TX: -acyclovir ```

*herpes

-Human papillomavirus -Molluscum contagiousum Are ____ diseases.

*wart

-very common infection -spread by direct contact or autoinoculation Oncoviruses: -cervical -vulvar -penile -mouth and throat cancers

*Human papillomavirus (HPV)

``` -often asymptomatic Warts: -flat, inconspicuous -condyloma acuminata: bunches of coliflower Diagnosis: -clinical -histology -PCR -prevent: vaccine tx: by removing warts ```

*(HPV)

-cause: Pox virus (poxviridae) -transmission: same as HPV plus fomites -warthy growths on genitalia and mucus membrane -no known complication Diagnosis: -clinical -histology -PCR -tx: by removing warts

*molluscum contagiosum

- 10-40% of women colonized are asymptomatic - pre term delivery - half will vertically pass on during delivery - slight chance of septicemia, meningitis or pneumonia-->death or permanent disability - screen and treat mothers at 35-37 weeks

*neonatal colonization of Group B Streptococcus