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Microbiology > UTI, Genital Tract Infections, GI Tract, Public Health > Flashcards

UTI, Genital Tract Infections, GI Tract, Public Health Flashcards

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1
Q

What is the CFU/ml calculation for the 0.01 ml loop (10 ul)?

A

CFU x 100

Bacteremia = > 10^5 CFU/mL

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2
Q

What is the CFU/ml calculation for the 0.001 ml loop (1 ul)?

A

CFU x 1000

Bacteremia = > 10^5 CFU/mL

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3
Q

Ascending Transmission (UTI)

A

Organisms multiply in bladder —> ureters and kidneys (goes upwards = ascending)

Common in women
Hospital-acquired UTI in both sexes

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4
Q

Hematogenous (descending) Transmission (UTI)

A

From bacteremia, bloodborne

Descends down to kidneys and urethra

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5
Q

Urethritis

A

Infection of the urethra

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6
Q

Asymptomatic bacteriuria

A

Isolation of bacteria without sign of infection

In elderly people, treat with antibiotics even if asymptomatic

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7
Q

Cystitis

A

Infection of the bladder

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8
Q

Cystitis

A

Infection of the bladder

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9
Q

Acute urethral syndrome

A

Primarily in young, sexually active women

Symptomatic (burning, frequent urination), few isolated organisms

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10
Q

Pyelonephritis

A

Inflammation of kidney parenchyma, calices and pelvis

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11
Q

Urine Collection Methods

A
  • Clean-catch midstream urine: least invasive
  • Straight catheterized urine: uncontaminated
  • Indwelling catheter collection: may have contamination like clean catch, collected from catheter port (not collection bag)
  • Suprapubic aspiration: needle goes straight into bladder, uncontaminated
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12
Q

Boric acid

A

Preservative for urine

Do not refrigerate, otherwise urine can form crystals

Up to 48 hrs, but analysis should not exceed 24 hrs

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13
Q

Urine Screening (what you might see if there is infection)

A
  • Pyuria (presence of PMNs/neutrophils) - >400,000 = infection
  • Leukocyte count - >=10/mm^3 = infection
  • Symptomatic women with pyuria without bacteriuria: UTI with <10^5 CFU/ml or have C. trachomatis, U. urealyticum
  • Nitrate (+)
  • Leukocyte esterate (+)
  • Catalase (+), except strep and entero
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14
Q

Media for Urine

A
  • SBA/MAC
  • Columbia colistic-nalidixic (CNA) or PEA: detect G(+) enterics (in case there is G(-) overgrowth — helps isolate)
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15
Q

Counts for UTI detection if there’s a single isolate

A

> 100,000 CFU/ml - significant bacteriuria — probably UTI

10,000-100,000 CFU/ml - possible UTI

<10,000 CFU/ml - do not work up, likely contaminant

If the same organism is seen on repeat urine cultures, likely a pathogen even if colony counts are low

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16
Q

What do you do for 1 isolate? 2? 3?

A

1 isolate: work up
2 isolates: usually work up, 1 might be contamination
3 isolates: likely contamination

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17
Q

UTI in kids

A

Bacteria is more common in boys than girls - circumcision can help keep area clean

Preschool girls (and up) develop more UTIs

May be asymptomatic

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18
Q

Acute, uncomplicated UTI in women

A

Immediate symptoms

Dysuria, urgency, frequency, suprapubic pain

Less bacteria in urine because infection just started >10 WBC/mm^3 or >10^3 CFU/ml

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19
Q

Acute, uncomplicated pyelonephritis

A

Involves kidneys

Fever, chills, flank pain

More bacteria - >10^4 CFU/ml

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20
Q

Uncomplicated UTIs

A

Occur in healthy women and men, responds well to antibiotics

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21
Q

Complicated UTIs

A

Occurs in both sexes

More difficult to treat, greater morbidity and mortality

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22
Q

Normal Flora of Urethra

A

Coag (-) staph (except S. saprophyticus)
Viridans and nonhemolytic strep
Lactobacilli
Diphtheroids
Nonpathogenic Neisseria in females
Anaerobic cocci
Anaerobic G(-) rod
Propionibacterium sp.
Commensal Mycobacterium sp.
Commensal Mycoplasma sp.

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23
Q

Female genital tract - in prepubescent and postmenopausal women

A

Staph and Corynebacteria

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24
Q

Is GBS common in elderly population?

A

Yes, work up if <50 yo. Otherwise, it’s normal

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25
Q

Common STD agents

A

C. trachomatis
N. gonorrhoeae
Trichomonas vaginalis
HIV
Ureaplasma urealyticum
Mycoplasma hominis
Adenovirus
Coxsackievirus
Molluscum contagiosum (poxvirus)
HPVs

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26
Q

Anorectic lesion

A

Inflammation of anal muscle

May cause proctitis

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27
Q

Vaginitis

A

Symptoms: abnormal discharge, offensive odor, itching

Agents:
- Candida albicans - 80-90% of cases, thick and cheese discharge
- Trichomonas vaginalis: slightly offensive, yellow-green discharge. Dies quickly so process immediately
- Gardnerella vaginalis: BV, polymicrobic (caused by many organisms, possibly the result of loss of lactobacilli). Clue Cells

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28
Q

Cervicitis

A

Symptoms: Increased PMNs in endocervix, purulent discharge (pus)

Agents: N. gonorrheae, C. trachomatis, HSV, HPV

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29
Q

Pelvic Inflammatory Disease (PID)

A

Cervical microorganisms travel to endometrium, fallopian tubes, other pelvic structure

May produce endometritis, salpingitis (inflammation of fallopian tubes), peritonitis (inflammation of abdomen lining), abscesses. Can cause scarring of fallopian tubes or infertility if left untreated

Agents: N. gonorrhoeae, C. trachomatis, anaerobes, G(-) rods, strep, mycoplasmas

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30
Q

Infections after gynecologic surgery

A

Cellulitis, abscesses

Agents: Aerobic G(+) cocci, G(-) rods, anaerobes, Mycoplasmas

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31
Q

Infections with pregnancy

A

Spread hematogenously (from blood) to upper tract

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32
Q

Transplacental Prenatal Infection Agents

A

Through placenta

Bacteria: Listeria monocytogenes, T. pallidum, Borrelia burgdorferi

Viruses: Cytomegalovirus (CMV), rubella, HIV, parvovirus B19, enteroviruses

Parasites: Toxoplasma gondii, Plasmodium sp.

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33
Q

Ascending Prenatal Infection Agents

A

During delivery

Bacteria: GBS, E. coli, L. monocytogenes, C. trachomatis, genital mycoplasmas

Viruses: CMV, HSV

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34
Q

Natal Infections Agents (passing through birth canal)

A

Similar to Ascending Prenatal Agents

Bacteria: GBS, E. coli, L. monocytogenes, N. gonorrhoeae, C. trachomatis

Viruses: CMV, HSV, enteroviruses, hepatitis B virus, HIV

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35
Q

Postnatal Infection Agents

A

Route of infection: transplacental, ascending, passing through birth canal, from nursery, environment, breastfeeding, etc.

Agents: all agents from prenatal and natal infections

36
Q

Orchitis

A

Inflammation of testicles

Typically acquired by bloodborne dissemination of viruses

37
Q

Prostatitis

A

Enlarged prostate gland - gets bigger naturally as men age

Lower back, lower abdominal pain, urinary discomfort ejaculatory complains

38
Q

Syphilis

A

T. pallidum

39
Q

Nontreponemal serological tests

A

VRDL (cardiolipin antigen) and RPR

non-specific reagin test

40
Q

Specific treponemal test

A

Antibody against antigen of the organisms

FTA-ABS, TP-PA, EIAs, MHA-TP

41
Q

Chlamydia

A

C. trachomatis

Non-gonococcal urethritis - most common STD in US

Symptoms: asymptomatic in 50% males, 70-80% females

Can cause: cervicitis, bartholinitis, proctitis, salpingitis, epididymitis, acute urethral syndrome, PID, lymphogranuloma venereum (small lesion on genital area)

Similar to gonorrhea

42
Q

Gonorrhea

A

N. gonorrhoeae

Symptoms: occur 2-5 days after infection in women, up to 1 month in men

Intracellular G(-) diplococci
Extracellular G(-) diplococci in women = normal flora

43
Q

Trichomoniasis

A

Trichomonas vaginalis - flagellated protozoan

Transmission: direct contact with contaminated clothing or towels

Trophozoite

Symptoms: purulent discharge, itchy skin/vulval pruritus, odor, edema, erythema

25-50% asymptomatic women, fewer in males

Diagnosis: wet mount, Giemsa/papanicolaou smear, culture, antigen detection, PCR

44
Q

Specimen Transport (for gonococci or chlamydia/mycoplasmas)

A

Gonococci: swab in modified Stuart’s or Amie’s charcoal media, room temp

Chlamydia/mycoplasma: swab in media with antibiotics, on ice

45
Q

3 major causes on BV

A

G. vaginalis
Candida sp.
T. vaginalis

Detected by hybridization assay

46
Q

Does the upper small intestine or distal ileum have a higher count of resident flora?

A

Distal ileum

47
Q

Invasive infection

A

Has leukocytes

48
Q

Toxic infection

A

No leukocytes

49
Q

Gastroenteritis

A

Syndrome with symptoms of n/v/d and abdominal discomfort

50
Q

Dysentery

A

Inflammatory disorder of GI tract

Usually has blood and pus in feces with pain, fever, abdominal cramps

Resulting from large intestine disease

51
Q

Enterocolitis

A

Inflammation of mucosa of small and large intestines

52
Q

Toxin Production - Enterotoxin

A

Causes gastroenteritis in intestines

Ex. of microorganisms: Vibrio, Shigella dysenteriae, ETEC, Salmonella, C. difficile, Aeromonas, Campylobacter jejuni

53
Q

Toxin Production - Cytotoxin

A

Causes destruction of cells

Ex. of microorganisms: Shigella sp., C. difficile, EHEC

54
Q

Toxin Production - Neurotoxin

A

Causes paralysis

C. botulinum, S. aureus, B. cereus

55
Q

Microorganisms with Attachment within or close to mucosal cells/adherence

A

EPEC, EHEC, Cryptosporidium parvum, Isopora belli, Rotavirus, Hep A/B/C, Norwalk virus

56
Q

Pathogenic Mechanism - Invasion

A

Invade epithelial

Shigella, EIEC, Campylobacter jejuni, Plesiomonas shigelloides, Yersinia enterocolitica, Edwardsiella tarda, etc.

57
Q

Enterotoxin-Mediated Diarrhea

A

Symptoms:
- Rapid onset of diarrhea, <12 hrs
- Lack of fever (not invasive) - no wbcs to help with infection
- Absence of blood or pus
- Large number of watery stools

58
Q

Food Poisoning Agents

A

S. aureus, B. cereus, Type A Clostridium perfringens, Clostridium botulinum

59
Q

Norwalk virus (Norovirus)

A

From shellfish and salads

Cruise ship diarrhea

60
Q

Why do we not accept cultures from inpatients after they’re hospitalized for 3 days if suspected bacterial cause of diarrhea?

A

Diarrhea is likely from antibiotic usage - C. difficile

61
Q

Virus (stool) transportation

A

Fresh stool in container, no preservatives, keep refrigerated

62
Q

Parasite (stool) transportation - O&P

A

Stools in preservative within half an hour of collection

Collect 3 samples over 3-9 days

63
Q

Media for C. difficile

A

CCFA
CDSA

64
Q

Pseudomembranous colitis

A

C. difficile

65
Q

Acceptable additive for urine

A

Boric acid

66
Q

V. vulnificus vs.
V. cholerae vs.
Yersinia enterocolitica

A

V. cholerae - yellow on TCBS (ferments sucrose). Rice water stools
V. vulnificus - green on TCBS. Ferments lactose while all others are non-lactose fermenters
- Raw tilapia, liver disease

Vibrios - 6.5% NaCl growth or fresh water, grows better in summer (20°C), O/129 Test (S)

Y. enterocolitica - bullseye on CIN, urease (+)

67
Q

Criteria for accepting stools for culture

A

Preservative (for bacteria, no preservative for viruses)

Refrigerated if not inoculated within 2 hrs of collection

68
Q

Vaginal flora changes with age

A

Lactobacilli is predominant

Prepubescent and postmenopausal women - Staph and Corynebacteria

Reproductive age women - facultative anerobes

Some women carry GBS - also popular in elderly population, normal if >50. Work up and report if <50 yo

69
Q

Trichomonas vaginalis culture media

A

Diamond’s medium or plastic envelopes with inoculum

70
Q

Urogenital specimen collection

A

Swab in sterile saline (T. vaginalis, different swab for gonococci, chlamydiae, ureaplasma)

Aspiration with syringe for Batholin gland exudate (not swab)

71
Q

Gonococci swab transport

A

Modified Stuart’s or Amie’s charcoal media in RT

72
Q

Chlamydia or mycoplasma specimen transport

A

Media with antibiotics, on ice or stored at 4°C

73
Q

Whiff test

A

BV diagnosis

Fishy odor

Indicates decrease in Lactobacillis and gold standard (Clue cells)

74
Q

Pathogens with virulence factors for UTIs

A
  • Uropathogenic E. coli
  • Proteus sp.
  • S. saprophyticus

Adherence

75
Q

Esophagitis

A

painful, difficulty swallowing, patients with underlying diseases (HIV)

Candida, HSB, CMV

76
Q

Gastritis (stomach ulcers)

A

Inflammation of gastric mucosa

H. pylori - urease (+)

77
Q

Proctitis

A

Inflammation of rectum

STIs

78
Q

EHEC/O157:H7

A

Bloody (hemorrhagic), watery diarrhea, abdominal cramps

Low-grade or no fever

No leukocytes in stools

Pink colonies (shiga toxin producing) on chromagar

MUG (-), SMAC (-)

79
Q

Shigella sp.

A

Highly infectious

Dysentery - often bloody diarrhea

High fever, chills, abdominal cramps, pain with tesnesmus (feels like having to go but no stools)

80
Q

Salmonella sp.

A

n/v/watery d, fever, chills, abdominal pain

Self-limiting

81
Q

Campylobacter sp.

A

Gull wing, G(-)

Self-limiting

Modified Skirrow’s, Campy blood agar, 42°C

82
Q

Clostridium difficile

A

Pseudomembranous colitis - from antibiotic use

Culture on CCFA or CDSA

Toxin production for diagnosis of C. difficile (vs just antigen (+)

83
Q

Rabies

A

Virus that infects CNS

Bats/dead wild animals

84
Q

Lyme Disease

A

Borrelia burgdorferi

Bulls eye rash, fever, fatigue, can spread to joints, heart CNS

85
Q

Francisella tularensis

A

Contact, ingestion of contaminated food/water, inhalation

Hunters and outdoor enthusiasts are more likely to get infected

Market men’s disease, water trapper’s disease, Ohara’s fever, rabbit fever, deer-fly fever

Rabbit = most common mammal associated

Small G(-) coccobacilli

Beta-lactamase (+)

Grows on Cysteine enriched media (thio, cysteine-heart agar, TM, chocolate, BCYE)

Slow grower

Oxidase (-)

Catalase weak +/-

86
Q

Brucella sp.

A

Break in skin, ingestion of unpasteurized milk, inhalation

Malaise, night sweats, fever, chills, can relapse

Highly infectious, do not sniff

B. melitensis, B. suis are more infectious than B. abortus

Small, G(-) coccobacilli

Catalase (+)
Oxidase (+)
Non-motile

87
Q

Bacillus anthracis

A

Large G(+) boxcar

Medusa Head, ground glass colonies

Non-hemolytic

Non-motile

Catalase (+)

Woolsorter’s Disease

Microbiology (9 decks)

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