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3820: Microbiology & Immunology > Week 11 - GU > Flashcards

Week 11 - GU Flashcards

1
Q

Upper UTI

A

Kidney & ureter infection

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2
Q

Lower UTI

A
  • Urinary bladder, prostate. Urethra
  • Non-specific = lower - bladder infection
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3
Q

Pyelonephritis

A
  • Infection of renal pelvis - urine drains into ureters & carried to bladder
  • More rare, higher up
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4
Q

UTI Risk Populations

A
  • Children & elderly
  • Women - pregnancy, menopause, sexual intercourse
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5
Q

E. Coli

A
  • Common causative agent of urinary system infection
  • Facultative anaerobic
  • Bacterial pathogen
  • Found in lower intestine
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6
Q

UTI Impairments

A
  • Disrupt normal washout of agent from urinary tract through flow
  • Change to protective properties of mucin lining
  • Disrupt protective function of normal bacterial flora
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7
Q

UTI Infectious Process

A
  • Bacteria enter through urethra with aid of pili
  • Colonize in bladder
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8
Q

Pyelonephritis Infectious Process

A

Infection can ascend from urinary tract to upper region

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9
Q

UTI Test Markers

A
  • Positive leukocytes
  • Positive blood
  • Occasionally protein
  • Positive nitrites - E.coli
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10
Q

UTI Testing

A
  • Sterile sample of midstream urine
  • Urine dipstick - point of care test
  • C&S
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11
Q

BV Causes

A
  • Multiple sex partners
  • New sex partner
  • Vaginal douching
  • Lack of vaginal lactobacilli
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12
Q

BV Infectious Process

A
  • Shift of vaginal flora
  • Reduced numbers of lactobacillus species
  • Overgrowth of Gardnerella vaginalis & some other anaerobes
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13
Q

Overgrowth of Vaginal Anaerobes

A
  • Increase conversion of vaginal peptides to variety of amines - high pH
  • Become volatile & malodorous
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14
Q

Elevated pH Conditions

A
  • Gardnerella vaginalis adhere to exfoliating epithelial cells of vaginal mucosa
  • Create clue cells
  • Epithelial cells covered with masses of coccobacilli
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15
Q

Candidiasis (Yeast Infections)

A
  • Common cause of vulvovaginitis
  • Candida albicans common organism
  • Not considered STI
  • Can be passed between partners
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16
Q

Yeast Infection Diagnosis

A
  • Vaginal culture
  • Show budding yeast filaments (hyphae) & spores
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17
Q

Epididymitis

A
  • Inflammation of epididymis
  • Can be associated with gonorrhea & chlamydia
  • Gram negative rods (e.coli)
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18
Q

Epididymitis Infectious Process

A
  • Pressure associated with voiding/physical strain fore pathogen urine up
  • Urine goes up ejaculatory duct into epididymis
  • Pre-pubertal - associated with congenital urinary tract abnormality
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19
Q

Epididymitis Testing

A
  • Urinalysis
  • Urine culture
  • Urethral swabs
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20
Q

Orchitis

A
  • Infection of testes
  • Precipitated by primary GU tract infection
  • Spread to testes via bloodstream/lymphatic
  • Caused by mumps virus
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21
Q

Protatitis

A
  • Variety of inflammatory disorders of prostate gland - some bacterial
  • Catheterization, instrumentation, secondary to other GU diseases
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22
Q

Acute Bacterial Prostatitis

A
  • Subtype of UTI
  • Ascending urethral infection, reflux of infected urine into prostatic ducts
  • Commonly e.coli
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23
Q

Balanitis

A
  • Fungal origin
  • Common in uncircumcised males
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24
Q

Retroviridae Family

A
  • Latency
  • Persistent viremia
  • Infection of nervous system
  • Weakened host immune responses
  • Destroys CD4 T-lymphocytes
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25
Q

HIV Composition

A
  • Two layers of lipids
  • Protein spikes embedded in envelope to enter hosts
  • High affinity for CD4 lymphocytes & monocytes
  • Bind to CD4 cells & becomes internalized
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26
Q

HIV Binding

A
  • HIV attacks CD4 cell
  • Binds to CD4 receptor then to CCR5 or CXCR4 co-receptor
  • Must bind both sites to enter cell
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27
Q

CD4 Co-Receptors

A
  • Protein on cell surface
  • Serves as second binding site for virus/other molecule
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28
Q

HIV Fusion

A
  • Viral envelope fuses with CD4 cell membrane
  • Allows HIV to enter CD4 cells
  • Release RNA & enzymes (transcriptase & integrase) - once inside
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29
Q

HIV Reverse Transcription

A
  • Uses reverse transcriptase to convert its genetic material
  • HIV RNA into HIV DNA
  • Allows HIV to enter CD4 cell nucleus & combine with cell’s genetic material
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30
Q

HIV Integration

A
  • Release integrase
  • Used to insert/integrate viral DNA into the host DNA
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31
Q

HIV Replication

A
  • Once integrated into host CD4 cell DNA
    • Virus uses CD4 machinery to create long chains of HIV proteins
  • Building blocks for more DNA
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32
Q

HIV Assembly

A
  • New HIV RNA & proteins are made by host CD4 cell
    • Move to cell surface
  • Assemble into immature non-infectious DNA
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33
Q

HIV Budding

A
  • Immature non-infectious HIV pushes out of host cell
  • Outside CD4 cell new HIV release protease
  • Protease breaks up long protein chains forming the non-infectious virus
  • Smaller HIV proteins combine to form mature infectious HIV
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34
Q

HIV Transmission

A
  • Direct contact with virus
    • Infected bodily fluids - semen/vaginal
  • Mother to child during pregnancy, labor & delivery, breastfeeding
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35
Q

Acute HIV

A
  • Rapid multiplication of virus
  • Progress to chronic infection
  • Multiplies less rapidly & levels tend to drop
  • Extends 2-4wks until body produces enough detectable antibodies
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36
Q

Chronic HIV

A
  • As infection advances HIV levels increase
  • Number of CD4 cells decrease - immune system damage
  • Antiretroviral therapy can help prevent advancement to AIDS
37
Q

Viral Latency

A
  • Chronic HIV infection
  • Virus present in body but exists without producing more virus
  • Doesn’t cause noticeable symptoms - can remain in this state for long time
  • Can be a highly transmissible time for those unaware
38
Q

AIDS CD4 Count

A

Less than 200

39
Q

AIDS Clinical Manifestations

A
  • Opportunistic infections - protozoal, fungal, bacterial, viral
  • Malignancies
  • Dementia type complex
40
Q

HIV Testing

A
  • Point-of-care - finger prick
  • If POC test positive confirmatory testing done with blood vial
  • Self-test - antibody levels
  • Genus HIV1/2 confirmatory assay - standard test confirm reactive HIV antibody
  • Positive = look for p24 antigen
41
Q

P24 Antigen

A
  • Major protein contained in HIV viral core
  • Most likely used to detect virus’s genetic material
42
Q

HIV Window Period

A
  • Time between exposure and when test can detect virus
  • 2wks-3mth
  • Once markers are in detectable amount window period over
  • Suspect exposure come back 4-12wks for repeat test
43
Q

Viral Load

A
  • Amount of HIV in a sample of blood
  • Reported as number of HIV copies per mL of blood
  • Higher viral load = more damage to immune system
44
Q

CD4 Count

A
  • Measures number of CD4 T lymphocytes in blood sample
  • Most important indicator of immune function
  • Strongest predictor of HIV progression
  • Monitor response to antiretroviral therapy
  • Want count to be as high as possible
45
Q

HIV Mutation

A
  • Exhibits frequent antigenic variations
  • Error-prone nature of reverse transcriptase
  • Medication non-compliance can contribute to mutation
46
Q

Syphilis Risk Factors

A
  • Sex between men
  • HIV (men or women)
  • Younger than 29
  • History of incarceration
  • Methamphetamine use
  • Injection drug use
  • Exchanging sex for money/drugs
47
Q

Syphilis Structure

A
  • Etiologic agent T. pallidum
  • Spirochete class
  • Corkscrew shaped
  • Motile microaerophilic bacterium
  • Cannot be view by normal light microscopy
48
Q

Primary Syphilis

A
  • Proliferate, sensitize lymphocytes, activate macrophages
  • Formation of primary lesion at inoculation site
  • Chancre appears 2-3wks after acquisition
  • Highly infections
  • Heal spontaneously 3-8wks
49
Q

Secondary Syphilis

A
  • Hematogenous dissemination
  • 4-10wks after onset of primary chancre
50
Q

Latent Syphilis

A
  • Persistence of T. pallidum organisms in body without symptoms
  • Classified into early & late
  • Early = less than 1 year
51
Q

Tertiary Syphilis

A
  • Rare due to antibiotic availability, screening, early treatment
  • Without treatment 50% progress in 2-50years
52
Q

Neurosyphilis

A
  • Invasion of CNS - can occur at any stage
  • Tends to form after multiple years/decades
  • CSF abnormalities scan occur
  • Meningeal syphilis common manifestation - weeks to moths after initial infection
53
Q

Congenital Syphilis

A
  • Transmitted from pregnant women to fetus
  • Less often occurrence at time of delivery
  • Primary & secondary stages
  • 3rd trimester
54
Q

Syphilis Enzyme Immunoassay EIA

A
  • Treponemal test
  • Measures IgM & IgG abs for T. pallidum
  • Once test is positive, will stay positive for life
55
Q

Rapid Plasma Reagin RPR

A
  • Non treponemal test
  • Measures antibody titres - correlate with disease activity
  • Indicator of response to therapy - fall in titers over time
56
Q

Syphilis Treatment

A
  • Penicillin G - parenteral admin, all stages
  • Doxycycline oral used for penicillin allergy
57
Q

STI Complication

A
  • Fertility
  • Gynecological issues
  • Pelvic inflammatory disease - abscesses & scaring of vagina, uterus, ovaries
  • Pelvic pain - painful periods
  • Ectopic pregnancies
58
Q

Chlamydia

A
  • Obligate intracellular pathogen
  • Lack of symptoms present
59
Q

Chlamydia Process

A

Bacteria enters through tiny breaks in perigenital skin/mucous membranes

60
Q

Gonorrhea

A
  • Diplococcus
  • Virulent strains have pili for attachment
  • Outer membrane & lipids - escape phagocytosis
  • Produces endotoxin
61
Q

Gonorrhoea Infection

A

Same time as chlamydia - treat both at same time

62
Q

Trichomoniasis

A
  • Flagellated protozoa
  • Considered STI
  • Not a reportable disease to public health
  • Predisposing factor: multiple partners
  • Men often asymptomatic
63
Q

Pregnancy & Trichomoniasis

A
  • Premature rupture of membranes
  • Preterm birth
  • Low birth weight
64
Q

Condylomata Acuminata (Genital Warts)

A
  • Caused by HPV
  • HPV infection can occur with any skin-to-skin contact
  • Often asymptomatic, transient, resolve without treatment
65
Q

HPV

A
  • Non-enveloped
  • Double stranded DNA virus
  • Cause proliferative lesions of squamous epithelium
  • Subtypes based on likelihood of inducing dysplasia/carcinoma
66
Q

HPV Subtypes 6 & 11

A

Considered low risk - found in most external genital warts

67
Q

HPV Subtypes 16 & 18

A

High risk - cervical dysplasia & anogenital cancers

68
Q

Genital Warts

A
  • Soft, raised
  • Fleshy lesion on external genitalia
  • Can be flat, rough-surface, pedunculated
69
Q

Genital Warts Timeline

A
  • Incubation 6wks-8mths for genital warts
  • Immune system clear virus in most people over 2y
70
Q

Molluscum Contagiosum

A
  • Viral disease of skin - gives rise to multiple umbilicated papules
  • Mildly contagious
  • Dom-like lesions, dimpled appearance
  • Benign, self-limiting infection
  • Spontaneously regress over 6mth-1y
71
Q

Molluscum Contagiosum Transmission

A
  • Skin-to-skin contact
  • Fomites
  • Auto-inoculation
72
Q

Human Monkeypox MPOX

A
  • Not an STI
  • Symptoms similar to smallpox patients - clinically less severe
  • Enveloped
  • Double strand DNA
  • Clade I & II - I most prominent
73
Q

MPOX Transmission

A
  • Animal hosts: rodents & non-human primates
  • Close contact with respiratory secretions - prolonged face to face contact
  • Skin lesions of infected person
  • Recently contaminated object
  • Pregnant women to unborn baby
74
Q

MPOX Risk Factors

A
  • Men who have sex with men
  • Preexisting HIV
75
Q

MPOX Timeline

A
  • Invasion period 0-5 days
  • Skin eruption begins 1-3 days after fever starts
  • Incubation 6-13 days up to 21 days
  • Symptoms last 2-4wks - longer with weakened immune system
76
Q

MPOX Testing

A
  • Detection of viral DNA by PCR testing
  • Diagnostic specimen taken directly from rash
  • Deroofing 1 of the lesions
77
Q

Imvamune Vaccine

A
  • Live attenuated
  • 2 doses, 28 days apart
  • Given within 4 days of contact with MPOX - up to 14 days if no symptoms develop
78
Q

Gonorrhea & Chlamydia Testing

A
  • Urine first catch
  • NAATs detect presence of infection DNA
79
Q

HIV, Hep, Syphilis Testing

A
  • Antigen detection
  • Blood test
80
Q

HPV Testing

A
  • No specific testing recommended to verify presence/type of warts
  • DNA/RNA tests to detect genotypes
81
Q

HSV Testing

A
  • Fluid for culture/NAAT detection - swab lesion
  • Scrape base of lesion for ulcers
  • Active lesions must be present to test
82
Q

Not Curable

A
  • HSV
  • HIV/AIDS
  • Hep B
83
Q

Urine Dip Analysis

A
  • Glucose
  • Protein ‘blood
  • Nitrites
  • Leukocytes
  • pH
  • Non-sterile urine sample
84
Q

Urine C&S

A
  • Growing bacteria from urine sample
  • Determine which antibiotics can treat identified bacteria
  • Takes 24-48h
  • Sterile urine sample
85
Q

Nucleic Acid Amplification Tests (NAATs)

A
  • Amplify specific segments of genetic material (DNA/RNA)
  • PCR to replicate target genetic material
  • Copies of target make it easier to detect
86
Q

Wet Mount Microscopy

A

Visually identify trichomonas parasite

87
Q

Syphilis Testing

A
  • Blood test
  • Antibodies produced in response to bacteria
  • Treponemal antibody test -most common
  • If positive 2nd test done (non-treponemal test)
  • Can identify current & past infections
88
Q

Herpes Testing

A
  • Blood test & viral culture/PCR
  • Type specific herpes antibody test

3820: Microbiology & Immunology (11 decks)

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