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Renal > Uropathogens -Steinauer > Flashcards

Uropathogens -Steinauer Flashcards

1
Q

What are the 2 pathogens most likely spread hematogeneously?

A

Staphylococcus aureus

candida albicans

(also myobacterium tuberculosis, salmonella, brucella, Enterococcus faecalis)

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2
Q

What makes a UTI Complicated?

A

Occur when functional, metabolic, or anatomic conditions exist that increase the risk of treatment failure or serious outcomes.

These conditions include obstruction, stones, pregnancy, diabetes, neurogenic bladders, renal insufficiency, immunosuppression, male gender, and hospitalized/healthcare associated settings

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3
Q

What are the 2 most common ascending UTI bacteria?

A

E. coli (UPEC) (gram - rod)

S. saprophyticus (gram + cocci)

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4
Q

What is normally the cause of upper UTIs?

A

UPEC

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5
Q

Where does S. saprophytic us normally exist?

A

it is a skin organism that colonizes the perineum

can cause lower UTIs in sexually active young women (2nd to E.coli)

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6
Q

What are the characteristics of Enterobacteriaeceae? What are some examples?

A 
General Characteristics:
Gram negative rods
Facultative
Ferment glucose
Oxidase negative
Nitrate Reductase Positive **(important)

E. coli, proteus mirabilis, klebsiella, enterobacter, serratia

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7
Q

Which enterobacteriaceae are lactose positive?

A

E. coli

klepsiella

enterobacter

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8
Q

Which enterobacteriaceae is motile and commonly introduced through long-term catheters (44%)?

A

Proteus

it is also urease + –> stones

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9
Q

What are the characteristics of S. saprophyticus?

A

gram + cocci

coagulase -

nitrate reductase negative

live in skin of perineum

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10
Q

What are some of the major host defenses against infection?

A
  1. urine flow flushes bacteria –> keep from attaching
  2. anti-adherence factors (THP adheres to type I pili)
  3. antimicrobial factors (lactoferrin and defensins)
  4. exfoliation promoted by pathogen
  5. chemokines and cytokines –> attract immune system
  6. neutrophils accumulate in inflamed tissue and kill bacteria
  7. prevention of upper UTI infection without functional abnormalities
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11
Q

What are UPECs virulence factors? (10)

A

Type I pili with FimH adhesion (fimbria) attaches to alpha-methyl-D-mannoside glycoprotein receptors on cells

P pilus with PapG adhesin attach to Gal-gal receptor (on bladder, ureters, kidney)

type III secretion system to get into cells

extracellular capsule–> protect

intracellular capsule–> biofilm formation and aids in persistence

HlyA (hemolysin A) =pore forming toxin that degrade the ECM and cells to free nutrients. may also suppress cytokines

shape change (filamentous form) –> hard to phagocytize

quiescent stage

Sis A and SisB which decrease host immune response and influences progression to pyelo

siderophores acquire iron and nutrients

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12
Q

What is required for UPEC to invade the upper urinary tract?

A

P pilus

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13
Q

What is the most common cause of infectious stones? How does this happen?

A

Proteus mirabilis

(any urease containing bacteria can cause –> klebsiella)

urease converts urea –> Nh3==> alkalize the urine –> precipitate phosphate and magnesium and apatite to cause struvite, calcium carbonate and apatite stones (containing bacteria)

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14
Q

What is the diagnostic gold standard for UTI?

A

detection of bacteria in a urine culture

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15
Q

What is the cutoff of bacteria in urine to be considered a UTI?

A

10^5

this has a low sensitivity
missing many UTI diagnoses

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16
Q

What can cause acute hemorrhagic cystitis in children?

A

adenovirus type 11

17
Q

What parasite is associated with bladder cancer?

A

schistosoma haematobium (africa and the middle east)

18
Q

Which of the following species is least likely to cause an uncomplicated UTI?

A. Staphylococcus saprophyticus
B. Klebsiella sp. 
C. Proteus mirabilis
D. Pseudomonas aeruginosa
E. Escherichia coli
A

?

19
Q 
Which of the following species is most closely associated with infectious stones?
A. Staphylococcus saprophyticus
B. Enterobacter sp.
C. Proteus mirabilis
D. Pseudomonas aeruginosa
E. Escherichia coli
A

C. Proteus mirabilis

20
Q 
Exfoliation of bladder epithelial cells is caused by:
A. Pap Pilus
B. Hemolysin A
C. Struvite Stone
D. SisA/ SisB
E. IgA protease
A

B. hemolysin A

21
Q 
Which of the following virulence factors modulates host immunity?
A. Pap Pilus
B. Hemolysin A
C. Struvite Stone
D. SisA/ SisB
A

D. SisA/SisB

22
Q 
Which of the following virulence factors is seemingly required for the formation of intracellular biofilms in UPEC?
A, Pap Pilus
B. Filamentous form
C. SisA/ SisB
D. Capsule
E. IgA protease
F. Hemolysin A
A

D. capsule

23
Q

A quantitative urinary culture from a clean catch sample determines 103 CFU/mL bacterial colonies. This suggests:
A. The patient likely has a UTI
B. Could indicate UTI
C. The bacteria cultured likely is contamination and thus the patient does not likely have a UTI

A

B. could indicate a UTI

Renal (9 decks)

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