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Block 4 Found Sci > VII- Bacterial STI > Flashcards

VII- Bacterial STI Flashcards

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1
Q

presentation of chyamydia trachomatis

serovars A,B,C

A

chronic follicular conjuctivitis > scarring > eyelids turn inward > eyelashes abrade cornea > corneal ulceration > blindness

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2
Q

chlamydia presentation women

serovars D-K

A
  1. vague abdom discomfort or spotting
  2. mucopurluent cervicitis > endometritis > endosalpingitis > pelvic peritonitis
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3
Q

pres of neisseria gonorrhoeae

in men

A

acute urethritis 95%
-discharge range from scant to profuse purluent
-epididymitis complication (unilateral testicular pain, swelling, tender)

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4
Q

pres of treponema pallidum

A

aka syphilis
1. primary = single painless lesion/chancre > cartilaginous ulcer > resolves in few weeks
2. secondary = skin lesions all over body but trunk and extremities first, pale red/pink, nonithcy + nonspecific + mucotaneous lesion
3. latent = no symps but still transmit and produce antibodies
4. late = tabes dorsalis (demyelination) + cardiovasc + benign gymma of solitary lesions ad central necrosis

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5
Q

neurosyphilis symptoms

A
  1. meningeal with headache/nausea/stiff neck/cranial nerves, seizures
  2. meningovascular syphilis with vasculitis and stroke
  3. general paresis - change in personality, halluncinate, delusions, inc reflex, mem loss
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6
Q

pres of mycoplasma genitalium

A

NGU in males, PID in women but commonly asymptomatic

non gonococcal urethritis

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7
Q

pres of ureaplasma urelyticum

A

NGU in males, pyelonephritis, spontaneous abortion, premature birth

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8
Q

pres of haemophilus ducreyi

A

chancroid in dev countries, sex workers, and drug users from break in skin during contact
-multiple lesions that bleed easy> inflammed papule > pustule > painful ulcer

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9
Q

H. ducreyi features

A
  1. fastidious
  2. gram neg coccobacillus
  3. growth factor X and V required
  4. chocolate agar
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10
Q

diagnose/treat H. ducreyi

A
  1. painful ulcers + lymphadenopathy without syphilis or HSV
  2. macrolide treat (azithromycin or erythromycin)
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11
Q

pres of klebsiella granulomatis

A

aka donovanosis associated with poor hygiene
-painless wartlike papule from trauma > ulcer

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12
Q

types of klebsiella lesions

A
  1. classic - beefy, red, bleed easy
  2. hypertrophic/verrucous ulcer with raised irreg edge
  3. necrotic - offensive smelling, tissue destruct
  4. sclerotic/cicatricial with fibrous scar tissue
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13
Q

Klebsiella granulomatis features

A
  1. gran neg rod
  2. capsule with mucoid like colonies
  3. donovan bodies on wrights stain- large mononuclear pund cells with intracytoplasmic cysts (deeply stain, safety pin)
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14
Q

epidemiology of chlamydia

A

most commonly reported in US
-entry thru microabrasions

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15
Q

epidemiology of N. gonorrhoeae

A

2nd most common reported bacterial in US

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16
Q

mycoplasma and ureaplasma features

A
  1. no cell wall so resistant to antibiotics that target
  2. sterols in cell membrane
  3. fried egg appearance
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17
Q

virulence factors for N. gonorrhoeae

A
  1. pili for adherence and transfer genetic material, resistance to neutrophil killing
  2. antigenic variation of pilins at C terminus
  3. opacity associated protein Opa
  4. porin
  5. LOS
  6. immunoglobulin A1 protease
  7. antibiotic resistance
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18
Q

life cycle of chlamydia

A

infected epi cells form membrane bound cytoplasmic inclusions
1. uptake of elementary bodies
2. initial inclusions
3. fusion of inclusions and RBs appear
4. RBs multiply and inclusion enlarges
5. RBs convert to EBs or persist as large aberrant if IFN-y then return to normal
6. RBs release

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19
Q

characteristics of chlamydia

A
  1. small nonmotile bacteria
  2. obligate intracellular parasite so needs ATP and will not grow on artificial media
  3. unique cell wall
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20
Q

chlamydia cell wall

A
  1. no peptidoglycan so not gram stain
  2. LPS pos - induces inflamm
  3. major outer membrane protein MOMP that determines serovar
  4. outer membrane protein 2 OMP2
21
Q

elementary bodies features

A
  1. transmissible form of chlamydia
  2. adapted to extracellular survival bc of extensive OMP2 disulfide bondsthat inhibit lysosome/phagosome fusion
22
Q

reticulate bodies featuers

A
  1. non infectious replicating form of chlamydia
  2. adapted to intracellular environ
  3. environmentally labile so can’t survive outside cell bc lack OMP2 sulfide bonds
23
Q

types of chlamydia

A
  1. serovars A,B,C - ocular trachoma, not sex transmit
  2. serovars D-K - urogenital chlamydia
  3. serovars L1-3 - lymphogranuloma venereum
24
Q

pelvic inflammatory disease

salpingitis

A

inflamm of fallopian tubes from ascending intraluminal spread from lower genital tract
-if untreated then scarring > occulsion > infertility

25
Q

pres of chlamydia in men

serovars D-K

A

asymp or acute urethritis
-white mucoid exudate
-meatal srythema and tenderness
-dysuria, urethral itching
-can progress to epididymitis and reactive arthritis

26
Q

pres of chlamydia in both men and women

serovars D-K

A
  1. conjunctivitis - unilateral discomfort with hyperemia + clear/cloudy secretions
  2. rectal infection, proctitis (severe pain, bloody mucopurulent discharge, fever, tenesmus)
  3. oropharyngeal infections- acute tonsilitis, pharyngitis, abnormal pharyngeal sensation syndrome
27
Q

chlamydia vertical transmission presentations

A
  1. 5-14 days show conjunctivitis with variety of discharge, pseudomembrane form, erythema
  2. 4-12 weeks show pneumonia with afebrile, cough, congest, tachypnea, rales
  3. 2-3 yrs show urogenital infect
28
Q

pres chlamydia

serovars L1-3

A
  1. genital lesions painless > ulcerate > heal in few days
  2. inguinal syndrome with painful lymphadenopathy, fever, headache, chills, meningismus, anorexia, myalgia, arthralgia
29
Q

how to diagnose chlamydia

A
  1. NAAT gold standard on urethral discharge or urine from men, vaginal swabs from women
  2. tissue culture NOT artifical media
30
Q

treating chlamydia

A
  1. nonpreg adults/adols = oral doxycycline x2/day for week
  2. preg women = oral azithromycin single dose
  3. neonates = oral erythrommycin base or ethylsuccinate for 4 doses/daily two weeks
  4. LGV = doxycycline x2 day for 21 days
31
Q

N. gonorrhoeae features

A
  1. gram neg cocci/diplococci aka coffee bean appearance
  2. oxidase pos
  3. aerobic
  4. glucose acid production pos, maltose neg
32
Q

Opa function

A

-bacterial adhesion
-epi cell invasion
-suppress lymphocyte activatin
-presence = local disease, absense = disseminated

N. gonorrhoeae

33
Q

porin function

A

-forms pores in bacterial membrane
-bacterium endocytosis/epi cell invasion
-PorB. 1A if disseminated vs PorB.1B in localized

N. gonorrhoeae

34
Q

LOS function

A
  1. lipid A and core oligosac but no repeating o antigen like most gram negs
  2. endotoxin activity for inflamm resp
  3. binding or directed antibodies
  4. contained in blebs released by growing bact
35
Q

immunoglobulin A1 protease function

A

cleave hinge region of IgA1 to inactivate

N. gonorrhoeae

36
Q

antibiotic resistance of N. gonorrhoeae

A

carry beta-lactamase gene so resist
-penicillin
-tetracycline
-ampicillin

37
Q

pres of N. gonorrhoeae in women

A

mostly asymp but gonococcal cervicitis:
-scant discharge + intermenstrual bleeding
-dysuria + dyspareunia
-low back pain

also gonococcal vaginitis in pre-puberty girls and post menopause women so intense inflamm and pain in exam

38
Q

combined pres of N. gonorrhoease

A
  1. anorectal gonorrhea
  2. pharyngeal - mild sore throat
  3. disseminated - skin lesions key, bunch of inflam, esp preg women or on period
  4. ocular gonorrhea- early (non pur conjunct) > progressing (eyelid swell, red, profuse pur) > late (ulcerative keratitis, blind)
39
Q

vertical transmission gonorrhea

A

within 2-5 days show
-gonococcal ophthalmia neonatorum but prevented by silver nitrate or topical antibiotics at delivery, nonspecific conjunct > tense edema of eyelid + chemosis + profuse pur

can also present as resp, pharyngeal, anal infections

40
Q

diagnosing gonorrhoeae

A
  1. gram stain for neg cocci in males with urethritis
  2. NAAT with cotesting for chlamydia
  3. culture on chocolate agar and selective media
41
Q

treating gonorrhea

A
  1. if uncomplicated genital - ceftriaxone single IM + doxycycline or azyithromycin if preg and no chlamydia
  2. if pharyngeal - ceftriaxone single IM + test for cure 7-14 days later
42
Q

treponema pallidum features

A
  1. spirochetes visualized with fluroescent tagged antibodies or darkfield microscopy
  2. microaerophilic
  3. no gram stain
43
Q

congenital syphilis pres

A

classic stigmata
1. hutchinson teeth
2. mulberry molars
3. saddle nose
4. saber shins

but stillbirths common

44
Q

diagnosing syphilis

A
  1. lipoidal test for screening - measures IgG and IgM vs cardiolipin-lectin-cholesterol antigen complex via FTA or TPPA
  2. treponemal test to confirm
45
Q

treating syphilis

A

PENICILLIN
-long term if latent or neurosyphilis

46
Q

treating mycoplasma genitalium

A

azithromycin or moxifloxacin NO cell wall inhibitors

diagnose via NAAT

47
Q

treating ureaplasma

A

doxycycline

48
Q

treating klebsiella

A

azithromycin for 3 weeks or until lesions healed

Block 4 Found Sci (67 decks)

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